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Bradley CP, Orchard V, McKinley G, Heggie R, Wu O, Good R, Watkins S, Lindsay M, Eteiba H, McGowan J, McGeoch R, Corcoran D, Kellman P, McConnachie A, Berry C. The coronary microvascular angina cardiovascular magnetic resonance imaging trial: Rationale and design. Am Heart J 2023; 265:213-224. [PMID: 37657593 DOI: 10.1016/j.ahj.2023.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction may cause myocardial ischemia with no obstructive coronary artery disease (INOCA). If functional testing is not performed INOCA may pass undetected. Stress perfusion cardiovascular MRI (CMR) quantifies myocardial blood flow (MBF) but the clinical utility of stress CMR in the management of patients with suspected angina with no obstructive coronary arteries (ANOCA) is uncertain. OBJECTIVES First, to undertake a diagnostic study using stress CMR in patients with ANOCA following invasive coronary angiography and, second, in a nested, double-blind, randomized, controlled trial to assess the effect of disclosure on the final diagnosis and health status in the longer term. DESIGN All-comers referred for clinically indicated coronary angiography for the investigation of suspected coronary artery disease will be screened in 3 regional centers in the United Kingdom. Following invasive coronary angiography, patients with ANOCA who provide informed consent will undergo noninvasive endotyping using stress CMR within 3 months of the angiogram. DIAGNOSTIC STUDY Stress perfusion CMR imaging to assess the prevalence of coronary microvascular dysfunction and clinically significant incidental findings in patients with ANOCA. The primary outcome is the between-group difference in the reclassification rate of the initial diagnosis based on invasive angiography versus the final diagnosis after CMR imaging. RANDOMIZED, CONTROLLED TRIAL Participants will be randomized to inclusion (intervention group) or exclusion (control group) of myocardial blood flow to inform the final diagnosis. The primary outcome of the clinical trial is the mean within-subject change in the Seattle Angina Questionnaire summary score (SAQSS) at 6 months. Secondary outcome assessments include the EUROQOL EQ-5D-5L questionnaire, the Brief Illness Perception Questionnaire (Brief-IPQ), the Treatment Satisfaction Questionnaire (TSQM-9), the Patient Health Questionnaire-4 (PHQ-4), the Duke Activity Status Index (DASI), the International Physical Activity Questionnaire- Short Form (IPAQ-SF), the Montreal Cognitive Assessment (MOCA) and the 8-item Productivity Cost Questionnaire (iPCQ). Health and economic outcomes will be assessed using electronic healthcare records. VALUE To clarify if routine stress perfusion CMR imaging reclassifies the final diagnosis in patients with ANOCA and whether this strategy improves symptoms, health-related quality of life and health economic outcomes. CLINICALTRIALS GOV: NCT04805814.
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Affiliation(s)
- Conor P Bradley
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK; Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - Vanessa Orchard
- Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - Gemma McKinley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Richard Good
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK; Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - Stuart Watkins
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK; Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - Mitchell Lindsay
- Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - Hany Eteiba
- Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK
| | - James McGowan
- Department of Cardiology, University Hospital Ayr, Ayr, UK
| | - Ross McGeoch
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, Scotland, UK
| | - David Corcoran
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK; Department of Cardiology, NHS Golden Jubilee Hospital, Clydebank, Scotland, UK.
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Ohashi H, Collison D, Mizukami T, Didagelos M, Sakai K, Aetesam-ur-Rahman M, Munhoz D, McCartney P, Ford TJ, Lindsay M, Shaukat A, Rocchiccioli P, Brogan R, Watkins S, McEntegart M, Good R, Robertson K, O’Boyle P, Davie A, Khan A, Hood S, Eteiba H, Amano T, Sonck J, Berry C, De Bruyne B, Oldroyd KG, Collet C. Fractional Flow Reserve-Guided Stent Optimisation in Focal and Diffuse Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2612. [PMID: 37568975 PMCID: PMC10417445 DOI: 10.3390/diagnostics13152612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was <0.90. Overall, 114 patients (n = 61 PIOS and 53 controls) with both pre-PCI fractional flow reserve (FFR) pullbacks and post-PCI FFR were included. A PPG ≥ 0.74 defined focal CAD. The PPG correlated significantly with post-PCI FFR (r = 0.43; 95% CI 0.26 to 0.57; p-value < 0.001) and normalised delta FFR (r = 0.49; 95% CI 0.34 to 0.62; p-value < 0.001). PIOS was more frequently applied to vessels with diffuse CAD (6% focal vs. 42% diffuse; p-value = 0.006). In patients randomized to PIOS, those with focal disease achieved higher post-PCI FFR than patients with diffuse CAD (0.93 ± 0.05 vs. 0.83 ± 0.07, p < 0.001). There was a significant interaction between CAD patterns and the randomisation arm for post-PCI FFR (p-value for interaction = 0.004). Physiology-guided stent optimisation was applied more frequently to vessels with diffuse disease; however, patients with focal CAD at baseline achieved higher post-PCI FFR.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo 157-8577, Japan
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu 500-8384, Japan
| | - Matthaios Didagelos
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Showa University Hospital, Tokyo 142-8666, Japan
| | - Muhammad Aetesam-ur-Rahman
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Peter McCartney
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Thomas J. Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
- Faculty of Medicine, University of Newcastle, Central Coast Campus, Ourimbah, NSW 2258, Australia
| | - Mitchell Lindsay
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Aadil Shaukat
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Paul Rocchiccioli
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Richard Brogan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Stuart Watkins
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Margaret McEntegart
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard Good
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Keith Robertson
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Patrick O’Boyle
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Andrew Davie
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Adnan Khan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Stuart Hood
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
| | - Hany Eteiba
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
| | - Colin Berry
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
- Department of Cardiology, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Keith G. Oldroyd
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; (D.C.); (M.D.); (M.A.-u.-R.); (P.M.); (M.L.); (A.S.); (P.R.); (R.B.); (S.W.); (M.M.); (R.G.); (K.R.); (P.O.); (A.D.); (A.K.); (S.H.); (H.E.); (C.B.); (K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (H.O.); (K.S.); (D.M.); (J.S.); (B.D.B.); (C.C.)
