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Illum E, Kofod DH, Ballegaard EF, Nelveg-Kristensen KE, Hornum M, Schou M, Torp-Pedersen C, Gislason G, Lassen JF, Carlson N. Coronary angiography in patients with kidney dysfunction and myocardial injury: A retrospective cohort study on management of myocardial injury in hospitalized patients with kidney disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:59-65. [PMID: 38212237 DOI: 10.1016/j.carrev.2024.01.001] [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: 10/18/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Although kidney insufficiency has been shown to be associated with increased risk of myocardial injury, benefit of coronary angiography (CAG) and revascularization remains uncertain, with implications on management strategies and outcomes. We aimed to compare rates of CAG and revascularization and subsequent risk of cardiovascular and kidney outcomes in hospitalized patients with myocardial injury and kidney dysfunction. METHODS Retrospective cohort study encompassing hospitalized patients with myocardial injury i.e. elevated troponin I or T and an eGFR ≤60 ml/min/1.73 m2 identified between 2011 and 2021 in Danish national registers. 30-day odds for CAG were computed across granular eGFR-categories based on multiple logistic regression. Standardized one-year risks of cardiovascular and kidney outcomes including mortality were determined based on hazards obtained in multiple Cox regression. RESULTS A total of 52,798 patients with myocardial injury were identified. CAG was performed in 14.3 % (n = 7549). 30-day odds ratios for CAG were 0.64 [0.60-0.68], 0.38 [0.34-0.42], 0.18 [0.14-0.22], and 0.35 [0.30-0.40] in patients with eGFR 31-45 ml/min/1.73 m2, eGFR 15-30 ml/min/1.73 m2 for eGFR<15 ml/min/1.73 m2 and chronic dialysis, respectively (eGFR 46-60 ml/min/1.73 m2 as reference). Median follow-up was 4.1 years. One-year mortality risk differences associated with CAG and revascularization (no CAG as reference) were -7.8 [-7.0; -8.7] and -9.1 [-8.4; -9.9] for eGFR 46-60 ml/min/1.73 m2; -7.0 [-5.7;-8-3] and -8.0 [-6.6; -9.5] for eGFR 31-45 ml/min/1.73 m2; -5.4 [-3.0; -7.2] and -5.2 [-2.2; -8.3] for eGFR 15-30 ml/min/1.73 m2; -8.8 [-3.1; -13.7] and -5.4 [3.1; -13.4] for eGFR<15 ml/min/1.73 m2; and -4.9 [-0.1; -9.7] and -4.2 [1.5; -9.2] for chronic dialysis, respectively. CONCLUSION Probability of CAG following myocardial injury declined with progressive kidney dysfunction. Overall, CAG was associated with lower mortality irrespective of kidney function and subsequent revascularization.
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Affiliation(s)
- Emilie Illum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Dea Haagensen Kofod
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | | | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital North Zealand, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark; Department of Research, The Danish Heart Foundation, Denmark
| | | | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Research, The Danish Heart Foundation, Denmark.
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Gorog DA, Ferreiro JL, Ahrens I, Ako J, Geisler T, Halvorsen S, Huber K, Jeong YH, Navarese EP, Rubboli A, Sibbing D, Siller-Matula JM, Storey RF, Tan JWC, Ten Berg JM, Valgimigli M, Vandenbriele C, Lip GYH. De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis. Nat Rev Cardiol 2023; 20:830-844. [PMID: 37474795 DOI: 10.1038/s41569-023-00901-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
Conventional dual antiplatelet therapy (DAPT) for patients with acute coronary syndromes undergoing percutaneous coronary intervention comprises aspirin with a potent P2Y purinoceptor 12 (P2Y12) inhibitor (prasugrel or ticagrelor) for 12 months. Although this approach reduces ischaemic risk, patients are exposed to a substantial risk of bleeding. Strategies to reduce bleeding include de-escalation of DAPT intensity (downgrading from potent P2Y12 inhibitor at conventional doses to either clopidogrel or reduced-dose prasugrel) or abbreviation of DAPT duration. Either strategy requires assessment of the ischaemic and bleeding risks of each individual. De-escalation of DAPT intensity can reduce bleeding without increasing ischaemic events and can be guided by platelet function testing or genotyping. Abbreviation of DAPT duration after 1-6 months, followed by monotherapy with aspirin or a P2Y12 inhibitor, reduces bleeding without an increase in ischaemic events in patients at high bleeding risk, particularly those without high ischaemic risk. However, these two strategies have not yet been compared in a head-to-head clinical trial. In this Consensus Statement, we summarize the evidence base for these treatment approaches, provide guidance on the assessment of ischaemic and bleeding risks, and provide consensus statements from an international panel of experts to help clinicians to optimize these DAPT approaches for individual patients to improve outcomes.
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Affiliation(s)
- Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.
- Centre for Health Services Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Jose Luis Ferreiro
- Department of Cardiology, Hospital Universitario de Bellvitge, CIBERCV, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, Cologne, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Dirk Sibbing
- Ludwig-Maximilians University München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Privatklinik Lauterbacher Mühle am Ostsee, Seeshaupt, Germany
| | | | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jack W C Tan
- National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Jurrien M Ten Berg
- St Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), Lugano, Switzerland
- University of Bern, Bern, Switzerland
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool, UK
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kuno T, Yamaji K, Aikawa T, Sawano M, Ando T, Numasawa Y, Wada H, Amano T, Kozuma K, Kohsaka S. Transradial intervention in dialysis patients undergoing percutaneous coronary intervention: a Japanese nationwide registry study. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead116. [PMID: 38105921 PMCID: PMC10721448 DOI: 10.1093/ehjopen/oead116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023]
Abstract
Aims Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is used to reduce periprocedural complications. However, its effectiveness and safety for patients on dialysis are not well established. We aimed to investigate the association of TRI with in-hospital complications in dialysis patients undergoing PCI. Methods and results We included 44 462 patients on dialysis who underwent PCI using Japanese nationwide PCI registry data (2019-21) regardless of acute or chronic coronary syndrome. Patients were categorized based on access site: TRI, transfemoral intervention (TFI). Periprocedural access site bleeding complication requiring transfusion was the primary outcome and in-hospital death, and other periprocedural complications were the secondary outcomes. Matched weighted analysis was performed for TRI and TFI. Here, 8267 (18.6%) underwent TRI, and 36 195 (81.4%) underwent TFI. Patients who received TRI were older and had lower rates of comorbidities than those who received TFI. Access site bleeding rate and in-hospital death were significantly lower in the TRI group (0.1% vs. 0.7%, P < 0.001; 1.8% vs. 3.2%, P < 0.001, respectively). After adjustment, TRI was associated with a lower risk of access site bleeding (odds ratio [OR] [95% confidence interval (CI)]: 0.19 [0.099-0.38]; P < 0.001) and in-hospital death (OR [95% CI]: 0.79 [0.65-0.96]; P = 0.02). Other periprocedural complications between TRI and TFI were not significantly different. Conclusion In patients undergoing dialysis and PCI, TRI had a lower risk of access site bleeding and in-hospital death than TFI. This suggests that TRI may be safer for this patient population.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467-2401, USA
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Aikawa
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Tomo Ando
- Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Abdullahi AH, Ismail Z, Obeidat O, Alzghoul H, Hurlock NP, Tarawneh M, Elsadek R, Ismail MF, Smock AL. In-hospital outcomes of PCI in patients who have ESRD vs non-ESRD patients, a retrospective study involving a National Inpatient Sample (NIS) database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:43-49. [PMID: 37331888 DOI: 10.1016/j.carrev.2023.05.016] [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: 01/24/2023] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death for patients with end-stage renal disease (ESRD). ESRD is known to affect a large portion of the American population. Previous data for patients undergoing percutaneous coronary intervention (PCI) in the setting of ESRD for Acute Coronary Syndrome (ACS) and non-ACS etiologies have shown to have an increase in in-hospital mortality, and prolonged hospitalization among other complications. METHODS The national inpatient sample (NIS) was used to identify patients who underwent PCI between the years 2016-2019. Patients were then grouped into those with ESRD on renal replacement therapy (RRT). Logistic regression models were employed to assess the primary outcome of in-hospital mortality, while linear regression models were utilized to evaluate secondary outcomes, including hospitalization cost and length of stay. RESULTS A total of 21,366 unweighted observations were initially included, consisting of 50 % ESRD patients and 50 % randomly selected patients without ESRD who underwent PCI. These observations were weighted to represent a national estimate of 106,830 patients. The mean age of the study population was 65 years, and 63 % of the patients were male. The ESRD group had a greater representation of minority groups compared to the control group. The in-hospital mortality rate was significantly higher in the ESRD group compared to the control group, with an odds ratio of 1.803 (95 % CI: 1.502 to 2.164; p-value of 0.0002). Additionally, the ESRD group had significantly higher healthcare costs and longer length of stay, with a mean difference of $47,618 (95 % CI: $42,701 to $52,534, p-value <0.0001) and 2.933 days (95 % CI, 2.729 to 3.138 days, p-value <0.0001), respectively. CONCLUSION In-hospital mortality, cost, and length of stay for patients undergoing PCI were found to be significantly greater in the ESRD group.
