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Yan Y, Yuan F, Liu X, Luo T, Feng X, Yao J, Zhang M, Gu F, Song G, Lyu S. Percutaneous Coronary Intervention Offers Clinical Benefits to Diabetic Patients With Stable Chronic Total Occlusion. Angiology 2024; 75:375-385. [PMID: 36809177 DOI: 10.1177/00033197231153246] [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] [Indexed: 02/23/2023]
Abstract
Whether percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers more benefits compared with initial medical therapy (CTO-MT) is unclear. In this study, diabetic patients with one CTO (clinical manifestations: stable angina or silent ischemia) were enrolled. Consecutively, enrolled patients (n = 1605) were assigned to different groups: CTO-PCI (1044 [65.0%]) and initial CTO-MT (561 [35%]). After a median follow-up of 44 months, CTO-PCI tended to be superior to initial CTO-MT in major adverse cardiovascular events (adjusted hazard-ratio [aHR]: .81, 95% conference-interval: .65-1.02) and significantly superior in cardiac death (aHR: .58 [.39-.87]) and all-cause death (aHR: .678[.473-.970]). Such superiority mainly attributed to a successful CTO-PCI. CTO-PCI tended to be performed in patients with younger age, good collaterals, left anterior descending branch CTO, and right coronary artery CTO. While, those with left circumflex CTO and severe clinical/angiographic situations were more likely to be assigned to initial CTO-MT. However, none of these variables influenced the benefits of CTO-PCI. Thus, we concluded that for diabetic patients with stable CTO, CTO-PCI (mainly successful CTO-PCI) offered patients survival benefits over initial CTO-MT. These benefits were consistent regardless of clinical/angiographic characteristics.
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Affiliation(s)
- Yunfeng Yan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Fei Yuan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xinmin Liu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Taiyang Luo
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xu Feng
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Jing Yao
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Mingduo Zhang
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Feifei Gu
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Guangyuan Song
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Shuzheng Lyu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
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2
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Bukhovets IL, Vorozhtsova IN, Maksimova AS, Shipulin VM, Babokin VE, Andreev SL, Sukhodolo IV. [Assessment of the results of left ventricular reconstruction in combination of coronary atherosclerosis and diabetes mellitus]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:125-130. [PMID: 34528596 DOI: 10.33529/angio2021314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. RESULTS The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. CONCLUSION The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.
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Affiliation(s)
- I L Bukhovets
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - I N Vorozhtsova
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia; Siberian State Medical University of the RF Ministry of Public Health, Tomsk, Russia
| | - A S Maksimova
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - V M Shipulin
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - V E Babokin
- Moscow Regional Scientific Research Clinical Institute named after V.F. Vladimirsky, Moscow, Russia
| | - S L Andreev
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - I V Sukhodolo
- Siberian State Medical University of the RF Ministry of Public Health, Tomsk, Russia
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3
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Wang R, Serruys PW, Gao C, Hara H, Takahashi K, Ono M, Kawashima H, O'leary N, Holmes DR, Witkowski A, Curzen N, Burzotta F, James S, van Geuns RJ, Kappetein AP, Morel MA, Head SJ, Thuijs DJFM, Davierwala PM, O'Brien T, Fuster V, Garg S, Onuma Y. Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease. Eur Heart J 2021; 43:56-67. [PMID: 34405232 PMCID: PMC8720143 DOI: 10.1093/eurheartj/ehab441] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Aims The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. Methods and results The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: −7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: −6.5%, 22.5%, P = 0.227). Conclusions The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
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Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Imperial College London, Exhibition Rd, London SW7 2BX, UK
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Neil O'leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - David R Holmes
- Department of Cardiology, Mayo ClinicSchool of Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Nick Curzen
- Cardiology Department, University Hospital Southampton, Coxford Rd, Southampton SO16 5YA, UK
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjolds vag 14B SE-752 37, Uppsala, Sweden
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Marie-Angele Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr Molewaterplein 40, 3015 GE Rotterdam, The Netherlands
| | - Piroze M Davierwala
- Department of Cardiac Surgery, Heart Centre Leipzig, Strumpelstrasse 39, Leipzig 4289, Germany
| | - Timothy O'Brien
- Regenerative Medicine Institute, CURAM, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Valentin Fuster
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicina at Mount Sinai School, 1 Gustave L. Levy Place, 10029-5674 New York, NY, USA
| | - Scot Garg
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Haslingden Rd, Blackburn BB2 3HH, Lancashire, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
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Wang H, Cao J, Su JB, Wang XQ, Zhang DM, Wang XH. The relationship between insulin sensitivity and serum antithrombin 3 activity in patients with type 2 diabetes. Endocr Connect 2021; 10:667-675. [PMID: 34077393 PMCID: PMC8240710 DOI: 10.1530/ec-21-0087] [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] [Received: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antithrombin 3 (AT3) is a physiological inhibitor of thrombin, and serum AT3 activity was found to decrease at the status of type 2 diabetes (T2D). T2D was presented with an increased risk of thrombotic complications at the background of impaired insulin sensitivity. The aim of this study was to investigate the relationship between insulin sensitivity indices and serum AT3 activity in patients with T2D. METHODS We conducted a cross-sectional study in patients with T2D who consented to participate in the study at the Endocrinology Department of Affiliated 2 Hospital of Nantong University from January 2015 to June 2018. All patients received serum AT3 activity test and 75 g oral glucose tolerance test (OGTT). Basal and systemic insulin sensitivity were assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index (ISIMatsuda), respectively, from the OGTT. And other relevant clinical data were also collected. RESULTS Total of 1612 patients with T2D were enrolled in the study, with a mean age of 58.67 ± 13.09 years and a median diabetes duration of 6 years (interquartile range, 1-10 years). Across ascending quartiles of serum AT3 activity, HOMA-IR progressively decreased, while ISIMatsuda progressively increased (all P for trend < 0.001). Moreover, serum AT3 activity was negatively correlated with HOMA-IR (r = -0.189, P < 0.001) and positively correlated with ISIMatsuda (r = 0.221, P < 0.001). After adjusting for other metabolic risk factors, hemostatic parameters and glucose-lowering therapies by multivariate linear regression analysis, HOMA-IR (β = -0.185, t = -5.960, P < 0.001) and ISIMatsuda (β = 0.197, t = 6.632, P < 0.001) remained independently associated with the serum AT3 activity in patients with T2D, respectively. CONCLUSIONS Reduced basal and systemic insulin sensitivity are associated with decreased serum AT3 activity in patients with T2D.
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Affiliation(s)
- Hong Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Jie Cao
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
| | - Jian-bin Su
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- Correspondence should be addressed to J Su or X Wang: or
| | - Xue-qin Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
- Correspondence should be addressed to J Su or X Wang: or
| | - Dong-mei Zhang
- Medical Research Center, Affiliated Hospital 2 of Nantong University, and First People’s Hospital of Nantong City, Nantong, China
| | - Xiao-hua Wang
- Department of Endocrinology, Affiliated Hospital 2 of Nantong University and First People’s Hospital of Nantong City, Nantong, China
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5
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Zabala A, Gottsäter A, Lind M, Svensson AM, Eliasson B, Bertilsson R, Ekelund J, Nyström T, Jonsson M. Early and long-term prognosis in patients with and without type 2 diabetes after carotid intervention: a Swedish nationwide propensity score matched cohort study. Cardiovasc Diabetol 2021; 20:85. [PMID: 33894785 PMCID: PMC8070321 DOI: 10.1186/s12933-021-01282-x] [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] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate early and long-term outcomes after treatment of carotid artery stenosis in patients with type 2 diabetes (T2D) compared to patients without T2D. DESIGN/METHOD This observational nationwide population-based retrospective cohort study investigated all T2D patients treated for carotid stenosis registered in the National Swedish Vascular Surgery and the National Diabetes Registries. Data was collected prospectively for all patients after carotid intervention, during 2009-2015. We estimated crude early (within 30-days) hazard ratios (HRs) risk of stroke and death, and long-term HRs risk, adjusted for confounders with 95% confidence intervals (CIs), for stroke and death and major adverse cardiovascular events (MACE) by using inverse probability of treatment weighting matching. RESULTS A total of 1341 patients with T2D and 4162 patients without T2D were included; 89% treated for symptomatic carotid stenosis, 96% with carotid endarterectomy. There was an increased early risk, HRs (95% CI), for stroke in T2D patients 1.65 (1.17-2.32), whereas risk for early death 1.00 (0.49-2.04) was similar in both groups. During a median follow-up of 4.3 (T2D) and 4.6 (without T2D), with a maximum of 8.0 years; after propensity score matching there was an increased HRs (95% CI) of stroke 1.27 (1.05-1.54) and death 1.27 (1.10-1.47) in T2D patients compared to patients without T2D. Corresponding numbers for MACE were 1.21 (1.08-1.35). CONCLUSIONS Patients with T2D run an increased risk for stroke, death, and MACE after carotid intervention. They also have an increased perioperative risk for stroke, but not for death.
