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Yang J, Zhao Y, Wang J, Ma L, Xu H, Leng W, Wang Y, Wang Y, Wang Z, Gao X, Yang Y. Current status of emergency medical service use in ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry. Int J Cardiol 2024; 406:132040. [PMID: 38614365 DOI: 10.1016/j.ijcard.2024.132040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. METHODS An observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. RESULTS Only 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). CONCLUSIONS EMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China. TRIAL REGISTRATION ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.
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Affiliation(s)
- Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianyi Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liyuan Ma
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wenxiu Leng
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen University, Xia Men, Fujian Province, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, He Nan Province, China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Beerkens FJ, Küçük IT, van Veelen A, de Lind van Wijngaarden RAF, Timmermans MJC, Mehran R, Dangas G, Klautz R, Henriques JPS, Claessen BEPM. Native coronary artery or bypass graft percutaneous coronary intervention in patients after previous coronary artery bypass surgery: A large nationwide analysis from the Netherlands Heart Registration. Int J Cardiol 2024; 405:131974. [PMID: 38493833 DOI: 10.1016/j.ijcard.2024.131974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with previous coronary artery bypass surgery (CABG) who require repeat revascularization frequently undergo percutaneous coronary intervention (PCI). We sought to identify factors associated with the decision to intervene on the native vessel versus a bypass graft and investigate their outcomes in a large nationwide prospective registry. METHODS We identified patients who underwent PCI with a history of prior CABG from the Netherlands Heart Registration between 2017 and 2021 and stratified them by isolated native vessel PCI versus PCI including at least one venous- or arterial graft. The primary endpoint of major adverse cardiac events (MACE) was a composite of all-cause death and target vessel revascularization (TVR) at one-year post PCI. The key secondary endpoint was a composite of all-cause death, myocardial infarction (MI), and TVR at 30 days. RESULTS Out of 154,146 patients who underwent PCI, 12,822 (8.3%) had a prior CABG. Isolated native vessel PCI was most frequently performed (75.2%), while an acute coronary syndrome (ACS) presentation was most strongly associated with graft interventions. The primary outcome of MACE at one-year post PCI occurred more frequently in interventions including grafts compared with native vessels alone (19.7% vs. 14.3%; adjOR 1.267; 95% CI 1.101-1.457); p < 0.001) driven by TVR. There was however no difference in mortality or the key secondary endpoint between the two groups. CONCLUSION In this nationwide prospective registry, ACS presentation was strongly associated with bypass graft PCI. At one year after PCI, interventions including bypass grafts had a higher composite of MACE compared with isolated native vessel interventions.
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Affiliation(s)
- Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - I Tarik Küçük
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Anna van Veelen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robert A F de Lind van Wijngaarden
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Yang Z, Tang Y, Sun W, Wen J, Tang D, Luo Y, Xiang C, Huang L, Xia L. Left Atrial Strain for Prediction of Left Ventricular Reverse Remodeling After ST-segment Elevation Myocardial Infarction by Cardiac Magnetic Resonance Feature Tracking. J Thorac Imaging 2024:00005382-990000000-00141. [PMID: 38856048 DOI: 10.1097/rti.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
PURPOSE The study aimed to investigate the potential utility of left atrial (LA) strain by using cardiac magnetic resonance feature-tracking (CMR-FT) to predict left ventricular reverse remodeling (LVRR) following ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS Patients with a first STEMI treated by primary percutaneous coronary intervention were consecutively enrolled in the prospective study and underwent CMR scans at 5 days and 4 months. LA global longitudinal strain (reservoir strain [εs], conduit strain [εe], booster strain [εa]) and corresponding strain rate were assessed by CMR-FT using cine images. LVRR was defined as a reduction in the LV end-systolic volume index of >10% from baseline to follow-up. Logistic regression analyses were performed to determine the predictors of LVRR. RESULTS Of 90 patients analyzed, patients with LVRR (n=35, 39%) showed higher values of LA strain and strain rate and less extensive infarct size (IS) compared with patients without LVRR (n=55, 61%) at initial and second CMR. The LVRR group demonstrated significant improvements in LV and LA cardiac function over time, especially the obvious increase in LA strain and strain rate. In multivariate logistic regression analyses, εs and εe, together with IS, were independent predictors of LVRR. The combination of εs and IS could optimally predict the LVRR with the highest area under the curve of 0.743. CONCLUSIONS Post-STEMI patients with LVRR presented better recovery from cardiac function and LA deformation compared with patients without LVRR. Assessment of εs and εe by using CMR-FT after STEMI enabled prediction of LVRR.
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Affiliation(s)
- Zhaoxia Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yuanyuan Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Wenzhe Sun
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinyang Wen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yi Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
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Qiao Z, Bian X, Song C, Zhang R, Yuan S, Lin Z, Zhu C, Liu Q, Ma W, Dou K. High stress hyperglycemia ratio predicts adverse clinical outcome in patients with coronary three-vessel disease: a large-scale cohort study. Cardiovasc Diabetol 2024; 23:190. [PMID: 38824608 PMCID: PMC11144339 DOI: 10.1186/s12933-024-02286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Coronary three-vessel disease (CTVD) accounts for one-third of the overall incidence of coronary artery disease, with heightened mortality rates compared to single-vessel lesions, including common trunk lesions. Dysregulated glucose metabolism exacerbates atherosclerosis and increases cardiovascular risk. The stress hyperglycemia ratio (SHR) is proposed as an indicator of glucose metabolism status but its association with cardiovascular outcomes in CTVD patients undergoing percutaneous coronary intervention (PCI) remains unclear. METHODS 10,532 CTVD patients undergoing PCI were consecutively enrolled. SHR was calculated using the formula: admission blood glucose (mmol/L)/[1.59×HbA1c (%)-2.59]. Patients were divided into two groups (SHR Low and SHR High) according to the optimal cutoff value of SHR. Multivariable Cox regression models were used to assess the relationship between SHR and long-term prognosis. The primary endpoint was cardiovascular (CV) events, composing of cardiac death and non-fatal myocardial infarction (MI). RESULTS During the median follow-up time of 3 years, a total of 279 cases (2.6%) of CV events were recorded. Multivariable Cox analyses showed that high SHR was associated with a significantly higher risk of CV events [Hazard Ratio (HR) 1.99, 95% Confidence interval (CI) 1.58-2.52, P < 0.001). This association remained consistent in patients with (HR 1.50, 95% CI 1.08-2.10, P = 0.016) and without diabetes (HR 1.97, 95% CI 1.42-2.72, P < 0.001). Additionally, adding SHR to the base model of traditional risk factors led to a significant improvement in the C-index, net reclassification and integrated discrimination. CONCLUSIONS SHR was a significant predictor for adverse CV outcomes in CTVD patients with or without diabetes, which suggested that it could aid in the risk stratification in this particular population regardless of glucose metabolism status.
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Affiliation(s)
- Zheng Qiao
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaohui Bian
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenxi Song
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Rui Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Sheng Yuan
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhangyu Lin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenggang Zhu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qianqian Liu
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wenjun Ma
- Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China.
- Cardiometabolic Medicine Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China.
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Murali N, Ali A, Okolo R, Pirzada S, Stryckman B, Day L, Lemkin D, Sutherland M, Dezman Z, Tran QK. Assessing risk of major adverse cardiac events among patients with chest pain and cocaine use using the HEART score. Am J Emerg Med 2024; 80:29-34. [PMID: 38490096 DOI: 10.1016/j.ajem.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Chest pain (CP), a common presentation in the emergency department (ED) setting, is associated with significant morbidity and mortality if emergency clinicians miss the diagnosis of acute coronary syndrome (ACS). The HEART (History, Electrocardiogram, Age, Risk Factors, Troponin) score had been validated for risk-stratification patients who are at high risk for ACS and major adverse cardiac events (MACE). However, the use of cocaine as a risk factor of the HEART score was controversial. We hypothesized that patients with cocaine-positive (COP) would not be associated with higher risk of 30-day MACE than cocaine-negative (CON) patients. METHODS This retrospective study included adult patients who presented to 13 EDs of a University's Medical System between August 7, 2017 to August 19, 2021. Patients who had CP and prospectively calculated HEART scores and urine toxicology tests as part of their clinical evaluation were eligible. Areas Under The Receiver Operating Curve (AUROC) were calculated for the performance of HEART score and 30-day MACE for each group. RESULTS This study analyzed 46,210 patients' charts, 663 (1.4%) were COP patients. Mean age was statistically similar between groups but there were fewer females in the COP group (26.2% vs 53.2%, p < 0.001). Mean (+/- SD) HEART score was 3.7 (1.4) comparing to 3.1 (1.8, p < 0.001) between COP vs CON groups, respectively. Although more COP patients (54%) had moderate HEART scores (4-6) vs. CON group (35.2%, p < 0.001), rates of 30-day MACE were 1.1% for both groups. HEART score's AUROC was 0.72 for COP and 0.78 for CON groups. AUROC for the Risk Factor among COP patients, which includes cocaine, was poor (0.54). CONCLUSION This study, which utilized prospective calculated HEART scores, demonstrated that overall performance of the HEART score was reasonable. Specifically, our analysis showed that the rate of 30-day MACE was not affected by cocaine use as a risk factor. We would recommend clinicians to consider the HEART score for this patient group.
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Affiliation(s)
- Neeraja Murali
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Afrah Ali
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robinson Okolo
- Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Saad Pirzada
- Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Benoit Stryckman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lauren Day
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Lemkin
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark Sutherland
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zachary Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Kelham M, Vyas R, Ramaseshan R, Rathod K, de Winter RJ, de Winter RW, Bendz B, Thiele H, Hirlekar G, Morici N, Myat A, Michalis LK, Sanchis J, Kunadian V, Berry C, Mathur A, Jones DA. Non-ST-elevation acute coronary syndromes with previous coronary artery bypass grafting: a meta-analysis of invasive vs. conservative management. Eur Heart J 2024:ehae245. [PMID: 38805681 DOI: 10.1093/eurheartj/ehae245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/20/2024] [Accepted: 04/07/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND AND AIMS A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov. Eligible studies were RCTs of routine invasive vs. a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data were collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction, and cardiac-related hospitalization. Using a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. RESULTS Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a weighted mean of 2.0 (range 0.5-10) years. A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97-1.29), cardiac mortality (RR 1.05, 95% CI 0.70-1.58), myocardial infarction (RR 0.90, 95% CI 0.65-1.23), or cardiac-related hospitalization (RR 1.05, 95% CI 0.78-1.40). CONCLUSIONS This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest that there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT.
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Affiliation(s)
- Matthew Kelham
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Rohan Vyas
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Krishnaraj Rathod
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Robbert J de Winter
- Department of Cardiology Heart Center, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bjorn Bendz
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Aung Myat
- Medical Director (Cardiology), Medpace UK, London, UK
| | - Lampros K Michalis
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, University Campus, Ioannina 45110, Greece
| | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, INCLIVA University of València, CIBER CV, València, Spain
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Colin Berry
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK
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Lin Z, He J, Song C, Zhang R, Yuan S, Bian X, Dou K. The Neutrophil to Lymphocyte Ratio Modifies Lipoprotein (a)-Related Poor Prognosis in Patients After Percutaneous Coronary Intervention. Angiology 2024:33197241255414. [PMID: 38763893 DOI: 10.1177/00033197241255414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Lipoprotein (a) [Lp(a)] could contribute to coronary artery disease (CAD) through proinflammatory effects. The neutrophil to lymphocyte ratio (NLR) is an inflammatory biomarker. We consecutively enrolled 7,922 CAD patients to investigate the synergistic association of Lp(a) and NLR with prognosis in patients undergoing percutaneous coronary intervention (PCI). NLR was calculated as the neutrophil count divided by the lymphocyte count. Cutoff for NLR was a median of 2.07. The threshold value was set at 30 mg/dL for Lp(a). The primary endpoint was major adverse cardiac events (MACEs), including all-cause mortality and myocardial infarction. During 2 years follow-up, 111 (1.40%) MACEs occurred. Lp(a) > 30 mg/dL was associated with an increased MACE risk in participants with NLR ≥2.07 [adjusted hazard ratio (HR), 1.84; 95% CI, 1.12-3.03], but not in participants with NLR <2.07 (adjusted HR, 0.74; 95% CI, 0.38-1.45) (Pinteraction = 0.021). Subgroup analysis demonstrated that the synergistic association of Lp(a) and NLR with prognosis was more pronounced in female patients (Pinteraction = 0.028). This study suggested that combining Lp(a) and NLR may be useful for risk stratification in CAD population.