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Collison D, Copt S, Mizukami T, Collet C, McLaren R, Didagelos M, Aetesam-Ur-Rahman M, McCartney P, Ford TJ, Lindsay M, Shaukat A, Rocchiccioli P, Brogan R, Watkins S, McEntegart M, Good R, Robertson K, O'Boyle P, Davie A, Khan A, Hood S, Eteiba H, Berry C, Oldroyd KG. Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors. Circ Cardiovasc Interv 2023; 16:e012511. [PMID: 36974680 PMCID: PMC10101135 DOI: 10.1161/circinterventions.122.012511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and procedural factors associated with post-PCI angina may inform alternative approaches to treatment. METHODS Two hundred thirty patients undergoing PCI completed the Seattle Angina Questionnaire (SAQ-7) and European quality of life-5 dimension-5 level (EQ-5D-5L) questionnaires at baseline and 3 months post-PCI. Patients received blinded intracoronary physiology assessments before and after stenting. A post hoc analysis was performed to compare clinical and procedural characteristics among patients with and without post-PCI angina (defined by follow-up SAQ-angina frequency score <100). RESULTS Eighty-eight of 230 patients (38.3%) reported angina 3 months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and history of previous myocardial infarction or PCI. Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59, P<0.001) and EQ-5D-5L health index scores (0.84±0.15 versus 0.69±0.22, P<0.001). Pre-PCI fractional flow reserve (FFR) was lower among patients who had no post-PCI angina (0.56±0.15 versus 0.62±0.13, P=0.003). Percentage change in FFR after PCI had a moderate correlation with angina frequency score at follow-up (r=0.36, P<0.0001). Patients with post-PCI angina had less improvement in FFR (43.1±33.5% versus 67.0±50.7%, P<0.001). There were no between-group differences in post-PCI FFR, coronary flow reserve, or corrected index of microcirculatory resistance. Patients with post-PCI angina had lower SAQ-summary scores (64.01±22 versus 95.16±8.72, P≤0.001) and EQ-5D-5L index scores (0.69±0.26 versus 0.91±0.17, P≤0.001) at follow-up. CONCLUSIONS Larger improvements in FFR following PCI were associated with less angina and better quality of life at follow-up. In patients with stable symptoms, intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03259815.
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Affiliation(s)
- Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | | | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Belgium (T.M., C.C.)
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Belgium (T.M., C.C.)
| | - Ruth McLaren
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Matthaios Didagelos
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Muhammad Aetesam-Ur-Rahman
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Peter McCartney
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Thomas J Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Mitchell Lindsay
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Aadil Shaukat
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Paul Rocchiccioli
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Richard Brogan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Stuart Watkins
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Margaret McEntegart
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Richard Good
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Keith Robertson
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Patrick O'Boyle
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Andrew Davie
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Adnan Khan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Stuart Hood
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
| | - Hany Eteiba
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Colin Berry
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
| | - Keith G Oldroyd
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.)
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.)
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4
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Ford TJ, Adamson C, Morrow AJ, Rocchiccioli P, Collison D, McCartney PJ, Shaukat A, Lindsay M, Good R, Watkins S, Eteiba H, Robertson K, Berry C, Oldroyd KG, McEntegart M. Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study. J Am Heart Assoc 2022; 11:e024492. [PMID: 36129052 DOI: 10.1161/jaha.121.024492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (r=0.73; P<0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), P<0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; P<0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; P=0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Clinicaltrials.gov. Identifier: NCT03862352.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
- Faculty of Medicine University of Newcastle Callaghan NSW Australia
| | - Carly Adamson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Andrew J Morrow
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Damien Collison
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Peter J McCartney
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Richard Good
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
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5
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He W, McCarroll CS, Nather K, Ford K, Mangion K, Riddell A, O’Toole D, Zaeri A, Corcoran D, Carrick D, Lee MMY, McEntegart M, Davie A, Good R, Lindsay MM, Eteiba H, Rocchiccioli P, Watkins S, Hood S, Shaukat A, McArthur L, Elliott EB, McClure J, Hawksby C, Martin T, Petrie MC, Oldroyd KG, Smith GL, Channon KM, Berry C, Nicklin SA, Loughrey CM. Inhibition of myocardial cathepsin-L release during reperfusion following myocardial infarction improves cardiac function and reduces infarct size. Cardiovasc Res 2022; 118:1535-1547. [PMID: 34132807 PMCID: PMC9074968 DOI: 10.1093/cvr/cvab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Identifying novel mediators of lethal myocardial reperfusion injury that can be targeted during primary percutaneous coronary intervention (PPCI) is key to limiting the progression of patients with ST-elevation myocardial infarction (STEMI) to heart failure. Here, we show through parallel clinical and integrative preclinical studies the significance of the protease cathepsin-L on cardiac function during reperfusion injury. METHODS AND RESULTS We found that direct cardiac release of cathepsin-L in STEMI patients (n = 76) immediately post-PPCI leads to elevated serum cathepsin-L levels and that serum levels of cathepsin-L in the first 24 h post-reperfusion are associated with reduced cardiac contractile function and increased infarct size. Preclinical studies demonstrate that inhibition of cathepsin-L release following reperfusion injury with CAA0225 reduces infarct size and improves cardiac contractile function by limiting abnormal cardiomyocyte calcium handling and apoptosis. CONCLUSION Our findings suggest that cathepsin-L is a novel therapeutic target that could be exploited clinically to counteract the deleterious effects of acute reperfusion injury after an acute STEMI.
