SYNTAX score may predict the severity of atherosclerosis of the ascending aorta

Predictive Values of the CatLet© Angiographic Scoring System for 30-Day Cardiac Mortality in Patients after Primary Percutaneous Coronary Intervention

Background

The Coronary Artery Tree Description and Lesion Evaluation (CatLet©) angiographic scoring system is a newly developed tool to predict the long-term clinical outcomes for patients with acute myocardial infarction (AMI). This study aimed to evaluate the predictive value of this novel angiographic scoring system for cardiac mortality in AMI patients within 30 days of primary percutaneous coronary intervention (pPCI) in AMI patients.

Methods

Patients with AMI undergoing pPCI were consecutively enrolled between January 2012 and July 2013. The CatLet© score was calculated for all the lesions in the non-occlusive status and were tertile partitioned into three groups: CatLet-low ≤14 (N = 124), CatLet-mid 14-22 (N = 82), and CatLet-top ≥22 (N = 102). The primary endpoint was cardiac mortality at 30 days after the procedure. Survival curves were generated using the Kaplan-Meier method, and survival rates among the CatLet© score tertiles were compared using the Log-rank test. Furthermore, Cox regression analysis was performed to identify the associations between the predictors and clinical outcomes.

Results

A total of 308 patients were included in the final analysis. The included patients were followed up for 30 days, with 19 (6.17%) cardiac death. Kaplan-Meier curves indicated that the CatLet-top tertile exhibited a significant increase in the risk of cardiac mortality when compared with the low and mid tertiles (p for trend <0.01); the CatLet© score remained an independent predictor of 30-day cardiac mortality in AMI patients after adjusting for clinical variables (HR (95% CI): 6.13 (1.29-29.17); p < 0.01). The multivariable analysis demonstrated that a per 1 unit increase in CatLet© score was associated with a 1.04 (1.01-1.06)-fold increased risk of cardiac death. The area under the receiver operating characteristic (ROC) curve (AUC) statistic for the CatLet© score was 0.80 (95% CI, 0.69-0.91), with a good calibration (χ2 = 12.92; p = 0.12).

Conclusion

The CatLet© score can be used to predict the short-term cardiac death in AMI patients. A CatLet© score ≥22 or ≥11 myocardial segments involved relative to the total 17 segments (the score divided by 2), including culprit or non-culprit vessels, accounting for 65% (11/17) of left ventricle mass involved, is significantly associated with poor prognosis. The current study has extended the application of the CatLet© score in clinical practice.

Clinical Trial Registration

ChiCTR-POC-17013536. Registered 25 November, 2017, https://www.chictr.org.cn/showproj.html?proj=22814.

Predictive ability of serum osmolarity for contrast-induced nephropathy after elective percutaneous coronary intervention: Are we having a new target?

BACKGROUND

Contrast-induced nephropathy (CIN) remains a serious complication following percutaneous coronary intervention (PCI), often leading to poor outcomes. Although the overall incidence of CIN is low, the risk can be significantly higher in certain susceptible cohorts.

RESULTS

This prospective observational analytic study enrolled 174 consecutive eligible patients. The study selectively included diabetic patients with heart failure who are receiving regular diuretic therapy, being scheduled for elective coronary angiography (CAG) and/or PCI. CIN occurred in 24.7% of the study participants. CIN patients had significantly higher baseline osmolarity compared to those who did not develop CIN. After adjusting for other factors, pre-procedure osmolarity ≥ 302.3 mOsm/L, higher CHA2DS2VA score, and larger contrast volume proved to be independent predictors for CIN with an odds ratio and 95% confidence interval of 7.07 (2.47-20.26), 3.99 (2.02-7.9), and 1.01 (1.0-1.014), respectively.

CONCLUSIONS

In patients at high risk for CIN, serum osmolarity can serve as a practical stratification tool for CIN risk before elective CAG or PCI. Future studies should evaluate whether targeting a specific pre-procedural osmolarity threshold can reduce the risk of post-PCI CIN.

Impact of Peripheral Arterial Disease on Outcomes of Acute Coronary Syndrome

BACKGROUND

Peripheral artery disease (PAD) refers to the extracardiac localization of atherosclerotic disease, generally in arteries that vascularize the lower limbs. More than 50% of patients with PAD also have coronary artery disease (CAD). There are concerns about possible differences in mortality rates among hospitalized patients and the need for immediate revascularization during hospital stay across different types of acute coronary syndrome (ACS) when PAD is present.

METHODS

This was a retrospective study that included 100 patients admitted with ACS between October 2019 and May 2022. Participants were divided into two groups: those with ACS and PAD (n=32) and those without PAD (n=68). We used the SYNTAX score to evaluate the severity of coronary artery disease, the amount of contrast and dose area product (DAP) dosage per patient during the procedure and how these factors vary.

RESULTS

There was a 6.8 higher average SYNTAX score among patients with ACS and PAD (p=0.034), which could negatively affect their prognosis. In addition, there was a 12.7-point increase in the SYNTAX score for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) and PAD (p=0.008). Patients with ACS and concomitant PAD were more likely to require complete revascularization of the left main disease.