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Affiliation(s)
- Abdullah H Abdullahi
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
| | - Zeeshan Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
| | - Omar Obeidat
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America.
| | - Hamza Alzghoul
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America.
| | - Natalie P Hurlock
- Graduate Medical Education, Physician Services Group, HCA Research, United States of America
| | - Mohammad Tarawneh
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
| | - Rabab Elsadek
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
| | - Mohamed F Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
| | - Andrew L Smock
- University of Central Florida College of Medicine, Graduate Medical Education, United States of America; HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, United States of America
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Chenna VSH, Anam H, Hassan M, Moeez A, Reddy R, Chaudhari SS, Sapkota K, Usama M. Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndrome and on Dialysis: A Meta-Analysis. Cureus 2023; 15:e40211. [PMID: 37435247 PMCID: PMC10332118 DOI: 10.7759/cureus.40211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
This study aims to compare the safety and efficacy of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) and undergoing dialysis. This study was conducted per the guidelines of the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed using electronic databases, including PubMed, EMBASE, and Web of Science, to identify relevant studies comparing clopidogrel and ticagrelor in patients undergoing dialysis. To ensure the inclusion of all relevant articles, a combination of the following keywords, along with medical subject heading (MeSH) terms, was used: "clopidogrel," "ticagrelor," "acute coronary syndrome," and "dialysis." The primary endpoint of this meta-analysis was the incidence of major adverse cardiovascular events (MACE), which consisted of cardiovascular death, myocardial infarction, stroke, and revascularization. The secondary endpoint was all-cause mortality. The occurrence of any bleeding events (including major and nonmajor bleeding events) and major bleeding events was chosen as the safety endpoints. A total of four studies were included in the pooled analysis. The pooled sample size was 5,417 patients, including 892 in the ticagrelor group and 4525 in the clopidogrel group. The findings indicate that ticagrelor, compared to clopidogrel, is associated with a significantly higher risk of MACEs, all-cause death, and major bleeding events. The findings suggest that clopidogrel may be a better choice for individuals with ACS undergoing dialysis due to its lower risk of MACE, all-cause death, and major bleeding events compared to ticagrelor.
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Affiliation(s)
| | - Hemalatha Anam
- Medicine, Apollo institute of Medical Sciences and Research, Hyderabad, IND
| | - Majid Hassan
- Medicine, Universidad Autonoma de Guadalajara, Sacramento, USA
| | - Abdul Moeez
- Medicine, Services Hospital Lahore, Lahore, PAK
| | - Raja Reddy
- Medicine, MNR Medical College and Hospital, Hyderabad, IND
| | - Sandipkumar S Chaudhari
- General Practice, Lions General Hospital, Mehsana, IND
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Vadnagar, IND
| | - Koushik Sapkota
- Medicine, All India Institute of Medical Sciences (AIIMS) Bathinda, Bathinda, IND
| | - Muhammad Usama
- Neurology, Sheikh Zayed Medical College/Hospital Rahim Yar Khan, Rahim Yar Khan, PAK
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He J, Song C, Wang H, Zhang R, Yuan S, Dou K. Diabetes Mellitus with Mild or Moderate Kidney Dysfunction is Associated with Poor Prognosis in Patients with Coronary Artery Disease: A Large-Scale Cohort Study. Diabetes Res Clin Pract 2023; 200:110693. [PMID: 37160234 DOI: 10.1016/j.diabres.2023.110693] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Abstract
AIM Both kidney dysfunction and diabetes mellitus (DM) predict long-term poor prognosis in patients with coronary artery disease (CAD). We aimed to evaluate the clinical outcomes according to the combined status of DM and different stages of kidney dysfunction in CAD patients. METHODS From January 2013 to December 2013, 9293 eligible patients hospitalized for percutaneous coronary intervention (PCI) at Fuwai hospital were followed up for major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction and stroke. Baseline kidney function was considered as stage I: normal or high kidney function; stage II: mild dysfunction and stage III: moderate dysfunction according to estimated glomerular filtration rate (eGFR). Upon baseline kidney function, diabetic and non-diabetic patients were divided into six groups. RESULTS During a median follow-up of 2.4 years, 326 (3.5%) MACCEs occurred. Compared to patients in the stage I/non-DM group, patients in the stage II/DM and stage III/DM groups had significantly increased MACCE risk [adjusted hazard ratio (aHR), 1.53; 95% confidence interval (CI), 1.09-2.15; P = 0.014; aHR, 3.00; 95%CI, 1.74-5.18; P<0.002, respectively]. Additionally, there were J-shaped associations of eGFR with MACCE risk regardless of glycemic metabolism status after adjusted for confounders. Furthermore, moderate kidney dysfunction conferred an increased MACCE risk in diabetic patients with uncontrolled glycemia (aHR, 2.93; 95%CI, 1.48-5.78; P=0.002). CONCLUSIONS DM with mild or moderate kidney dysfunction is associated with poor prognosis in CAD patients. Categorical classification of patients with DM and kidney dysfunction could provide prognostic information for risk stratification of CAD patients.
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Affiliation(s)
- 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
| | - Haoyu Wang
- 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
| | - 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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Tajti P, Ayoub M, Ahres A, Rahimi F, Behnes M, Buettner HJ, Neumann FJ, Westermann D, Mashayekhi K. Procedural outcomes of chronic total occlusion percutaneous coronary interventions in patients with acute kidney injury. Cardiol J 2023; 31:84-94. [PMID: 36588312 PMCID: PMC10919567 DOI: 10.5603/cj.a2022.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/03/2022] [Accepted: 11/12/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prognostic impact of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains underestimated. METHODS We examined 2707 consecutive procedures performed in a referral CTO center between 2015 and 2019. CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 50% within 48 h post-PCI. Primary endpoints were in-hospital major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, target vessel revascularization, stroke) and at one year of follow-up. RESULTS The overall incidence of CA-AKI was 11.5%. Technical success was comparable (87.2% vs. 90.5%, p = 0.056) whereas procedural success was lower in the CA-AKI group (84.3% vs. 89.7%, p = 0.004). Overall in-hospital MACCE was 1.3%, and it was similar in patients with and without CA-AKI (1.6% vs. 1.3%, p = 0.655); however, the rate of pericardial tamponade requiring pericardiocentesis was significantly higher in patients with CA-AKI (2.2% vs. 0.5%, p = 0.001). In multivariate analysis, CA-AKI was not independently associated with higher risk for in-hospital MACCE (adjusted odds ratio [OR] 1.34, 95% confidence intervals [CI] 0.45-3.19, p = 0.563). At a median follow-up time of 14 months (interquartile range [IQR], 11 to 35 months), one-year MACCE was significantly higher in patients with vs. without CA-AKI (20.8% vs. 12.8%, p < 0.001), and CA-AKI increased the risk for one-year MACCE (adjusted hazard ratio [HR] 1.46, 95% CI 1.07-1.95, p = 0.017) following CTO PCI. CONCLUSIONS CA-AKI in patients undergoing CTO PCI occurs in approximately one out of 10 patients. Our study highlights that patients developing CA-AKI are at increased risk for long-term MACCE.
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Affiliation(s)
- Peter Tajti
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany.
- Division of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany.
| | - Mohamed Ayoub
- University Heart and Diabetes Center North-Rhine and Westphalia, Department of Cardiology and Angiology - Bochum, Germany
| | - Abdelkrim Ahres
- Division of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany
| | - Faridun Rahimi
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim - Mannheim, Germany
| | - Heinz-Joachim Buettner
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
- MediClin Heart Center - Lahr, Germany
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Yager N, Hongalgi K, Torosoff M. Chronic Kidney Disease and Post-Percutaneous Coronary Intervention Mortality in Patients With Left Main and Equivalent Coronary Artery Disease. Tex Heart Inst J 2022; 49:487717. [PMID: 36265481 PMCID: PMC9632372 DOI: 10.14503/thij-21-7670] [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: 01/25/2023]
Abstract
BACKGROUND Patients with chronic kidney disease are underrepresented in registries and in randomized trials of coronary artery disease management. To investigate effects of chronic kidney disease on outcomes of nonemergent percutaneous coronary intervention in patients with left main or left main-equivalent coronary artery disease, we analyzed data from the New York State Percutaneous Coronary Intervention Registry during the calendar year 2015, involving 2,956 elective percutaneous coronary intervention cases. Outcomes of percutaneous coronary intervention in patients with various degrees of chronic kidney disease and stable left main or left main-equivalent coronary artery disease were compared. METHODS Only patients with left main or left main-equivalent coronary artery disease and elective percutaneous coronary intervention were included in the study cohort. Patients with acute coronary syndromes within 24 hours of the index percutaneous coronary intervention, patients reported to be in shock, and patients with prior coronary artery bypass surgery were excluded from the study cohort. RESULTS In this cohort, stage 4 or 5 chronic kidney disease, current congestive heart failure, and left main disease remained statistically significant predictors of post-percutaneous coronary intervention mortality. CONCLUSION Our findings in this large, statewide cohort indicate that advanced kidney disease is associated with markedly increased post-nonemergent percutaneous coronary intervention mortality.
