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Siracuse JJ, Menard MT, Rosenfield K, Conte MS, Powell R, Hamburg N, Doros G, Strong MB, Farber A. Characterization of cardiovascular serious adverse events after bypass or endovascular revascularization for limb-threatening ischemia in the BEST-CLI trial. J Vasc Surg 2024:S0741-5214(24)00987-X. [PMID: 38626847 DOI: 10.1016/j.jvs.2024.04.025] [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: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Cardiovascular complications after revascularization to treat chronic limb-threatening ischemia (CLTI) are a major concern that guides treatment. Our goal was to assess periprocedural cardiac and vascular serious adverse events (SAEs) in the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. METHODS BEST-CLI was a prospective randomized trial comparing surgical (OPEN) and endovascular (ENDO) revascularization for patients with CLTI. Thirty-day SAEs, classified as cardiac or vascular, were analyzed. Adverse events are defined as serious when they affect safety in the trial, require prolonged hospitalization, result in significant disability or incapacitation, are life-threatening, or result in death. Interventions were analyzed in a per protocol fashion. RESULTS In the BEST-CLI trial, 850 OPEN and 896 ENDO interventions were evaluated. Forty (4.7%) and 34 (3.8%) patients experienced at least one cardiac SAE after OPEN and ENDO intervention, respectively (P = .35). Overall, there were 53 cardiac SAEs (0.06 per patient) after OPEN and 40 (0.045 per patient) after ENDO interventions. Cardiac SAEs in the OPEN arm were classified as related to ischemia (50.9%), arrhythmias (17%), heart failure (15.1%), arrest (13.2%), and heart block (3.8%); in the ENDO arm, they were classified as ischemia (47.5%), heart failure (17.5%), arrhythmias (15%), arrest (15%), and heart block (5%). Approximately half of SAEs were classified as severe for both OPEN and ENDO. SAEs were definitely or probably related to the procedure in 30.2% and 25% in the OPEN and ENDO arms, respectively (P = .2). Vascular SAEs occurred in 58 (6.8%) and 86 (9.6%) of patients after OPEN and ENDO revascularization, respectively (P = .19). In total, there were 59 (0.07 per patient) and 87 (0.097 per patient) vascular SAEs after OPEN and ENDO procedures. Vascular SAEs in the OPEN arm were classified as distal ischemia/infection (44.1%), bleeding (16.9%), occlusive (15.3%), thromboembolic (15.3%), cerebrovascular (5.1%), and other (3.4%); in the ENDO arm, they were distal ischemia/infection (40.2%), occlusive (31%), bleeding (12.6%), thromboembolic (8%), cerebrovascular (1.1%), and other (4.6%). SAEs were classified as severe for OPEN in 45.8% and ENDO in 46%. SAEs were definitely or probably related to the procedure in 23.7% and 35.6% in the OPEN and ENDO arms (P = .35), respectively. CONCLUSIONS Patients undergoing OPEN and ENDO revascularization experienced similar degrees of cardiac and vascular SAEs. The majority were not related to the index intervention, but approximately half were severe.
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Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | - Richard Powell
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Naomi Hamburg
- Division of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | | | - Michael B Strong
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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Siracuse JJ, Farber A, Menard MT, Conte MS, Kaufman JA, Jaff M, Kiang SC, Ochoa Chaar CI, Osborne N, Singh N, Tan TW, Guzman RJ, Strong MB, Hamza TH, Doros G, Rosenfield K. Perioperative complications following open or endovascular revascularization for chronic limb-threatening ischemia in the BEST-CLI Trial. J Vasc Surg 2023; 78:1012-1020.e2. [PMID: 37318428 DOI: 10.1016/j.jvs.2023.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Anticipated perioperative morbidity is an important factor for choosing a revascularization method for chronic limb-threatening ischemia (CLTI). Our goal was to assess systemic perioperative complications of patients treated with surgical and endovascular revascularization in the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial. METHODS BEST-CLI was a prospective randomized trial comparing open (OPEN) and endovascular (ENDO) revascularization strategies for patients with CLTI. Two parallel cohorts were studied: Cohort 1 included patients with adequate single-segment great saphenous vein (SSGSV), whereas Cohort 2 included those without SSGSV. Data were queried for major adverse cardiovascular events (MACE-composite myocardial infarction, stroke, death), non-serious (non-SAEs) and serious adverse events (SAEs) (criteria-death/life-threatening/requiring hospitalization or prolongation of hospitalization/significant disability/incapacitation/affecting subject safety in trial) 30 days after the procedure. Per protocol analysis was used (intervention