CONCLUSION

Patients with PAD and concomitant ACS have more severe CAD, with more frequent involvement of the left main artery than those without PAD.

Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas - A Single-Center Retrospective Study

OBJECTIVES

Aortic intramural hematoma (IMH) is a rare disease. Thus far, only limited data is available and the indications for conservative and endovascular treatment are not well defined. The aim of this study was to investigate clinical presentation, course, CT imaging features and outcome of patients with type B aortic IMHs.

METHODS

We included all patients with type B IMHs between 2012 and 2021 in this retrospective monocentric study. Clinical data, localization, thickness of IMHs and the presence of ulcer-like projections (ULPs) was evaluated before and after treatment.

RESULTS

Thirty five patients (20 females; 70.3 y ± 11 y) were identified. Almost all IMHs (n = 34) were spontaneous and symptomatic with back pain (n = 34). At the time of diagnosis, TEVAR was deemed indicated in 9 patients, 26 patients were treated primarily conservatively. During the follow-up, in another 16 patients TEVAR was deemed indicated. Endovascularly and conservatively treated patients both showed decrease in thickness after treatment. Patients without ULPs showed more often complete resolution of the IMH than patients with ULPs (endovascularly treated 90.9% (10/11) vs 71.4% (5/7); conservatively treated 71.4% (10/14) vs 33.3% (1/3); P = .207). Complications after TEVAR occurred in 32% and more frequently in patients treated primarily conservatively (37.5% vs 22.2%). No in-hospital mortality was observed during follow-up.

CONCLUSIONS

Prognosis of IMH seems favourable in both surgically as well as conservatively treated patients. However, it is essential to identify patients at high risk for complications under conservative treatment, who therefore should be treated by TEVAR. In our study, ULPs seem to be an adverse factor for remodeling.

Redox Status and Telomere-Telomerase System Biomarkers in Patients with Acute Myocardial Infarction Using a Principal Component Analysis: Is There a Link?

In the present study, we examined redox status parameters in arterial and venous blood samples, its potential to predict the prognosis of acute myocardial infarction (AMI) patients assessed through its impact on the comprehensive grading SYNTAX score, and its clinical accuracy. Potential connections between common blood biomarkers, biomarkers of redox status, leukocyte telomere length, and telomerase enzyme activity in the acute myocardial infarction burden were assessed using principal component analysis (PCA). This study included 92 patients with acute myocardial infarction. Significantly higher levels of advanced oxidation protein products (AOPP), superoxide anion (O2•-), ischemia-modified albumin (IMA), and significantly lower levels of total oxidant status (TOS) and total protein sulfhydryl (SH-) groups were found in arterial blood than in the peripheral venous blood samples, while biomarkers of the telomere-telomerase system did not show statistical significance in the two compared sample types (p = 0.834 and p = 0.419). To better understand the effect of the examined biomarkers in the AMI patients on SYNTAX score, those biomarkers were grouped using PCA, which merged them into the four the most contributing factors. The "cholesterol-protein factor" and "oxidative-telomere factor" were independent predictors of higher SYNTAX score (OR = 0.338, p = 0.008 and OR = 0.427, p = 0.035, respectively), while the ability to discriminate STEMI from non-STEMI patients had only the "oxidative-telomere factor" (AUC = 0.860, p = 0.008). The results show that traditional cardiovascular risk factors, i.e., high total cholesterol together with high total serum proteins and haemoglobin, are associated with severe disease progression in much the same way as a combination of redox biomarkers (pro-oxidant-antioxidant balance, total antioxidant status, IMA) and telomere length.

Clinical significance of the presence of puff-chandelier ruptures detected by nonobstructive aortic angioscopy

OBJECTIVE

This study aimed to investigate the prevalence and prognostic significance of atherosclerotic aortic plaques (AAPs) or specific AAP types detected by nonobstructive angioscopy (NOA) in patients who underwent percutaneous coronary intervention (PCI).

BACKGROUND

Although recent studies have reported the presence of various patterns of AAPs, identified by NOA, the clinical significance of the presence of AAPs remains elusive.

METHODS

In this retrospective, multicenter cohort study, a total of 167 patients who underwent PCI and intra-aortic scans with NOA were studied. The association between AAPs and the incidence of major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and clinically driven unplanned revascularizations, was assessed.

RESULTS

AAPs were detected in 126 patients (75%) who underwent NOA. MACEs occurred in 28 (17%) patients during the follow-up (median 2.9 years [range 2.1-3.8]). Among all types of AAPs, only puff-chandelier rupture (PCR) showed a significant difference in frequency between patients with and those without MACEs: 21 (75%) and 49 (35%), respectively (p < .001). Multivariable Cox proportional hazard analysis revealed that PCR (hazard ratio [HR] 3.73, 95% confidence interval [CI] 1.57-8.87, p = .004) and chronic kidney disease (HR 2.97, 95% CI 1.37-6.44, p = .010) were independent predictors of MACEs. Kaplan-Meier analysis revealed that PCR was significantly associated with more frequent MACEs.

CONCLUSION

The detection of PCR in the aorta using NOA was significantly associated with an increased risk of subsequent adverse events after PCI.