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Affiliation(s)
- Neil Yager
- Division of Cardiology and Nephrology, Albany Medical College, Albany, New York
| | | | - Mikhail Torosoff
- Division of Cardiology and Nephrology, Albany Medical College, Albany, New York
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Bangalore S, Hochman JS, Stevens SR, Jones PG, Spertus JA, O’Brien SM, Reynolds HR, Boden WE, Fleg JL, Williams DO, Stone GW, Sidhu MS, Mathew RO, Chertow GM, Maron DJ. Clinical and Quality-of-Life Outcomes Following Invasive vs Conservative Treatment of Patients With Chronic Coronary Disease Across the Spectrum of Kidney Function. JAMA Cardiol 2022; 7:825-835. [PMID: 35767253 PMCID: PMC9244774 DOI: 10.1001/jamacardio.2022.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/09/2022] [Indexed: 11/14/2022]
Abstract
Importance Prior trials of invasive vs conservative management of chronic coronary disease (CCD) have not enrolled patients with severe chronic kidney disease (CKD). As such, outcomes across kidney function are not well characterized. Objectives To evaluate clinical and quality-of-life (QoL) outcomes across the spectrum of CKD following conservative and invasive treatment strategies. Design, Setting, and Participants Participants from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) and ISCHEMIA-Chronic Kidney Disease (CKD) trials were categorized by CKD stage: stage 1 (estimated glomerular filtration rate [eGFR] 90 mL/min/1.73m2 or greater), stage 2 (eGFR 60-89 mL/min/1.73m2), stage 3 (eGFR 30-59 mL/min/1.73m2), stage 4 (eGFR 15-29 mL/min/1.73m2), or stage 5 (eGFR less than 15 mL/min/1.73m2 or receiving dialysis). Enrollment took place from July 26, 2012, through January 31, 2018, with a median follow-up of 3.1 years. Data were analyzed from January 2020 to May 2021. Interventions Initial invasive management of coronary angiography and revascularization with guideline-directed medical therapy (GDMT) vs initial conservative management of GDMT alone. Main Outcomes and Measures The primary clinical outcome was a composite of death or nonfatal myocardial infarction (MI). The primary QoL outcome was the Seattle Angina Questionnaire (SAQ) summary score. Results Among the 5956 participants included in this analysis (mean [SD] age, 64 [10] years; 1410 [24%] female and 4546 [76%] male), 1889 (32%), 2551 (43%), 738 (12%), 311 (5%), and 467 (8%) were in CKD stages 1, 2, 3, 4, and 5, respectively. By self-report, 18 participants (<1%) were American Indian or Alaska Native; 1676 (29%), Asian; 267 (5%), Black; 861 (16%), Hispanic or Latino; 18 (<1%), Native Hawaiian or Other Pacific Islander; 3884 (66%), White; and 13 (<1%), multiple races or ethnicities. There was a monotonic increase in risk of the primary composite end point (3-year rates, 9.52%, 10.72%, 18.42%, 34.21%, and 38.01% respectively), death, cardiovascular death, MI, and stroke in individuals with higher CKD stages. Invasive management was associated with an increase in stroke (3-year event rate difference, 1%; 95% CI, 0.3 to 1.7) and procedural MI (1.6%; 95% CI, 0.9 to 2.3) and a decrease in spontaneous MI (-2.5%; 95% CI, -3.9 to -1.1) with no difference in other outcomes; the effect was similar across CKD stages. There was heterogeneity of treatment effect for QoL outcomes such that invasive management was associated with an improvement in angina-related QoL in individuals with CKD stages 1 to 3 and not in those with CKD stages 4 to 5. Conclusions and Relevance Among participants with CCD, event rates were inversely proportional to kidney function. Invasive management was associated with an increase in stroke and procedural MI and a reduced risk in spontaneous MI, and the effect was similar across CKD stages with no difference in other outcomes, including death. The benefit for QoL with invasive management was not observed in individuals with poorer kidney function.
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Affiliation(s)
| | | | | | - Philip G. Jones
- Saint Luke’s Mid America Heart Institute/University of Missouri, Kansas City
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri, Kansas City
| | | | | | - William E. Boden
- Veterans Affairs New England Healthcare System, Boston, Massachusetts
| | - Jerome L. Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York, New York
| | | | - Roy O. Mathew
- Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Glenn M. Chertow
- Department of Medicine, Stanford University, Stanford, California
| | - David J. Maron
- Department of Medicine, Stanford University, Stanford, California
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10
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Mikail N, Meseguer E, Lavallée P, Klein I, Hobeanu C, Guidoux C, Cabrejo L, Lesèche G, Amarenco P, Hyafil F. Evaluation of non-stenotic carotid atherosclerotic plaques with combined FDG-PET imaging and CT angiography in patients with ischemic stroke of unknown origin. J Nucl Cardiol 2022; 29:1329-1336. [PMID: 33462787 DOI: 10.1007/s12350-020-02511-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Non-stenotic plaques are an underestimated cause of ischemic stroke. Imaging aspects of high-risk carotid plaques can be identified on CT angiography (CTA) and 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET) imaging. We evaluated in patients with cryptogenic ischemic stroke the usefulness of FDG-PET-CTA. METHODS 44 patients imaged with CTA and FDG-PET were identified retrospectively. Morphological features were identified on CTA. Intensity of FDG uptake in carotid arteries was quantified on PET. RESULTS Patients were imaged 7 ± 8 days after stroke. 44 non-stenotic plaques with increased 18F-FDG uptake were identified in the carotid artery ipsilateral to stroke and 7 contralateral. Most-diseased-segment TBR on FDG-PET was higher in artery ipsilateral vs. contralateral to stroke (2.24 ± 0.80 vs. 1.84 ± 0.50; p < .05). In the carotid region with high FDG uptake, prevalence of hypodense plaques and extent of hypodensity on CTA were higher in artery ipsilateral vs. contralateral to stroke (41% vs. 11%; 0.72 ± 1.2 mm2 vs. 0.13 ± 0.43 mm2; p < .05). CONCLUSIONS In patients with ischemic stroke of unknown origin and non-stenotic plaques, we found an increased prevalence of high-risk plaques features ipsilateral vs. contralateral to stroke on FDG-PET-CTA imaging suggesting a causal role for these plaques.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Elena Meseguer
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Philippa Lavallée
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Isabelle Klein
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Cristina Hobeanu
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Céline Guidoux
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Lucie Cabrejo
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Guy Lesèche
- Department of Vascular Surgery, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Pierre Amarenco
- Department of Neurology, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 rue Leblanc, 75015, Paris, France.
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11
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Bidulka P, Scott J, Taylor DM, Udayaraj U, Caskey F, Teece L, Sweeting M, Deanfield J, de Belder M, Denaxas S, Weston C, Adlam D, Nitsch D. Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study. BMJ Open 2022; 12:e057909. [PMID: 35351727 PMCID: PMC8961119 DOI: 10.1136/bmjopen-2021-057909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets. METHODS We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Project (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES or both were included in the study cohort. CKD status was defined using eGFR, derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR <60 mL/min/1.73 m2, and mild CKD or at risk of CKD was defined as eGFR ≥60 mL/min/1.73 m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD and Stages 1-2 (eGFR missing or ≥60 mL/min/1.73 m2), (2) Stage 3a (eGFR 45-59 mL/min/1.73 m2), (3) Stage 3b (eGFR 30-44 mL/min/1.73 m2) and (4) Stages 4-5 (eGFR <30 mL/min/1.73 m2). RESULTS We identified 6748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared with people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs 11%, respectively), or MINAP only (22% vs 5%), and less likely to be recorded in HES only (36% vs 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared with those recorded in both (adjusted OR 1.61, 95% CI 1.32 to 1.96 and OR 1.60, 95% CI 1.26 to 2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, SE 0.012). CONCLUSIONS AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.