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Affiliation(s)
- Zhangyu Lin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jining He
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenxi Song
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Yuan
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohui Bian
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Liu Y, Li X, Sun T, Li T, Li Q. Pyroptosis in myocardial ischemia/reperfusion and its therapeutic implications. Eur J Pharmacol 2024; 971:176464. [PMID: 38461908 DOI: 10.1016/j.ejphar.2024.176464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/17/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
Ischemic heart disease, a prevalent cardiovascular disease with global significance, is associated with substantial morbidity. Timely and successful reperfusion is crucial for reducing infarct size and enhancing clinical outcomes. However, reperfusion may induce additional myocardium injury, manifesting as myocardial ischemia/reperfusion (MI/R) injury. Pyroptosis is a regulated cell death pathway, the signaling pathway of which is activated during MI/R injury. In this process, the inflammasomes are triggered, initiating the cleavage of gasdermin proteins and pro-interleukins, which results in the formation of membrane pores and the maturation and secretion of inflammatory cytokines. Numerous preclinical evidence underscores the pivotal role of pyroptosis in MI/R injury. Inhibiting pyroptosis is cardioprotective against MI/R injury. Although certain agents exhibiting promise in preclinical studies for attenuating MI/R injury through inhibiting pyroptosis have been identified, the suitability of these compounds for clinical trials remains untested. This review comprehensively summarizes the recent developments in this field, with a specific emphasis on the impact of pyroptosis on MI/R injury. Deciphering these findings not only sheds light on new disease mechanisms but also paves the way for innovative treatments. And then the exploration of the latest advances in compounds that inhibit pyroptosis in MI/R is discussed, which aims to provide insights into potential therapeutic strategies and identify avenues for future research in the pursuit of effective clinical interventions.
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Affiliation(s)
- Yin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Xi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Tingting Sun
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Tao Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Mitochondria and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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9
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Paolucci L, Mangiacapra F, Sergio S, Nusca A, Briguori C, Barbato E, Ussia GP, Grigioni F. Periprocedural myocardial infarction after percutaneous coronary intervention and long-term mortality: a meta-analysis. Eur Heart J 2024:ehae266. [PMID: 38742545 DOI: 10.1093/eurheartj/ehae266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND AIMS Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition. METHODS Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia ('ancillary criteria') were included and reported as 'definition-like'. Data were pooled in a random-effect model. RESULTS A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32-1.97; I2 34%; ARC-2: HR 2.07, 95% CI 1.40-3.08, I2 0%; SCAI: HR 3.24, 95% CI 2.36-4.44, I2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity. CONCLUSIONS All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition.
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Affiliation(s)
- Luca Paolucci
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Fabio Mangiacapra
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Sara Sergio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
| | - Annunziata Nusca
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
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10
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Moscardelli S, Kearney KE, Lombardi WL, Azzalini L. Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions. EUROINTERVENTION 2024; 20:571-578. [PMID: 38726716 PMCID: PMC11067721 DOI: 10.4244/eij-d-23-01082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Controlled antegrade and retrograde subintimal tracking (CART) is rarely performed in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS We aimed to analyse the indications, procedural characteristics, and outcomes of CART at a high-volume CTO programme. METHODS We included all patients undergoing a retrograde CTO PCI in which CART was performed at our institution between January 2019 and November 2023. The primary endpoint was technical success. RESULTS Of 1,582 CTO PCI, the retrograde approach was performed in 603 procedures (38.1%), and CART was used in 45 cases (7.5%). The mean age was 69.1±10.3 years, 93.3% were male, and prior coronary artery bypass graft surgery was present in 68.9%. The most common target CTO vessel was the right coronary artery (48.9%). Anatomical complexity was high (Multicentre CTO Registry of Japan [J-CTO] score of 3.6±0.9). The most common collateral used for CART was a saphenous vein graft (62.2%). Advanced calcium modification was required in 15.6% of cases. CART was successful in 73.3%. Technical and procedural success was 82.2%. Coronary perforation was diagnosed in 4 subjects (8.9%), but only 1 patient (2.2%) suffered tamponade and required pericardiocentesis. No other in-hospital major adverse cardiac events were diagnosed. CONCLUSIONS CART is a useful technique in selected, very complex CTOs tackled with the retrograde approach. Success rates were high, while complication rates were low, considering the high anatomical complexity and baseline patient risk.
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Affiliation(s)
- Silvia Moscardelli
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
- Università degli Studi di Milano, Milan, Italy
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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11
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Carrillo-Aleman L, Agamez-Luengas AA, Guia M, Renedo-Villarroya A, Alonso-Fernández N, Lopez-Gomez L, Bayoumy-Delis P, Sanchez-Nieto JM, Pascual-Figal D, Carrillo-Alcaraz A. Effectiveness and safety of non-invasive ventilation in the management of cardiogenic shock. Rev Port Cardiol 2024; 43:259-273. [PMID: 37949366 DOI: 10.1016/j.repc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiogenic shock (CS) has long been considered a contraindication for the use of non-invasive ventilation (NIV). The main objective of this study was to analyze the effectiveness, measured as NIV success, in patients with respiratory failure due to CS. As secondary objective, we studied risk factors for NIV failure and compared the outcome of patients treated with NIV versus invasive mechanical ventilation (IMV). METHODS Retrospective study on a prospective database, over a period of 25 years, of all consecutively patients admitted to an intensive care unit, with a diagnosis of CS and treated with NIV. A comparison was made between patients on NIV and patients on IMV using propensity score matching analysis. RESULTS Three hundred patients were included, mean age 73.8 years, mean SAPS II 49. The main cause of CS was acute myocardial infarction (AMI): 164 (54.7%). NIV failure occurred in 153 (51%) cases. Independent factors for NIV failure included D/E stages of CS, AMI, NIV related complications, and being transferred from the ward. In the propensity analysis, hospital mortality (OR 1.69, 95% CI 1.09-2.63) and 1 year mortality (OR 1.61, 95% CI 1.04-2.51) was higher in IMV. Mortality was lower with NIV (vs. EIT-IMV) in C stage (10.1% vs. 32.9%; p<0.001) but did not differ in D stage or E stage. CONCLUSIONS NIV seems to be relatively effective and safe in the treatment of early-stage CS.
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Affiliation(s)
| | | | - Miguel Guia
- Sleep and Non-invasive Ventilation Unit, Thorax Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; ISAMB, Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
| | | | | | | | | | | | - Domingo Pascual-Figal
- Cardiology Department, Virgen de la Arrixaca Hospital, Ctra. Madrid-Cartagena, Murcia, Spain
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12
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Jayo-Montoya JA, Jurio-Iriarte B, Aispuru GR, Villar-Zabala B, Blanco-Guzman S, Maldonado-Martin S. Impact of Aerobic High-Intensity Interval Training Intervention and Mediterranean Diet Recommendations on Health-Related Quality of Life and Lifestyle Modification in Post-Myocardial Infarction Patients: Results From the INTERFARCT Surveys. Am J Lifestyle Med 2024; 18:389-402. [PMID: 38737886 PMCID: PMC11082858 DOI: 10.1177/15598276221087628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
This study aims to determine the impact of 2 (low vs high volume) high-intensity interval training (HIIT) programs with Mediterranean diet (MedDiet) recommendations on health-related quality of life (HRQoL) and lifestyle modification, and to examine the relationships between the changes in anxiety and depression with HRQoL and lifestyle variables after myocardial infarction (MI). Participants (n = 80) were randomized to attention control or one of the two supervised HIIT groups (2 d/weeks). Surveys before and after intervention (16 weeks): HRQoL (SF-36), anxiety and depression (HADS), MedDiet adherence (MEDAS), and physical activity (PA) and sedentary behavior (SB) levels. After intervention, there were improvements (P < .05) in HRQoL, HADS scores, and MedDiet adherence, with higher PA level in both HIIT groups with no between-HIIT group differences. The HADS score decline correlated (P < .05) with both the increase in physical component of SF-36 (r = .42), the overall metabolic expenditure (r = .26), and adherence to the MedDiet (r = .24), and the reduction in the SB (r = .35). HIIT exercise intervention with MedDiet recommendations improved HRQoL, along with reduced anxiety and depression symptoms, and a healthier lifestyle after MI. Better mental health was related to higher values of PA and MedDiet adherence.
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Affiliation(s)
- Jon A. Jayo-Montoya
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
| | - Borja Jurio-Iriarte
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
| | - Gualberto R. Aispuru
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
| | - Beatriz Villar-Zabala
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
| | - Sonia Blanco-Guzman
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
| | - Sara Maldonado-Martin
- Faculty of Education and Sport-Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (JJ-M, BJ-I); Primary Care Administration of Burgos, Health Service of the Castile & Leon Community (Sacyl), Spain (GA, BV-Z); Internal Medicine Department, Santiago Apóstol Hospital, Miranda de Ebro, Burgos (SB-G); Faculty of Education and Sport- Physical Activity and Sport Sciences Section, Department of Physical Education and Sport, GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Physical Exercise Research Group, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain (SM-M); and Physical Activity, Exercise and Health Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain (SM-M)
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13
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Celeski M, Segreti A, Piscione M, Monticelli LM, Di Gioia G, Fossati C, Ussia GP, Pigozzi F, Grigioni F. The current paradigm of cardiac troponin increase among athletes. Monaldi Arch Chest Dis 2024. [PMID: 38700130 DOI: 10.4081/monaldi.2024.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Although it is known that exercise improves cardiovascular health and extends life expectancy, a significant number of people may also experience an elevation in cardiac troponin levels as a result of exercise. For many years, researchers have argued whether exercise-induced cardiac troponin rises are a consequence of a physiological or pathological reaction and whether they are clinically significant. Differences in cardiac troponin elevation and cardiac remodeling can be seen between athletes participating in different types of sports. When forecasting the exercise-induced cardiac troponin rise, there are many additional parameters to consider, as there is a large amount of interindividual heterogeneity in the degree of cardiac troponin elevation. Although it was previously believed that cardiac troponin increases in athletes represented a benign phenomenon, numerous recent studies disproved this notion by demonstrating that, in specific individuals, cardiac troponin increases may have clinical and prognostic repercussions. This review aims to examine the role of cardiac troponin in athletes and its role in various sporting contexts. This review also discusses potential prognostic and clinical implications, as well as future research methods, and provides a straightforward step-by-step algorithm to help clinicians interpret cardiac troponin rise in athletes in both ischemic and non-ischemic circumstances.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Mariagrazia Piscione
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Luigi Maria Monticelli
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico"; Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome.
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
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14
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Alfaddagh A, Khraishah H, Romeo GR, Kassab MB, McMillan Z, Chandra-Strobos N, Blumenthal R, Albaghdadi M. Cardiovascular Outcomes Among Patients with Acute Coronary Syndromes and Diabetes: Results from ACS QUIK Trial in India. Glob Heart 2024; 19:37. [PMID: 38681971 PMCID: PMC11049669 DOI: 10.5334/gh.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Abstract
Background Despite cardiovascular disease being the leading cause of death in India, limited data exist regarding the factors associated with outcomes in patients with diabetes who suffer acute myocardial infarction (AMI). Methods We examined 21,374 patients with AMI enrolled in the ACS QUIK trial. We compared in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding in those with and without diabetes. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results Mean ± SD age was 60.1 ± 12.0 years, 24.3% were females, and 44.4% had diabetes. Those with diabetes were more likely to be older, female, hypertensive, and have higher Killip class but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P < 0.001) and, in case of STEMI, longer door-to-balloon times (median, 75 vs 91 min; P < 0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR, 1.52; 95% CI, 1.15-2.02), 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day major bleeding. Conclusion Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased cardiovascular risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle-income countries who develop AMI. Clinical Trial registration ClinicalTrials.gov Unique identifier: NCT02256658.