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Affiliation(s)
| | | | - Katrin Nather
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Kristopher Ford
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Alexandra Riddell
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Dylan O’Toole
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ali Zaeri
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - David Corcoran
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mathew M Y Lee
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mitchell M Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Lisa McArthur
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Elspeth B Elliott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - John McClure
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Catherine Hawksby
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Tamara Martin
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | | | - Keith M Channon
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart A Nicklin
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow G12 8TA, UK
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6
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Bulluck H, Carberry J, Carrick D, McCartney PJ, Maznyczka AM, Greenwood JP, Maredia N, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, McEntegart M, Petrie MC, Eteiba H, Watkins S, Lindsay M, Mahrous A, Oldroyd KG, Berry C. A Noncontrast CMR Risk Score for Long-Term Risk Stratification in Reperfused ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:431-440. [PMID: 35272808 DOI: 10.1016/j.jcmg.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure. BACKGROUND A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI). METHODS The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score. RESULTS There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score. CONCLUSIONS This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).
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Affiliation(s)
- Heerajnarain Bulluck
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; University of East Anglia, Norwich, United Kingdom; Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | | | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Neil Maredia
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Saqib Chowdhary
- South Manchester Hospitals NHS Trust, Manchester, United Kingdom
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - James M Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom
| | - Andrew Wragg
- Barts and the London Hospital, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton Foundation Trust, Southampton, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
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7
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Routledge H, Sharp AS, Kovac J, Westwood M, Keeble TR, Bathula R, Eteiba H, Grunwald IQ, Curzen N. Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group. Interv Cardiol 2022; 17:e07. [PMID: 35774864 PMCID: PMC9214600 DOI: 10.15420/icr.2021.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022] Open
Abstract
There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.
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Affiliation(s)
| | - Andrew Sp Sharp
- University Hospital of Wales Cardiff, Wales, UK.,University of Exeter Exeter, UK
| | - Jan Kovac
- University Hospitals of Leicester NHS Trust Leicester, UK
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin University Chelmsford, Essex, UK
| | - Raj Bathula
- London North West University Healthcare NHS Trust London, UK
| | - Hany Eteiba
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital Glasgow, Scotland, UK
| | - Iris Q Grunwald
- University of Dundee Dundee, Scotland, UK.,Cardiovascular Center Frankfurt Frankfurt, Germany
| | - Nick Curzen
- Faculty of Medicine, University of Southampton Southampton, UK.,Cardiothoracic Unit, University Hospital Southampton Southampton, UK
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8
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Rishad S, McENTEGART M, Ford TJ, DI-Mario C, Fajadet J, Lindsay M, Watkins S, Eteiba H, Brogan R, Good R, Oldroyd KG. Comparative study of costs and resource utilisation of rotational atherectomy versus intravascular lithotripsy for percutaneous coronary intervention. Minerva Cardiol Angiol 2021; 70:332-340. [PMID: 34761665 DOI: 10.23736/s2724-5683.21.05681-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) for the modification of heavily calcified coronary stenoses prior to percutaneous coronary intervention (PCI). We compare the real-world resource utilisation and associated costs of PCI with adjunctive RA and IVL. METHODS We compared the resource utilisation, in-lab consumable costs and procedural data of 120 patients who underwent PCI with IVL from the Disrupt-CAD II study (NCT03328949) to 60 patients who underwent PCI with RA at the Golden Jubilee National Hospital, Glasgow. The RA patients were consecutive and selected on the basis of being deemed suitable for IVL by an independent interventional cardiologist experienced in the use of both techniques. RESULTS PCI with IVL was associated with significantly lower costs than PCI with RA (mean difference £398 [95% CI, £181-£615]; p<0.001). Considering between-group differences, the IVL group used 4.02 fewer balloons (p<0.001), 3.03 fewer guidewires (p<0.001), 0.52 fewer guide catheters (p=0.001), 0.22 fewer guide extensions (p=0.004) and 1.03 fewer drug eluting stents (DES) (p<0.001) per case than the RA group. The IVL group had shorter procedural duration (mean difference 13.3 min [95% CI, 3.6-23.0]; p=0.008) but longer fluoroscopy times (mean difference 4.4 min [95% CI, 1.7-7.1]; p=0.002). CONCLUSIONS In this indirect comparison, we found that the higher initial device costs of IVL may be offset by a lower overall resource utilisation. Further research is required to confirm this, and future randomised trials should include a formal health economic analysis.
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Affiliation(s)
- Shafeer Rishad
- University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McENTEGART
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.,Faculty of Medicine, University of Newcastle NSW, Newcastle, Australia
| | - Carlo DI-Mario
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Brogan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Keith G Oldroyd
- University of Glasgow, Glasgow, UK - .,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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9
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McCartney P, Ang D, Mangion K, Maznyczka A, McEntegart M, Eteiba H, Greenwood J, Muir D, Chowdhary S, Appleby C, Cotton J, Wragg A, Curzen N, Oldroyd K, Good R, Robertson K, Ford T, Collison D, Gillespie L, Petrie M, Weir R, Macfarlane P, Ford I, McConnachie A, Berry C. TCT-189 Effect of Low-Dose Intracoronary Alteplase on Global Circumferential Strain: Myocardial Strain Cardiovascular Magnetic Resonance Substudy of the T-TIME Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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McCartney P, Ang D, Mangion K, McEntegart M, Greenwood JP, Muir D, Chowdhary S, Appleby C, Cotton JM, Eteiba H, Oldroyd KG, Maznyczka A, Radjenovic A, McConnachie A, Berry C. Effect of low dose intracoronary alteplase on global circumferential strain (myocardial strain CMR substudy from the T-TIME trial). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Microvascular obstruction affects half of patients with ST-segment elevation myocardial infarction (STEMI) and confers an adverse prognosis. Feature-tracking (FT) cardiac magnetic resonance (CMR) allows myocardial strain assessment from standard cine images without the need for specialist sequences. Myocardial strain reflects both systolic and diastolic function allowing the assessment of both global and regional myocardial deformation. Strain recovery is impaired in patients with microvascular obstruction. There is growing evidence to suggest that global circumferential strain may offer incremental value beyond traditional CMR endpoints.