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Affiliation(s)
- Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jemima Scott
- Population Health Sciences, University of Bristol, Bristol, UK
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Dominic M Taylor
- Population Health Sciences, University of Bristol, Bristol, UK
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Udaya Udayaraj
- Oxford Kidney Unit, Churchill Hospital, Oxford, Oxfordshire, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Lucy Teece
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Michael Sweeting
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - John Deanfield
- National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK, London, UK
| | - Clive Weston
- Glangwili General Hospital, Carmarthen, Carmarthenshire, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, Leicestershire, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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12
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Association of autosomal dominant polycystic kidney disease with cardiovascular disease: a US-National Inpatient Perspective. Clin Exp Nephrol 2022; 26:659-668. [PMID: 35212882 DOI: 10.1007/s10157-022-02200-5] [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] [Received: 01/07/2022] [Accepted: 02/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Data on the epidemiology of cardiovascular diseases (CVD) in patients with autosomal dominant polycystic kidney disease (ADPKD) are limited. In this study, we assess the prevalence of CVD in patients with ADPKD and evaluate associations between these two entities. METHODS Using the National Inpatient Sample database, we identified 71,531 hospitalizations among adults aged ≥ 18 years with ADPKD, from 2006 to 2014 and collected relevant clinical data. RESULTS The prevalence of CVD in the study population was 42.6%. The most common CVD were ischemic heart diseases (19.3%), arrhythmias (14.2%), and heart failure (13.1%). The prevalence of CVD increased with the severity of renal dysfunction (RD). We found an increase in hospitalizations of patients with ADPKD and CVD over the years (ptrend < 0.01), irrespective of the degree of RD. CVD was the greatest independent predictor of mortality in these patients (OR: 3.23; 95% CI 2.38-4.38 [p < 0.001]). In a propensity matched model of hospitalizations of patients with CKD with and without ADPKD, there was a significant increase in the prevalence of atrial fibrillation/flutter (AF), pulmonary hypertension (PHN), non-ischemic cardiomyopathy (NICM), and hemorrhagic stroke among patients with ADPKD when compared to patients with similar degree of RD without ADPKD. CONCLUSIONS The prevalence of CVD is high among patients with ADPKD, and the most important risk factor associated with CVD is severity of RD. We found an increase in the trend of hospitalizations of patients with ADPKD associated with increased risk of AF, PHN, NICM, and hemorrhagic stroke. History of CVD is the strongest predictor of mortality among patients with ADPKD.
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13
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Lichaa H. Coronary stent positioning under live IVUS guidance in low contrast percutaneous coronary interventions: The live IVUS stenting technique. Catheter Cardiovasc Interv 2021; 98:E977-E984. [PMID: 34463431 DOI: 10.1002/ccd.29940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/11/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022]
Abstract
In patients with renal insufficiency, advanced techniques have been described to achieve ultra-low contrast or zero contrast percutaneous coronary interventions (PCI). However, these techniques use intra-coronary imaging before stent placement to determine adequate landing zones, by correlating them with saved fluoroscopic landmarks. Still, this leaves the operator with a certain degree of uncertainty about the exact lesion coverage, which is checked with post-stent intra-coronary imaging. We hereby describe a novel technique which takes away the concern of uncertainty regarding stent-landing zones and allows for the highest amount of precision in stent positioning, arguably even better than with the use of angiography. This technique involves positioning coronary stents under the live guidance of an intravascular ultrasound (IVUS) catheter which is positioned simultaneously, side by side to a stent. This technique takes advantage of all the benefits of IVUS based PCI without losing the precision in stent positioning when compared to traditional angiography. It simplifies the application of low contrast PCI by the interventional cardiology community, while maintaining the confidence in precise stenting. It has also the potential to decrease the incidence of contrast-induced nephropathy, hence procedural morbidity, while allowing for optimal long-term image based PCI outcomes. Obviously, it applies to moderate or larger coronary segments, without significant tortuosity. It also comes at the expense of slightly larger guide catheters, which is compensated for by the use of thin walled sheaths or sheathless catheter systems. Finally, radial access is still applicable depending on radial artery size and available equipment.
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Affiliation(s)
- Hady Lichaa
- Ascension Saint Thomas Heart, Ascension Saint Thomas Rutherford, Murfreesboro, Tennessee, USA
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14
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Pana TA, Quinn J, Mohamed MO, Mamas MA, Myint PK. Thrombolysis in acute ischaemic stroke patients with chronic kidney disease. Acta Neurol Scand 2021; 144:669-679. [PMID: 34328648 DOI: 10.1111/ane.13513] [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: 03/23/2021] [Revised: 06/18/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to determine whether chronic kidney disease (CKD) is associated with adverse in-hospital outcomes after acute ischaemic stroke (AIS) and whether this association is dependent on thrombolysis administration. METHODS 885,537 records representative of 4,283,086 AIS admissions were extracted from the US National Inpatient Sample (2005-2015) and categorized into 3 mutually exclusive groups: no CKD, CKD without end-stage renal disease (ESRD) and ESRD. Outcomes (mortality, prolonged hospitalisation >4 days and disability on discharge-derived using discharge destination as a proxy) were compared between groups using multivariable logistic regressions. Separate models containing interaction terms with thrombolysis were also computed. RESULTS The median age (interquartile range) of the cohort was 73 (61-83) years and 47.32% were men. Compared with the no CKD group, both CKD/no ESRD group (odds ratio (99% confidence interval) = 1.04 (1.0003-1.09), p = 0.009) and the ESRD groups (2.06 (1.90-2.25), p < 0.001) had significantly increased odds of in-hospital mortality. Patients with CKD/No ESRD (1.03 (1.02-1.06), p < 0.001) and ESRD (1.44 (1.37-1.51), p < 0.001) were at higher odds of prolonged hospitalisation. Patients with CKD/No ESRD (1.13 (1.10-1.15), p < 0.001) and ESRD (1.34 (1.26-1.41), p < 0.001) were also at higher odds of moderate-to-severe disability on discharge. Interaction terms between thrombolysis and the CKD/ESRD groups were not statistically significant (p > 0.01) for any outcome. CONCLUSIONS Renal dysfunction was independently associated with worse in-hospital outcomes in the acute phase of AIS. These associations were not influenced by the use of thrombolysis as an emergency treatment for AIS. CKD/ESRD should not represent sole contraindications to thrombolysis for AIS.
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Affiliation(s)
- Tiberiu A. Pana
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke‐on‐Trent UK
- Institute of Applied Health Sciences School of Medicine Medical Sciences & Nutrition University of Aberdeen Aberdeen UK
| | - Jonathan Quinn
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke‐on‐Trent UK
- Institute of Applied Health Sciences School of Medicine Medical Sciences & Nutrition University of Aberdeen Aberdeen UK
| | - Mohamed O. Mohamed
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke‐on‐Trent UK
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke‐on‐Trent UK
| | - Phyo K. Myint
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke‐on‐Trent UK
- Institute of Applied Health Sciences School of Medicine Medical Sciences & Nutrition University of Aberdeen Aberdeen UK
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15
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Looking Beyond the Allograft Survival: Long-Term, 5-Year Renal Outcome in Lung Transplant Recipients. Transplant Proc 2021; 53:3065-3068. [PMID: 34756711 DOI: 10.1016/j.transproceed.2021.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
With the increased incidence and survival of lung transplant (LTx) recipients, the risk for chronic sequelae such as chronic kidney disease (CKD) is on the rise. Data on the long-term renal outcome are scarce. We performed a retrospective chart review of 171 adults with LTx from January 1, 2014, to January 1, 2019. Primary outcomes were prevalence of CKD/end-stage renal disease, acute kidney injury (AKI) as a risk factor for future CKD, and all-cause mortality in recipients with CKD compared with the non-CKD group. Secondary outcomes were frequency of utilization of modalities for CKD (urinalysis, imaging, biopsy, nephrology consultations). Baseline median creatinine and estimated glomerular filtration rate (eGFR) were 0.8 mg/dL and 90 mL/min/1.73 m2, respectively. Of the participants, 60% (96 of 161), 67% (102 of 153), 79% (37 of 47), 86% (10 of 12) had CKD at the end of 6, 12, 36, and 60 months, respectively, and 16% were on dialysis at the end of the study period; 3% received a subsequent renal transplant, and 27% mortality was noted over a 5-year follow-up period. The odds of CKD development in patients with an AKI during index hospitalization vs no AKI was 6.22 (2.87 to 13.06, P < .0001). The odds ratio of all-cause mortality in patients with CKD compared with non-CKD was 3.36 (95% confidence interval, 1.44-8.64, P = .005). Measurement of hematuria/proteinuria, imaging, and renal biopsy were infrequently used. Given the high prevalence of AKI and CKD in this population, a multidisciplinary team approach with an early nephrology consultation will be key to improve the overall and renal outcomes in LTx recipients.