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Affiliation(s)
- Abdulhamied Alfaddagh
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Giulio R. Romeo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, US
| | - Mohamad B. Kassab
- Cardiovascular research center, Massachusetts General Hospital, Boston, MA, US
| | - Zeb McMillan
- Department of Anesthesiology, Division of Critical Care, UC San Diego, San Diego, CA, USA
| | - Nisha Chandra-Strobos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Roger Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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15
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Gaba P, Sabik JF, Murphy SA, Bellavia A, O'Gara PT, Smith PK, Serruys PW, Kappetein AP, Park SJ, Park DW, Christiansen EH, Holm NR, Nielsen PH, Sabatine MS, Stone GW, Bergmark BA. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation 2024; 149:1328-1338. [PMID: 38465592 DOI: 10.1161/circulationaha.123.065571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Diabetes may be associated with differential outcomes in patients undergoing left main coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim of this study was to investigate outcomes in patients with left main disease with and without diabetes randomized to PCI versus CABG. METHODS Individual patient data were pooled from 4 trials (SYNTAX [Synergy Between PCI With Taxus and Cardiac Surgery], PRECOMBAT [Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease], NOBLE [Nordic-Baltic-British Left Main Revascularisation Study], and EXCEL [Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization]) that randomized patients with left main disease to PCI or CABG. Patients were considered suitable for either approach. Patients were categorized by diabetes status. Kaplan-Meier event rates, Cox model hazard ratios, and interactions were assessed. RESULTS Among 4393 patients, 1104 (25.1%) had diabetes. Patients with diabetes experienced higher rates of 5-year death (158/1104 [Kaplan-Meier rate, 14.7%] versus 297/3289 [9.3%]; P<0.001), spontaneous myocardial infarction (MI; 67/1104 [6.7%] versus 114/3289 [3.7%]; P<0.001), and repeat revascularization (189/1104 [18.5%] versus 410/3289 [13.2%]; P<0.001). Rates of all-cause mortality did not differ after PCI versus CABG in those with (84/563 [15.3%] versus 74/541 [14.1%]; hazard ratio, 1.11 [95% CI, 0.82-1.52]) or without (155/1634 [9.7%] versus 142/1655 [8.9%]; hazard ratio, 1.08 [95% CI, 0.86-1.36; PintHR=0.87) diabetes. Rates of stroke within 1 year were lower with PCI versus CABG in the entire population, with no heterogeneity based on diabetes status (PintHR=0.51). The 5-year rates of spontaneous MI and repeat coronary revascularization were higher after PCI regardless of diabetes status (spontaneous MI: 45/563 [8.9%] versus 22/541 [4.4%] in diabetes and 82/1634 [5.3%] versus 32/1655 [2.1%] in no diabetes, PintHR=0.47; repeat revascularization: 127/563 [24.5%] versus 62/541 [12.4%] in diabetes and 254/1634 [16.3%] versus 156/1655 [10.1%] in no diabetes, PintHR=0.18). For spontaneous MI and repeat revascularization, there were greater absolute risk differences beyond 1 year in patients with diabetes (4.9% and 9.9%) compared with those without (2.1% and 4.3%; PintARD=0.047 and 0.016). CONCLUSIONS In patients with left main disease considered equally suitable for PCI or CABG and with largely low to intermediate SYNTAX scores, diabetes was associated with higher rates of death and cardiovascular events through 5 years. Compared with CABG, PCI resulted in no difference in the risk of death and a lower risk of early stroke regardless of diabetes status, and a higher risk of spontaneous MI and repeat coronary revascularization, with larger late absolute excess risks in patients with diabetes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01205776, NCT0146651, NCT00422968, and NCT00114972.
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Affiliation(s)
- Prakriti Gaba
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, OH (J.F.S.)
| | - Sabina A Murphy
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Andrea Bellavia
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Patrick T O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Peter K Smith
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC (P.K.S)
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, UK (P.W.S.)
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (A.P.K.)
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, Seoul, South Korea (S.-J.P., D.-W.P.,)
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, Seoul, South Korea (S.-J.P., D.-W.P.,)
| | - Evald H Christiansen
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Niels R Holm
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Per H Nielsen
- Department of Cardiology, Aarhus, Aarhus University Hospital, Denmark (E.H.C., N.R.H., P.H.N.)
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | - Brian A Bergmark
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (P.G., S.A.M., A.B., M.S.S., B.A.B.)
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.G., S.A.M., A.B., P.T.O., M.S.S., B.A.B.)
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Xu X, Wang Z, Yang J, Fan X, Yang Y. Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord 2024; 24:218. [PMID: 38654151 PMCID: PMC11036585 DOI: 10.1186/s12872-024-03889-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The coexistence of cardiac arrhythmias in patients with acute myocardial infarction (AMI) usually exhibits poor prognosis. However, there are few contemporary data available on the burden of cardiac arrhythmias in AMI patients and their impact on in-hospital outcomes. METHODS The present study analyzed data from the China Acute Myocardial Infarction (CAMI) registry involving 23,825 consecutive AMI patients admitted to 108 hospitals from January 2013 to February 2018. Cardiac arrhythmias were defined as the presence of bradyarrhythmias, sustained atrial tachyarrhythmias, and sustained ventricular tachyarrhythmias that occurred during hospitalization. In-hospital outcome was defined as a composite of all-cause mortality, cardiogenic shock, re-infarction, stroke, or heart failure. RESULTS Cardiac arrhythmia was presented in 1991 (8.35%) AMI patients, including 3.4% ventricular tachyarrhythmias, 2.44% bradyarrhythmias, 1.78% atrial tachyarrhythmias, and 0.73% ≥2 kinds of arrhythmias. Patients with arrhythmias were more common with ST-segment elevation myocardial infarction (83.3% vs. 75.5%, P < 0.001), fibrinolysis (12.8% vs. 8.0%, P < 0.001), and previous heart failure (3.7% vs. 1.5%, P < 0.001). The incidences of in-hospital outcomes were 77.0%, 50.7%, 43.5%, and 41.4%, respectively, in patients with ≥ 2 kinds of arrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and atrial tachyarrhythmias, and were significantly higher in all patients with arrhythmias than those without arrhythmias (48.9% vs. 12.5%, P < 0.001). The presence of any kinds of arrhythmia was independently associated with an increased risk of hospitalization outcome (≥ 2 kinds of arrhythmias, OR 26.83, 95%CI 18.51-38.90; ventricular tachyarrhythmias, OR 8.56, 95%CI 7.34-9.98; bradyarrhythmias, OR 5.82, 95%CI 4.87-6.95; atrial tachyarrhythmias, OR4.15, 95%CI 3.38-5.10), and in-hospital mortality (≥ 2 kinds of arrhythmias, OR 24.44, 95%CI 17.03-35.07; ventricular tachyarrhythmias, OR 13.61, 95%CI 10.87-17.05; bradyarrhythmias, OR 7.85, 95%CI 6.0-10.26; atrial tachyarrhythmias, OR 4.28, 95%CI 2.98-6.16). CONCLUSION Cardiac arrhythmia commonly occurred in patients with AMI might be ventricular tachyarrhythmias, followed by bradyarrhythmias, atrial tachyarrhythmias, and ≥ 2 kinds of arrhythmias. The presence of any arrhythmias could impact poor hospitalization outcomes. REGISTRATION Clinical Trial Registration: Identifier: NCT01874691.
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Affiliation(s)
- Xu Xu
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhao Wang
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jingang Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Mateu-Fabregat J, Mostafa H, Sanchez-Gimenez R, Peiró ÓM, Bonet G, Carrasquer A, Fragkiadakis GA, Bardaji A, Bulló M, Papandreou C. Bile Acids and Risk of Adverse Cardiovascular Events and All-Cause Mortality in Patients with Acute Coronary Syndrome. Nutrients 2024; 16:1062. [PMID: 38613095 PMCID: PMC11013079 DOI: 10.3390/nu16071062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
The relationship between bile acids (BAs) and adverse cardiovascular events following acute coronary syndrome (ACS) have been little investigated. We aimed to examine the associations of BAs with the risk of cardiovascular events and all-cause mortality in ACS. We conducted a prospective study on 309 ACS patients who were followed for 10 years. Plasma BAs were quantified by liquid chromatography coupled to tandem mass spectrometry. Cox regression analyses with elastic net penalties were performed to associate BAs with MACE and all-cause mortality. Weighted scores were computed using the 100 iterated coefficients corresponding to each selected BA, and the associations of these scores with these adverse outcomes were assessed using multivariable Cox regression models. A panel of 10 BAs was significantly associated with the increased risk of MACE. The hazard ratio of MACE per SD increase in the estimated BA score was 1.35 (95% CI 1.12-1.63). Furthermore, four BAs were selected from the elastic net model for all-cause mortality, although their weighted score was not independently associated with mortality. Our findings indicate that primary and secondary BAs may play a significant role in the development of MACE. This insight holds potential for developing strategies to manage ACS and prevent adverse outcomes.
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Affiliation(s)
- Javier Mateu-Fabregat
- Nutrition and Metabolic Health Research Group, Department of Biochemistry and Biotechnology, Rovira i Virgili University (URV), 43201 Reus, Spain; (J.M.-F.); (M.B.)
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Center of Environmental, Food and Toxicological Technology—TecnATox, Rovira i Virgili University, 43201 Reus, Spain
| | - Hamza Mostafa
- Nutrition and Metabolic Health Research Group, Department of Biochemistry and Biotechnology, Rovira i Virgili University (URV), 43201 Reus, Spain; (J.M.-F.); (M.B.)
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Center of Environmental, Food and Toxicological Technology—TecnATox, Rovira i Virgili University, 43201 Reus, Spain
| | - Raul Sanchez-Gimenez
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Department of Medicine and Surgery, Rovira i Virgili University, 43005 Tarragona, Spain
| | - Óscar M. Peiró
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Department of Medicine and Surgery, Rovira i Virgili University, 43005 Tarragona, Spain
| | - Gil Bonet
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Department of Medicine and Surgery, Rovira i Virgili University, 43005 Tarragona, Spain
| | - Anna Carrasquer
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Department of Medicine and Surgery, Rovira i Virgili University, 43005 Tarragona, Spain
| | - Georgios A. Fragkiadakis
- Department of Nutrition and Dietetics Sciences, School of Health Sciences, Hellenic Mediterranean University, 72300 Siteia, Greece;
| | - Alfredo Bardaji
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain
- Department of Medicine and Surgery, Rovira i Virgili University, 43005 Tarragona, Spain
| | - Mònica Bulló
- Nutrition and Metabolic Health Research Group, Department of Biochemistry and Biotechnology, Rovira i Virgili University (URV), 43201 Reus, Spain; (J.M.-F.); (M.B.)
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Center of Environmental, Food and Toxicological Technology—TecnATox, Rovira i Virgili University, 43201 Reus, Spain
- CIBER Physiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Christopher Papandreou
- Nutrition and Metabolic Health Research Group, Department of Biochemistry and Biotechnology, Rovira i Virgili University (URV), 43201 Reus, Spain; (J.M.-F.); (M.B.)
- Institute of Health Pere Virgili (IISPV), 43204 Reus, Spain; (R.S.-G.); (Ó.M.P.); (G.B.); (A.C.); (A.B.)
- Center of Environmental, Food and Toxicological Technology—TecnATox, Rovira i Virgili University, 43201 Reus, Spain
- Department of Nutrition and Dietetics Sciences, School of Health Sciences, Hellenic Mediterranean University, 72300 Siteia, Greece;
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Buono A, Pellicano M, Regazzoli D, Donahue M, Tedeschi D, Loffi M, Zimbardo G, Reimers B, Danzi G, DE Blasio G, Tespili M, Ielasi A. Procedural and one-year outcomes following drug-eluting stent and drug-coated balloon combination for the treatment of de novo diffuse coronary artery disease: the HYPER Study. Minerva Cardiol Angiol 2024; 72:163-171. [PMID: 37705369 DOI: 10.23736/s2724-5683.23.06352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND De novo diffuse coronary artery disease (CAD) is a challenging scenario in interventional cardiology with limited treatment option, beside stent implantation. In this context, a hybrid approach, combining the use of drug-eluting stent (DES) and drug-coated balloon (DCB) to treat different segments of the same lesion (e.g. long lesion and/or true bifurcation), might be an interesting and alternative strategy to limit the metal amount. The aim of this study was to evaluate the safety and efficacy of a hybrid approach in addressing percutaneous treatment of de novo diffuse CAD. METHODS This was a prospective, multicenter study including patients affected by de novo diffuse CAD treated with a hybrid approach from April 2019 to December 2020. Angiographic and clinical data were collected. The primary endpoint was the one-year device-oriented composite endpoint (DOCE, cardiac death, target vessel myocardial infarction and ischemia-driven target lesion revascularization [ID-TLR]). Periprocedural myocardial infarctions and periprocedural success were included among secondary endpoints. RESULTS One hundred six patients were included, mean age was 68.2±10.2 years and 78.3% were male. De novo diffuse CAD consisted of 52.8% long lesions and 47.2% true bifurcation lesions. Significant increase in the final minimal lumen diameters and significant decrease in the final diameter stenosis were observed when compared to the baseline values in both DES- and DCB-target segments. Procedural success was 96.2%. DOCE at one-year was 3.7%, with all the adverse events characterized by ID-TLR. CONCLUSIONS Combination of DES and DCB could be a safe and effective treatment option for the treatment of de novo diffuse CAD (NCT03939468).