Purpose
We aimed to determine whether a therapeutic strategy involving low-dose intracoronary alteplase improves global circumferential strain in STEMI.
Methods
Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the United Kingdom within 6 hours of STEMI were randomised in a 1:1:1 dose-ranging trial design. Participants were randomly assigned to treatment with placebo (n=151), alteplase 10mg (n=144), or alteplase 20mg (n=145). The primary outcome was the amount of microvascular obstruction (%left ventricular mass) quantified by CMR at 2–7 days. Global circumferential strain was a prespecified secondary endpoint measured at 2–7 days and 3 months. Troponin T AUC was measured at 0, 2, and 24 hours post reperfusion. Patients were followed up to 1 year with all events adjudicated by an independent committee.
Results
Among the 440 patients who were randomised (mean age 60.5 years; 85% male), the primary endpoint was achieved in 396 (90%), all patients were followed up to 1 year for clinical events. The amount (mean, standard deviation) of microvascular obstruction was not different between the groups (2.3% vs. 2.6% vs. 3.5% left ventricular mass); p=0.28. Global circumferential strain was worse in patients receiving alteplase. −23.1% (placebo) vs −20.6 (10mg alteplase) vs −22.0% (20mg alteplase); mean difference for both doses combined vs placebo: 1.8% (95% CI 0.5, 3.2), p=0.009. There were no differences between groups in the other CMR endpoints including LV ejection fraction (LVEF). The area-under-the-curve for troponin T measured in 317 (72%) patients was increased in both treatment groups compared to placebo, mean difference 1.53 (95% CI: 1.16, 2.01), p=0.002. There were no differences in MACE at 1 year; placebo n=16 (10.6%), 10mg alteplase n=22 (15.3%), 20mg alteplase group n=15 (10.3%).
Conclusion
In patients presenting within 6 hours of STEMI, low-dose intracoronary alteplase compared with placebo did not reduce microvascular obstruction. There was a reduction in global circumferential strain and an increase in Troponin T AUC supporting an increase in myocardial injury early after reperfusion in patients receiving alteplase. There was no differences in MACE at one year suggesting no long-term clinical sequelae.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): T-TIME was supported by grant 12/170/4 from the Efficacy and Mechanism Evaluation (EME) programme of the National Institute for Health Research (NIHR-EME). Boehringer-Ingelheim U.K. Ltd. provided the study drugs (alteplase 10mg, 20mg), matched placebo, and sterile water for injection. Study recruitment flowchartTable- Study endpoints
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Affiliation(s)
- P McCartney
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - D Ang
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - K Mangion
- University of Glasgow, ICAMS, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | | | - D Muir
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - S Chowdhary
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - C Appleby
- Cardiothoracic Centre Trust of Liverpool, Liverpool, United Kingdom
| | - J M Cotton
- New Cross Hospital, Wolverhampton, United Kingdom
| | - H Eteiba
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - K G Oldroyd
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - A Maznyczka
- Golden Jubilee national hospital, Glasgow, United Kingdom
| | - A Radjenovic
- University of Glasgow, ICAMS, Glasgow, United Kingdom
| | - A McConnachie
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - C Berry
- University of Glasgow, ICAMS, Glasgow, United Kingdom
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11
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Collison D, Didagelos M, Aetesam-Ur-Rahman M, Copt S, McDade R, McCartney P, Ford TJ, McClure J, Lindsay M, Shaukat A, Rocchiccioli P, Brogan R, Watkins S, McEntegart M, Good R, Robertson K, O'Boyle P, Davie A, Khan A, Hood S, Eteiba H, Berry C, Oldroyd KG. Post-stenting fractional flow reserve vs coronary angiography for optimisation of percutaneous coronary intervention: TARGET-FFR trial. Eur Heart J 2021; 42:4656-4668. [PMID: 34279606 PMCID: PMC8634564 DOI: 10.1093/eurheartj/ehab449] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/29/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Aims A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval −1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (−11.2%, 95% confidence interval −21.87 to −0.35], P = 0.045). Conclusion Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.
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Affiliation(s)
- Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Matthaios Didagelos
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Muhammad Aetesam-Ur-Rahman
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Samuel Copt
- University of Geneva, 24 rue de Général-Dufour, 1211 Genève 4, Switzerland
| | - Robert McDade
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Peter McCartney
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Thomas J Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - John McClure
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Mitchell Lindsay
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Aadil Shaukat
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Paul Rocchiccioli
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Richard Brogan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Stuart Watkins
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Margaret McEntegart
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Richard Good
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Keith Robertson
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Patrick O'Boyle
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Andrew Davie
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Adnan Khan
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Stuart Hood
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Hany Eteiba
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Colin Berry
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Keith G Oldroyd
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
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12
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Maznyczka A, Carrick D, Oldroyd KG, James-Rae G, McCartney P, Greenwood J, Good R, McEntegart MB, Eteiba H, Lindsay M, Cotton J, Petrie M, Berry C. Thermodilution-derived temperature recovery time: a novel predictor of microvascular reperfusion and prognosis after myocardial infarction. EUROINTERVENTION 2021; 17:220-228. [PMID: 32122822 PMCID: PMC9724875 DOI: 10.4244/eij-d-19-00904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Novel parameters that detect failed microvascular reperfusion might identify better the patients likely to benefit from adjunctive treatments during primary percutaneous coronary intervention (PCI). AIMS The aim of this study was to test the hypothesis that a novel invasive parameter, the thermodilution-derived temperature recovery time (TRT), would be associated with microvascular obstruction (MVO) and prognosis. METHODS TRT was derived and validated in two independent ST-elevation myocardial infarction populations and was measured immediately post PCI. TRT was defined as the duration (seconds) from the nadir of the hyperaemic thermodilution curve to 20% from baseline body temperature. MVO extent (% left ventricular mass) was assessed by cardiovascular magnetic resonance imaging at 2-7 days. RESULTS In the retrospective derivation cohort (n=271, mean age 60±12 years, 72% male), higher TRT was associated with more MVO (coefficient: 4.09 [95% CI: 2.70-5.48], p<0.001), independently of IMR >32, CFR ≤2, hyperaemic Tmn >median, thermodilution waveform, age and ischaemic time. At five years, higher TRT was multivariably associated with all-cause death/heart failure hospitalisation (OR 4.14 [95% CI: 2.08-8.25], p<0.001) and major adverse cardiac events (OR 4.05 [95% CI: 2.00-8.21], p<0.001). In the validation population (n=144, mean age 59±11 years, 80% male), the findings were confirmed prospectively. CONCLUSIONS TRT represents a novel diagnostic advance for predicting MVO and prognosis. ClinicalTrials.gov Identifiers: NCT02072850 & NCT02257294 Visual summary. Thermodilution-derived temperature recovery time (TRT): a novel predictor of microvascular reperfusion & prognosis after STEMI. CMR: cardiovascular magnetic resonance; MACE: major adverse cardiac events; MVO: microvascular obstruction; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction.