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Affiliation(s)
- Alexander Zabala
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden.
| | - Anders Gottsäter
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.,Vascular Center, Department of Cardio Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Ann-Marie Svensson
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Jan Ekelund
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883, Stockholm, Sweden
| | - Magnus Jonsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Matsoukis IL, Karanasos A, Patsa C, Anousakis‐Vlachochristou N, Triantafyllou K, Kantzanou M, Drakopoulou M, Tsiamis E, Latsios G, Synetos A, Petridou ET, Tousoulis D, Toutouzas K. Long‐term clinical outcomes of coronary artery bypass graft surgery compared to those of percutaneous coronary intervention with second generation drug eluting stents in patients with stable angina and an isolated lesion in the proximal left anterior descending artery. Catheter Cardiovasc Interv 2020; 98:447-457. [DOI: 10.1002/ccd.29247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Ioannis L. Matsoukis
- Department of Hygiene, Epidemiology and Medical Statistics Athens Medical School Athens Greece
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Antonios Karanasos
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Chrysoula Patsa
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | | | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics Athens Medical School Athens Greece
| | - Maria Drakopoulou
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Eleftherios Tsiamis
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - George Latsios
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Andreas Synetos
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics Athens Medical School Athens Greece
- Clinical Epidemiology Unit Karolinska Institute Stockholm Sweden
| | - Dimitris Tousoulis
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
| | - Konstantinos Toutouzas
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital Athens Greece
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7
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Tsai CT, Huang WC, Teng HI, Tsai YL, Lu TM. Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:119. [PMID: 32738906 PMCID: PMC7395357 DOI: 10.1186/s12933-020-01093-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS AND RESULTS From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1-10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349-0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156-0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095-0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn't improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125-0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142-0.851, P: 0.021). CONCLUSIONS Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population.
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Affiliation(s)
- Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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8
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Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease. J Interv Cardiol 2020; 2020:6736704. [PMID: 32372888 PMCID: PMC7191400 DOI: 10.1155/2020/6736704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Many studies have compared the outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (<45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a second-generation drug-eluting stent (DES) and CABG in young patients with LM or three-vessel disease. Methods In young patients with complex CAD who underwent PCI or CABG, a Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stroke, death, and repeat revascularization. Results During follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% of patients in the CABG group (hazard ratio (HR): 3.263, 95% confidence interval (CI): 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7%, respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in the other endpoints. After propensity score matching, no conclusions were modified. Conclusions In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However, this did not translate into hard endpoint differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.
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Iglesias JF, Heg D, Roffi M, Tüller D, Lanz J, Rigamonti F, Muller O, Moarof I, Cook S, Weilenmann D, Kaiser C, Cuculi F, Valgimigli M, Jüni P, Windecker S, Pilgrim T. Five-Year Outcomes in Patients With Diabetes Mellitus Treated With Biodegradable Polymer Sirolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents. J Am Heart Assoc 2019; 8:e013607. [PMID: 31696762 PMCID: PMC6915288 DOI: 10.1161/jaha.119.013607] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The choice of optimal drug‐eluting stent therapy for patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention remains uncertain. We aimed to assess the long‐term clinical outcomes after percutaneous coronary intervention with biodegradable polymer sirolimus‐eluting stents (BP‐SES) versus durable polymer everolimus‐eluting stents (DP‐EES) in patients with DM. Methods and Results In a prespecified subgroup analysis of the BIOSCIENCE (Ultrathin Strut Biodegradable Polymer Sirolimus‐Eluting Stent Versus Durable Polymer Everolimus‐Eluting Stent for Percutaneous Coronary Revascularization) trial (NCT01443104), patients randomly assigned to ultrathin‐strut BP‐SES or thin‐strut DP‐EES were stratified according to diabetic status. The primary end point was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularization, at 5 years. Among 2119 patients, 486 (22.9%) presented with DM. Compared with individuals without DM, patients with DM were older and had a greater baseline cardiac risk profile. In patients with DM, target lesion failure at 5 years occurred in 74 patients (cumulative incidence, 31.0%) treated with BP‐SES and 57 patients (25.8%) treated with DP‐EES (risk ratio, 1.23; 95% CI, 0.87–1.73 [P=0.24]). In individuals without DM, target lesion failure at 5 years occurred in 124 patients (16.8%) treated with BP‐SES and 132 patients (16.8%) treated with DP‐EES (risk ratio, 0.98; 95% CI, 0.77–1.26 [P=0.90; P for interaction=0.31]). Cumulative 5‐year incidence rates of cardiac death, target vessel myocardial infarction, clinically indicated target lesion revascularization, and definite stent thrombosis were similar among patients with DM treated with BP‐SES or DP‐EES. There was no interaction between diabetic status and treatment effect of BP‐SES versus DP‐EES. Conclusions In a prespecified subgroup analysis of the BIOSCIENCE trial, we found no difference in clinical outcomes throughout 5 years between patients with DM treated with ultrathin‐strut BP‐SES or thin‐strut DP‐EES. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01443104.
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Affiliation(s)
- Juan F Iglesias
- Division of Cardiology Geneva University Hospitals Geneva Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit Bern University Hospital Bern Switzerland
| | - Marco Roffi
- Division of Cardiology Geneva University Hospitals Geneva Switzerland
| | - David Tüller
- Department of Cardiology Triemlispital Zurich Switzerland
| | - Jonas Lanz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Fabio Rigamonti
- Division of Cardiology Geneva University Hospitals Geneva Switzerland
| | - Olivier Muller
- Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Igal Moarof
- Department of Cardiology Kantonsspital Aarau Switzerland
| | - Stéphane Cook
- Department of Cardiology University and Hospital Fribourg Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology Basel University Hospital Basel Switzerland
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Luzern Switzerland
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - 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 Canada
| | | | - Thomas Pilgrim
- Department of Cardiology Bern University Hospital Bern Switzerland
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10
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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox. Curr Cardiol Rep 2019; 21:9. [PMID: 30790113 DOI: 10.1007/s11886-019-1091-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM. RECENT FINDINGS Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox). CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
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11
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Roffi M, Iglesias JF. CTO PCI in Patients With Diabetes Mellitus: Sweet Perspectives. JACC Cardiovasc Interv 2019; 10:2182-2184. [PMID: 29122131 DOI: 10.1016/j.jcin.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Roffi
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland.
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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12
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Kang SH, Ahn JM, Lee CH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Differential Event Rates and Independent Predictors of Long-Term Major Cardiovascular Events and Death in 5795 Patients With Unprotected Left Main Coronary Artery Disease Treated With Stents, Bypass Surgery, or Medication: Insights From a Large International Multicenter Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004988. [PMID: 28701487 DOI: 10.1161/circinterventions.116.004988] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies. METHODS AND RESULTS The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608). We analyzed the incidence and independent predictors of major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) and all-cause mortality in each treatment stratum. During follow-up (median, 4.3 years), the rates of MACCE and death were substantially higher in the medical group than in the percutaneous coronary intervention and coronary-artery bypass grafting groups (P<0.001). In the percutaneous coronary intervention group, the 3 strongest predictors for MACCE were chronic renal failure, old age (≥65 years), and previous heart failure; those for all-cause mortality were chronic renal failure, old age, and low ejection fraction. In the coronary-artery bypass grafting group, old age, chronic renal failure, and low ejection fraction were the 3 strongest predictors of MACCE and death. In the medication group, old age, low ejection fraction, and diabetes mellitus were the 3 strongest predictors of MACCE and death. CONCLUSIONS Among patients with unprotected left main coronary artery disease, the key clinical predictors for MACCE and death were generally similar regardless of index treatment. This study provides effect estimates for clinically relevant predictors of long-term clinical outcomes in real-world left main coronary artery patients, providing possible guidance for tailored preventive strategies. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT01341327.