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Affiliation(s)
- Andrea Buono
- Unit of Interventional Cardiology, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Mariano Pellicano
- Division of Cardiology, Galeazzi Sant'Ambrogio IRCCS Hospital, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | | | - Delio Tedeschi
- Interventional Cardiology, Sant'Anna Clinical Institute, Brescia, Italy
| | - Marco Loffi
- Operative Unit of Cardiology, Territorial Social Health Authority of Cremona, Cremona, Italy
| | | | | | - Giambattista Danzi
- Operative Unit of Cardiology, Territorial Social Health Authority of Cremona, Cremona, Italy
| | - Giuseppe DE Blasio
- Division of Cardiology, Galeazzi Sant'Ambrogio IRCCS Hospital, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Maurizio Tespili
- Division of Cardiology, Galeazzi Sant'Ambrogio IRCCS Hospital, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Alfonso Ielasi
- Division of Cardiology, Galeazzi Sant'Ambrogio IRCCS Hospital, Gruppo Ospedaliero San Donato, Milan, Italy -
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Bramucci A, Nerla R, Bianchini Massoni C, Giovannini D, Chester J, Freyrie A, Castriota F. Thirty-day outcomes of carotid endarterectomy versus carotid artery stenting in asymptomatic and symptomatic patients: a propensity score-matched analysis. EUROINTERVENTION 2024; 20:e445-e452. [PMID: 38562068 PMCID: PMC10979384 DOI: 10.4244/eij-d-23-00624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Technological and surgical approaches to carotid artery stenting (CAS) have evolved. Modern randomised controlled trials comparing CAS and carotid endarterectomy (CEA) are limited, and information about updated post-intervention outcomes are mostly from retrospective, small studies. AIMS This study aims to compare the 30-day outcomes of stroke, transient ischaemic attack (TIA), acute myocardial infarction (AMI) and death with propensity-matched groups of CEA and CAS in asymptomatic and symptomatic patients over a recent study period of new CAS technologies and approaches. METHODS A retrospective, observational, multicentre analysis was conducted including consecutive symptomatic and asymptomatic patients treated with either primary CEA or CAS for internal carotid artery stenosis, between 2015 and 2022. Patients were propensity score-matched based on comorbidities and assessed according to symptom status. Primary endpoints include composite ipsilateral stroke, TIA, AMI and death within 30 days. Secondary endpoints include technical success and length of hospital stay. RESULTS From a cohort of 1,110 patients, propensity matching produced 269 distinct treatment pairs (n=538). Most patients were asymptomatic (n=456, 85%). All 6 strokes were minor (CEA=2; CAS=4) and registered among asymptomatic patients. One AMI (CEA) and 1 patient death (CAS) were reported among symptomatic patients. Composite stroke/AMI/death were not significantly different between both types of symptom status and both revascularisation techniques (p=0.44 and p=1, respectively). Technical success was 100%. The length of hospital stay was significantly shorter in asymptomatic patients treated with CAS compared to those treated with CEA (p=0.05), but no difference was registered among symptomatic patients (p=0.32). CONCLUSIONS Propensity-matched analysis suggests that CAS has similar postprocedural outcomes for stroke, AMI and death at 30 days compared to CEA.
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Affiliation(s)
- Alberto Bramucci
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Roberto Nerla
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Davide Giovannini
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Johanna Chester
- Medical and Dental Department of Morphological Sciences related to Transplant, Research Unit, Surgical, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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20
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Espejo T, Terhalle L, Malinovska A, Riedel HB, Arntz L, Hafner L, Delport-Lehnen K, Zuppinger J, Geigy N, Leuppi J, Somasundaram R, Bingisser R, Nickel CH. Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study. Acad Emerg Med 2024. [PMID: 38532263 DOI: 10.1111/acem.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Emergency department (ED) presentations after a ground-level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high-sensitivity cardiac troponin (hs-cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), as well as the diagnostic accuracy of hs-cTnT and hs-cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF. METHODS This was a prospective, international, multicenter, cohort study with a follow-up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs-cTnT and hs-cTnI levels were determined from thawed samples for every patient. RESULTS In total, 558 patients were included. Median (IQR) age was 83 (77-89) years, and 67.7% were female. Elevated hs-cTnT levels were found in 384 (68.8%) patients, and elevated hs-cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the gold standard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs-cTnT and hs-cTnI levels compared with survivors (hs-cTnT 40 [23-85] ng/L in nonsurvivors and 20 [13-33] ng/L in survivors; hs-cTnI 25 [14-54] ng/L in nonsurvivors and 8 [4-16] ng/L in survivors; p < 0.001 for both). CONCLUSIONS A majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs-cTnT levels and 86 (15.4%) elevated hs-cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs-cTnT and hs-cTnI were both found to have prognostic properties for mortality prediction up to 1 year.
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Affiliation(s)
- Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Terhalle
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra Malinovska
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Arntz
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Livia Hafner
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Joanna Zuppinger
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Nicolas Geigy
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jörg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Araujo GND, Machado GP, Moura M, Silveira AD, Bergoli LC, Fuchs FC, Wainstein RV, Goncalves SC, Lemos PA, Quadros ASD, Wainstein MV. Clinical outcomes with biodegradable versus durable polymer drug-eluting stents in patients with ST-elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00078-2. [PMID: 38492976 DOI: 10.1016/j.carrev.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Coronary drug-eluting stents (DES) built with either durable (DP) or biodegradable (BP) polymeric coatings have been largely tested and are extensively available for routine use. However, their comparative performance remains an open question, particularly in more complex subsets of patients. AIMS We evaluated the outcomes of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) using DP-DES versus BP-DES in a large multicenter real-world registry. METHODS The population comprised patients with STEMI treated with pPCI within 12 h of symptoms onset. Those treated with more than one DES who received different polymer types were excluded. The final cohort for analysis was selected after propensity score matching (PSM), computed to generate similar groups of DP DES versus BP DES. Primary endpoint was the incidence of major adverse cardiac events (MACE), defined as the composite of total death, myocardial infarction and target lesion revascularization at 2 years. RESULTS From January 2017 to April 2022, a total of 1527 STEMI patients underwent pPCI with a single DES type (587 DP-DES; 940 BP-DES). After PSM, 836 patients (418 patients in the DP-DES and 418 patients in the BP-DES groups), comprised the final study population. Both study groups had a similar baseline profile. Patients treated with BP-DES group had similar rates of MACE (15.3 % vs. 19.4 %, HR 0.69, 95 % CI 0.50-0.94, p = 0.022). Rates of target lesion revascularization was lower in BP DES group (0.7 % vs. 3.8 %, HR 0.17, 95 % CI 0.05-0.51, p = 0.006). CONCLUSION In a cohort of STEMI patients submitted to pPCI, BP and DP DES had similar rates of the primary outcome. Patients treated with BP DES, however, had a decreased incidence of TLR at after 2-year follow-up.
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Affiliation(s)
- Gustavo Neves de Araujo
- Instituto de Cardiologia de Santa Catarina, São Jose, Brazil; Hospital Unimed Grande Florianopolis, São Jose, Brazil.
| | | | - Marcia Moura
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | - Pedro A Lemos
- Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marco Vugman Wainstein
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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22
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Grazide MH, Ruidavets JB, Martinet W, Elbaz M, Vindis C. Association of Circulating Autophagy Proteins ATG5 and Beclin 1 with Acute Myocardial Infarction in a Case-Control Study. Cardiology 2024; 149:217-224. [PMID: 38432214 DOI: 10.1159/000537816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a main contributor of sudden cardiac death worldwide. The discovery of new biomarkers that can improve AMI risk prediction meets a major clinical need for the identification of high-risk patients and the tailoring of medical treatment. Previously, we reported that autophagy a highly conserved catabolic mechanism for intracellular degradation of cellular components is involved in atherosclerotic plaque phenotype and cardiac pathological remodeling. The crucial role of autophagy in the normal and diseased heart has been well described, and its activation functions as a pro-survival process in response to myocardial ischemia. However, autophagy is dysregulated in ischemia/reperfusion injury, thus promoting necrotic or apoptotic cardiac cell death. Very few studies have focused on the plasma levels of autophagy markers in cardiovascular disease patients, even though they could be companion biomarkers of AMI injury. The aims of the present study were to evaluate (1) whether variations in plasma levels of two key autophagy regulators autophagy-related gene 5 (ATG5) and Beclin 1 (the mammalian yeast ortholog Atg6/Vps30) are associated with AMI and (2) their potential for predicting AMI risk. METHODS The case-control study population included AMI patients (n = 100) and control subjects (n = 99) at high cardiovascular risk but without known coronary disease. Plasma levels of ATG5 and Beclin 1 were measured in the whole population study by enzyme-linked immunosorbent assay. RESULTS Multivariate analyses adjusted on common cardiovascular factors and medical treatments, and receiver operating characteristic curves demonstrated that ATG5 and Beclin 1 levels were inversely associated with AMI and provided original biomarkers for AMI risk prediction. CONCLUSION Plasma levels of autophagy regulators ATG5 and Beclin 1 represent relevant candidate biomarkers associated with AMI.
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Affiliation(s)
- Marie-Hélène Grazide
- Center for Clinical Investigation (CIC1436)/CARDIOMET, Rangueil University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France
| | | | - Wim Martinet
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Meyer Elbaz
- Center for Clinical Investigation (CIC1436)/CARDIOMET, Rangueil University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Cécile Vindis
- Center for Clinical Investigation (CIC1436)/CARDIOMET, Rangueil University Hospital, Toulouse, France
- University of Toulouse III, Toulouse, France
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23
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Ríos-Navarro C, Gavara J, de Dios E, Pérez-Solé N, Molina-García T, Marcos-Garcés V, Ruiz-Saurí A, Bayés-Genís A, Carrión-Valero F, Chorro FJ, Bodí V. Effect of serum from patients with ST-segment elevation myocardial infarction on endothelial cells. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:254-264. [PMID: 37696331 DOI: 10.1016/j.rec.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Clinical and experimental studies have shown that, in patients with reperfused ST-segment elevation myocardial infarction (STEMI), abnormalities in the endothelial monolayer are initiated during ischemia but rapidly intensify upon restoration of blood perfusion to the ischemic area. We aimed to evaluate the effect of serum isolated after revascularization from STEMI patients on the degree of endothelial permeability in vitro, by promoting endothelial cell apoptosis and necrosis in vitro. We also investigated the association between the percentage of serum-induced endothelial cell apoptosis or necrosis in vitro and the extent of cardiovascular magnetic resonance (CMR)-derived parameters of reperfusion injury (edema, hemorrhage, and microvascular obstruction). METHODS Human coronary artery endothelial cells were incubated with serum isolated 24hours after revascularization from 43 STEMI patients who underwent CMR and 14 control participants. We assessed the effect of STEMI serum on activation of apoptosis and necrosis, as well as on the permeability and structure of the endothelial monolayer. RESULTS Serum from STEMI patients increased apoptosis (P <.01) and necrosis (P <.05) in human coronary artery endothelial cells and caused increased permeability of the endothelial monolayer in vitro (P <.01), due to enlarged intercellular spaces (P <.05 vs control in all cases). Higher serum-induced necrosis was associated with greater endothelial permeability in vitro (P <.05) and with more extensive CMR-derived indices of reperfusion injury and infarct size. CONCLUSIONS Postreperfusion serum activates necrosis and apoptosis in endothelial cells and increases the degree of endothelial permeability in vitro. The more potent the necrosis-triggering effect of serum, the more deleterious the consequences in terms of the resulting cardiac structure.
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Affiliation(s)
- César Ríos-Navarro
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - José Gavara
- Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain
| | - Elena de Dios
- Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | | | | | - Víctor Marcos-Garcés
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Amparo Ruiz-Saurí
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Can Ruti Campus, Badalona, Spain; Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Francisco Carrión-Valero
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; Servicio de Neumología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francisco J Chorro
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Vicente Bodí
- Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
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24
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Jeong JH, Kook H, Lee SH, Joo HJ, Park JH, Hong SJ, Kim M, Park S, Jung JS, Yang JH, Gwon H, Ahn C, Jang WJ, Kim H, Bae J, Kwon SU, Lee WS, Jeong J, Park S, Lim S, Lee J, Lee J, Yu CW. Prediction of In-Hospital Mortality for Ischemic Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation. J Am Heart Assoc 2024; 13:e032701. [PMID: 38362865 PMCID: PMC11010074 DOI: 10.1161/jaha.123.032701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Clinical outcome of ischemic cardiogenic shock (CS) requiring extracorporeal membrane oxygenation is highly variable, necessitating appropriate assessment of prognosis. However, a systemic predictive model estimating the mortality of refractory ischemic CS is lacking. The PRECISE (Prediction of In-Hospital Mortality for Patients With Refractory Ischemic Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation Support) score was developed to predict the prognosis of refractory ischemic CS due to acute myocardial infarction. METHODS AND RESULTS Data were obtained from the multicenter CS registry RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) that consists of 322 patients with acute myocardial infarction complicated by refractory ischemic CS requiring extracorporeal membrane oxygenation support. Fifteen parameters were selected to assess in-hospital mortality. The developed model was validated internally and externally using an independent external cohort (n=138). Among 322 patients, 138 (42.9%) survived postdischarge. Fifteen predictors were included for model development: age, diastolic blood pressure, hypertension, chronic kidney disease, peak lactic acid, serum creatinine, lowest left ventricular ejection fraction, vasoactive inotropic score, shock to extracorporeal membrane oxygenation insertion time, extracorporeal cardiopulmonary resuscitation, use of intra-aortic balloon pump, continuous renal replacement therapy, mechanical ventilator, successful coronary revascularization, and staged percutaneous coronary intervention. The PRECISE score yielded a high area under the receiver-operating characteristic curve (0.894 [95% CI, 0.860-0.927]). External validation and calibration resulted in competent sensitivity (area under the receiver-operating characteristic curve, 0.895 [95% CI, 0.853-0.930]). CONCLUSIONS The PRECISE score demonstrated high predictive performance and directly translates into the expected in-hospital mortality rate. The PRECISE score may be used to support clinical decision-making in ischemic CS (www.theprecisescore.com). REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, College of MedicineHanyang UniversitySeoulKorea
| | - Seung Hun Lee
- Department of Internal MedicineKorea University Graduate SchoolSeoulKorea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Jae Hyoung Park
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Mi‐Na Kim
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Seong‐Mi Park
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular SurgeryAnam Hospital, Korea University College of MedicineSeoulKorea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
| | - Chul‐Min Ahn
- Division of Cardiology, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Woo Jin Jang
- Department of CardiologyEwha Woman’s University Seoul Hospital, Ehwa Woman’s University School of MedicineSeoulKorea
| | - Hyun‐Joong Kim
- Division of Cardiology, Department of MedicineKonkuk University Medical CenterSeoulKorea
| | - Jang‐Whan Bae
- Department of Internal MedicineChungbuk National University College of MedicineCheongjuKorea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik HospitalInje University College of MedicineGoyangKorea
| | - Wang Soo Lee
- Division of Cardiology, Department of MedicineChung‐Ang University HospitalSeoulKorea
| | - Jin‐Ok Jeong
- Division of Cardiology, Department of Internal MedicineChungnam National University HospitalDaejeonKorea
| | - Sang‐Don Park
- Division of Cardiology, Department of MedicineInha University HospitalIncheonKorea
| | - Seong‐Hoon Lim
- Division of Cardiovascular Medicine, Department of Internal MedicineDankook University Hospital, Dankook University College of MedicineCheonanKorea
| | - Jiyoon Lee
- Department of Biostatistics, College of MedicineKorea UniversitySeoulKorea
| | - Juneyoung Lee
- Department of Biostatistics, College of MedicineKorea UniversitySeoulKorea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Anam HospitalKorea University College of MedicineSeoulKorea
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25
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Uleberg B, Bønaa KH, Govatsmark RES, Olsen F, Jacobsen BK, Stensland E, Hauglann B, Vonen B, Førde OH. Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study. BMJ Open 2024; 14:e081301. [PMID: 38367969 PMCID: PMC10875564 DOI: 10.1136/bmjopen-2023-081301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy. DESIGN National register-based cohort study. SETTING Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy. PARTICIPANTS 7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015-2018. MAIN OUTCOME MEASURES The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis. RESULTS Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.Patients aged 75-84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1-2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time. CONCLUSIONS The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.