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IVUS-Guided Zero-Contrast PCI in CKD Patients: Safety and Short-Term Outcome in Patients with Complex Demographics and/or Lesion Characteristics. J Interv Cardiol 2021. [DOI: 10.1155/2021/6626749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Percutaneous coronary intervention (PCI) in patients with significant renal dysfunction is challenging because of the lesion characteristics and the risk of contrast-induced acute kidney injury (CI-AKI). With the advent of intravascular ultrasound- (IVUS-) guided zero-contrast PCI, outcomes have improved considerably. Objective. To assess the safety and short-term outcomes of IVUS-guided zero-contrast PCI in chronic kidney disease (CKD) patients with complex demographics or lesion morphology. Methods. Patients who underwent IVUS-guided zero-contrast PCI at a tertiary center, from November 2019 to May 2020, were included in this prospective analysis. Clinical characteristics, procedural data, and follow-up data were collected and analyzed. Results. A total of 15 patients (27 vessels), all men (mean age, 70.0 ± 11.0 years), underwent zero-contrast PCI. The mean estimated glomerular filtration rate (eGFR) and serum creatinine were 30.8 ± 7.3 mL/min/1.73 m2 and 2.6 ± 1.3 mg/dL, respectively. The mean BMC2 risk for dialysis was 2.1 ± 1.1%, mean SYNTAX score was 20.3 ± 10.3, and mean left ventricular ejection fraction (LVEF) was 42.4 ± 11.6%. Four patients (26.6%) underwent left main coronary artery (LMCA) PCI including one LMCA bifurcation. One patient underwent chronic total occlusion PCI. Technical and procedural success were 100% without any periprocedural complications. No major adverse cardiovascular events (MACE) were reported, and no patient required dialysis within three months of follow-up. Conclusion. Zero-contrast PCI guided by IVUS is safe in coronary artery disease (CAD) patients with moderate-to-severe CKD. High procedural success without complications can be achieved even in cases with complex clinical characteristics and lesion morphology.
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Liu ZY, Yin ZH, Liang CY, He J, Wang CL, Peng X, Zhang Y, Zheng ZF, Pan HW. Zero contrast optical coherence tomography-guided percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction and chronic kidney disease. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1072-1079. [PMID: 33764682 DOI: 10.1002/ccd.29655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate a strategy for ultra-low volume contrast percutaneous coronary intervention (PCI) with the aims of preserving renal function and observing the 90-day clinical endpoint in patients with non-ST-elevated myocardial infarction (non-STEMI) and chronic kidney disease (CKD). BACKGROUND The feasibility, safety, and clinical utility of PCI with ultra-low radio-contrast medium in patients with non-STEMI and CKD are unknown. METHODS A total of 29 patients with non-STEMI and CKD (estimated glomerular filtration rate [eGFR] of ≤60 ml/min/1.73 m2 ) were included. Ultra-low volume contrast PCI was performed after minimal contrast coronary angiography using zero contrast optical coherence tomography (OCT) guidance. Pre- and post-PCI angiographic measurements were performed using quantitative flow ratio (QFR) for pre-perfusion assessment and verifying improvement. RESULTS The median creatinine level was 2.1 (inter-quartile range 1.8-3.3), and mean eGFR was 48 ± 8 ml/min/1.73 m2 pre-PCI. During the PCI procedure, OCT revealed 15 (52%) cases of abnormalities post-dilation. There was no significant change in the creatinine level and eGFR in the short- or long-term, and no major adverse events were observed. CONCLUSION In non-STEMI patients with high-risk CKD who require revascularization, QFR and no contrast OCT-guided ultra-low contrast PCI may be performed safely without major adverse events.
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Affiliation(s)
- Zheng-Yu Liu
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Zi-Hui Yin
- The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Cheng-Yang Liang
- Interventional Vascular Complex Operation Department, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jing He
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Chang-Lu Wang
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Xiang Peng
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Yu Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Zhao-Fen Zheng
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Hong-Wei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.,Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China
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18
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Rashid M, Nagaraja V, Shoaib A, Curzen N, Ludman PF, Kapadia SR, Palmer N, Elgendy IY, Kalra A, Vachharajani TJ, Anderson HV, Kwok CS, Mohamed M, Banning AP, Mamas MA. Outcomes Following Percutaneous Coronary Intervention in Renal Transplant Recipients: A Binational Collaborative Analysis. Mayo Clin Proc 2021; 96:363-376. [PMID: 33358453 DOI: 10.1016/j.mayocp.2020.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the clinical and procedural characteristics in patients with a history of renal transplant (RT) and compare the outcomes with patients without RT in 2 national cohorts of patients undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Data from the National Inpatient Sample (NIS) and British Cardiovascular Intervention Society (BCIS) were used to compare the clinical and procedural characteristics and outcomes of patients undergoing PCI who had RT with those who did not have RT. The primary outcome of interest was in-hospital mortality. RESULTS Of the PCI procedures performed in 2004-2014 (NIS) and 2007-2014 (BCIS), 12,529 of 6,601,526 (0.2%) and 1521 of 512,356 (0.3%), respectively, were undertaken in patients with a history of RT. Patients with RT were younger and had a higher prevalence of congestive cardiac failure, hypertension, and diabetes but similar use of drug-eluting stents, intracoronary imaging, and pressure wire studies compared with patients who did not have RT. In the adjusted analysis, patients with RT had increased odds of in-hospital mortality (NIS: odds ratio [OR], 1.90; 95% CI, 1.41-2.57; BCIS: OR, 1.60; 95% CI, 1.05-2.46) compared with patients who did not have RT but no difference in vascular or bleeding events. Meta-analysis of the 2 data sets suggested an increase in in-hospital mortality (OR, 1.79; 95% CI, 1.40-2.29) but no difference in vascular (OR, 1.24; 95% CI, 0.77-2.00) or bleeding (OR, 1.21; 95% CI, 0.86-1.68) events. CONCLUSION This large collaborative analysis of 2 national databases revealed that patients with RT undergoing PCI are younger, have more comorbidities, and have increased mortality risk compared with the general population undergoing PCI.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Vinayak Nagaraja
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton, and University of Southampton, Southampton, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Nick Palmer
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Tushar J Vachharajani
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - H Vernon Anderson
- Department of Internal Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA.
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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020; 69:557-578. [PMID: 33146480 DOI: 10.23736/s2724-5683.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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20
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Park S, Kim Y, Jo HA, Lee S, Kim MS, Yang BR, Lee J, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Clinical outcomes of prolonged dual antiplatelet therapy after coronary drug-eluting stent implantation in dialysis patients. Clin Kidney J 2020; 13:803-812. [PMID: 33125004 PMCID: PMC7577762 DOI: 10.1093/ckj/sfaa037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/25/2020] [Indexed: 11/12/2022] Open
Abstract
Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks. Methods In this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major bleeding was a safety outcome. Inverse probability of treatment weighting Cox regression was performed. Results Mean follow-up periods were 278.3-292.4 days, depending on landmarks. Overall, incidences of major bleeding were far lower than those of MACE. Continued DAPT groups showed lower incidences of MACE and higher incidences of major bleeding, compared with discontinued DAPT groups. In Cox analyses, continued DAPT reduced the hazards of MACE at the 12- [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.61-0.90; P = 0.003], 15- (HR = 0.78, 95% CI 0.64-0.96; P = 0.019) and 18-month landmarks (HR = 0.79, 95% CI 0.63-0.99; P = 0.041), but without a significant increase in major bleeding at 12 (HR = 1.39, 95% CI 0.90-2.16; P = 0.14), 15 (HR = 1.13, 95% CI 0.75-1.70; P = 0.55) or 18 months (HR = 1.27, 95% CI 0.83-1.95; P = 0.27). Conclusions Prolonged DAPT reduced MACE without significantly increasing major bleeding in patients who were event-free at 12 months after DES implantation. In deciding on DAPT duration, prolonged DAPT should be considered in dialysis patients.
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Affiliation(s)
- Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yaerim Kim
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyung Ah Jo
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi-Sook Kim
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Korea
| | - Bo Ram Yang
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, Incheon, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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21
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Jonas M, Kagan M, Sella G, Haberman D, Chernin G. Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis. BMC Nephrol 2020; 21:445. [PMID: 33097001 PMCID: PMC7583297 DOI: 10.1186/s12882-020-02089-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD. Methods In a retrospective analysis, outcomes of PCI with drug-eluting balloons were compared between 101 patients with CKD and 261 without CKD. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73m2. We compared demographics, procedure data and clinical outcomes in the first and second years following the procedure. Results Rates of major adverse cardiac events (MACE) and myocardial infarction were higher in patients with than without CKD: 23.8% vs. 13.8%, P < 0.005 and 15.9% vs. 3.8%, P < 0.001, respectively. Rates of target lesion revascularization were similar, 14.9 and 11.5%, respectively, P = 0.4. Shorter duration of dual anti-platelet therapy was observed among patients with than without CKD (10.0 + 3.4 vs. 10.9 + 3.7 months, P < 0.05). First-year hemorrhage episodes were similar in the two groups (0.08 ± 0.4 and 0.03 ± 0.2, respectively, P = 0.2). In a multivariate regression analysis, CKD was associated with increased risks of first year MACE (OR 2.1; 95% confidence interval 1.0-4.3, P < 0.001). Conclusions PCI with drug-eluting balloons was associated with increased cardiovascular morbidity and mortality in patients with than without CKD. However, rates of target lesion revascularization were similar in the two groups. Shorter duration of dual anti-platelet therapy was observed in the CKD group.
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Affiliation(s)
- Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Maayan Kagan
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel
| | - Gal Sella
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Dan Haberman
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Gil Chernin
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel.