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Affiliation(s)
- Se Hun Kang
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Jung-Min Ahn
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Cheol Hyun Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Pil Hyung Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Soo-Jin Kang
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Seung-Whan Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Young-Hak Kim
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Cheol Whan Lee
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Seong-Wook Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
| | - Duk-Woo Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.).
| | - Seung-Jung Park
- From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.)
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13
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Huang J, Li N, Li Z, Hou XJ, Li ZZ. Low-Dose Unfractionated Heparin with Sequential Enoxaparin in Patients with Diabetes Mellitus and Complex Coronary Artery Disease during Elective Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:764-769. [PMID: 29578118 PMCID: PMC5887733 DOI: 10.4103/0366-6999.228251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Despite its limitations, unfractionated heparin (UFH) has been the standard anticoagulant used during percutaneous coronary intervention (PCI). This study compared the safety of low-dose UFH with sequential enoxaparin with that of UFH in patients with diabetes mellitus (DM) and complex coronary artery disease receiving elective PCI. Methods: In this retrospective study, 514 consecutive patients with atherosclerotic cardiovascular diseases and type 2 DM were admitted to the hospital and received selective PCI, from January 2013 to December 2015. All patients with PCI received low-dose UFH with enoxaparin (intraductal 50 U/kg UFH and 0.75 mg/kg enoxaparin, n = 254; UFH-Enox group) or UFH only (intraductal 100 U/kg UFH, n = 260; UFH group). The study endpoints were major adverse cardiac events (MACEs), namely death, myocardial infarction (MI), stroke, target-vessel immediate revascularization (TVR), and thrombolysis in MI (TIMI) major bleeding, within 30 days and 1 year after PCI. Any catheter thrombosis during the procedure was recorded. Results: Only one patient had an intraductal thrombus in the UFH group. At the 30-day follow-up, no MACE occurred in any group; seven and five cases of recurrent angina and/or rehospitalization were reported in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ2 = 0.11, P = 0.77). There was no TIMI major bleeding in the groups. With respect to the 1-year endpoint, two cases of recurrent MI and two of TVRs were reported in the UFH-Enox group, whereas in the UFH group, one case of recurrent MI and three of TVRs were reported; no significant difference existed between the two groups (χ2 = 0, P = 0.99). There were 30 and 25 recurrent angina and/or rehospitalizations in the UFH-Enox and UFH groups, respectively; there was no significant difference between the two groups (χ2 = 0.37, P = 0.57). Conclusion: In elective PCI, low-dose UFH with sequential enoxaparin has similar effects and safety to the UFH-only method.
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Affiliation(s)
- Ji Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhao Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xue-Jian Hou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhi-Zhong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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14
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van den Heuvel M, Sorop O, van Ditzhuijzen NS, de Vries R, van Duin RWB, Peters I, van Loon JE, de Maat MP, van Beusekom HM, van der Giessen WJ, Jan Danser AH, Duncker DJ. The effect of bioresorbable vascular scaffold implantation on distal coronary endothelial function in dyslipidemic swine with and without diabetes. Int J Cardiol 2017; 252:44-51. [PMID: 29191384 DOI: 10.1016/j.ijcard.2017.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/03/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND We studied the effect of bioresorbable vascular scaffold (BVS) implantation on distal coronary endothelial function, in swine on a high fat diet without (HFD) or with diabetes (DM+HFD). METHODS Five DM+HFD and five HFD swine underwent BVS implantation on top of coronary plaques, and were studied six months later. Conduit artery segments >5mm proximal and distal to the scaffold and corresponding segments of non-scaffolded coronary arteries, and segments of small arteries within the flow-territory of scaffolded and non-scaffolded arteries were harvested for in vitro vasoreactivity studies. RESULTS Conduit segments proximal and distal of the BVS edges showed reduced endothelium-dependent vasodilation as compared to control vessels (p≤0.01), with distal segments being most prominently affected(p≤0.01). Endothelial dysfunction was only observed in DM±HFD swine and was principally due to a loss of NO. Endothelium-independent vasodilation and vasoconstriction were unaffected. Surprisingly, segments from the microcirculation distal to the BVS showed enhanced endothelium-dependent vasodilation (p<0.01), whereas endothelium-independent vasodilation and vasoconstriction were unaltered. This enhanced vasorelaxation was only observed in DM+HFD swine, and did not appear to be either NO- or EDHF-mediated. CONCLUSIONS Six months of BVS implantation in DM+HFD swine causes NO-mediated endothelial dysfunction in nearby coronary segments, which is accompanied by a, possibly compensatory, increase in endothelial function of the distal microcirculation. Endothelial dysfunction extending into coronary conduit segments beyond the implantation-site, is in agreement with recent reports expressing concern for late scaffold thrombosis and of early BVS failure in diabetic patients.
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Affiliation(s)
- Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Nienke S van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - René de Vries
- Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W B van Duin
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Peters
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janine E van Loon
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Hematology, Cardiovascular Research School COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Moniek P de Maat
- Department of Hematology, Cardiovascular Research School COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heleen M van Beusekom
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wim J van der Giessen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - A H Jan Danser
- Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands.
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15
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Mezei Z, Váczi S, Török V, Stumpf C, Ónody R, Földesi I, Szabó G. Effects of kisspeptin on diabetic rat platelets. Can J Physiol Pharmacol 2017; 95:1319-1326. [DOI: 10.1139/cjpp-2017-0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hyperglycemia, hyperlipidemia, and free radicals result in platelet activation and atherogenesis. Kisspeptin (KP) is able to regulate metabolism, hemostasis, and the development of atherosclerosis. We examined whether platelet aggregation of streptozotocin-induced diabetic rats depends on the inducer type and if KP-13 and RF-9 (a kisspeptin receptor modifier) can influence platelet function. We measured the speed and the maximum of aggregation, along with the area under the curve. Serum glucose and calcium levels and urine formation of diabetic animals increased, while the body mass and platelet count decreased. Collagen was the most effective inducer of platelet aggregation. The aggregability of nondiabetic platelets was elevated in the presence of 5 × 10−8 mol/L KP-13. This effect was less expressed in diabetic animals. The effectivity of RF-9 was stronger than that of KP-13 in nondiabetic platelets, however it was ineffective in diabetic animals. RF-9 pre-treatment did not change the effects of 5 × 10−8 mol/L KP-13 in either animal group. The in vivo activation of diabetic platelets, which may be due to elevated serum calcium, induces thrombocytopenia and may lead to reduced in vitro aggregability. We could not demonstrate the antagonistic effect of RF-9 against KP-13 in isolated platelets.
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Affiliation(s)
- Zsófia Mezei
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, 6725 Szeged, Hungary
| | - Sándor Váczi
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, 6725 Szeged, Hungary
| | - Viktória Török
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, 6725 Szeged, Hungary
| | - Csaba Stumpf
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, 6725 Szeged, Hungary
| | - Rita Ónody
- Institute of Laboratory Medicine, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary
| | - Imre Földesi
- Institute of Laboratory Medicine, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary
| | - Gyula Szabó
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, 6725 Szeged, Hungary
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16
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Lee PH, Lee JY, Lee CW, Han S, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Park SJ. Long-term outcomes of bypass grafting versus drug-eluting stenting for left main coronary artery disease: Results from the IRIS-MAIN registry. Am Heart J 2017; 193:76-83. [PMID: 29129258 DOI: 10.1016/j.ahj.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Abstract
There are limited data on comparative outcomes and its determinants following coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for left main coronary artery disease (LMCAD) in a real-world setting. METHODS A total of 3,504 consecutive patients with LMCAD treated with CABG (n=1,301) or PCI with DES (n=2,203) from the IRIS-MAIN registry were analyzed. The relative treatment effect of one strategy over another was assessed by propensity-score matching method. The primary outcome was a composite of death, myocardial infarction, or stroke. RESULTS Median follow-up duration was 4.7 years. In the matched cohort, both groups demonstrated a similar risk for the primary outcome (adjusted hazard ratio [HR]: 0.94; 95% CI: 0.77-1.15; P=.54). Compared with CABG, PCI exhibited higher risks of myocardial infarction (HR: 2.11; 95% CI: 1.16-3.83; P=.01) and repeated revascularization (HR: 5.95; 95% CI: 3.94-8.98; P<.001). In the overall population, age, presence of chronic kidney disease, and low ejection fraction (<40%) were key clinical predictors of primary outcome regardless of the treatment strategy. However, factors deemed to be associated with perioperative morbidity were determinants of primary outcome in the CABG group, whereas those generally associated with the severity of atherosclerotic coronary artery disease were strong predictors in the PCI group. CONCLUSIONS Among patients with significant LMCAD, the long-term risk of the composite outcome of death, myocardial infarction, or stroke was similar between CABG and PCI. Clinical variables that differentially predict adverse outcomes might be useful in triaging appropriate revascularization strategy.