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Affiliation(s)
- Bård Uleberg
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Kaare Harald Bønaa
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Clinic for Heart Disease, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Ragna Elise Støre Govatsmark
- Department of Medical Quality Registers, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Frank Olsen
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Eva Stensland
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Beate Hauglann
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Barthold Vonen
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
| | - Olav Helge Førde
- Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Bodo, Norway
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26
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Fatima L, Goyal A, Yakkali S, Jain H, Raza FA, Peer T, Kanagala SG, Sohail AH, Malik J. Precision medicine in Myocardial Infarction With Non-obstructive Coronary Disease (MINOCA): A comprehensive review. Curr Probl Cardiol 2024; 49:102185. [PMID: 37925046 DOI: 10.1016/j.cpcardiol.2023.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
Cardiovascular diseases, particularly myocardial infarction (MI), are a significant cause of mortality globally. Traditional MIs are commonly linked to substantial coronary artery blockage. However, a distinct subset of patients experience MI with non-obstructive coronary arteries, known as MINOCA. Imaging techniques, such as invasive coronary angiograms, are employed to diagnose MI or assess predisposition to one. Coronary angiograms help visualize vessel blockages; however, these blockages are absent in MINOCA cases, posing a diagnostic challenge. Precision medicine aims to introduce new diagnostic tools to assist in early diagnosis and further management of MINOCA. As percutaneous coronary intervention (PCI) does not benefit MINOCA patients, medical management tailored to the specific pathophysiological mechanism of MINOCA is employed. For example, if MINOCA is attributed to plaque disruption with or without plaque thrombus formation, the fundamental treatments may include statins, agents that modulate the renin-angiotensin system (RAS), and antiplatelet therapies. On the other hand, if coronary artery spasm is identified as the primary cause, essential intervention involves the use of calcium channel blockers. This approach has been previously utilized in patients with vasospastic angina and could be utilized in MINOCA, although research specific to MINOCA is ongoing. Therefore, the handling of MINOCA underscores the necessity for a tailored therapeutic strategy that corresponds to the underlying physiological mechanism responsible for the patient's clinical symptoms. Ongoing research initiatives are directed at expanding the availability of these treatments, uncovering new biomarkers, creating advanced diagnostic instruments, and establishing a more individualized approach for managing MINOCA patients.
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Affiliation(s)
- Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shreyas Yakkali
- Department of Internal Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hritvik Jain
- All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Fatima Ali Raza
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Taha Peer
- Undergraduate student, University of California Los Angeles (UCLA), California, LA, USA
| | - Sai Gautham Kanagala
- Department of Internal Medicine, Metropolitan Hospital Center, NY, New York, USA
| | - Amir H Sohail
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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27
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Almendro-Delia M, Padilla-Rodríguez G, Hernández-Meneses B, Blanco-Ponce E, Arboleda-Sánchez JA, Rodríguez-Yáñez JC, Soto-Blanco JM, Fernández-García I, Castillo-Caballero JM, García-Rubira JC, Hidalgo-Urbano R. Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:113-124. [PMID: 37573968 DOI: 10.1016/j.rec.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). METHODS We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. RESULTS Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,-0.99-1.24). CONCLUSIONS In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor. Clinical trial registered at ClinicalTrials.gov (Identifier: NCT02500290).
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Affiliation(s)
- Manuel Almendro-Delia
- Unidad de Agudos Cardiovascular, Hospital Universitario Virgen Macarena, Seville, Spain.
| | | | | | - Emilia Blanco-Ponce
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | | | | | - Juan C García-Rubira
- Unidad de Agudos Cardiovascular, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Rafael Hidalgo-Urbano
- Unidad de Agudos Cardiovascular, Hospital Universitario Virgen Macarena, Seville, Spain
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28
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Bandorski D, Höltgen R, Wieczorek M, Ghofrani HA, Bogossian H, Iliodromitis K. Evaluation of troponin I serum levels in patients with arrhythmias with and without coronary artery disease. Med Klin Intensivmed Notfmed 2024; 119:39-45. [PMID: 37266667 DOI: 10.1007/s00063-023-01011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/11/2023] [Accepted: 03/23/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Elevated levels of cardiac enzymes in the blood are an indicator of ongoing cardiac ischemia. Persistent tachycardia may lead to myocardial ischemia due to oxygen supply-demand mismatch. OBJECTIVES We sought to evaluate the probability of underlying coronary artery disease (CAD) in patients with symptomatic supraventricular (SVT) or ventricular tachyarrhythmias (VT) based on cardiac enzyme level fluctuation. MATERIALS AND METHODS Troponin I (TNI) levels were measured twice and coronary angiography was also performed in patients without a history of cardiovascular disease and symptomatic SVT or VT. RESULTS Of the 114 (group A: CAD (n = 40), group B: no CAD (n = 74)) patients eligible for the study, 34 patients in group A and 64 patients in group B had SVT, while 6 patients in group A and 10 patients in group B had VT. All patients with underlying CAD developed a significantly elevated TNI level compared to baseline, irrespective of arrhythmia type (2.02 ± 7.98 ng/ml vs. 5.64 ± 13.38, p = 0.031). In patients without CAD, TNI level was not significantly elevated compared to the baseline level, irrespective of arrhythmia type (0.34 ± 1.38 ng/ml vs. 0.48 ± 1.48 ng/ml, p = 0.158). Most patients with normal TNI levels (46 of 47 patients; 98 %) had SVT. CAD was present in 13 of 47 patients (27 %) with tachycardia, despite normal TNI levels. CONCLUSIONS Elevated TNI levels are not helpful to discriminate between SVT and VT. An increase in TNI level in repeated blood sampling can help identify patients with higher probability of underlying CAD. Patients with VT demonstrated higher increases in TNI levels, compared to patients with SVT.
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Affiliation(s)
- Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Germany.
- Neurological Clinic Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Germany.
| | - Reinhard Höltgen
- St. Agnes-Hospital Bocholt Rhede, Medical Clinic, Cardiology/Electrophysiology, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Germany
| | - Marcus Wieczorek
- St. Agnes-Hospital Bocholt Rhede, Medical Clinic, Cardiology/Electrophysiology, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Germany
| | - Hossein Ardeschir Ghofrani
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Harilaos Bogossian
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Germany
- School of Medicine, Witten/Herdecke University, 58455, Witten, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Germany
- School of Medicine, Witten/Herdecke University, 58455, Witten, Germany
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29
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Gaudino M, Flather M, Capodanno D, Milojevic M, Bhatt DL, Biondi Zoccai G, Boden WE, Devereaux PJ, Doenst T, Farkouh M, Freemantle N, Fremes S, Puskas J, Landoni G, Lawton J, Myers PO, Redfors B, Sandner S. European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. Eur J Cardiothorac Surg 2024; 65:ezad415. [PMID: 38420786 DOI: 10.1093/ejcts/ezad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 03/02/2024] Open
Abstract
Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Davide Capodanno
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Farkouh
- Academic Affairs, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Stephen Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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30
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Yu C, Li X, Ma J, Liang S, Zhao Y, Li Q, Zhang R. Spatiotemporal modulation of nitric oxide and Notch signaling by hemodynamic-responsive Trpv4 is essential for ventricle regeneration. Cell Mol Life Sci 2024; 81:60. [PMID: 38279064 PMCID: PMC10817848 DOI: 10.1007/s00018-023-05092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/28/2024]
Abstract
Zebrafish have a remarkable ability to regenerate injured hearts. Altered hemodynamic forces after larval ventricle ablation activate the endocardial Klf2a-Notch signaling cascade to direct zebrafish cardiac regeneration. However, how the heart perceives blood flow changes and initiates signaling pathways promoting regeneration is not fully understood. The present study demonstrated that the mechanosensitive channel Trpv4 sensed the altered hemodynamic forces in injured hearts and its expression was regulated by blood flow. In addition to mediating the endocardial Klf2a-Notch signal cascade around the atrioventricular canal (AVC), we discovered that Trpv4 regulated nitric oxide (NO) signaling in the bulbus arteriosus (BA). Further experiments indicated that Notch signaling primarily acted at the early stage of regeneration, and the major role of NO signaling was at the late stage and through TGF-β pathway. Overall, our findings revealed that mechanosensitive channels perceived the changes in hemodynamics after ventricle injury, and provide novel insights into the temporal and spatial coordination of multiple signaling pathways regulating heart regeneration.
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Affiliation(s)
- Chunxiao Yu
- TaiKang Medical School, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China
| | - Xueyu Li
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Jinmin Ma
- Medical Frontier Innovation Research Center, The First Hospital of Lanzhou University, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Shuzhang Liang
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Yan Zhao
- TaiKang Medical School, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China
| | - Qi Li
- TaiKang Medical School, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China
| | - Ruilin Zhang
- TaiKang Medical School, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, China.
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, China.
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China.
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31
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Min S, Basir MB, Lemor A, Zhou Z, Abu-Much A, Redfors B, Thompson JB, Truesdell AG, Bharadwaj AS, Li Y, Kaki A, Brott BC, Wohns DH, Meraj PM, Daggubati R, Grines CL, O'Neill WW, Moses JW. Clinical characteristics and outcomes of patients requiring prolonged mechanical circulatory support after high-risk percutaneous coronary intervention. EUROINTERVENTION 2024; 20:e135-e145. [PMID: 38224254 PMCID: PMC10786176 DOI: 10.4244/eij-d-23-00512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND There are limited data on the clinical characteristics and outcomes of patients who require prolonged mechanical circulatory support (MCS) after Impella-supported high-risk percutaneous coronary intervention (HR-PCI). AIMS The aim of this study is to describe the contemporary clinical characteristics, outcomes, and predictors associated with prolonged MCS support after assisted HR-PCI. METHODS Patients enrolled in the prospective, multicentre, clinical endpoint-adjudicated PROTECT III study who had undergone HR-PCI using Impella were evaluated. Patient and procedural characteristics and outcomes for those who received prolonged MCS beyond the duration of their index procedure were compared to those in whom MCS was successfully weaned and explanted at the conclusion of the index PCI. RESULTS Among 1,155 patients who underwent HR-PCI with Impella between 2017 and 2020 and had sufficient data to confirm the duration of Impella support, 16.5% received prolonged MCS (mean duration 25.2±31.1 hours compared with 1.8±5.8 hours for those who only received intraprocedural MCS). Patients receiving prolonged support presented with more urgent indications (e.g., acute coronary syndromes [ACS], lower ejection fraction [EF], elevated baseline heart rate and lower systolic blood pressure). Use of the Impella CP, intraprocedural complications, periprocedural complications and in-hospital mortality were all more common amongst the prolonged MCS group. Prolonged MCS was associated with increased rates of major adverse cardiovascular and cerebrovascular events, cardiovascular death, and all-cause mortality at 90-day follow-up. CONCLUSIONS Patients receiving prolonged MCS after Impella-supported HR-PCI presented with more ACS, reduced EF and less favourable haemodynamics. Additionally, they were more likely to experience intraprocedural and periprocedural complications as well as increased in-hospital and post-discharge mortality.
