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Yeoh J, Kanyal R, Pareek N, Macaya F, Cannata S, Tzalamouras V, Webb I, Dworakowski R, Melikian N, Shah AM, MacCarthy P, Hill J, Byrne J. Intravascular lithotripsy in the treatment of coronary artery calcification in a high-risk real world population. Catheter Cardiovasc Interv 2023; 101:233-242. [PMID: 36617393 DOI: 10.1002/ccd.30546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/03/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The DISRUPT-CAD study series demonstrated feasibility and safety of intravascular lithotripsy (IVL) in selected patients, but applicability across a broad range of clinical scenarios remains unclear. AIMS This study aims to evaluate the procedural and clinical outcomes of IVL in a high-risk real-world cohort, compared to a regulatory approval cohort. METHODS Consecutive patients treated with IVL and percutaneous coronary intervention at our center from May 2016 to April 2020 were included. Comparison was made between those enrolled in the DISRUPT-CAD series of studies to those with calcified lesions but an exclusion criteria. RESULTS Among 177 patients treated with IVL, 142 were excluded from regulatory trials due to acute coronary syndrome presentation (47.2%), left ventricular ejection fraction <40% (22.5%), chronic renal failure (12.0%), or use of mechanical circulatory support (8.5%). This clinical cohort had a higher SYNTAX score (22.6 ± 12.1 vs. 17.4 ± 9.9, p = 0.019), and more treated ACC/AHA C lesions (56.3% vs. 37.1%, p = 0.042). Rates of device success (93.7% vs. 100.0%, p = 0.208), procedural success (96.5% vs. 100.0%, p = 0.585), and minimal lumen area gain (221.2 ± 93.7% vs. 198.6 ± 152.0%, p = 0.807) were similar in both groups. The DISRUPT-CAD cohort had no in-hospital mortality, 30-day major adverse cardiac events (MACE), or 30-day target vessel revascularization (TVR). The clinical cohort had an in-hospital mortality of 4.2%, 30-day MACE of 7.8%, and 30-day TVR of 1.5%. There was no difference in 12-month TVR (2.9% vs. 2.2%; p = 0.825). Twelve-month MACE was higher in the clinical cohort (21.1% vs. 8.6%, p = 0.03). CONCLUSION IVL use remains associated with high clinical efficacy, procedural success, and low complication rates in a real-world population previously excluded from regulatory approving trials.
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Affiliation(s)
- Julian Yeoh
- King's College Hospital NHS Foundation Trust, London, UK
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Ritesh Kanyal
- King's College Hospital NHS Foundation Trust, London, UK
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Ian Webb
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Ajay M Shah
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Jonathan Hill
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jonathan Byrne
- King's College Hospital NHS Foundation Trust, London, UK
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Liu YS, Wei M, Wang L, Liu G, Ma GP, Ono K, Cao ZL, Yang M, Zheng MQ. The impact of subclinical hypothyroidism on long-term outcomes in older patients undergoing percutaneous coronary intervention. BMC Endocr Disord 2021; 21:43. [PMID: 33673843 PMCID: PMC7934482 DOI: 10.1186/s12902-021-00702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is reportedly associated with an increased risk of adverse events in patients undergoing percutaneous coronary intervention (PCI). The prognostic significance of SCH in the elderly was poorly defined. The purpose of this study was to evaluate the association between SCH and long-term outcomes in older patients undergoing PCI. METHODS Three thousand one hundred sixty-eight patients aged 65 years or older who underwent PCI from January 2012 to October 2014 were included. Patients were divided into SCH group (n = 320) and euthyroidism (ET) group (n = 2848) based on thyroid function test. Cox proportional hazard regression analyses were used to estimate the relative risks (RRs) of all-cause death and cardiac death for patients with SCH during a 4-year follow-up period. RESULTS There were 227 deaths during the follow-up period including 124 deaths caused by cardiac events. There was no significant difference in mortality rate between the SCH group and the ET group (p > 0.05). After adjustment for covariates, compared with patients with ET, the RRs of death from all-cause and cardiac in patients with SCH were 1.261 (95%CI: 0.802-1.982, p = 0.315) and 1.231 (95%CI: 0.650-2.334, p = 0.524), respectively. When SCH was stratified by age, gender, and degree of thyroid-stimulating hormone elevation, no significant associations were also found in any stratum. CONCLUSION Our investigation revealed that SCH was negatively associated with the outcome of PCI in older patients.