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Affiliation(s)
- Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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17
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Wang H, Gao Z, Song Y, Tang X, Xu J, Jiang P, Jiang L, Chen J, Gao L, Song L, Zhang Y, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Impact of Diabetes Mellitus on Percutaneous Coronary Intervention in Chinese Patients: A Large Single-Center Data. Angiology 2017; 69:540-547. [PMID: 29073786 DOI: 10.1177/0003319717735226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To investigate the impact of diabetic status on 2-year clinical outcomes in Chinese patients undergoing contemporary percutaneous coronary intervention (PCI) treatment. Methods and Results: A total of 10 724 consecutive patients underwent PCI at Fu Wai Hospital were prospectively collected. Two-year clinical outcomes were compared between patients with and without diabetes mellitus (DM). Diabetic patients had more baseline clinical risks and more extensive coronary disease. During 2-year follow-up, the rates of all-cause death, myocardial infarction (MI), revascularization, and major adverse cardiac events (MACE) were significantly higher in DM group. After multivariable-adjusted Cox regression analysis, DM was an independent risk factor for MACE but not for the individual components of MACE. After performing propensity score matching, rates of all-cause death, MI, revascularization, stroke, stent thrombosis, and MACE were not significantly different between the 2 groups, and DM was not predictive of MACE and any clinical adverse outcomes. Conclusions: Diabetic patients who underwent PCI had worse prognosis including death and repeat revascularization during 2-year follow-up, but DM was not an independent risk factor for adverse clinical outcomes.
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Affiliation(s)
- Huanhuan Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Zhan Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ying Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xiaofang Tang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jingjing Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ping Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Lin Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jue Chen
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Lijian Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Lei Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yin Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Xueyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jinqing Yuan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Nyström T, Sartipy U, Franzén S, Eliasson B, Gudbjörnsdottir S, Miftaraj M, Lagerqvist B, Svensson AM, Holzmann MJ. PCI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease. J Am Coll Cardiol 2017; 70:1441-1451. [DOI: 10.1016/j.jacc.2017.07.744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 12/21/2022]
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19
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Fishbein I, Guerrero DT, Alferiev IS, Foster JB, Minutolo NG, Chorny M, Monteys AM, Driesbaugh KH, Nagaswami C, Levy RJ. Stent-based delivery of adeno-associated viral vectors with sustained vascular transduction and iNOS-mediated inhibition of in-stent restenosis. Gene Ther 2017; 24:717-726. [PMID: 28832561 PMCID: PMC5709213 DOI: 10.1038/gt.2017.82] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 01/05/2023]
Abstract
In-stent restenosis remains an important clinical problem in the era of drug eluting stents. Development of clinical gene therapy protocols for the prevention and treatment of in-stent restenosis is hampered by the lack of adequate local delivery systems. Herein we describe a novel stent-based gene delivery platform capable of providing local arterial gene transfer with adeno-associated viral (AAV) vectors. This system exploits the natural affinity of protein G (PrG) to bind to the Fc region of mammalian IgG, making PrG a universal adaptor for surface immobilization of vector-capturing antibodies (Ab). Our results: 1) demonstrate the feasibility of reversible immobilization of AAV2 vectors using vector tethering by AAV2-specific Ab appended to the stent surface through covalently attached PrG, 2) show sustained release kinetics of PrG/Ab-immobilized AAV2 vector particles into simulated physiological medium in vitro and site-specific transduction of cultured cells, 3) provide evidence of long-term (12 weeks) arterial expression of luciferase with PrG/Ab-tethered AAV2Luc, and 4) show anti-proliferative activity and anti-restenotic efficacy of stent-immobilized AAV2iNOS in the rat carotid artery model of stent angioplasty.
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Affiliation(s)
- I Fishbein
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - D T Guerrero
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - I S Alferiev
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - J B Foster
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N G Minutolo
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - M Chorny
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - A M Monteys
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - K H Driesbaugh
- The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - C Nagaswami
- The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - R J Levy
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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20
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Comparative determinants of 5-year cardiovascular event rates in patients with unprotected left main coronary artery disease. Coron Artery Dis 2017; 28:387-394. [PMID: 28692459 DOI: 10.1097/mca.0000000000000497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes mellitus (DM), low ejection fraction (EF), and the extent of coronary artery disease (CAD) have all been identified as predictors of cardiovascular events in multivessel disease, but their comparative contributions to future risk remain unclear in patients with unprotected left main coronary artery (ULMCA) disease. Through this study we aimed to categorize the risk for cardiovascular events in patients with ULMCA disease using simple clinical descriptors. PATIENTS AND METHODS Our study included a total of 5975 patients with ULMCA disease from the Interventional Research Incorporation Society-Left MAIN Revascularization registry who were treated with percutaneous coronary intervention (n=2850), coronary artery bypass grafting (n=2337), or medical therapy alone (n=608). We categorized the risk for cardiovascular events using simple clinical descriptors (DM, low EF, and the extent of CAD). The primary outcome was a major adverse cardiac or cerebrovascular event (MACCE) (i.e. death from any cause, stroke, myocardial infarction, or repeat revascularization). RESULTS Overall, the 5-year rate of MACCE was highest in the medical group, lower in the percutaneous coronary intervention group, and lowest in the coronary artery bypass grafting group (42.5, 25.7, and 19.9%, respectively; P<0.001). In multivariable modeling, the presence of DM [hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.12-1.40; P<0.001], low EF of 40% or less (HR: 1.83; 95% CI: 1.56-2.15; P<0.001), and the extent of CAD (HR: 1.14; 95% CI: 1.08-1.21; P<0.001) were independent predictors of MACCE; in addition, these factors were consistently associated with a significantly higher risk for MACCE, regardless of index treatment strategies. CONCLUSION Simple clinical descriptors can assist clinicians in identifying high-risk patients and in predicting future cardiovascular events within the broad range of risk factors for ULMCA disease.
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21
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Sweeny JM, Angiolillo DJ, Franchi F, Rollini F, Waksman R, Raveendran G, Dangas G, Khan ND, Carlson GF, Zhao Y, Teng R, Mehran R. Impact of Diabetes Mellitus on the Pharmacodynamic Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Ad Hoc Percutaneous Coronary Intervention. J Am Heart Assoc 2017; 6:JAHA.117.005650. [PMID: 28356282 PMCID: PMC5533039 DOI: 10.1161/jaha.117.005650] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Diabetes mellitus (DM) is associated with enhanced platelet reactivity and impaired response to oral antiplatelet therapy, including clopidogrel. This post hoc analysis investigated the pharmacodynamic effects of ticagrelor versus clopidogrel loading dose (LD) in troponin‐negative acute coronary syndrome patients with or without DM undergoing percutaneous coronary intervention in the Ad Hoc PCI study. Methods and Results Patients randomized (1:1) to receive ticagrelor 180 mg LD or clopidogrel 600 mg LD were assessed by diabetic status. Platelet reactivity (P2Y12 reaction units [PRU] on VerifyNow® assay) was measured pre‐LD, at 0.5, 2, and 8 hours post‐LD, and at the end of the percutaneous coronary intervention. The primary endpoint was PRU levels 2 hours post‐LD; secondary endpoints included rates of high on‐treatment platelet reactivity (PRU≥208). Of 100 randomized patients, 51 received ticagrelor (DM, n=20; non‐DM, n=31) and 49 clopidogrel (DM, n=16; non‐DM, n=33). At 2 hours post‐LD, mean (SD) PRU levels in DM patients were 130.1 (111.7) with ticagrelor versus 287.6 (71.9) with clopidogrel (mean [95%CI] difference −157.5 [−225.3, −89.8]; P<0.001); in non‐DM patients, they were 75.3 (75.7) versus 243.0 (72.4) (mean difference −167.7 [−207.1, −128.3]; P<0.001). High on‐treatment platelet reactivity rates at 2 hours post‐LD were also significantly (P<0.001) reduced with ticagrelor versus clopidogrel in DM and non‐DM patients. Between‐treatment differences for PRU and high on‐treatment platelet reactivity were not significant at earlier time points but were at 8 hours post‐LD (P<0.001). Conclusions Compared with clopidogrel, ticagrelor achieved faster, enhanced platelet inhibition and reduced high on‐treatment platelet reactivity rates, in DM and non‐DM patients. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01603082.