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22
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Feldman DA, Shroff AR, Bao H, Curtis JP, Minges KE, Ardati AK. Stent selection among patients with chronic kidney disease: Results from the NCDR CathPCI Registry. Catheter Cardiovasc Interv 2020; 96:1213-1221. [PMID: 31909543 DOI: 10.1002/ccd.28698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/20/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study sought to define contemporary rates of drug eluting stent (DES) usage in patients with chronic kidney disease (CKD). BACKGROUND Among patients with CKD undergoing percutaneous coronary interventions (PCIs), outcomes are superior for those who receive DES compared to those who receive bare metal stents (BMSs). However, perceived barriers may limit the use of DES in this population. METHODS All adult PCI cases from the NCDR CathPCI Registry involving coronary stent placement between July 1, 2009 and December 31, 2015 were analyzed. The rate of DES usage was then compared among four groups, stratified by CKD stage (I/II, III, IV, and V). Subgroup analysis was conducted based on PCI status and indication. Cases were linked to Medicare claims data to assess 1-year mortality. RESULTS A total of 3,650,333 PCI cases met criteria for analysis. DES usage significantly declined as renal function worsened (83.0%, 79.9%, 75.6%, and 75.6%, respectively, in the four CKD stages; p < .001). DES usage was universally lower across the four groups in the setting of ST-Elevation Myocardial Infarction (STEMI) (70.6%, 66.5%, 58.7%, 58.0%; p < .001) and higher in the setting of elective PCI (87.6%, 84.9%, 82.3%, 77.9%; p < .0001). DES was associated with improved 1-year survival, and usage increased over time across each group. CONCLUSIONS DESs are underutilized in patients with advanced renal dysfunction. Although DES usage has increased over time, variation still exists between patients with normal renal function and those with CKD.
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Affiliation(s)
- Daniel A Feldman
- Section of Cardiology, Adventist Health Portland, Portland, Oregon
| | - Adhir R Shroff
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
| | - Haikun Bao
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Amer K Ardati
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
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23
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Klein EC, Kapoor R, Lewandowski D, Mason PJ. Revascularization Strategies in Patients with Chronic Kidney Disease and Acute Coronary Syndromes. Curr Cardiol Rep 2019; 21:113. [PMID: 31471758 DOI: 10.1007/s11886-019-1213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a highly prevalent condition that increases the incidence and complexity of acute coronary syndrome (ACS). The purpose of this review is to summarize current evidence, uncertainties, and opportunities in the management of patients with CKD and ACS, with a focus on revascularization. RECENT FINDINGS Patients with CKD have been systematically under-represented or excluded from clinical trials in ACS. Available data, however, demonstrates that although patients with CKD and ACS benefit from revascularization, they are also less likely to receive recommended medical and revascularization therapies when compared to patients with normal kidney function. Despite the increased short-term risk of major morbidity and mortality, patients with CKD and ACS should be considered for an early invasive strategy while also trying to mitigate the risks of procedural related complications. Until evidence emerges from randomized clinical trials, the decision about revascularization strategy should involve multi-disciplinary collaboration, heart team consensus, and patient shared decision-making.
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Affiliation(s)
- Evan C Klein
- Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Subahi A, Abdullah A, Yassin AS, Abubakar H, Abugroun A, Eigbire G, Salama A, Wahab A, Abulawi A, Kanaan E, Javed A, Elder M, Kaki A, Alweis R, Mohamad T. Impact and Outcomes of Patients with Congestive Heart Failure Complicating Non-ST-Segment Elevation Myocardial Infarction,Results from a Nationally-Representative United States Cohort. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:659-662. [DOI: 10.1016/j.carrev.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022]
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Efficacy and Safety of Ticagrelor Compared with Clopidogrel in Patients with End-Stage Renal Disease with Acute Myocardial Infarction. Am J Cardiovasc Drugs 2019; 19:325-334. [PMID: 30746615 DOI: 10.1007/s40256-018-00318-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study investigated the efficacy and safety of ticagrelor compared with clopidogrel in patients with end-stage renal disease (ESRD) and acute myocardial infarction (AMI). METHODS We retrospectively enrolled patients who had received regular dialysis and had undergone percutaneous coronary intervention (PCI) for AMI at our hospital between January 2013 and December 2016. Outcomes analyzed included cardiovascular death, death from any cause, MI, stroke, and bleeding events. RESULT Patients were allocated to the ticagrelor group (N = 74) or the clopidogrel group (N = 116) according to the treatment they had received. No statistically significant differences were found between the groups in terms of in-hospital primary endpoint (composite of cardiovascular death, MI, and stroke: 12.2% and 15.5% for ticagrelor and clopidogrel, respectively; p = 0.518), secondary endpoint, or any bleeding events (39.2 vs. 34.5%; p = 0.511). No statistically significant differences were found for the 1-year primary endpoint (p = 0.424), secondary endpoint, and any bleeding events (p = 0.663). Risk factors for in-hospital cardiovascular death were shock and cardiopulmonary resuscitation at initial AMI presentation, lack of beta-blocker use, and in-hospital gastrointestinal bleeding. Risk factors for 1-year cardiovascular death were shock at initial AMI presentation and lack of beta-blocker use. Only respiratory failure was a risk factor for in-hospital and 1-year gastrointestinal bleeding. CONCLUSION In patients with ESRD and AMI, ticagrelor resulted in numerically fewer but statistically nonsignificant rates of in-hospital and 1-year cardiovascular events with no significant increase in bleeding events compared with clopidogrel.
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26
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Trans-radial percutaneous coronary intervention for patients with severe chronic renal insufficiency and/or on dialysis. Heart Vessels 2019; 34:1412-1419. [DOI: 10.1007/s00380-019-01387-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/15/2019] [Indexed: 12/16/2022]
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27
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Xu N, Tang XF, Yao Y, Zhao XY, Chen J, Gao Z, Qiao SB, Yang YJ, Gao RL, Xu B, Yuan JQ. Association of Plasma Lipoprotein(a) With Long-Term Adverse Events in Patients With Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:2043-2048. [PMID: 30477725 DOI: 10.1016/j.amjcard.2018.04.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 01/17/2023]
Abstract
We aimed to determine the association of plasma lipoprotein(a) (Lp[a]) with long-term clinical outcomes in patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI) in an observational cohort study. Four hundred and twenty-seven consecutive patients with CKD who underwent PCI from January 2013 to December 2013 were included in this study. Patients were divided into 2 groups according to median levels of Lp(a). Outcomes included 2-year risk of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding according to Bleeding Academic Research Consortium definitions. Overall, median of Lp(a) in all the patients was 217.8 mg/L. The 2-year MACCE rate across the high Lp(a) and low Lp(a) group was 23.0% versus 15.4% (p = 0.047) and bleeding event rate of the two groups 8.9% versus 4.2% (p = 0.049). The Lp(a) was significantly and positively correlated with high-sensitivity C-reactive protein levels (r2 = 0.03, p < 0.001). Kaplan-Meier curves revealed that high Lp(a) had higher incidence of bleeding than low Lp(a) (p = 0.043) and had higher risk of MACCE (p = 0.049). Multivariable Cox regression analysis indicated that high Lp(a) was an independent predictor of Bleeding Academic Research Consortium bleeding compared with low Lp(a) (hazard ratios 2.29, 95% confidence intervals 1.01 to 5.15, p = 0.046). In conclusion, a high Lp(a) value may be associated with a poor prognosis after PCI for patients with CKD.
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28
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Li Q, Wang D, Zhu X, Shen K, Xu F, Chen Y. Combination of renal apparent diffusion coefficient and renal parenchymal volume for better assessment of split renal function in chronic kidney disease. Eur J Radiol 2018; 108:194-200. [DOI: 10.1016/j.ejrad.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
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29
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Roldán Torres I, Salvador Mercader I, Cabadés Rumbeu C, Díez Gil JL, Ferrando Cervelló J, Monteagudo Viana M, Fernández Galera R, Mora Llabata V. Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy. Nefrologia 2018. [PMID: 28648204 DOI: 10.1016/j.nefro.2016.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIM Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. METHODS We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m2. The composite primary end-point was cardiac death and non fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3-years according to the presence or absence of CKD. RESULTS We included 248 p with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; P<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank P=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). CONCLUSIONS In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years.
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Affiliation(s)
| | | | | | - José Luis Díez Gil
- Servicio de Cardiología, Hospital Universitario Dr. Peset, Valencia, España
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Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH. The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 2018; 31:302-309. [PMID: 29495125 DOI: 10.1111/joic.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). RESULTS The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007). CONCLUSIONS Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
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Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Lieng Lee
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tse-Min Lu
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Washam JB, Kaltenbach LA, Wojdyla DM, Patel MR, Klein AJ, Abbott JD, Rao SV. Anticoagulant Use Among Patients With End-Stage Renal Disease Undergoing Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 11:e005628. [DOI: 10.1161/circinterventions.117.005628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/05/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey B. Washam
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - Lisa A. Kaltenbach
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - Daniel M. Wojdyla
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - Manesh R. Patel
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - Andrew J. Klein
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - J. Dawn Abbott
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
| | - Sunil V. Rao
- From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.)