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Affiliation(s)
- Yong-Sheng Liu
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Mei Wei
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Gang Liu
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Guo-Ping Ma
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Katsushige Ono
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ze-Long Cao
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Man Yang
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Ming-Qi Zheng
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China.
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Shah M, Najam O, Bhindi R, De Silva K. Calcium Modification Techniques in Complex Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2021; 14:e009870. [PMID: 33441017 DOI: 10.1161/circinterventions.120.009870] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention is the most common mode of revascularization and is increasingly undertaken in high-risk subsets, including the elderly. The presence of coronary artery calcification is increasingly observed and significantly limits technical success. The mechanisms for this are multi-factorial, including increased arterial wall stiffness and impaired delivery of devices, leading to suboptimal stent delivery, deployment, and expansion which are harbingers for increased risk of in-stent restenosis and stent thrombosis. Although conventional balloon pretreatment techniques aim to mitigate this risk by modifying the lesion before stent placement, many lesions remain resistant to conventional strategies, due to the severity of calcification. There have been several substantial technological advancements in calcium modification methods in recent years, which have allowed improved procedural success with low periprocedural complication rates. This review will summarize the current adjunctive modification technologies that can be employed to improve technical outcomes in percutaneous coronary intervention in calcific disease and the evidence supporting these tools.
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Affiliation(s)
- Mohammed Shah
- University College London, United Kingdom (M.S., O.N.)
| | - Osman Najam
- University College London, United Kingdom (M.S., O.N.)
| | | | - Kalpa De Silva
- St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, King's College London, United Kingdom (K.D.S.)
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Wang L, Cong H, Zhang J, Hu Y, Wei A, Zhang Y. Prognostic Value of Lipoprotein(a) Levels in Patients Undergoing Coronary Angiography for Premature Acute Coronary Syndromes. Angiology 2019; 71:160-166. [PMID: 31722547 DOI: 10.1177/0003319719886493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the association between lipoprotein(a) [Lp(a)] levels and future ischemic cardiovascular events in patients with premature acute coronary syndrome (ACS). A total of 1464 consecutive patients who underwent coronary angiography for premature ACS (males <45 years and females <55 years) were enrolled in this study. Patients were divided into quartiles according to serum Lp(a) levels (Q1: ≤11.1 nmol/L; Q2: 11.1-27.7 nmol/L; Q3: 27.7-79.3 nmol/L; and Q4: >79.3 nmol/L). Major adverse cardiovascular events (MACEs) increased with Lp(a) quartiles after 2-year follow-up (among quartiles, respectively; P = .001). Kaplan-Meier curves revealed significant differences in event-free survival rates among Lp(a) quartile groups ( P = .001). Multivariate Cox proportional hazards regression analysis indicated that serum Lp(a) level was an independent predictor of MACE either as a continuous variable (hazard ratio [HR]: 1.002, 95% confidence interval [CI]: 1.001-1.004; P = .009) or as a categorical variable (HR: 1.443, 95% CI: 1.074-1.937; P = .015). Furthermore, Lp(a) levels (as a variable) significantly improved the prognostic value for MACE. These findings suggest that Lp(a) measurement has value for cardiovascular risk stratification in patients with premature ACS.
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Affiliation(s)
- Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jingxia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yuecheng Hu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ao Wei
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yingyi Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Clinical and procedural predictors and short-term survival of the patients with no reflow phenomenon after primary percutaneous coronary intervention. Int J Cardiol 2019; 294:27-31. [DOI: 10.1016/j.ijcard.2019.07.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/04/2019] [Accepted: 07/22/2019] [Indexed: 11/24/2022]
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Abstract
Intravascular lithotripsy facilitates percutaneous coronary intervention of lesions with severe calcification by using high-pressure ultrasonic energy. It is the newest adjunctive tool for calcium modification and is showing promise as its users gather more experience and it becomes readily available worldwide. This article reviews intravascular lithotripsy technology, the evidence in the literature, and the advantages and disadvantages compared with other forms of calcium modification, and discusses its role in specific subsets of coronary lesions. It concludes with a discussion about the future direction of research involving this new technology as its role within percutaneous cardiac procedures becomes more defined.
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Affiliation(s)
- Julian Yeoh
- King's College Hospital NHS Foundation Trust, London SE59RS, UK
| | - Jonathan Hill
- King's College Hospital NHS Foundation Trust, London SE59RS, UK.