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Affiliation(s)
- Annette Maznyczka
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom,Portsmouth University Hospitals NHS Trust, Portsmouth, United Kingdom
| | - David Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G. Oldroyd
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Greg James-Rae
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Peter McCartney
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - John Greenwood
- Leeds University and Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Margaret B. McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - James Cotton
- Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom
| | - Mark Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, United Kingdom
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13
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Maznyczka AM, McCartney PJ, Oldroyd KG, Lindsay M, McEntegart M, Eteiba H, Rocchiccioli JP, Good R, Shaukat A, Robertson K, Malkin CJ, Greenwood JP, Cotton JM, Hood S, Watkins S, Collison D, Gillespie L, Ford TJ, Weir RAP, McConnachie A, Berry C. Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e009529. [PMID: 33591821 DOI: 10.1161/circinterventions.120.009529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown. METHODS IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year. RESULTS IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17-55), the median LVEDP was 17 mm Hg (interquartile range, 12-21), and the correlation between them was not statistically significant (r=0.15; P=0.087). Fifty-three patients (40%) had low IMR (≤32) and low LVEDP (≤18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade ≤1, TIMI (Thrombolysis In Myocardial Infarction) flow grade ≤2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events; P=0.045) and major adverse cardiac events (n=21 events; P=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60-21.22] P=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7-98.2; P=0.033) when LVEDP>18 was added to IMR>32. CONCLUSIONS IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - J Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Christopher J Malkin
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (C.J.M., J.P.G.)
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.M.C.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Damien Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Lynsey Gillespie
- Project Management Unit, Greater Glasgow and Clyde Health Board, United Kingdom (L.G.)
| | - Thomas J Ford
- Faculty of Medicine, University of Newcastle, Callaghan NSW, Australia (T.J.F.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
| | - Robin A P Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom (R.A.P.W.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (A.M.), University of Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (A.M.M., P.J.M., K.G.O., M.M., H.E., D.C., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., P.J.M., K.G.O., M.L., M.M., H.E., J.P.R., R.G., A.S., K.R., S.H., S.W., D.C., T.J.F., C.B.)
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14
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Maznyczka AM, McCartney P, Duklas P, McEntegart M, Oldroyd KG, Greenwood JP, Muir D, Chowdhary S, Gershlick AH, Appleby C, Eteiba H, Cotton J, Wragg A, Curzen N, Tait RC, MacFarlane P, Welsh P, Sattar N, Petrie MC, Ford I, Fox KAA, McConnachie A, Berry C. Effect of coronary flow on intracoronary alteplase: a prespecified analysis from a randomised trial. Heart 2021; 107:heartjnl-2020-317828. [PMID: 33436493 DOI: 10.1136/heartjnl-2020-317828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Persistently impaired culprit artery flow ( METHODS In T-TIME (trial of low-dose adjunctive alTeplase during primary PCI), patients ≤6 hours from onset of ST-elevation myocardial infarction (STEMI) were randomised to placebo, alteplase 10 mg or alteplase 20 mg, administered by infusion into the culprit artery, pre-stenting. In this prespecified, secondary analysis, coronary flow was assessed angiographically at the point immediately before drug administration. Microvascular obstruction, myocardial haemorrhage and infarct size were assessed by cardiovascular magnetic resonance (CMR) at 2-7 days and 3 months. RESULTS TIMI flow was assessed after first treatment (balloon angioplasty/aspiration thrombectomy), immediately pre-drug administration, in 421 participants (mean age 61±10 years, 85% male) and was 3, 2 or 1 in 267, 134 and 19 participants respectively. In patients with TIMI flow ≤2 pre-drug, there was higher incidence of microvascular obstruction with alteplase (alteplase 20 mg (53.1%) and 10 mg (59.5%) combined versus placebo (34.1%); OR=2.47 (95% CI 1.16 to 5.22, p=0.018) interaction p=0.005) and higher incidence of myocardial haemorrhage (alteplase 20 mg (53.1%) and 10 mg (57.9%) combined vs placebo (27.5%); OR=3.26 (95% CI 1.44 to 7.36, p=0.004) interaction p=0.001). These effects were not observed in participants with TIMI 3 flow pre-drug. There were no interactions between TIMI flow pre-drug, alteplase and 3-month CMR findings. CONCLUSION In patients with impaired culprit artery flow ( TRIAL REGISTRATION NUMBER NCT02257294.