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The Impact of Chronic Kidney Disease on Postoperative Outcomes in Patients Undergoing Lumbar Decompression and Fusion. World Neurosurg 2018; 110:e266-e270. [DOI: 10.1016/j.wneu.2017.10.147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/18/2022]
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Patel B, Shah M, Dusaj R, Maynard S, Patel N. Percutaneous coronary intervention and inpatient mortality in patients with advanced chronic kidney disease presenting with acute coronary syndrome. Proc (Bayl Univ Med Cent) 2018; 30:400-403. [PMID: 28966444 DOI: 10.1080/08998280.2017.11930205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chronic kidney disease (CKD) is an important risk factor for coronary artery disease, yet patients with CKD are less likely to undergo coronary angiography and percutaneous coronary intervention (PCI). We retrospectively analyzed the 2006-2012 National Inpatient Sample Database to examine the temporal trends in coronary angiography and PCI among patients without CKD, with advanced CKD (CKD III-V), and with end-stage renal disease (ESRD) presenting with unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). A total of 579,747 admissions for NSTE-ACS and 293,950 admissions for STEMI were studied. Patients with NSTE-ACS were less likely to undergo coronary angiography/PCI than those with STEMI, irrespective of CKD. Between 2006 and 2012, performance of PCI saw an uptrend across all CKD groups with NSTE-ACS (no CKD, 29.9%-36.8%; CKD III-V, 18.2%-21.5%; ESRD, 19.8%-27.5%; all Ptrends < 0.01) and STEMI (no CKD, 57.0%-76.0%; CKD III-V, 33.0%-52.6%; ESRD, 29.9%-42.9%; Ptrends < 0.01). Multivariate analyses revealed that PCI was associated with a lower risk of hospital mortality across all degrees of CKD in both NSTE-ACS (adjusted odds ratios: no CKD, 0.44; CKD III-V, 0.48; ESRD, 0.46; P < 0.01) and STEMI (no CKD, 0.35; CKD III-V, 0.50; ESRD, 0.52; P < 0.01). Performance of PCI increased over time among patients presenting with NSTE-ACS and STEMI in the presence of advanced CKD and independently predicted lower in-hospital mortality.
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Affiliation(s)
- Brijesh Patel
- Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Mahek Shah
- Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Raman Dusaj
- Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Sharon Maynard
- Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Nainesh Patel
- Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania
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Doshi R, Shah J, Patel V, Jauhar V, Meraj P. Transcatheter or surgical aortic valve replacement in patients with advanced kidney disease: A propensity score-matched analysis. Clin Cardiol 2017; 40:1156-1162. [PMID: 29166543 DOI: 10.1002/clc.22806] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an alternative for surgically inoperable patients with severe aortic stenosis. Advanced kidney disease may significantly affect outcomes in patients treated with TAVR and surgical aortic valve replacement (SAVR). HYPOTHESIS TAVR is associated with better in-hospital outcomes compared with SAVR in patients with advanced kidney disease. METHODS We identified our sample from the National Inpatient Sample between 2012 and 2014, using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We included patients with chronic kidney disease stages IV and V and end-stage renal disease as advanced kidney disease patients. We excluded patients with acute kidney injury on admission and patients on dialysis. RESULTS After propensity matching, 2485 patients were included in each group. The primary outcome of in-hospital mortality (12.9% vs 6.2%; P < 0.01) was higher with SAVR as compared with TAVR. Patients who underwent SAVR reported higher acute kidney injury (50.3% vs 33%; P < 0.01) and dialysis requirements (26.8% vs 20.1%; P < 0.01). Other secondary outcomes including blood transfusion, atrial fibrillation, iatrogenic cardiac complications, pericardial complications, perioperative stroke, perioperative infections, and postoperative shock were more common with SAVR. With SAVR, the length of hospitalization and hospitalization costs were significantly higher; however, permanent pacemaker placement was more common with TAVR compared with SAVR. CONCLUSIONS In patients with advanced kidney disease, SAVR was associated with higher mortality and higher periprocedural complications, as compared with TAVR. Thus, benefits of TAVR could be extended in patients with advanced kidney disease who cannot undergo surgery.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Jay Shah
- Department of Internal Medicine, Mercy Saint Vincent Hospital, University of Toledo, Toledo, Ohio
| | - Vaibhav Patel
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Varun Jauhar
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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Shavadia JS, Southern DA, James MT, Welsh RC, Bainey KR. Kidney function modifies the selection of treatment strategies and long-term survival in stable ischaemic heart disease: insights from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 4:274-282. [DOI: 10.1093/ehjqcco/qcx042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Jay S Shavadia
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta
- Duke Clinical Research Institute, Durham, NC, USA
| | - Danielle A Southern
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Matthew T James
- Division of Nephrology, Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robert C Welsh
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta
| | - Kevin R Bainey
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta
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Baber U, Chandrasekhar J, Sartori S, Aquino M, Kini AS, Kapadia S, Weintraub W, Muhlestein JB, Vogel B, Faggioni M, Farhan S, Weiss S, Strauss C, Toma C, DeFranco A, Baker BA, Keller S, Effron MB, Henry TD, Rao S, Pocock S, Dangas G, Mehran R. Associations Between Chronic Kidney Disease and Outcomes With Use of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the PROMETHEUS Study. JACC Cardiovasc Interv 2017; 10:2017-2025. [PMID: 28780028 DOI: 10.1016/j.jcin.2017.02.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to compare clinical outcomes in a contemporary acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) cohort stratified by chronic kidney disease (CKD) status. BACKGROUND Patients with CKD exhibit high risks for both thrombotic and bleeding events, thus complicating decision making regarding antiplatelet therapy in the setting of ACS. METHODS The PROMETHEUS study was a multicenter observational study comparing outcomes with prasugrel versus clopidogrel in ACS PCI patients. Major adverse cardiac events (MACE) at 90 days and at 1 year were defined as a composite of death, myocardial infarction, stroke, or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Cox regression multivariable analysis was performed for adjusted associations between CKD status and clinical outcomes. Hazard ratios for prasugrel versus clopidogrel treatment were generated using propensity score stratification. RESULTS The total cohort included 19,832 patients, 28.3% with and 71.7% without CKD. CKD patients were older with greater comorbidities including diabetes and multivessel disease. Prasugrel was less often prescribed to CKD versus non-CKD patients (11.0% vs. 24.0%, respectively; p < 0.001). At 1 year, CKD was associated with higher adjusted risk of MACE (1.27; 95% confidence interval: 1.18 to 1.37) and bleeding (1.46; 95% confidence interval: 1.24 to 1.73). Although unadjusted rates of 1-year MACE were lower with prasugrel versus clopidogrel in both CKD (18.3% vs. 26.5%; p < 0.001) and non-CKD (10.9% vs. 17.9%; p < 0.001) patients, associations were attenuated after propensity stratification. Similarly, unadjusted differences in 1-year bleeding with prasugrel versus clopidogrel (6.0% vs. 7.4%; p = 0.18 in CKD patients; 2.6% vs. 3.5%; p = 0.008 in non-CKD patients) were not significant after propensity score adjustment. CONCLUSIONS Although risks for 1-year MACE were significantly higher in ACS PCI patients with versus without CKD, prasugrel use was 50% lower in patients with renal impairment. Irrespective of CKD status, outcomes associated with prasugrel use were not significant after propensity adjustment. These data highlight the need for randomized studies evaluating the optimal antiplatelet therapy in CKD patients with ACS.