received without crossover), and risk-adjusted analysis was performed. RESULTS There were 1367 patients (662 OPEN, 705 ENDO) in Cohort 1 and 379 patients (188 OPEN, 191 ENDO) in Cohort 2. Thirty-day mortality in Cohort 1 was 1.5% (OPEN 1.8%; ENDO 1.3%) and in Cohort 2 was 1.3% (2.7% OPEN; 0% ENDO). MACE in Cohort 1 was 4.7% for OPEN vs 3.13% for ENDO (P = .14), and in Cohort 2, was 4.28% for OPEN and 1.05% for ENDO (P = .15). On risk-adjusted analysis, there was no difference in 30-day MACE for OPEN vs ENDO for Cohort 1 (hazard ratio [HR] 1.5; 95% confidence interval [CI], 0.85-2.64; P = .16) or Cohort 2 (HR, 2.17; 95% CI, 0.48-9.88; P = .31). The incidence of acute renal failure was similar across interventions; in Cohort 1 it was 3.6% for OPEN vs 2.1% for ENDO (HR, 1.6; 95% CI, 0.85-3.12; P = .14), and in Cohort 2, it was 4.2% OPEN vs 1.6% ENDO (HR, 2.86; 95% CI, 0.75-10.8; P = .12). The occurrence of venous thromboembolism was low overall and was similar between groups in Cohort 1 (OPEN 0.9%; ENDO 0.4%) and Cohort 2 (OPEN 0.5%; ENDO 0%). Rates of any non-SAEs in Cohort 1 were 23.4% in OPEN and 17.9% in ENDO (P = .013); in Cohort 2, they were 21.8% for OPEN and 19.9% for ENDO (P = .7). Rates for any SAEs in Cohort 1 were 35.3% for OPEN and 31.6% for ENDO (P = .15); in Cohort 2, they were 25.5% for OPEN and 23.6% for ENDO (P = .72). The most common types of non-SAEs and SAEs were infection, procedural complications, and cardiovascular events. CONCLUSIONS In BEST-CLI, patients with CLTI who were deemed suitable candidates for open lower extremity bypass surgery had similar peri-procedural complications following either OPEN or ENDO revascularization: In such patients, concern about risk of peri-procedure complications should not be a deterrent in deciding revascularization strategy. Rather, other factors, including effectiveness in restoring perfusion and patient preference, are more relevant.
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Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA.
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | - John A Kaufman
- Department of Interventional Radiology, Oregon Health & Science University, Portland, OR
| | | | - Sharon C Kiang
- Division of Vascular Surgery, Loma Linda University Medical Center and Veterans Affairs, Loma Linda, CA
| | - Cassius I Ochoa Chaar
- Division of Vascular and Endovascular Surgery, Yale University, School of Medicine, New Haven, CT
| | - Nicholas Osborne
- Division of Vascular and Endovascular Surgery, University of Michigan, Ann Arbor, MI
| | - Niten Singh
- Division of Vascular and Endovascular Surgery, University of Washington, Seattle, WA
| | - Tze-Woei Tan
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA
| | - Raul J Guzman
- Division of Vascular and Endovascular Surgery, Yale University, School of Medicine, New Haven, CT
| | - Michael B Strong
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Gheorghe Doros
- Department of Biostatics, Boston University, School of Public Health, Boston, MA
| | - Kenneth Rosenfield
- Section of Vascular Medicine and Intervention Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Ferreira da Silva R, Silva AM, Morato M, Ribeiro‐Vaz I, Polónia JJ. Embracing Uncertainties Over the Evidence of New Oral Antivirals for COVID-19: Challenges in Pharmacoepidemiologic Research. J Clin Pharmacol 2023; 63:521-525. [PMID: 36519976 PMCID: PMC9878095 DOI: 10.1002/jcph.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Renato Ferreira da Silva
- Porto Pharmacovigilance CentreFaculty of Medicine of the University of PortoPortoPortugal
- Department of Community MedicineHealth Information and DecisionFaculty of Medicine of the University of PortoPortugal
- CINTESIS – Center for Health Technology and Services ResearchPortoPortugal
| | - Ana Marta Silva
- Porto Pharmacovigilance CentreFaculty of Medicine of the University of PortoPortoPortugal
- Department of Community MedicineHealth Information and DecisionFaculty of Medicine of the University of PortoPortugal
- CINTESIS – Center for Health Technology and Services ResearchPortoPortugal
| | - Manuela Morato
- LAQV/REQUIMTELaboratory of PharmacologyDepartment of Drug SciencesFaculty of Pharmacy of the University of PortoPortoPortugal
| | - Inês Ribeiro‐Vaz
- Porto Pharmacovigilance CentreFaculty of Medicine of the University of PortoPortoPortugal
- Department of Community MedicineHealth Information and DecisionFaculty of Medicine of the University of PortoPortugal
- CINTESIS – Center for Health Technology and Services ResearchPortoPortugal
| | - Jorge Junqueira Polónia
- Porto Pharmacovigilance CentreFaculty of Medicine of the University of PortoPortoPortugal
- CINTESIS – Center for Health Technology and Services ResearchPortoPortugal
- Department of MedicineFaculty of Medicine of the University of PortoPortoPortugal