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Affiliation(s)
- Annette Marie Maznyczka
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter McCartney
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
| | - Patrycja Duklas
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Keith G Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John P Greenwood
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Douglas Muir
- James Cook University Hospital, Middlesbrough, UK
| | | | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Hany Eteiba
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
| | - James Cotton
- Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | | | - Nick Curzen
- Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Campbell Tait
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keith A A Fox
- Department of Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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15
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Ford T, Yii E, Morrow A, Sidik N, Good R, Rocchiccioli J, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, Oldroyd K, Berry C. Angina, quality of life and prognosis: prospective comparison of patients undergoing invasive management. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Angina is associated with impaired quality of life and an adverse prognosis.
Purpose
Prospectively evaluate quality of life and clinical outcomes in patients with angina undergoing invasive coronary angiography according to endotype: symptoms and/or signs of ischaemia and no obstructive coronary artery disease (INOCA) compared to obstructive coronary artery disease subjects managed by medical therapy, revascularization with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery, respectively.
Methods
We conducted a prospective clinical evaluation of patients with angina undergoing clinically indicated invasive management (NCT03193294). Symptom severity and quality of life were assessed at baseline and repeated after 6 months. Comparisons between treatment groups were based on analysis of covariance general linear models adjusting for baseline score, sex, and cardiovascular risk. INOCA subjects were considered as one diagnostic group and not all subjects had invasive vasoreactivity testing.
Results
391 patients (mean age 62±10 years, 52% female) were enrolled over 12 months and classified into one of four groups: INOCA (N=185; 47%), obstructive CAD treated by PCI (N=126; 32%), obstructive CAD treated by CABG (N=48; 12%) and obstructive CAD managed with medical therapy (N=32; 8%). After adjusting for between group differences and overall risk, INOCA subjects had worse angina and worse treatment response at follow up (21% and 27% reduction in angina score compared to CAD patients revascularized with PCI and CABG respectively). INOCA subjects had numerically lower treatment response than CAD patients managed with medications (6.4 units, −12%; P=0.181). Population baseline mean Seattle Angina Questionnaire (SAQ) frequency score (60±26) and SAQ summary score (52.5±19) were similar between groups. The absolute difference was 6.4 units versus medically managed CAD (95% CI: −3.0 to 15.9; P=0.181), 11.3 units versus the CAD group undergoing PCI (6.1 to 16.5; P<0.001) and 14.3 units versus CABG (6.2 to 22.3; P=0.001). INOCA subjects had overall reduced quality of life (EQ5D index) and increased psychological distress scores versus all CAD groups at 6 months. During longer-term follow-up (median 18 months), 23 (6%) MACE events occurred with no differences between the groups (Kaplan Meier log-rank P=0.890).
Conclusion(s)
Patients with INOCA had more severe angina symptoms reflecting worse quality of life and treatment response at 6 months with similar MACE as CAD subjects even after adjustment for confounding factors. This study highlights the need for evidence-based antianginal therapies and disease-modifying treatments for angina patients regardless of the presence of obstructive coronary disease.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This work was funded by the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/6134217)
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Affiliation(s)
- T.J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - E Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - A Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - N Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - M McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - S Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - H Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M.M Lindsay
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - K Robertson
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S Hood
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - K.G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
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16
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McCartney P, Maznyczka A, McEntegart M, Eteiba H, Greenwood J, Muir D, Chowdhary S, Gershlick A, Appleby C, Cotton J, Wragg A, Curzen N, Oldroyd K, Lindsay M, Rocchiccioli P, Shaukat A, Good R, Watkins S, Robertson K, Malkin CJ, Collison D, Gillespie L, Martin L, Ford T, Petrie M, Weir R, Murphy A, Petrie C, Wetherall K, Macfarlane P, McConnachie A, Berry C. TCT CONNECT-28 Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction, Association With Infarct Pathology, Left Ventricular Function, and Health Outcomes. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Maznyczka A, McCartney P, Duklas P, Greenwood J, Muir D, Chowdhary S, Curzen N, McEntegart M, Oldroyd K, Gershlick A, Appleby C, Tait C, Cotton J, Wragg A, Sattar N, Fox K, Eteiba H, McConnachie A, Berry C. TCT CONNECT-16 Implications of Impaired Coronary Flow on the Effects of Intracoronary Alteplase During Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Ford TJ, Corcoran D, Padmanabhan S, Aman A, Rocchiccioli P, Good R, McEntegart M, Maguire JJ, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, Sattar N, Hsu LY, Arai AE, Oldroyd KG, Touyz RM, Davenport AP, Berry C. Genetic dysregulation of endothelin-1 is implicated in coronary microvascular dysfunction. Eur Heart J 2020; 41:3239-3252. [PMID: 31972008 PMCID: PMC7557475 DOI: 10.1093/eurheartj/ehz915] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/12/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Endothelin-1 (ET-1) is a potent vasoconstrictor peptide linked to vascular diseases through a common intronic gene enhancer [(rs9349379-G allele), chromosome 6 (PHACTR1/EDN1)]. We performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction (CMD) in patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease (CAD). METHODS AND RESULTS Three hundred and ninety-one patients with angina were enrolled. Of these, 206 (53%) with obstructive CAD were excluded leaving 185 (47%) eligible. One hundred and nine (72%) of 151 subjects who underwent invasive testing had objective evidence of CMD (COVADIS criteria). rs9349379-G allele frequency was greater than in contemporary reference genome bank control subjects [allele frequency 46% (129/280 alleles) vs. 39% (5551/14380); P = 0.013]. The G allele was associated with higher plasma serum ET-1 [least squares mean 1.59 pg/mL vs. 1.28 pg/mL; 95% confidence interval (CI) 0.10-0.53; P = 0.005]. Patients with rs9349379-G allele had over double the odds of CMD [odds ratio (OR) 2.33, 95% CI 1.10-4.96; P = 0.027]. Multimodality non-invasive testing confirmed the G allele was associated with linked impairments in myocardial perfusion on stress cardiac magnetic resonance imaging at 1.5 T (N = 107; GG 56%, AG 43%, AA 31%, P = 0.042) and exercise testing (N = 87; -3.0 units in Duke Exercise Treadmill Score; -5.8 to -0.1; P = 0.045). Endothelin-1 related vascular mechanisms were assessed ex vivo using wire myography with endothelin A receptor (ETA) antagonists including zibotentan. Subjects with rs9349379-G allele had preserved peripheral small vessel reactivity to ET-1 with high affinity of ETA antagonists. Zibotentan reversed ET-1-induced vasoconstriction independently of G allele status. CONCLUSION We identify a novel genetic risk locus for CMD. These findings implicate ET-1 dysregulation and support the possibility of precision medicine using genetics to target oral ETA antagonist therapy in patients with microvascular angina. TRIAL REGISTRATION ClinicalTrials.gov: NCT03193294.