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Affiliation(s)
| | | | - Francesco Franchi
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Fabiana Rollini
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC
| | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY
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22
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Hammoudeh AJ, Tabbalat R, Alhaddad IA, Khader Y, Jarrah M, Izraiq M, Al-Mousa E. Short- and long-term outcomes in Middle Eastern diabetic patients after percutaneous coronary intervention: results from The First Jordanian PCI Registry (JoPCR1). Diabetol Int 2017; 8:30-38. [PMID: 30603304 PMCID: PMC6224930 DOI: 10.1007/s13340-016-0273-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/20/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is highly prevalent among Middle Eastern patients admitted with acute coronary syndrome (ACS) or who undergo percutaneous coronary intervention (PCI). This study used data from the First Jordanian PCI Registry (JoPCR1) to determine the short- and long-term outcomes in a subgroup of diabetic patients within a large PCI population. METHODS JoPCR1, a prospective, multicenter study of consecutive patients who underwent PCI from January 2013 to February 2014, assessed the incidence of major cardiovascular events (cardiac mortality, stent thrombosis, major bleeding events and coronary revascularization) in diabetic compared with nondiabetic patients from the index hospitalization to 1 year of follow-up. RESULTS Of 2426 patients enrolled, 1300 (53.6 %) were diabetics. Compared with nondiabetic patients, diabetic patients were older, more likely to be female and to have hypertension, hypercholesterolemia and chronic renal disease. Diabetic patients had higher prevalences of multivessel coronary artery disease and PCI than nondiabetic patients. Although both groups had similar proportions of patients undergoing PCI for ACS (76.3 vs. 78.4 %; p = 0.237), fewer diabetic patients had PCI for ST-segment elevation myocardial infarction than nondiabetics (27.5 vs. 33.7 %; p = 0.0002). Both groups had similar incidences of stent thrombosis (ST) during hospitalization (0.46 vs. 0.27 %; p = 0.665) and at 1 year (2.36 vs. 1.53 %; p = 0.196). Similarly, major bleeding events were not different between diabetic and nondiabetic patients during hospitalization (1.31 vs. 0.53 %; p = 0.077) and at 1 year (1.47 vs. 0.98 %; p = 0.377). Compared with nondiabetic patients, diabetic patients had a higher incidence of readmission for ACS and coronary revascularization at 1 year. Diabetic patients had higher incidences of cardiac mortality than nondiabetic patients during the index hospitalization (1.23 vs. 0.27 %; p = 0.015) and at 1 year (2.58 vs. 0.81 %; p = 0.002). In multivariate analysis, diabetic patients were four times more likely to die in the hospital compared to nondiabetic patients (odds ratio = 4.2; 95 % CI 1.2-14.8, p = 0.025). CONCLUSIONS Diabetic patients, who accounted for more than half of this Middle Eastern PCI population, had a higher risk of cardiac mortality, readmission for ACS and coronary revascularization at 1 year compared with nondiabetic patients.
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Affiliation(s)
- Ayman J. Hammoudeh
- Cardiology Department, Istishari Hospital, 44 Kindi Street, Amman, 11954 Jordan
| | - Ramzi Tabbalat
- Cardiology Department, Khalidi Medical Center, Amman, Jordan
| | | | - Yousef Khader
- Allied Medical Sciences School, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad Jarrah
- Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan
| | - Mahmoud Izraiq
- Cardiology Department, Specialty Hospital, Amman, Jordan
| | - Eyas Al-Mousa
- Cardiology Department, Istishari Hospital, 44 Kindi Street, Amman, 11954 Jordan
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Cordunean A, Hodas R, Benedek E, Bordi L, Benedek I, Benedek T. Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPatients who suffer from diabetes mellitus and present coronary artery disease are at a higher risk of cardiovascular events. The coronary arteries of diabetic patients present a diffuse process of atherosclerosis with frequent distal involvement, being prone to acute cardiovascular events. Diabetics present an increased rate of developing coronary artery remodeling, negative remodeling being representative for this class of patients; this process is characterized by vessel shrinkage and an increased rate of coronary calcium accumulation that is a predictor for cardiovascular risk. Currently, it is desired to improve the treatment of diabetic patients with bioresorbable vascular scaffolds (BVS), because of their reduced risk of restenosis and the ability to restore coronary function, including vasomotion, adaptive shear stress, and expansive remodeling. Optical coherence tomography, intravascular ultrasound and multi-slice computed tomography are imaging techniques used for a high accuracy of diagnosis in coronary artery disease. This manuscript is a review that aims to highlight imaging techniques used for evaluating the functional impact of coronary lesions in diabetic patients who underwent coronary PCI with bioresorbable scaffolds and to describe the functional markers that show the specificity for predicting coronary artery disease.
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Konishi H, Miyauchi K, Shitara J, Endo H, Wada H, Doi S, Naito R, Tsuboi S, Ogita M, Dohi T, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H. Impact of Lipoprotein(a) on Long-term Outcomes in Patients With Diabetes Mellitus Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:1781-1785. [PMID: 27712648 DOI: 10.1016/j.amjcard.2016.08.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Patients with diabetes mellitus (DM) are at twofold to fourfold higher cardiovascular risk than those without DM. Serum levels of lipoprotein(a) (Lp(a)) can be risk factors for adverse events. However, the clinical implications of Lp(a) in patients with DM who underwent percutaneous coronary intervention (PCI) is unknown. The aim of the study was to determine the role of Lp(a) in patients with DM who underwent PCI. A total of 3,508 patients were treated by PCI from 1997 to 2011 at our institution. Among them, we analyzed consecutive 1,546 patients with DM. Eligible 1,136 patients were divided into 2 groups (high Lp(a) [n = 575] and low Lp(a) [n = 561]) by the median of Lp(a) levels. The number of chronic kidney disease, multivessel disease, and the level of LDL-C were higher in the group with high Lp(a) than with low Lp(a). The median follow-up period was 4.7 years. Event rate of all-cause death was same between the 2 groups (p = 0.37). However, cumulative incidence of cardiac death and acute coronary syndrome was significantly higher in the high Lp(a) than in the low Lp(a) group (p = 0.03). Multivariable analysis selected a high Lp(a) level as an independent predictor of cardiac death and acute coronary syndrome (hazard ratio 1.20; 95% confidence interval 1.00 to 1.42; p = 0.04). In conclusion, a high Lp(a) value could be associated with advanced cardiac events after PCI for patients with DM.
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25
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Bezdenezhnykh NA, Sumin AN. Myocardial revascularization in patients with coronary heart disease and type 2 diabetes. DIABETES MELLITUS 2016. [DOI: 10.14341/dm7922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The review discusses myocardial revascularization in patients with coronary heart disease and type 2 diabetes. The data presented include findings from recent research and international and national recommendations and provides evidence on the advantages of coronary artery bypass surgery over percutaneous coronary intervention for patients with diabetes mellitus, stable coronary artery disease and multiple coronary artery lesions. Type 2 diabetes remains a significant predictor of adverse long-term outcomes of coronary artery bypass surgery. Therefore, we review studies showing that different strategies of coronary revascularization and preoperative preparation can affect the results of coronary intervention in patients with diabetes.