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Affiliation(s)
- Sugi Min
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mir Babar Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Alejandro Lemor
- Department of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Julia B Thompson
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Alexander G Truesdell
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
| | - Aditya S Bharadwaj
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Yanru Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Amir Kaki
- Interventional Cardiology Department, Ascension St. John Hospital and Center, Detroit, MI, USA
| | - Brigitta C Brott
- Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David H Wohns
- Spectrum Health, Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI, USA
| | - Perwaiz M Meraj
- Department of Cardiology, Zucker School of Medicine, Northwell Health, Manhasset, New York, NY, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Cindy L Grines
- Medical College of Georgia, Augusta, GA, USA
- Northside Hospital Cardiovascular Institute, Atlanta, GA, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Department of Cardiology, Henry Ford Health Care System, Detroit, MI, USA
| | - Jeffrey W Moses
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- St. Francis Heart Center, Roslyn, NY, USA
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32
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Ho AFW, Yau CE, Ho JSY, Lim SH, Ibrahim I, Kuan WS, Ooi SBS, Chan MY, Sia CH, Mosterd A, Gijsberts CM, de Hoog VC, Bank IEM, Doevendans PA, de Kleijn DPV. Predictors of major adverse cardiac events among patients with chest pain and low HEART score in the emergency department. Int J Cardiol 2024; 395:131573. [PMID: 37931658 DOI: 10.1016/j.ijcard.2023.131573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
AIM For patients who present to the emergency departments (ED) with undifferentiated chest pain, the risk of major adverse cardiac events (MACE) may be underestimated in low-HEART score patients. We aimed to identify characteristics of patients who were classified as low risk by HEART score but subsequently developed MACE at 6 weeks. METHODS We studied a multiethnic cohort of patients who presented with chest pain arousing suspicion of acute coronary syndrome to EDs in the Netherlands and Singapore. Patients were risk-stratified using HEART score and followed up for MACE at 6 weeks. Risk factors of developing MACE despite low HEART scores (scores 0-3) were identified using logistic and Cox regression models. RESULTS Among 1376 (39.8%) patients with low HEART scores, 63 (4.6%) developed MACE at 6 weeks. More males (53/806, 6.6%) than females (10/570, 2.8%) with low HEART score developed MACE. There was no difference in outcomes between ethnic groups. Among low-HEART score patients with 2 points for history, 21% developed MACE. Among low-HEART score patients with 1 point for troponin, 50% developed MACE, while 100% of those with 2 points for troponin developed MACE. After adjusting for HEART score and potential confounders, male sex was independently associated with increased odds (OR 4.12, 95%CI 2.14-8.78) and hazards (HR 3.93, 95%CI 1.98-7.79) of developing MACE despite low HEART score. CONCLUSION Male sex, highly suspicious history and elevated troponin were disproportionately associated with MACE. These characteristics should prompt clinicians to consider further investigation before discharge.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore.
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jamie Sin-Ying Ho
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | | | - Mark Y Chan
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Crystel M Gijsberts
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vince C de Hoog
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ingrid E M Bank
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter A Doevendans
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
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33
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Lin Z, He J, Yuan S, Song C, Bian X, Yang M, Dou K. Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study. Cardiovasc Diabetol 2024; 23:11. [PMID: 38184572 PMCID: PMC10771684 DOI: 10.1186/s12933-023-02112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels. METHODS A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke. RESULTS During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02-1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42-0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53-1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56-1.25) TyG index subgroups. CONCLUSIONS Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.
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Affiliation(s)
- Zhangyu Lin
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Jining He
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Sheng Yuan
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Chenxi Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Xiaohui Bian
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Min Yang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Kefei Dou
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167A, Beilishi Road, Xicheng District, Beijing, 100037, China.
- State Key Laboratory of Cardiovascular Disease, Beijing, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Roule V, Beygui F, Cayla G, Rangé G, Motovska Z, Delarche N, Jourda F, Goube P, Guedeney P, Zeitouni M, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Derimay F, Van Belle E, Manigold T, Cador R, Combaret N, Vicaut E, Montalescot G, Silvain J. P2Y 12 Inhibitor Loading Time Before Elective PCI and the Prevention of Myocardial Necrosis. Can J Cardiol 2024; 40:31-39. [PMID: 37660934 DOI: 10.1016/j.cjca.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND There are dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is associated with poor outcomes. We aimed to assess the impact of the P2Y12 inhibitor loading time on periprocedural myocardial necrosis in the population of the randomized Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting (ALPHEUS) trial, which compared ticagrelor with clopidogrel in high-risk patients who received elective PCI. METHODS The ALPHEUS trial divided 1809 patients into quartiles of loading time. The ALPHEUS primary outcome was used (type 4 [a or b] myocardial infarction or major myocardial injury) as well as the main secondary outcome (type 4 [a or b] myocardial infarction or any type of myocardial injury). RESULTS Patients in the first quartile group (Q1) presented higher rates of the primary outcome (P = 0.01). When compared with Q1, incidences of the primary outcome decreased in patients with longer loading times (adjusted odds ratio [adjOR], 0.70 [0.52.-0.95]; P = 0.02 for Q2; adjOR 0.65 [0.48-0.88]; P < 0.01 for Q3; adjOR 0.66 [0.49-0.89]; P < 0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications (any bleeding ranging between 4.9% and 7.3% and only 1 major bleeding at 48 hours) and clinical ischemic events were rare and did not differ among groups. CONCLUSIONS In elective PCI, administration of the oral P2Y12 inhibitor at the time of PCI could be associated with more frequent periprocedural myocardial necrosis than an earlier administration. The long-term clinical consequences remain unknown.
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Affiliation(s)
- Vincent Roule
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Département de Cardiologie, CHU de Caen, Caen, France
| | - Farzin Beygui
- Département de Cardiologie, CHU de Caen, Caen, France
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégoire Rangé
- Département de Cardiologie, CH de Chartres, Chartres, France
| | - Zuzana Motovska
- Cardiocentre, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | | | - Pascal Goube
- Service de Cardiologie, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Paul Guedeney
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Department of Cardiology, Grand Hôpital de l'Est Francilien, Jossigny, France
| | - Mikael Laredo
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - François Derimay
- Service de Cardiologie Interventionnelle, Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
| | - Eric Van Belle
- CHU Lille, Institut Cœur Poumon, Cardiology, and Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | | | - Romain Cador
- Department of Cardiology Saint Joseph Hospital, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), Paris, France and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon, Sorbonne, France
| | - Gilles Montalescot
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. http://www.action-cœur.org
| | - Johanne Silvain
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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35
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Pedicino D, Liuzzo G. Does MULTISTARS shed light on the timing of complete revascularization in ST-elevation myocardial infarction? Eur Heart J 2024; 45:15-17. [PMID: 37978876 DOI: 10.1093/eurheartj/ehad733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
- Daniela Pedicino
- Intensive Cardiac Care Unit, Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
| | - Giovanna Liuzzo
- Intensive Cardiac Care Unit, Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University, School of Medicine, Largo F. Vito 1, Rome 00168, Italy
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Bhatnagar S, Jain M. Unveiling the Role of Biomarkers in Cardiovascular Risk Assessment and Prognosis. Cureus 2024; 16:e51874. [PMID: 38327929 PMCID: PMC10849159 DOI: 10.7759/cureus.51874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality, necessitating innovative approaches for accurate risk assessment and prognosis. This review explores the evolving role of biomarkers in advancing cardiovascular risk evaluation and prognostication. Utilizing cardiac biomarkers that represent diverse pathophysiological pathways has the potential to enhance risk stratification for CVD. We delve into the intricate molecular signatures indicative of cardiovascular health, focusing on established biomarkers such as troponins, natriuretic peptides, and lipid profiles while also examining emerging candidates like microRNAs and inflammatory markers. This review provides a holistic perspective on the current landscape of cardiovascular biomarkers, offering insights into their applications in risk assessment and prognosis. In evaluating the risk and prognosis of heart failure (HF), the measurement of natriuretic peptides (B-type natriuretic peptide [BNP] or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) or markers of myocardial injury (cardiac troponin I [TnI] or T [TnT]) has demonstrated utility. By elucidating the synergistic interplay between traditional markers and cutting-edge technologies, this work aims to guide future research endeavors and clinical practices, ultimately contributing to more effective strategies for risk assessment and prognosis of cardiovascular disease.
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Affiliation(s)
- Sumit Bhatnagar
- Medicine/Interventional Cardiology, Ram Krishna Dharmarth Foundation University (RKDF) Medical College Hospital & Research Centre, Bhopal, IND
| | - Mohit Jain
- Cardiology, Liaquat National Hospital and Medical College (LNMC), Bhopal, IND
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Wang Y, Zhang Y, Wang Y, Zhai C, Gao J, Huang G, Ma S. Chest pain with ST-elevation in leads AVR, III, AVF, V 1, V 3R, V 4R and V 5R. Clin Exp Hypertens 2023; 45:2153134. [PMID: 36484289 DOI: 10.1080/10641963.2022.2153134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We mistakenly diagnosed a patient with pulmonary embolism as ST-elevation acute myocardial infarction. The case complained of chest pain with ST-elevation in leads AVR, III, AVF, V1, V3R, V4R and V5R. In addition, we also found ST- elevation AVR, III>ST- elevation AVF, QIII>QAVF and QV1. Multi-site pulmonary embolism can lead to type 2 myocardial infarction or special type of myocardial infarction with non-obstructive coronary arteries through multiple pathological mechanisms.
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Affiliation(s)
- Yuehai Wang
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
| | - Yuqiang Zhang
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
| | - Changpeng Zhai
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
| | - Jie Gao
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to WEIFANG MEDICAL UNIVERSITY, Liaocheng, PR China
| | - Guangyong Huang
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
| | - Shengjun Ma
- Heart Center, Liaocheng People's Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, PR China
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Romagnoli E, Burzotta F, Vergallo R, Gatto L, Biondi-Zoccai G, Ramazzotti V, Biccirè F, Budassi S, Trani C, Ali Z, Stone GW, Prati F. Clinical impact of OCT-derived suboptimal stent implantation parameters and definitions. Eur Heart J Cardiovasc Imaging 2023; 25:48-57. [PMID: 37463223 PMCID: PMC10735315 DOI: 10.1093/ehjci/jead172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/09/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Despite growing evidence supporting the clinical utility of optical coherence tomography (OCT) guidance during percutaneous coronary interventions (PCIs), there is no common agreement as to the optimal stent implantation parameters that enhance clinical outcome. METHODS AND RESULTS We retrospectively examined the predictive accuracy of suboptimal stent implantation definitions proposed from the CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA studies for the long-term risk of device-oriented cardiovascular events (DoCE) in the population of large all-comers CLI-OPCI project. A total of 1020 patients undergoing OCT-guided drug-eluting stent implantation in the CLI-OPCI registry with a median follow-up of 809 (quartiles 414-1376) days constituted the study population. According to CLI-OPCI II, ILUMIEN-IV OPTIMAL PCI, and FORZA criteria, the incidence of suboptimal stent implantation was 31.8%, 58.1%, and 57.8%, respectively. By multivariable Cox analysis, suboptimal stent implantation criteria from the CLI-OPCI II [hazard ratio 2.75 (95% confidence interval 1.88-4.02), P < 0.001] and ILUMIEN-IV OPTIMAL PCI [1.79 (1.18-2.71), P = 0.006] studies, but not FORZA trial [1.11 (0.75-1.63), P = 0.597], were predictive of DoCE. At long-term follow-up, stent edge disease with minimum lumen area <4.5 mm2 [8.17 (5.32-12.53), P < 0.001], stent edge dissection [2.38 (1.33-4.27), P = 0.004], and minimum stent area <4.5 mm2 [1.68 (1.13-2.51), P = 0.011] were the main OCT predictors of DoCE. CONCLUSION The clinical utility of OCT-guided PCI might depend on the metrics adopted to define suboptimal stent implantation. Uncovered disease at the stent border, stent edge dissection, and minimum stent area <4.5 mm2 were the strongest OCT associates of stent failure.