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Kalashnikova YS, Magilevets AI, Pek DV, Babkina KG, Zolotukhin PY, Grishin АA, Glomozda GA, Shvarev NY, Isayan MV, Schneider YA. [Early Invasive Strategy in Patients over 75 Years with Acute Coronary Syndrome. A Single Center Study]. KARDIOLOGIIA 2019; 59:15-24. [PMID: 31397226 DOI: 10.18087/cardio.2019.8.2662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE to assess the clinical status, comorbidities, complications, in-hospital mortality and its structure in dependence of age and type of acute coronary syndrome (ACS) in case of early invasive strategy of ACS management. MATERIALS AND METHODS we included in this retrospective study data of all patients (n=1353) with ACS subjected to emergency and urgent myocardial revascularization in High Medical Technologies Center (Kaliningrad, Russia) in 2014-2016. Age of 984 patients was <75 (group 1) and of 369 >75 years (group 2). RESULTS Mean age was 60±8.6 and 80.1±4.2 years, in groups 1 and 2, respectively. Anamnesis of group 2 patients was substantially burdened by myocardial infarction and stroke, they significantly more often had reduced left ventricular ejection fraction (EF), congestive heart failure, valve disorders, and atrial fibrillation. Patients of group 2 more frequently had severe manifestations of acute heart failure (AHF) and cardiogenic shock. Portions of patients with Killip class III were 5.9 and 11.4%, IV -2.1% and 9.1% in 1 and 2, respectively. Group 2 patients compared with those of group 1 had higher GRACE score and higher bleeding risk. In-hospital all-cause mortality was 3.1 and 10%, ST elevation myocardial infarction mortality - 2.6 and 9.5% in groups 1 and 2, respectively. Non-ST elevation myocardial infarction + unstable angina mortality (0.5%) did not differ between groups. Mortality from AHF (2 and 6.5%) and percutaneous coronary intervention complications (stent thrombosis and no-reflow) (0.5 and 2.4%) was significantly higher in group 2. AHF mortality was similar in patients with preserved and mid-range EF of both groups, but among those with reduced EF it was significantly higher in group 2 compared with group 1 (7.3 vs. 18.6%, respectively). There were no significant differences between groups in rates of gastro-intestinal and major bleedings. CONCLUSIONS Clinical course of ACS was more severe in patients aged >75 years compared with patients aged <75 years. Early invasive strategy was effective irrespective of patient's age and ACS type. Rate of fatal outcomes due to complications of stenting and AHF were higher among very elderly patients. AHF more often caused death in very elderly patients with reduced EF. The rest of the structure of complications and mortality was similar in patients of different ages.
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Affiliation(s)
| | - A I Magilevets
- Federal centers of High Medical Technologies Health Ministry
| | - D V Pek
- Federal centers of High Medical Technologies Health Ministry
| | - K G Babkina
- Federal centers of High Medical Technologies Health Ministry
| | - P Yu Zolotukhin
- Federal centers of High Medical Technologies Health Ministry
| | - А A Grishin
- Federal centers of High Medical Technologies Health Ministry
| | - G A Glomozda
- Federal centers of High Medical Technologies Health Ministry
| | - N Yu Shvarev
- Federal centers of High Medical Technologies Health Ministry
| | - M V Isayan
- Federal centers of High Medical Technologies Health Ministry
| | - Yu A Schneider
- Federal centers of High Medical Technologies Health Ministry
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A Calcific, Undilatable Stenosis. JACC Cardiovasc Interv 2017; 10:304-306. [DOI: 10.1016/j.jcin.2016.11.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022]
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De Silva K, Myat A, Cotton J, James S, Gershlick A, Stone GW. Bleeding associated with the management of acute coronary syndromes. Heart 2017; 103:546-562. [PMID: 28087588 DOI: 10.1136/heartjnl-2015-307602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Kalpa De Silva
- Department of Cardiology, King's College Hospital, London, UK
| | - Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - James Cotton
- Department of Cardiology, Heart and Lung Centre, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Anthony Gershlick
- Department of Cardiology, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, UK
| | - Gregg W Stone
- Department of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital, New York City, New York, USA
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Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y. Impact of Low Diastolic Blood Pressure on Risk of Cardiovascular Death in Elderly Patients With Coronary Artery Disease After Revascularization – The CREDO-Kyoto Registry Cohort-1 –. Circ J 2016; 80:1232-41. [DOI: 10.1253/circj.cj-15-1151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Kai
- Department of Cardiology, Kurume University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kenji Fukuda
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
- Department of Cerebrovascular Medicine, St. Mary’s Hospital
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
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