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Harada Y, Colleran R, Kufner S, Giacoppo D, Rheude T, Michel J, Cassese S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Five-year clinical outcomes in patients with diabetes mellitus treated with polymer-free sirolimus- and probucol-eluting stents versus second-generation zotarolimus-eluting stents: a subgroup analysis of a randomized controlled trial. Cardiovasc Diabetol 2016; 15:124. [PMID: 27586678 PMCID: PMC5009646 DOI: 10.1186/s12933-016-0429-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background Improved outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention remain an unmet clinical need. We assessed the long-term efficacy and safety of novel polymer-free sirolimus- and probucol-eluting stent in diabetic patients enrolled in intracoronary stenting and angiographic results: test efficacy of sirolimus- and probucol-eluting versus zotarolimus-eluting stents 5 trial. Methods In a pre-specified subgroup analysis, outcomes of diabetic patients treated with a sirolimus- and probucol-eluting stent or a second-generation zotarolimus-eluting stent were compared. The primary endpoint was a device-oriented composite outcome comprising cardiac death, target vessel-related myocardial infarction (MI), or target lesion revascularization (TLR) at 5-year follow-up. Event-free survival was assessed using the Kaplan–Meier method. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated from univariate Cox proportional hazards models. Results A total of 870 patients with diabetes mellitus were treated with either a sirolimus- and probucol-eluting stent (n = 575) or a second-generation zotarolimus-eluting stent (n = 295). At 5 years, the rate of device-oriented composite endpoint was comparable between the sirolimus- and probucol-eluting stent and the second-generation zotarolimus-eluting stent (32.9 versus 33.4 %, HR 0.88, 95 % CI 0.76–1.26). No significant differences were observed between the sirolimus- and probucol-eluting stent and the second-generation zotarolimus-eluting stent groups in the incidence of cardiac death (15.6 versus 16.7 % HR 0.92, 95 % CI 0.63–1.32), target-vessel MI (4.6 versus 6.6 %, HR 0.73, 95 % CI 0.40–1.34), and TLR (18.6 versus 18.8 %, HR 1.00, 95 % CI, 0.72–1.41). The rate of definite or probable stent thrombosis was low and similar in both groups (2.5 versus 2.6 %, HR 1.02, 95 % CI, 0.41–2.52). Conclusions In patients with diabetes the long-term efficacy and safety of a polymer-free sirolimus- and probucol-eluting stent were comparable to a second-generation durable polymer zotarolimus-eluting stent. Trial registration ClinicalTrials.gov NCT00598533. Registered 10 January 2008
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Jonathan Michel
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Tareq Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, Munich, Germany.
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Foussas SG. Acute coronary syndromes and diabetes mellitus. Hellenic J Cardiol 2016; 57:375-377. [DOI: 10.1016/j.hjc.2016.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022] Open
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Piccolo R, Franzone A, Koskinas KC, Räber L, Pilgrim T, Valgimigli M, Stortecky S, Rat-Wirtzler J, Silber S, Serruys PW, Jüni P, Heg D, Windecker S. Effect of Diabetes Mellitus on Frequency of Adverse Events in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:345-52. [PMID: 27289296 DOI: 10.1016/j.amjcard.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Few data are available on the timing of adverse events in relation to the status of diabetes mellitus and the type of acute coronary syndrome (ACS). We investigated this issue in diabetic and nondiabetic patients admitted with a diagnosis of non-ST-segment elevation ACS (NSTE-ACS) or ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Patient-level data from 6 studies (n = 16,601) were pooled and only patients with ACS are included (n = 9,492). Early (0 to 30 days), late (31 to 365 days), and overall (0 to 365 days) events were analyzed. Diabetes mellitus was present in 1,927 patients (20.3%). At 1 year, all-cause mortality was highest for diabetic patients with STEMI (13.4%), followed by diabetic patients with NSTE-ACS (10.3%), nondiabetic patients with STEMI (6.4%) and nondiabetic patients with NSTE-ACS (4.4%; p <0.001). Among patients with diabetes, there was a significant interaction (p <0.001) for STEMI versus NSTE-ACS in early compared with late mortality, due to an excess of early mortality associated with STEMI (9.3% vs 3.7%; hazard ratio 2.31, 95% CI 1.52 to 3.54, p <0.001). Compared with diabetic NSTE-ACS patients, diabetic patients with STEMI had an increased risk of early stent thrombosis (hazard ratio 2.26, 95% CI 1.48 to 3.44, p <0.001), as well as a significant interaction (p = 0.009) in the risk of target lesion revascularization between the early and late follow-up. The distribution of fatal and nonfatal events according to the type of ACS was not influenced by diabetic status. In conclusion, diabetes in ACS setting confers a worse prognosis with 1-year mortality >10% in both STEMI and NSTE-ACS. Notwithstanding the high absolute rates, the temporal distribution of adverse events related to the type of ACS is similar between diabetic and nondiabetic patients.
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Loutfi M, Sadaka MA, Sobhy M. Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:103-10. [PMID: 27398035 PMCID: PMC4933531 DOI: 10.4137/cmc.s37239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022]
Abstract
Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary revascularization. Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD).
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Affiliation(s)
- Mohamed Loutfi
- Cardiology Department, Alexandria University, Alexandria, Egypt
| | | | - Mohamed Sobhy
- Cardiology Department, Alexandria University, Alexandria, Egypt
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30
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Kim EJ, Soh S, Kim SY, Kil HK, Lee JH, Kim JM, Kim TW, Koo BN. Impact of Diabetes Mellitus on Radial and Ulnar Arterial Vasoreactivity after Radial Artery Cannulation: A Randomized Controlled trial. Int J Med Sci 2016; 13:701-7. [PMID: 27648000 PMCID: PMC5027189 DOI: 10.7150/ijms.16007] [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] [Received: 04/29/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Endothelial dysfunction associated with diabetes mellitus (DM) may influence arterial vasoreactivity after arterial stimulus, such as cannulation, and cause changes in diameter and blood flow. Despite the frequent use of arterial cannulation during anesthesia and critical care, little information is available regarding vasoreactivity of the radial and ulnar arteries and its influence on underlying DM. METHODS Forty non-DM and 40 DM patients, who required arterial cannulation during general anesthesia, were enrolled. Using duplex Doppler ultrasonography, we measured the patients' arterial diameter, peak systolic velocity, end-diastolic velocity, resistance index, and mean volume flow of both arteries at five different time points. RESULTS After radial artery cannulation, ulnar arterial diameter and blood flow did not significantly increase in DM group, as they did in non-DM group. Ulnar arterial resistance index significantly increased in both groups, but the degree of decrease in DM group was significantly less than non-DM. CONCLUSION Ulnar artery's ability to increase blood flow for compensating the sudden reduction of radial arterial flow in DM patients was significantly less than that in non-DM patients under general anesthesia. Such attenuated vasoreactivity of ulnar artery to compensate the reduced radial arterial flow may have to be considered in radial arterial cannulation for DM patients.
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Affiliation(s)
- Eun Jung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Whan Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2015; 37:267-315. [PMID: 26320110 DOI: 10.1093/eurheartj/ehv320] [Citation(s) in RCA: 4222] [Impact Index Per Article: 469.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Li Z, Amsterdam EA, Young JN, Hoegh H, Armstrong EJ. Contemporary Outcomes of Coronary Artery Bypass Grafting Among Patients With Insulin-Treated and Non-Insulin-Treated Diabetes. Ann Thorac Surg 2015; 100:2262-9. [PMID: 26319487 DOI: 10.1016/j.athoracsur.2015.06.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/14/2015] [Accepted: 06/08/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND More than 40% of patients undergoing coronary artery bypass grafting (CABG) have diabetes. However, it is unknown how insulin treatment status influences cardiac surgical outcomes among patients with diabetes. METHODS All isolated CABG, CABG plus aortic valve replacement or plus mitral valve repair/replacement procedures performed in 2012 were extracted from the California CABG Outcomes Reporting Program database. Patients were grouped into three categories: (1) no diabetes, (2) non-insulin-treated diabetes (NITDM), and (3) insulin-treated diabetes (ITDM). Demographic and clinical baseline characteristics and observed postoperative major adverse events, including 30-day mortality, stroke, deep sternal wound infection, prolonged ventilation, new dialysis requirement, renal failure, and 30-day readmission were compared. Multivariable logistic regression models were developed for predicting the impact of NITDM and ITDM on postoperative major adverse events. RESULTS A total of 14,051 patients underwent isolated CABG or CABG plus aortic/mitral valve procedures in California during 2012; 6700 (47.7%) had no diabetes, 5165 (36.8%) had NITDM, and 2183 (15.6%) had ITDM. Compared with the nondiabetic and NITDM groups, the ITDM group was younger, more frequently women and nonwhite, and had a higher prevalence of preoperative comorbidities (all p < 0.05). After adjusting for baseline risk factors and surgery type compared with patients without diabetes, both NITDM and ITDM were associated with significantly increased risk of major adverse events [NITDM: adjusted odds ratio (AOR), 1.15, 95 % confidence interval (CI), 1.04 to 1.26, p = 0.005; ITDM: AOR, 1.49, 95% CI, 1.32 to 1.68, p < 0.0001]. A subgroup comparison indicated a similar gradient of risk for each category of cardiac surgery. CONCLUSIONS Patients with diabetes undergoing CABG have substantially increased risk of major adverse events. Patients with ITDM represent an especially high-risk group.