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Affiliation(s)
- Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- Department of Cardiology, Gosford Hospital, NSW, Australia
- Faculty of Medicine, University of Newcastle, NSW, Australia
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Sandosh Padmanabhan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Alisha Aman
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Richard Good
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Janet J Maguire
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Addenbrooke's Centre for Clinical Investigation (ACCI), Box 110, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Ross McGeoch
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McDade
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Li-Yueh Hsu
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Anthony P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Addenbrooke's Centre for Clinical Investigation (ACCI), Box 110, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
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19
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Mangion K, Loughrey CM, Auger DA, McComb C, Lee MM, Corcoran D, McEntegart M, Davie A, Good R, Lindsay M, Eteiba H, Rocchiccioli P, Watkins S, Hood S, Shaukat A, Haig C, Epstein FH, Berry C. Displacement Encoding With Stimulated Echoes Enables the Identification of Infarct Transmurality Early Postmyocardial Infarction. J Magn Reson Imaging 2020; 52:1722-1731. [PMID: 32720405 DOI: 10.1002/jmri.27295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post-ST-segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. HYPOTHESIS We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature-tracking strain, and noninferior to extracellular volume fraction (ECV). STUDY TYPE Prospective. POPULATION Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post-STEMI. FIELD-STRENGTH/SEQUENCES 1.5T/cine, DENSE, T1 mapping, ECV, LGE. ASSESSMENT Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature-tracking, T1 relaxation times, and ECV. STATISTICAL TESTS Normality was tested using the Shapiro-Wilk test. Skewed distributions were analyzed utilizing Mann-Whitney or Kruskal-Wallis tests and normal distributed data using independent t-tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z-statistic. RESULTS Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0.9 [0.8, 0.9], -10%) similar to ECV (AUC = 0.8 [0.8, 0.9], 37%) (P = 0.117) and superior to feature-tracking circumferential strain (AUC = 0.7[0.7, 0.8], -19%) (P < 0.05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0.9 [0.8, 0.9], -10%) was noninferior to ECV (AUC = 0.8 [0.7, 0.9], 42%) (P = 0.132) and superior to feature-tracking (AUC = 0.7 [0.7, 0.8], -13%) (P < 0.05). For MVO detection, circumferential strain with DENSE (AUC = 0.8 [0.8, 0.9], -12%) was superior to ECV (AUC = 0.8 [0.7, 0.8] 34%) (P < 0.05) and feature-tracking (AUC = 0.7 [0.6, 0.7] -21%) (P < 0.05). DATA CONCLUSION Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 5 J. MAGN. RESON. IMAGING 2020;52:1722-1731.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Christopher M Loughrey
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew M Lee
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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20
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Bulluck H, Carberry J, Carrick D, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay M, Mahrous A, Ford I, Oldroyd KG, Berry C. Redefining Adverse and Reverse Left Ventricular Remodeling by Cardiovascular Magnetic Resonance Following ST-Segment-Elevation Myocardial Infarction and Their Implications on Long-Term Prognosis. Circ Cardiovasc Imaging 2020; 13:e009937. [PMID: 32689822 DOI: 10.1161/circimaging.119.009937] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cut off values for change in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction have recently been proposed and 4 patterns of LV remodeling were described. We aimed to assess their long-term prognostic significance. METHODS A prospective cohort of unselected patients with ST-segment-elevation myocardial infarction with paired acute and 6-month cardiovascular magnetic resonance, with the 5-year composite end point of all-cause death and hospitalization for heart failure was included. The prognosis of the following groups (group 1: reverse LV remodeling [≥12% decrease in LVESV]; group 2: no LV remodeling [changes in LVEDV and LVESV <12%]; group 3: adverse LV remodeling with compensation [≥12% increase in LVEDV only]; and group 4: adverse LV remodeling [≥12% increase in both LVESV and LVEDV]) was compared. RESULTS Two hundred eighty-five patients were included with a median follow-up was 5.8 years. The composite end point occurred in 9.5% in group 1, 12.3% in group 2, 7.1% in group 3, and 24.2% in group 4. Group 4 had significantly higher cumulative event rates of the composite end point (log-rank test, P=0.03) with the other 3 groups showing similar cumulative event rates (log-rank test, P=0.51). Cox proportional hazard for group 2 (hazard ratio, 1.3 [95% CI, 0.6-3.1], P=0.53) and group 3 (hazard ratio, 0.6 [95% CI, 0.2-2.3], P=0.49) were not significantly different but was significantly higher in group 4 (hazard ratio, 3.0 [95% CI, 1.2-7.1], P=0.015) when compared with group 1. CONCLUSIONS Patients with ST-segment-elevation myocardial infarction developing adverse LV remodeling at 6 months, defined as ≥12% increase in both LVESV and LVEDV by cardiovascular magnetic resonance, was associated with worse long-term clinical outcomes than those with adverse LV remodeling with compensation, reverse LV remodeling, and no LV remodeling, with the latter 3 groups having similar outcomes in a cohort of stable reperfused patients with ST-segment-elevation myocardial infarction. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
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Affiliation(s)
- Heerajnarain Bulluck
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.).,Norfolk and Norwich University Hospital, Norwich, England (H.B.)