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Affiliation(s)
- Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Gatto
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | | | - Flavio Biccirè
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Simone Budassi
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | - Carlo Trani
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Ziad Ali
- St Francis Hospital & Heart Center, Roslyn, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- The Icahn School of Medicine at Mount Sinai, Mount Sinai Heart and the Cardiovascular Research Foundation, New York, NY, USA
| | - Francesco Prati
- Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
- UniCamillus—Saint Camillus International University of Health Sciences, Rome, Italy
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Bhagat AA, Kalogeropoulos AP, Baer L, Lacey M, Kort S, Skopicki HA, Butler J, Bloom MW. Biomarkers and Strain Echocardiography for the Detection of Subclinical Cardiotoxicity in Breast Cancer Patients Receiving Anthracyclines. J Pers Med 2023; 13:1710. [PMID: 38138937 PMCID: PMC10744645 DOI: 10.3390/jpm13121710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
The optimal surveillance and management strategies for breast cancer patients receiving anthracycline therapy are limited by our incomplete understanding of the role of biomarkers heralding the onset of cardiotoxicity. The purpose of this study was to determine whether there is a temporal correlation between cardiac biomarkers and subclinical left ventricular dysfunction in breast cancer patients receiving anthracycline chemotherapy. Thirty-one females between 46 and 55 years old with breast cancer treated with anthracycline chemotherapy were prospectively enrolled. Cardiac biomarkers were correlated with echocardiography with speckle tracking at baseline, post-anthracycline therapy, and 6 months post-anthracycline chemotherapy. Subclinical cardiotoxicity was defined as ≥ 10% reduction in global longitudinal strain (GLS). There was a relative reduction in left ventricular ejection fraction (LVEF) ≥ 10% in 5/30 (17%) and 7/27 (26%) patients post-anthracycline therapy and 6 months post-anthracycline therapy, respectively. Subclinical cardiotoxicity was noted in 8/30 (27%) and 10/26 (38%) patients post-anthracycline and 6 months post-anthracycline therapy, respectively. Baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) was the strongest predictor of LVEF (ρ = -0.45; p = 0.019), with post-therapy NT-proBNP values illustrating similar predictive value (ρ = -0.40; p = 0.038). Interim changes in suppression of tumorigenicity 2 (ST2) and galectin-3 correlated with a 6-month change in LVEF (ρ = -0.48; p = 0.012 and ρ = -0.45; p = 0.018, for ST2 and galectin-3, respectively). Changes in galectin-3 from baseline to mid-therapy paralleled changes in GLS. NT-proBNP, ST2, and galectin-3 correlate with reduced LVEF among breast cancer patients receiving anthracycline therapy. Additional trials focusing on a cardiac biomarker approach may provide guidance in the early diagnosis and management of anthracycline-induced cardiotoxicity.
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Affiliation(s)
- Aditi A. Bhagat
- Division of Cardiology, Stony Brook University, Stony Brook, NY 11794, USA; (A.A.B.); (A.P.K.); (S.K.); (H.A.S.)
| | - Andreas P. Kalogeropoulos
- Division of Cardiology, Stony Brook University, Stony Brook, NY 11794, USA; (A.A.B.); (A.P.K.); (S.K.); (H.A.S.)
| | - Lea Baer
- Division of Oncology, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Matthew Lacey
- Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA;
| | - Smadar Kort
- Division of Cardiology, Stony Brook University, Stony Brook, NY 11794, USA; (A.A.B.); (A.P.K.); (S.K.); (H.A.S.)
| | - Hal A. Skopicki
- Division of Cardiology, Stony Brook University, Stony Brook, NY 11794, USA; (A.A.B.); (A.P.K.); (S.K.); (H.A.S.)
| | - Javed Butler
- Division of Cardiology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Michelle Weisfelner Bloom
- Division of Cardiology, Stony Brook University, Stony Brook, NY 11794, USA; (A.A.B.); (A.P.K.); (S.K.); (H.A.S.)
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Cui J, Zhao Y, Qian G, Yue X, Luo C, Li T. Cardiac magnetic resonance for the early prediction of reverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction. Eur Radiol 2023; 33:8501-8512. [PMID: 37458756 DOI: 10.1007/s00330-023-09907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To evaluate the changes in cardiac magnetic resonance (CMR) characteristics and investigate the predictors of reverse left ventricular remodeling (r-LVR) in ST-segment elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS Eighty-six STEMI patients (median 56 years) were retrospectively studied. The patients were divided into r-LVR and without r-LVR groups. CMR analysis included LV volume, infarct characteristics, and global and regional myocardial function. The strain and displacement were assessed by CMR-feature tracking. The predictors of r-LVR were analyzed by the logistic regression method. RESULTS There were 37 patients in the r-LVR group and 49 patients in the without r-LVR group. At initial CMR, there was no difference in LV volume and global cardiac function between the two groups. However, the infarct zone radial and longitudinal displacements were higher in the r-LVR group (p < 0.05, respectively). At the second CMR, the r-LVR group showed higher LVEF, lower LV volume, and total enhanced mass (all p < 0.05). The infarct zone radial and circumferential strains and radial displacement were higher in the r-LVR group (all p < 0.05). The r-LVR group had better recovery of myocardial injury and function. Of note, microvascular obstruction (MVO) mass (odds ratio: 0.779 (0.613-0.989), p = 0.041) and infarct zone peak longitudinal displacement (PLD) (odds ratio: 1.448 (1.044-2.008), p = 0.026) were independent predictors of r-LVR. CONCLUSIONS At initial CMR, there were no differences in global cardiac function between the two groups, but infarct zone displacements were higher in the r-LVR group. The r-LVR group had better recovery of cardiac function. In addition, MVO mass and infarct zone PLD were independent predictors of r-LVR. CLINICAL RELEVANCE STATEMENT Our study assessed changes in cardiac structure, function, and tissue characteristics after STEMI by CMR, investigated the best predictors of r-LVR in STEMI patients, and laid the foundation for the development of new parameter-guided treatment strategies for STEMI patients. KEY POINTS • At initial CMR, the reverse left ventricular remodeling (r-LVR) group had less myocardial damage and higher infarct zone displacement, but there were no differences in global function between the two groups. • Both groups showed recovery of myocardial injury and cardiac function over time, but the r-LVR group had less enhanced mass and better cardiac function compared to the without r-LVR group at the second CMR. • Microvascular obstruction mass and infarct zone peak longitudinal displacement by cardiac magnetic resonance feature-tracking were significant predictors of r-LVR in STEMI patients.
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Affiliation(s)
- Jianing Cui
- Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China
| | - Yanan Zhao
- Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China
| | - Geng Qian
- Department of Cardiology, The Six Medical Center, PLA General Hospital, Beijing, China
| | | | - Chuncai Luo
- Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China
| | - Tao Li
- Department of Radiology, the First Medical center, PLA General Hospital, Beijing, China.
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Galli S, Troiano S, Palloshi A, Rapetto C, Pisano F, Aprigliano G, Leoncini M, Ravagnani P, Del Maestro M, Montorsi P. Comparison of acute versus stable coronary syndrome in patients treated with the Magmaris scaffold: Two-year results from the Magmaris Multicenter Italian Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:53-59. [PMID: 37543502 DOI: 10.1016/j.carrev.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The magnesium Magmaris scaffold is the latest resorbable technology with low thrombogenicity, short scaffolding time, and almost complete resorption at 12 months (95 %). As compared with stable coronary artery disease (SCAD), acute coronary syndrome (ACS) is associated with increased risk of adverse clinical outcome after percutaneous coronary intervention. We analyzed the data of the Magmaris Multicenter Italian Registry to compare clinical outcomes in SCAD versus ACS patients. METHODS We evaluated the 24-month rates of target lesion failure (TLF) and scaffold thrombosis (ST). Device implantation procedures were performed according to the manufacturer's recommendations (proper patient/lesion selection, pre-dilatation, proper scaffold sizing, and post-dilatation). Dual antiplatelet therapy was terminated after 12 months. RESULTS Data from 207 patients (145 SCAD and 62 ACS) were collected from July 2016 to June 2018. The 2-year follow-up compliance was 92.8 % (192 patients). At 2 years, TLF rates were 7.4 % in the SCAD group and 8.8 % in the ACS group (p = 0.7); ST rates were 0 % in the SCAD group and 1.8 % in the ACS group (p = 0.1). CONCLUSION The 2-year clinical results from the Magmaris Multicenter Italian Registry are favorable in terms of TLF and ST, indicating the safety and effectiveness of the Magmaris scaffold in both SCAD and ACS patients.
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Affiliation(s)
- Stefano Galli
- Cardiologia Invasiva 2, Centro Cardiologico Fondazione Monzino, IRCCS, Università di Milano, Italy.
| | - Sarah Troiano
- Cardiologia Invasiva 2, Centro Cardiologico Fondazione Monzino, IRCCS, Università di Milano, Italy
| | - Altin Palloshi
- Laboratorio di emodinamica e interventistica cardiovascolare, Istituto Clinico Città Studi, Milano, Italy
| | - Claudio Rapetto
- S.S.D. Cardiologia Interventistica, Ospedale di Sanremo (IM), Italy
| | - Francesco Pisano
- Unità di Emodinamica e Cardiologia Interventistica, Ospedale regionale Umberto Parini, Aosta, Italy
| | - Gianfranco Aprigliano
- Laboratorio di emodinamica e interventistica cardiovascolare, Istituto Clinico Città Studi, Milano, Italy
| | - Massimo Leoncini
- S.S.D. Cardiologia Interventistica, Ospedale di Sanremo (IM), Italy
| | - Paolo Ravagnani
- Cardiologia Invasiva 2, Centro Cardiologico Fondazione Monzino, IRCCS, Università di Milano, Italy
| | | | - Piero Montorsi
- Cardiologia Invasiva 2, Centro Cardiologico Fondazione Monzino, IRCCS, Università di Milano, Italy
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Manzo-Silberman S, Montalescot G. [Benefits of an observatory for myocardial infarction in women under 50 : The WAMIF study]. Ann Cardiol Angeiol (Paris) 2023; 72:101691. [PMID: 37890322 DOI: 10.1016/j.ancard.2023.101691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis. . The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Institut de cardiologie, APHP - Hôpital Pitié-Salpêtrière, Paris, Sorbonne Université, ACTION Study Group, 10459, France.
| | - Gilles Montalescot
- Institut de cardiologie, APHP - Hôpital Pitié-Salpêtrière, Paris, Sorbonne Université, ACTION Study Group, 10459, France
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Slingerland SR, van Beek KAJ, Schulz DN, van Steenbergen GJ, Brouwer T, Stoel M, Vlaar PJ, Tonino PA, Dekker L, van Nunen LX, Teeuwen K, van Veghel D. Results of systematic patient outcome monitoring: Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes? Hellenic J Cardiol 2023:S1109-9666(23)00223-3. [PMID: 37979617 DOI: 10.1016/j.hjc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVES This study evaluates clinical outcomes after implementing a liberal post-dilatation strategy during PCI. BACKGROUND Post-dilatation after percutaneous coronary intervention (PCI) is performed to achieve optimal stent expansion and reduce complications. However, its prognostic effects are unclear and conflicting. METHODS This study is a pre-post-intervention analysis of two cohorts, before (2015-2017) and after (2018-2020) implementation of a liberal post-dilatation strategy. The primary end point consisted of major adverse cardiovascular events (MACE) at 30 days. Secondary end points consisted of the individual components of the primary end point as well as 1 year mortality and target vessel revascularization. RESULTS A total of 10,153 patients were included: 5,383 in the pre-cohort and 4,770 in the post-cohort. The 30-day MACE was 5.00% in the pre-cohort and 4.09% in the post-cohort (p = 0.008; OR 0.75 (CI 0.61-0.93)). There was a significant difference between the pre- and post-cohort in 30-day mortality, respectively, 2.91% and 2.25% (p = .01; OR 0.70 (CI 0.53-0.93)), and MI at 30 days, 1.17% versus 0.59% (p = .003; OR 0.49 (CI 0.31-0.78)). At 1 year, there was a significant difference in mortality between the pre-cohort, 5.84%, and post-cohort, 5.19% (p = .02; OR 0.79 (CI 0.66-0.96)). CONCLUSIONS A liberal post-dilatation strategy after PCI was associated with a significant decrease in 30-day MACE, 30-day MI, 30-day mortality, and 1-year mortality. Future studies are warranted to validate the causality between post-dilatation and improvement of clinical outcomes.
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Affiliation(s)
| | | | | | | | - Tim Brouwer
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Pim A Tonino
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas Dekker
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen Teeuwen
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
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Dakshi A, Salmon T, Collinson P, Ihsan J, Campbell M, Khand A. Unstable angina in the context of high-sensitive troponins: Still a marker of high risk? A comparison of outcomes with adjudicated type 1 myocardial infarction. Int J Cardiol 2023; 391:131226. [PMID: 37524123 DOI: 10.1016/j.ijcard.2023.131226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Unstable angina (UA), considered historically a marker of high risk, has rarely been studied in the high sensitive troponin era. We sought to characterise this population and determine short- and medium-term outcomes for UA and compared this to both patients with musculoskeletal chest pain and adjudicated type 1 MI (NSTEMI). METHOD We conducted a post-hoc analysis of 2 prospective cohort studies of suspected acute coronary syndrome in 2 hospitals in the northwest of England. (n = 3018) We used a dedicated symptom score to diagnose unstable angina. Type 1 MI (NSTEMI) was diagnosed by independent physician adjudication according to 3rd universal definition of MI. Follow-up was 100% complete for all patients to 1 year. RESULTS 185 (6.1%) and 249 (8.3%) were adjudicated as suffering from UA and NSTEMI respectively. We restricted our analysis of UA to 158 (5.2%) patients with UA with high sensitive troponin T (Roche Elecsys) ≤14 ng/L (≤99th percentile). Compared to the NSTEMI population, the UA cohort were younger (59 vs 74, p < 0.002), had a lower incidence of hypertension (56.3% vs 69.1%, p = 0.009), had significantly lower composite risk scores and had fewer ECG abnormalities (ST depression >1 mm, 5.1% vs 15.6%, p = 0.001, T wave flattened, biphasic or inverted 24.1% vs 47.8%, p < 0.0001). Subsequent Type 1 MI to 30 days and 1 year in the UA cohort was 1.9% and 1.9% respectively compared to 0.8% and 2.4% in the index type 1 MI (NSTEMI cohort) respectively. However, compared to patients presenting with musculoskeletal chest pain (n = 468) there was a significantly greater incidence of subsequent MI and coronary revascularisation in patients with unstable angina. All cause death at 30 days and 1 year was 0.0% and 0.6% (n = 1) for UA patients and 2.8% (n = 7) and 16.1% (n = 40) for the NSTEMI cohort respectively. CONCLUSION UA, defined objectively by a symptom score and absence of myocyte necrosis, is still prevalent as an entity, with a risk of subsequent MI and urgent or emergency coronary revascularisation. However, mortality is >10-fold lower when compared to NSTEMI, indicating a less severe pathology in terms of atherosclerosis or plaque burden, and implying the need for a different management strategy to that of NSTEMI.