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Affiliation(s)
- Zhongmin Li
- University of California, Davis Medical Center, Sacramento, California.
| | - Ezra A Amsterdam
- University of California, Davis Medical Center, Sacramento, California
| | - J Nilas Young
- University of California, Davis Medical Center, Sacramento, California
| | - Holly Hoegh
- California Office of Statewide Health Planning and Development, Sacramento, California
| | - Ehrin J Armstrong
- University of California, Davis Medical Center, Sacramento, California
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Head SJ, Kappetein AP. Coronary artery bypass grafting in diabetic patients: do not bypass the pump! Eur J Cardiothorac Surg 2015; 49:418-9. [PMID: 26092665 DOI: 10.1093/ejcts/ezv218] [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: 11/14/2022] Open
Affiliation(s)
- Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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Franzone A, Pilgrim T, Heg D, Roffi M, Tüller D, Vuilliomenet A, Muller O, Cook S, Weilenmann D, Kaiser C, Jamshidi P, Räber L, Stortecky S, Wenaweser P, Jüni P, Windecker S. Clinical Outcomes According to Diabetic Status in Patients Treated With Biodegradable Polymer Sirolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002319. [DOI: 10.1161/circinterventions.114.002319] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background—
Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) proved noninferior to durable polymer everolimus-eluting stents (DP-EES) for a composite clinical end point in a population with minimal exclusion criteria. We performed a prespecified subgroup analysis of the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation (BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in patients with diabetes mellitus.
Methods and Results—
BIOSCIENCE trial was an investigator-initiated, single-blind, multicentre, randomized, noninferiority trial comparing BP-SES versus DP-EES. The primary end point, target lesion failure, was a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target lesion revascularization within 12 months. Among a total of 2119 patients enrolled between February 2012 and May 2013, 486 (22.9%) had diabetes mellitus. Overall diabetic patients experienced a significantly higher risk of target lesion failure compared with patients without diabetes mellitus (10.1% versus 5.7%; hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.27–2.56;
P
=0.001). At 1 year, there were no differences between BP-SES versus DP-EES in terms of the primary end point in both diabetic (10.9% versus 9.3%; HR, 1.19; 95% CI, 0.67–2.10;
P
=0.56) and nondiabetic patients (5.3% versus 6.0%; HR, 0.88; 95% CI, 0.58–1.33;
P
=0.55). Similarly, no significant differences in the risk of definite or probable stent thrombosis were recorded according to treatment arm in both study groups (4.0% versus 3.1%; HR, 1.30; 95% CI, 0.49–3.41;
P
=0.60 for diabetic patients and 2.4% versus 3.4%; HR, 0.70; 95% CI, 0.39–1.25;
P
=0.23, in nondiabetics).
Conclusions—
In the prespecified subgroup analysis of the BIOSCIENCE trial, clinical outcomes among diabetic patients treated with BP-SES or DP-EES were comparable at 1 year.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01443104.
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Affiliation(s)
- Anna Franzone
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Thomas Pilgrim
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Dik Heg
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Marco Roffi
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - David Tüller
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - André Vuilliomenet
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Olivier Muller
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Stéphane Cook
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Daniel Weilenmann
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Christoph Kaiser
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Peiman Jamshidi
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Lorenz Räber
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Stefan Stortecky
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Peter Wenaweser
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Peter Jüni
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
| | - Stephan Windecker
- From the Department of Cardiology, Swiss Cardiovascular Center (A.F., T.P., L.R., S.S., P.W., S.W.), Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H., P. Jüni), University Hospital, Bern, Switzerland; Department of Cardiology, University Hospital, Geneva, Switzerland (M.R.); Department of Cardiology, Triemlispital, Zurich, Switzerland (D.T.); Department of Cardiology, University Hospital, Lausanne, Switzerland (A.V., O.M.); Department of Cardiology, Kantonsspital, Aarau,
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Marui A, Kimura T, Nishiwaki N, Mitsudo K, Komiya T, Hanyu M, Shiomi H, Tanaka S, Sakata R. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol 2015; 115:1063-72. [PMID: 25733384 DOI: 10.1016/j.amjcard.2015.01.544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to 2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95% CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between diabetic status and the effect of PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary revascularization. There was no difference in the direction and magnitude of treatment effect of CABG relative to PCI regardless of diabetic status.
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Affiliation(s)
- Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Cardiovascular Surgery, Nara Hospital Kinki University School of Medicine, Ikoma, Japan.
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Nara Hospital Kinki University School of Medicine, Ikoma, Japan
| | - Kazuaki Mitsudo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Paneni F, Costantino S, Cosentino F. Insulin resistance, diabetes, and cardiovascular risk. Curr Atheroscler Rep 2015; 16:419. [PMID: 24781596 DOI: 10.1007/s11883-014-0419-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are major drivers of cardiovascular disease (CVD). The link between environmental factors, obesity, and dysglycemia indicates that progression to diabetes with time occurs along a "continuum", not necessarily linear, which involves different cellular mechanisms including alterations of insulin signaling, changes in glucose transport, pancreatic beta cell dysfunction, as well as the deregulation of key genes involved in oxidative stress and inflammation. The present review critically addresses key pathophysiological aspects including (i) hyperglycemia and insulin resistance as predictors of CV outcome, (ii) molecular mechanisms underpinning the progression of diabetic vascular complications despite intensive glycemic control, and (iii) stratification of CV risk, with particular emphasis on emerging biomarkers. Taken together, these important aspects may contribute to the development of promising diagnostic approaches as well as mechanism-based therapeutic strategies to reduce CVD burden in obese and diabetic subjects.
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Affiliation(s)
- Francesco Paneni
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
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38
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Abstract
A new guideline for the treatment of blood cholesterol was recently released by the American College of Cardiology (ACC) and the American Heart Association (AHA), serving as an update to the National Cholesterol Education Program’s (NCEP) Adult Treatment Panel III cholesterol guideline first released in 2001. With significant changes to key definitions, treatment strategy, and therapy selection, the guideline has transformed the treatment of blood cholesterol and also created controversy within the health care community. This controversy is largely focused on appropriate identification and treatment of patients for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Whereas statins play an integral role in the treatment and secondary prevention of ASCVD, their use for primary prevention is less clearly defined. It is imperative that health care providers are well versed in the concepts and controversies of the new guideline recommendations for primary prevention of ASCVD and can effectively assess the risks and benefits of statin therapy in this patient population.
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39
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De Luca L, Bolognese L, Valgimigli M, Ceravolo R, Danzi GB, Piccaluga E, Rakar S, Cremonesi A, Bovenzi FM, Abbate R, Andreotti F, Bolognese L, Biondi-Zoccai G, Bovenzi FM, Capodanno D, Caporale R, Capranzano P, Carrabba N, Casella G, Cavallini C, Ceravolo R, Colombo P, Conte MR, Cordone S, Cremonesi A, Danzi GB, Del Pinto M, De Luca G, De Luca L, De Servi S, Di Lorenzo E, Di Pasquale G, Esposito G, Farina R, Fiscella A, Formigli D, Galli S, Giudice P, Gonzi G, Greco C, Grieco NB, La Vecchia L, Lazzari M, Lettieri C, Lettino M, Limbruno U, Lupi A, Macchi A, Marini M, Marzilli M, Montinaro A, Musumeci G, Navazio A, Olivari Z, Oltrona Visconti L, Oreglia JA, Ottani F, Parodi G, Pasquetto G, Patti G, Perkan A, Perna GP, Piccaluga E, Piscione F, Prati F, Rakar S, Ravasio R, Ronco F, Rossini R, Rubboli A, Saia F, Sardella G, Satullo G, Savonitto S, Sbarzaglia P, Scorcu G, Signore N, Tarantini G, Terrosu P, Testa L, Tubaro M, Valente S, Valgimigli M, Varbella F, Vatrano M. ANMCO/SICI-GISE paper on antiplatelet therapy in acute coronary syndrome. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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40
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Katz P, Leiter LA, Mellbin L, Rydén L. The clinical burden of type 2 diabetes in patients with acute coronary syndromes: prognosis and implications for short- and long-term management. Diab Vasc Dis Res 2014; 11:395-409. [PMID: 25187508 DOI: 10.1177/1479164114546854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality in patients with acute coronary syndromes (ACS). Cardiometabolic risk factors, including hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, increased visceral fat and inflammation, are associated with increased risk in this population and represent potential targets for treatment. In this review, management strategies for patients with T2DM post-ACS, both in the acute-care setting and in the long-term, are discussed. Although the benefits of long-term, aggressive, multifactorial risk factor modification are well established, a significant burden of recurrent events remains and the search for novel strategies continues. Several studies are assessing the potential cardiovascular (CV) benefits and safety of various classes of newer agents. Of these, AleCardio (aleglitazar), Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care in Patients With Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE; alogliptin) and Evaluation of LIXisenatide in Acute Coronary Syndrome (ELIXA; lixisenatide) specifically address patients with type 2 diabetes post-ACS. The mechanisms of action of these new therapies and aims of the CV outcome studies are briefly reviewed. The prevalence of type 2 diabetes continues to increase worldwide highlighting the need for new strategies that address the complex underlying processes that drive atherosclerosis and CV events in this high-risk patient population.