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Cañari B, Moya-Salazar J, Bussalleu D, Contreras-Pulache H. Does the use of cysteine-rich whey protein supplements (Inmunocal®) improve the health well-being of COVID-19 patients? A qualitative study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
<b>Introduction:</b> In the context of SARS-CoV-2 infection, it has been proposed that oxidative stress may contribute to the management of COVID-19 severity. The impact on the well-being of patients with COVID-19 using cysteine-providing supplements has not yet been evaluated and there is a need to understand the benefits and limitations they may offer.<br />
<b>Aim:</b> The aim of this study is to understand the experiences of improved well-being with cysteine-rich whey protein supplementation (Immunocal®) in patients with COVID-19.<br />
<b>Methods:</b> A qualitative study was conducted by conducting semi-structured interviews with four participants taking Immunocal® while they had COVID-19. Participants were randomly recruited through internet networking. Ethical approval was obtained from the University ethics committee. Participants were informed of the study objectives two days in advance and consent was obtained before interviews began. We used the 16-item “Use of Immunocal supplement for COVID-19” (USIC-19) questionnaire to inquire about COVID-19 behavior (time of illness, symptoms, and severity of illness) and the experience of using the supplement during illness. Confidentiality was maintained throughout this study.<br />
<b>Results:</b> All participants presented mild discomfort such as headache, weakness, and tiredness when they had COVID-19 impacting most of them emotionally. The use of Immunocal® produced a partial improvement in all patients as only two continued to experience fatigue. Immunocal® improved the mood (50%) and physical health of the participants. In addition, participants reported that the supplement was recommended and dosed primarily by a consultant and that they did not feel hesitant to use it because of previous experiences of friends and family. The daily dosage of half of the participants was two sachets and all felt the need to consume the supplement which resulted in daily use.<br />
<b>Conclusion:</b> Following the daily dosage indications of the consultants, the participants who have consumed Inmunocal® have presented a partial improvement of the symptoms related to COVID-19, however, they feel the need to consume the supplement daily to improve their quality of life.
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Affiliation(s)
- Betsy Cañari
- South American Center for Research in Education and Public Health, Universidad Norbert Wiener, Lima, PERU
| | - Jeel Moya-Salazar
- South American Center for Research in Education and Public Health, Universidad Norbert Wiener, Lima, PERU
- Hospital Nacional Docente Madre Niño San Bartolomé, Lima, PERU
| | | | - Hans Contreras-Pulache
- South American Center for Research in Education and Public Health, Universidad Norbert Wiener, Lima, PERU
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Falcinelli E, Petito E, Gresele P. The role of platelets, neutrophils and endothelium in COVID-19 infection. Expert Rev Hematol 2022; 15:727-745. [PMID: 35930267 DOI: 10.1080/17474086.2022.2110061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 is associated to an increased risk of thrombosis, as a result of a complex process that involves the activation of vascular and circulating cells, the release of soluble inflammatory and thrombotic mediators and blood clotting activation. AREAS COVERED This article reviews the pathophysiological role of platelets, neutrophils and the endothelium, and of their interactions, in the thrombotic complications of COVID-19 patients, and the current and future therapeutic approaches targeting these cell types. EXPERT OPINION Virus-induced platelet, neutrophil and endothelial cell changes are crucial triggers of the thrombotic complications and of the adverse evolution of COVID-19. Both the direct interaction with the virus and the associated cytokine storm concur to trigger cell activation in a classical thromboinflammatory vicious circle. Although heparin has proven to be an effective prophylactic and therapeutic weapon for the prevention and treatment of COVID-19-associated thrombosis, it acts downstream of the cascade of events triggered by SARS-CoV-2. The identification of specific molecular targets interrupting the thromboinflammatory cascade upstream, and more specifically acting either on the interaction of SARS-CoV-2 with blood and vascular cells or on the specific signalling mechanisms associated with their COVID-19-associated activation, might theoretically offer greater protection with potentially lesser side effects.
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Affiliation(s)
- E Falcinelli
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - E Petito
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - P Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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