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Affiliation(s)
- Usman Baber
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jaya Chandrasekhar
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Aquino
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Samir Kapadia
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - William Weintraub
- Division of Cardiology, Christiana Care Health System, Newark, Delaware
| | | | - Birgit Vogel
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michela Faggioni
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sandra Weiss
- Division of Cardiology, Christiana Care Health System, Newark, Delaware
| | - Craig Strauss
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anthony DeFranco
- Division of Cardiology, Aurora Cardiovascular Services, Milwaukee, Wisconsin
| | | | | | - Mark B Effron
- Eli Lilly and Company, Indianapolis, Indiana; Division of Cardiology, John Ochsner Heart and Vascular Center, Ochsner Medical Center, New Orleans, Louisiana
| | - Timothy D Henry
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Sunil Rao
- Division of Cardiology, Duke University, Durham, North Carolina
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Khattak A, Mandel EI, Reynolds MR, Charytan DM. Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Stable Angina in Advanced CKD: A Decision Analysis. Am J Kidney Dis 2017; 69:350-357. [PMID: 27646423 PMCID: PMC5329119 DOI: 10.1053/j.ajkd.2016.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) use is low in the setting of stable symptomatic angina in individuals with advanced chronic kidney disease (CKD) despite high cardiovascular risk in this population, and PCI is frequently deferred out of concern for precipitating dialysis therapy. Whether this is appropriate is uncertain, and patient-centered data comparing the relative risks and benefits of continued medical therapy versus PCI in patients with advanced CKD and stable angina are scarce. STUDY DESIGN Decision analysis. SETTING & POPULATION Hypothetical cohort of individuals with advanced CKD (stages 4-5 with estimated glomerular filtration rates ≤ 20mL/min/1.73m2) and stable angina. MODEL, PERSPECTIVE, & TIMELINE A Markov model with a Monte Carlo simulation through 12 cycles, that is, 3 years of 3-month intervals, with 10,000 microsimulations predicted mean quality-adjusted life-years. INTERVENTION PCI first, medical management, or dialysis (hemodialysis [HD]) followed by PCI. OUTCOMES Outcomes modeled were progression to HD therapy (for those not assigned to the preemptive HD strategy), catheter infection, and death. RESULTS Our analysis showed mean quality-adjusted life-years of 1.103 ± 0.69 for PCI first, 1.088±0.70 for medical management, and 0.670±0.58 for HD followed by PCI. Probabilistic sensitivity analysis found PCI as the preferred strategy > 60% of the time. LIMITATIONS Values for probabilities and utilities were estimated and/or derived from multiple sources that were not uniform in their populations in terms of age, comorbid condition burden, and degree of kidney failure, and several simplifying assumptions were made. CONCLUSIONS Our analysis demonstrates that quality-adjusted life expectancy is similar for the PCI first and medical management strategies in patients with advanced CKD with stable angina and that the decision depends on patient preferences other than those incorporated in our model. Both strategies are superior to preemptive dialysis.
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Affiliation(s)
- Aisha Khattak
- Renal Division, Brigham and Women's Hospital, Boston, MA
| | - Ernest I Mandel
- Renal Division, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Matthew R Reynolds
- Department of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, MA; Harvard Clinical Research Institute, Boston, MA
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Recent Trends in Management and Inhospital Outcomes of Acute Myocardial Infarction in Renal Transplant Recipients. Am J Cardiol 2017; 119:542-552. [PMID: 27939383 DOI: 10.1016/j.amjcard.2016.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/23/2022]
Abstract
Renal transplant recipients (RTR) are at high risk of cardiovascular events including acute myocardial infarction (AMI). We evaluated recent trends in AMI admissions in 9,243 RTR with functioning grafts using data from the 2003 to 2011 Nationwide Inpatient Sample database. Findings were compared with those of patients with end-stage renal disease without transplantation (ESRD-NRT, n = 160,932) and those without advanced kidney disease (non-ESRD/RT, n = 5,640,851) admitted with AMI. RTR comprised 0.2% of AMI admissions with increasing numbers during the study period (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.04 to 1.05; ptrend <0.001). Overall, 29.3% of admissions in RTR were for acute ST-segment elevation myocardial infarction (STEMI). Compared with non-ESRD/RT, history of renal transplantation was independently associated with a decreased likelihood of STEMI at presentation (aOR 0.73; 95% CI 0.65 to 0.80; p <0.001). Inhospital mortality among RTR admitted for NSTEMI decreased from 3.8% in 2003 to 2.1% in 2011 (aOR 0.85; 95% CI 0.78 to 0.93; p <0.001), whereas that for STEMI remained unchanged (7.6% in 2003; 9.3% in 2011, aOR 0.97; 95% CI 0.90 to 1.03; p = 0.36). Rates of percutaneous coronary interventions were higher, and inhospital mortality was lower among RTR compared with ESRD-NRT (p <0.001 for both). Treatment strategies appeared largely unchanged during the course of this study with the exception of an increase in primary percutaneous coronary intervention among RTR admitted with STEMI. In conclusion, RTR were frequently admitted with AMI, particularly NSTEMI, and were found to have multiple coronary artery disease risk factors despite their younger age. Compared with other forms of renal replacement therapy, renal transplant was associated with lower inhospital mortality.
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Chatterjee S, Kundu A, Mukherjee D, Sardar P, Mehran R, Bashir R, Giri J, Abbott JD. Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data. Catheter Cardiovasc Interv 2017; 90:205-212. [DOI: 10.1002/ccd.26928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Saurav Chatterjee
- Division of Cardiology; St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System; New York New York
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Debabrata Mukherjee
- Division of Cardiology; Texas Tech University Health Sciences Center; El Paso Texas
| | - Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Roxana Mehran
- Director of Interventional Research, Icahn School of Medicine, Mount Sinai Health System; New York New York
| | - Riyaz Bashir
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Jay Giri
- Penn Cardiovascular Outcomes; Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania; Philadelphia PA
| | - Jinnette D. Abbott
- Warren Alpert School of Medicine and Brown University; Rhode Island Hospital; Providence Rhode Island
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Lingel JM, Srivastava MC, Gupta A. Management of coronary artery disease and acute coronary syndrome in the chronic kidney disease population-A review of the current literature. Hemodial Int 2017; 21:472-482. [DOI: 10.1111/hdi.12530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Justin M. Lingel
- Department of Internal Medicine, University of Maryland Medical Center; Baltimore MD
| | - Mukta C. Srivastava
- Division of Cardiovascular Medicine, University of Maryland School of Medicine; Baltimore MD
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine; Baltimore MD
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Gupta T, Kolte D, Mohananey D, Khera S, Goel K, Mondal P, Aronow WS, Jain D, Cooper HA, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Relation of Obesity to Survival After In-Hospital Cardiac Arrest. Am J Cardiol 2016; 118:662-7. [PMID: 27381664 DOI: 10.1016/j.amjcard.2016.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/30/2022]
Abstract
Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox."
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Divyanshu Mohananey
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Sahil Khera
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Kashish Goel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Pratik Mondal
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
| | - Diwakar Jain
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Howard A Cooper
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Sei Iwai
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - William H Frishman
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Julio A Panza
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
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Patel AD, Ibrahim M, Swaminathan RV, Minhas IU, Kim LK, Venkatesh P, Feldman DN, Minutello RM, Bergman GW, Wong SC, Singh HS. Five-year mortality outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 89:E124-E132. [PMID: 27519355 DOI: 10.1002/ccd.26664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine peri-procedural and long-term outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI). BACKGROUND Patients with advanced CKD are considered high risk when undergoing PCI. Limited published data exist on quantifying risk and assessment of long-term outcomes after PCI in this group. METHODS Examining the Cornell Coronary Registry, we prospectively collected data of 6,478 consecutive patients who underwent elective or urgent PCI between 2009 and 2013. Patients were grouped into CKD stages by estimated glomerular filtration rate (eGFR) according to KDOQI guidelines. Procedural and 30-day outcomes are reported with assessment of long-term differences in 5-year all-cause mortality. RESULTS Patients were grouped by CKD stages: 1,351 patients with eGFR ≥90 mL/min/1.73 m2 (stage 1), 2,882 with eGFR 60-89 (stage 2), 1,742 with eGFR 30-59 (stage 3), 191 with eGFR 15-29 (stage 4), and 312 with eGFR <15 or on dialysis (stage 5). The incidence of post-procedural acute heart failure, stroke, new dialysis requirement, transfusions, and bleeding events were higher in patients with greater CKD stage (P < 0.05). Five-year Kaplan-Meier overall survival among CKD stages 1-5 was 98.1, 95.5, 91.8, 82.5, and 76.9%, respectively (P < 0.001 by log-rank test). The hazard ratios of all-cause mortality for CKD stages 2-5 as compared to stage 1 by multivariate Cox regression analysis were as follows: 1.32 (P = 0.26), 2.04 (P < 0.01), 2.79 (P < 0.01), and 5.49 (P < 0.001). CONCLUSION Among patients undergoing PCI, lower GFR is associated with decreased long-term survival. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Agam D Patel
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Mohammed Ibrahim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Irfan U Minhas
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Luke K Kim
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Prashanth Venkatesh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Robert M Minutello
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Geoffrey W Bergman
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - S Chiu Wong
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Harsimran S Singh
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Alkhatib B, Wolfe L, Naidu SS. Hemodynamic Support Devices for Complex Percutaneous Coronary Intervention. Interv Cardiol Clin 2016; 5:187-200. [PMID: 28582203 DOI: 10.1016/j.iccl.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
High-risk percutaneous coronary intervention (PCI) encompasses a growing portion of total PCIs performed and typically includes patients with high-risk clinical and anatomic characteristics. Such patients may represent not only a high-risk group for complications but also a group who may derive the most benefit from complete revascularization. Several hemodynamic support devices are available. Trial data, consensus documents, and guidelines currently recommend high-risk PCI aided by hemodynamic support devices, and this article discusses the patient populations who would benefit from such an approach, the available devices and strategies, and expected outcomes.
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Affiliation(s)
- Basil Alkhatib
- Division of Cardiology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola NY 11501, USA
| | - Laura Wolfe
- Division of Cardiology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola NY 11501, USA
| | - Srihari S Naidu
- Cardiac Catheterization Laboratory, Division of Cardiology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola, NY 11501, USA.
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