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Affiliation(s)
- Pamela Katz
- Division of Endocrinology & Metabolism, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada Departments of Medicine and Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Harskamp RE, Walker PF, Alexander JH, Xian Y, Liberman HA, de Winter RJ, Vassiliades TA, Peterson ED, Puskas JD, Halkos ME. Clinical outcomes of hybrid coronary revascularization versus coronary artery bypass surgery in patients with diabetes mellitus. Am Heart J 2014; 168:471-8. [PMID: 25262256 DOI: 10.1016/j.ahj.2014.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) involves minimally invasive left internal mammary artery to left anterior descending coronary artery grafting combined with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. The safety and efficacy of HCR among diabetic patients are unknown. METHODS Patients with diabetes were included who underwent HCR at a US academic center between October 2003 and September 2013. These patients were matched 1:5 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity score (PS)-matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and inhospital complications, a composite measure of 30-day mortality, myocardial infarction and stroke, and up to 3-year all-cause mortality. RESULTS Of 618 patients (HCR = 103; CABG = 515) in the PS-matched cohort, the 30-day composite of death, MI, or stroke after HCR and CABG was 4.9% and 3.9% (odds ratio: 1.25; 95% CI [0.47-3.33]; P = .66). Compared with CABG, HCR also had similar need for reoperation (7.6% versus 6.3%; P = .60) and renal failure (4.2% versus 4.9%; P = .76) but required less blood products (31.4% versus. 65.8%; P < .0001), lower chest tube drainage (655 mL [412-916] versus 898 mL [664-1240]; P < .0001), and shorter length of stay (<5 days: 48.3% versus 25.3%; P < .0001). Over a 3-year follow-up period, mortality was similar after HCR and CABG (12.3% versus 14.9%, hazard ratio: 0.94, 95% CI [0.47-1.88]; P = .86). CONCLUSION Among diabetic patients, the use of HCR appears to be safe and has similar longitudinal outcomes but is associated with less blood product usage and faster recovery than conventional CABG surgery.
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Dangas GD, Farkouh ME, Sleeper LA, Yang M, Schoos MM, Macaya C, Abizaid A, Buller CE, Devlin G, Rodriguez AE, Lansky AJ, Siami FS, Domanski M, Fuster V. Long-Term Outcome of PCI Versus CABG in Insulin and Non–Insulin-Treated Diabetic Patients. J Am Coll Cardiol 2014; 64:1189-97. [DOI: 10.1016/j.jacc.2014.06.1182] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 05/14/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
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Uemura S. Comprehensive treatment of diabetic patients with second-generation drug-eluting stent implantation. Circ J 2014; 78:2149-50. [PMID: 25088143 DOI: 10.1253/circj.cj-14-0772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Uemura
- First Department of Internal Medicine, Nara Medical University
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Abstract
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. Near-normal glycemic control does not reduce cardiovascular events. For many patients with 1- or 2-vessel coronary artery disease, there is little benefit from any revascularization procedure over optimal medical therapy. For multivessel coronary disease, randomized trials demonstrated the superiority of coronary artery bypass grafting over multivessel percutaneous coronary intervention in patients with treated DM. However, selection of the optimal myocardial revascularization strategy requires a multidisciplinary team approach ('heart team'). This review summarizes the current evidence regarding the effectiveness of various medical therapies and revascularization strategies in patients with DM.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, Technion, Israel Institute of Technology, P.O.B 9602, Haifa 31096, Israel.
| | - Elazer R Edelman
- Cardiovascular Division, Department of Medicine, Institute for Medical Science and Engineering, Massachusetts Institute of Technology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Optimal Conduit for Diabetic Patients: Propensity Analysis of Radial and Right Internal Thoracic Arteries. Ann Thorac Surg 2014; 98:30-6; discussion 36-7. [DOI: 10.1016/j.athoracsur.2014.03.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/18/2014] [Accepted: 03/26/2014] [Indexed: 11/23/2022]
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47
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Savonitto S, Morici N, De Servi S. Update: acute coronary syndromes (VI): treatment of acute coronary syndromes in the elderly and in patients with comorbidities. ACTA ACUST UNITED AC 2014; 67:564-73. [PMID: 24952397 DOI: 10.1016/j.rec.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 01/08/2023]
Abstract
Acute coronary syndromes have a wide spectrum of clinical presentations and risk of adverse outcomes. A distinction should be made between treatable (extent of ischemia, severity of coronary disease and acute hemodynamic deterioration) and untreatable risk (advanced age, prior myocardial damage, chronic kidney dysfunction, other comorbidities). Most of the patients with "untreatable" risk have been excluded from the "guideline-generating" clinical trials. In recent years, despite the paucity of specific randomized trials, major advances have been completed in the management of elderly patients and patients with comorbidities: from therapeutic nihilism to careful titration of antithrombotic agents, a shift toward the radial approach to percutaneous coronary interventions, and also to less-invasive cardiac surgery. Further advances should be expected from the development of drug regimens suitable for use in the elderly and in patients with renal dysfunction, from a systematic multidisciplinary approach to the management of patents with diabetes mellitus and anemia, and from the courage to undertake randomized trials involving these high-risk populations.
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Affiliation(s)
| | - Nuccia Morici
- Cardiologia Prima-Emodinamica, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Stefano De Servi
- Cure Intensive Coronariche, IRCCS Policlinico S. Matteo, Pavia, Italy
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Schoos MM, Clemmensen P, Dangas GD. Second-Generation Drug-Eluting Stents and Bioresorbable Vascular Scaffolds in Patients With Diabetes. JACC Cardiovasc Interv 2014; 7:494-6. [DOI: 10.1016/j.jcin.2014.01.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 01/29/2023]
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Roy S. Atherosclerotic Cardiovascular Disease Risk and Evidence-based Management of Cholesterol. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:191-8. [PMID: 24926443 PMCID: PMC4049051 DOI: 10.4103/1947-2714.132916] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An elevated level of low-density lipoprotein cholesterol is directly associated with development of atherosclerotic cardiovascular disease, which may present as coronary heart disease, stroke, and peripheral arterial disease. The new cholesterol management guidelines from the American College of Cardiology and the American Heart Association aim to address a comprehensive approach to prevent and reduce the risk of atherosclerotic cardiovascular disease. The new guidelines recommend initiation of heart healthy lifestyle modifications and 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor ("statin") therapy in individuals who are at a high risk for atherosclerotic cardiovascular disease. It is estimated that these guidelines could result in "statin" therapy for one in every three adults in the United States. This article presents a review of the current cholesterol management guidelines, recommendations from relevant randomized controlled trials and meta-analyses obtained from the searches in Medline/PubMed and Cochrane Database of Systematic Reviews, and publications from the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Service, and the United States Preventive Services Task Force.
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Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, 1 Cooper Plaza, Camden, New Jersey 08103, USA
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Rodríguez AE, Arismendi L, Romero G, Rodríguez-Granillo AM. Randomized trials of PCIs versus CABG surgery: why coronary stenting should remain the first choice of revascularization in non-diabetic patients and why the controversy is still present in diabetics. Expert Rev Cardiovasc Ther 2014; 12:297-309. [PMID: 24490769 DOI: 10.1586/14779072.2014.882770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Knowing the best revascularization option for diabetic patients with multiple vessel disease is a challenge without a definitive answer. There have been several randomized clinical trials and subsequent meta-analyses comparing current available technology trying to reach an exhaustive conclusion; comparisons between coronary artery bypass grafts and bare-metal stents, coronary artery bypass grafts and first generation drug-eluting stents and, most recently, first generation versus latest generation drug-eluting stents generated some interesting results. Information provided by pooled data from some of the most important randomized clinical cardiology trials from the last two decades have produced surprising results. The authors analyze these data to discuss the best therapeutic procedures for each patient.
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