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Affiliation(s)
- Ahmed Dakshi
- Liverpool University Hospital NHS Foundation Trust, UK
| | - Thomas Salmon
- Liverpool University Hospital NHS Foundation Trust, UK
| | | | - Jhanzeb Ihsan
- Liverpool University Hospital NHS Foundation Trust, UK
| | | | - Aleem Khand
- Liverpool University Hospital NHS Foundation Trust, UK; Liverpool Heart and Chest Hospital, Liverpool, UK; University of Liverpool, UK.
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Ndrepepa G, Cassese S, Xhepa E, Joner M, Sager HB, Kufner S, Laugwitz KL, Schunkert H, Kastrati A. Coronary no-reflow and adverse events in patients with acute myocardial infarction after percutaneous coronary intervention with current drug-eluting stents and third-generation P2Y 12 inhibitors. Clin Res Cardiol 2023:10.1007/s00392-023-02340-y. [PMID: 37962571 DOI: 10.1007/s00392-023-02340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The frequency and prognostic value of coronary no-reflow (CNR) was investigated in studies that have used an outdated reperfusion therapy in terms of stent technology and antithrombotic drugs. We assessed the association of CNR with adverse outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and newer antithrombotic drugs, ticagrelor or prasugrel. METHODS This study included 3100 patients with AMI who underwent PCI with current DES and third-generation P2Y12 inhibitors. CNR was defined as Thrombolysis in Myocardial Infarction (TIMI) blood flow grade ≤ 2 at the end of PCI. The primary end point was 1-year incidence of net adverse clinical and cerebral events-a composite end point of death of any cause, myocardial infarction, stroke or major bleeding. RESULTS CNR was diagnosed in 130 patients (4.2%). The primary end point occurred in 28 patients in the CNR group and 354 patients in the reflow group (cumulative incidence 23.2% and 12.8%; adjusted hazard ratio = 1.53, 95% confidence interval 1.01-2.33; P = 0.049). The 1-year incidences of death or myocardial infarction (14.6% vs. 7.6%; P = 0.003), myocardial infarction (8.8% vs. 3.9%; P = 0.007) and major bleeding (10.9% vs. 5.6%; P = 0.008) were significantly higher in patients with CNR than patients with reflow. The risk of adverse events in patients with CNR was highest within the first 30 days after PCI. CONCLUSION In patients with AMI undergoing PCI with current DES and third generation P2Y12 receptor inhibitors, CNR was associated with a higher risk of adverse outcomes at 1 year.
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Affiliation(s)
- Gjin Ndrepepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Hendrik B Sager
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Karl-Ludwig Laugwitz
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Piccolo R, Leone A, Avvedimento M, Simonetti F, Ippolito D, Angellotti D, Verde N, Manzi L, Cirillo P, Serafino LD, Fortunato G, Franzone A, Esposito G. Impact of biomarker type on periprocedural myocardial infarction in patients undergoing elective PCI. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:680-690. [PMID: 36385164 DOI: 10.1093/ehjqcco/qcac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Periprocedural myocardial infarction (MI) according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria has prognostic relevance among patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether the type of cardiac biomarker used for the diagnosis of periprocedural MI plays a role in terms of event frequency and outcomes. OBJECTIVES To compare the characteristics of SCAI periprocedural MI based on creatine kinase-myocardial band fraction (CK-MB) vs. high-sensitivity cardiac troponin (hs-cTn) in patients undergoing elective PCI. METHODS AND RESULTS Between 2017 and 2021, periprocedural MI was assessed in a prospective study. The primary clinical outcome of interest was all-cause death at 1-year follow-up. A total of 1010 patients undergoing elective PCI were included. SCAI periprocedural MI based on CK-MB vs. hs-cTnI occurred in 1.8 and 13.5% of patients, respectively. hs-cTnI periprocedural MI in the absence of concomitant CK-MB criteria was associated with lower rates of ancillary criteria, including angiographic, ECG, and cardiac imaging criteria. At 1-year follow-up, periprocedural MI defined by CK-MB (adjusted hazard ratio, HR, 4.27, 95% confidence intervals, CI, 1.23-14.8; P = 0.022) but not hs-cTnI (adjusted HR 2.04, 95% CI 0.94-4.45; P = 0.072) was associated with a higher risk of all-cause death. Hs-cTnI periprocedural MI was not predictive of death unless accompanied by CK-MB criteria (adjusted HR 4.64, 95% CI 1.32-16.31; P = 0.017). CONCLUSION In the setting of elective PCI, using hs-cTn instead of CK-MB resulted in a substantial increase in SCAI periprocedural MI events, which were not prognostically relevant in the absence of concurrent CK-MB elevations.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Ippolito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, 80131 Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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47
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Hsieh YK, Wang MT, Wang CY, Chen CF, Ko YL, Huang WC. Recent advances in the diagnosis and management of acute myocardial infarction. J Chin Med Assoc 2023; 86:950-959. [PMID: 37801590 DOI: 10.1097/jcma.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
With the discovery of new biomarkers for the early detection of acute myocardial infarction (AMI), advancements in valid medication, and percutaneous coronary intervention (PCI), the overall prognosis of AMI has improved remarkably. Nevertheless, challenges remain which require more difficult work to overcome. Novel diagnostic and therapeutic techniques include new AMI biomarkers, hypothermia therapy, supersaturated oxygen (SSO 2 ) therapy, targeted anti-inflammatory therapy, targeted angiogenesis therapy, and stem cell therapy. With these novel methods, we believe that the infarction size after AMI will decrease, and myocardial injury-associated ventricular remodeling may be avoided. This review focuses on novel advances in the diagnosis and management of AMI.
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Affiliation(s)
- Yi-Keng Hsieh
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
| | - Mei-Tzu Wang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
| | - Chien-Ying Wang
- School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Trauma, Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan, ROC
| | - Yu-Ling Ko
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
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48
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Ferrer-Curriu G, Rueda F, Revuelta-López E, García-García C, Codina P, Gálvez-Montón C, Roura S, Aimo A, Emdin M, Planavila A, Bayés-Genís A. Meteorin-like protein is associated with a higher risk profile and predicts a worse outcome in patients with STEMI. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:891-900. [PMID: 37105412 DOI: 10.1016/j.rec.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Meteorin-like protein (Metrnl) is a cytokine involved in the attenuation of inflammation. In patients with heart failure, high levels of this biomarker are associated with a worse outcome. In this study, we evaluated the circulating levels and prognostic value of Metrnl in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We enrolled STEMI patients undergoing primary percutaneous coronary intervention. Circulating Metrnl levels were measured in peripheral blood 12hours after symptom onset. The primary endpoint was a composite of all-cause mortality or nonfatal myocardial infarction (MI) at 3 years. RESULTS We studied 381 patients (mean age 61 years, 21% female, 8% Killip class III/IV). Metrnl levels were associated with age, cardiovascular risk factors and the extent of coronary artery disease, as well as with STEMI complications, particularly heart failure and cardiogenic shock. Multivariable Cox regression analysis revealed that Metrnl independently predicted all-cause death or nonfatal MI at 3 years (HR, 1.86; 95%CI, 1.23-2.81; P=.003). Moreover, patients in the highest tertile (> 491.6 pg/mL) were at higher risk for the composite endpoint than those in the lowest tertiles (HR, 3.24; 95%CI, 1.92-5.44; P <.001), even after adjustment by age, diabetes mellitus, cardiac arrest, Killip-Kimball III/IV class, left ventricular ejection fraction, and creatinine clearance (HR, 1.90; 95%CI, 1.10-3.29; P=.021). CONCLUSIONS Circulating Metrnl levels are associated with complications during the acute phase of STEMI and independently predict a worse outcome in these patients.
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Affiliation(s)
- Gemma Ferrer-Curriu
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena Revuelta-López
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Cosme García-García
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Codina
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carolina Gálvez-Montón
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Santiago Roura
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, Spain
| | - Alberto Aimo
- Interdisciplinary Center of Health Science, Scuola Superiore Sant'Anna, Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Interdisciplinary Center of Health Science, Scuola Superiore Sant'Anna, Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Planavila
- Departament de Bioquímica i Biologia Molecular; Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red de Fisiopatología de la Obesidad y Nutrición (CIBERON), Spain
| | - Antoni Bayés-Genís
- ICREC Research Program, Institut de Recerca Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Barcelona, Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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49
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Nagy FT, Olajos D, Vattay B, Borzsák S, Boussoussou M, Deák M, Vecsey-Nagy M, Sipos B, Jermendy ÁL, Tóth GG, Nemes B, Merkely B, Szili-Török T, Ruzsa Z, Szilveszter B. Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia-A Pilot Study. J Cardiovasc Dev Dis 2023; 10:443. [PMID: 37998501 PMCID: PMC10671941 DOI: 10.3390/jcdd10110443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC). AIM To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients. METHODS Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization. RESULTS Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+ patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCT as compared to invasive evaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and -negative patients (p = 0.065). CONCLUSIONS Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.
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Affiliation(s)
- Ferenc T. Nagy
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Dorottya Olajos
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Sarolta Borzsák
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Melinda Boussoussou
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Mónika Deák
- Bács-Kiskun County Hospital, 6725 Kecskemét, Hungary
| | - Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Barbara Sipos
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Ádám L. Jermendy
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Gábor G. Tóth
- Graz University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
| | - Tamás Szili-Török
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary; (F.T.N.); (D.O.)
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, Határőr Str. 18, 1122 Budapest, Hungary
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50
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Angiolillo DJ, Cao D, Sartori S, Baber U, Dangas G, Zhang Z, Vogel B, Kunadian V, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Ielasi A, Stefanini GG, Pivato CA, Mehta S, Moliterno DJ, Ohman EM, Escaned J, Sardella G, Sharma SK, Shlofmitz R, Weisz G, Witzenbichler B, Steg PG, Pocock S, Mehran R. Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2514-2524. [PMID: 37879803 DOI: 10.1016/j.jcin.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Nearly 20% of patients on ticagrelor experience dyspnea, which may lead to treatment discontinuation in up to one-third of cases. OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of dyspnea-related ticagrelor discontinuation after percutaneous coronary intervention (PCI). METHODS In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The occurrence of dyspnea associated with ticagrelor discontinuation was evaluated among all patients enrolled in the trial. A landmark analysis was performed at 3 months after PCI, that is, the time of randomization. Predictors of dyspnea-related ticagrelor discontinuation were obtained from multivariable Cox regression with stepwise selection of candidate variables. RESULTS The incidence of dyspnea-related ticagrelor discontinuation was 6.4% and 9.1% at 3 and 15 months after PCI, respectively. Independent predictors included Asian race (lower risk), smoking, prior PCI, hypercholesterolemia, prior coronary artery bypass, peripheral artery disease, obesity, and older age. Among 179 patients who discontinued ticagrelor because of dyspnea after randomization, ticagrelor monotherapy was not associated with a higher risk of subsequent ischemic events (composite of all-cause death, myocardial infarction, or stroke) compared with ticagrelor plus aspirin (5.0% vs 7.1%; P = 0.566). CONCLUSIONS In the TWILIGHT trial, dyspnea-related ticagrelor discontinuation occurred in almost 1 in 10 patients and tended to occur earlier rather than late after PCI. Several demographic and clinical conditions predicted its occurrence, and their assessment may help identify subjects at risk for therapy nonadherence.
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Affiliation(s)
- Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, Roslyn, New York, USA
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Gil
- Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kurt Huber
- 3rd Dept Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo A Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Shamir Mehta
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - E Magnus Ohman
- Duke University Medical Center-Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | | | - P Gabriel Steg
- Université de Paris and Assistance Paris-Hôpitaux de Paris, Paris, France
| | - Stuart Pocock
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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