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., S.W., C.B.), University of Glasgow, Scotland
| | - David Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., S.W., C.B.), University of Glasgow, Scotland
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., S.W., C.B.), University of Glasgow, Scotland
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics (I.F.), University of Glasgow, Scotland
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.)
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.).,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., S.W., C.B.), University of Glasgow, Scotland
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21
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Maznyczka AM, Oldroyd KG, Greenwood JP, McCartney PJ, Cotton J, Lindsay M, McEntegart M, Rocchiccioli JP, Good R, Robertson K, Eteiba H, Watkins S, Shaukat A, Petrie CJ, Murphy A, Petrie MC, Berry C. Comparative Significance of Invasive Measures of Microvascular Injury in Acute Myocardial Infarction. Circ Cardiovasc Interv 2020; 13:e008505. [PMID: 32408817 PMCID: PMC7237023 DOI: 10.1161/circinterventions.119.008505] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The resistive reserve ratio (RRR) expresses the ratio between basal and hyperemic microvascular resistance. RRR measures the vasodilatory capacity of the microcirculation. We compared RRR, index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) for predicting microvascular obstruction (MVO), myocardial hemorrhage, infarct size, and clinical outcomes, after ST-segment-elevation myocardial infarction. METHODS In the T-TIME trial (Trial of Low-Dose Adjunctive Alteplase During Primary PCI), 440 patients with acute ST-segment-elevation myocardial infarction from 11 UK hospitals were prospectively enrolled. In a subset of 144 patients, IMR, CFR, and RRR were measured post-primary percutaneous coronary intervention. MVO extent (% left ventricular mass) was determined by cardiovascular magnetic resonance imaging at 2 to 7 days. Infarct size was determined at 3 months. One-year major adverse cardiac events, heart failure hospitalizations, and all-cause death/heart failure hospitalizations were assessed. RESULTS In these 144 patients (mean age, 59±11 years, 80% male), median IMR was 29.5 (interquartile range: 17.0-55.0), CFR was 1.4 (1.1-2.0), and RRR was 1.7 (1.3-2.3). MVO occurred in 41% of patients. IMR>40 was multivariably associated with more MVO (coefficient, 0.53 [95% CI, 0.05-1.02]; P=0.031), myocardial hemorrhage presence (odds ratio [OR], 3.20 [95% CI, 1.25-8.24]; P=0.016), and infarct size (coefficient, 5.05 [95% CI, 0.84-9.26]; P=0.019), independently of CFR≤2.0, RRR≤1.7, myocardial perfusion grade≤1, and Thrombolysis in Myocardial Infarction frame count. RRR was multivariably associated with MVO extent (coefficient, -0.60 [95% CI, -0.97 to -0.23]; P=0.002), myocardial hemorrhage presence (OR, 0.34 [95% CI, 0.15-0.75]; P=0.008), and infarct size (coefficient, -3.41 [95% CI, -6.76 to -0.06]; P=0.046). IMR>40 was associated with heart failure hospitalization (OR, 5.34 [95% CI, 1.80-15.81] P=0.002), major adverse cardiac events (OR, 4.46 [95% CI, 1.70-11.70] P=0.002), and all-cause death/ heart failure hospitalization (OR, 4.08 [95% CI, 1.55-10.79] P=0.005). RRR was associated with heart failure hospitalization (OR, 0.44 [95% CI, 0.19-0.99] P=0.047). CFR was not associated with infarct characteristics or clinical outcomes. CONCLUSIONS In acute ST-segment-elevationl infarction, IMR and RRR, but not CFR, were associated with MVO, myocardial hemorrhage, infarct size, and clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M. Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.C.P., C.B.)
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Keith G. Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.C.P., C.B.)
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - John P. Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (J.P.G.)
| | - Peter J. McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.C.P., C.B.)
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - James Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.C.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - J. Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
| | - Colin J. Petrie
- University Hospital Monklands, NHS Lanarkshire, United Kingdom (C.J.P.)
| | | | - Mark C. Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.C.P., C.B.)
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.C.P., C.B.)
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (A.M.M., K.G.O., P.J.M., M.L., M.McE., J.P.R., R.G., K.R., H.E., S.W., A.S., C.B.)
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22
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McCartney PJ, Maznyczka AM, Eteiba H, McEntegart M, Oldroyd KG, Greenwood JP, Maredia N, Schmitt M, McCann GP, Fairbairn T, McAlindon E, Tait C, Welsh P, Sattar N, Orchard V, Corcoran D, Ford TJ, Radjenovic A, Ford I, McConnachie A, Berry C. Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time. J Am Coll Cardiol 2020; 75:1406-1421. [PMID: 32216909 PMCID: PMC7109518 DOI: 10.1016/j.jacc.2020.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time. METHODS This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; ≥2 h but <4 h, n = 235; ≥4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440). RESULTS Overall, there was no association between alteplase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time ≥4 to 6 h, alteplase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20% (20 mg); p = 0.009 for the trend. The interaction between ischemic time and alteplase dose was statistically significant (p = 0.018). CONCLUSION In patients presenting with ST-segment elevation myocardial infarction and an ischemic time ≥4 to 6 h, adjunctive treatment with low-dose intracoronary alteplase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary alteplase may be harmful for this subgroup. (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME]; NCT02257294).
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Affiliation(s)
- Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Neil Maredia
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Matthias Schmitt
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gerry P McCann
- University of Leicester and the National Institute for Health Research Leicester Biomedical Research Center, Leicester, United Kingdom
| | - Timothy Fairbairn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Elisa McAlindon
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Campbell Tait
- Department of Hematology, Royal Infirmary, Glasgow, United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Vanessa Orchard
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom.
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23
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Hennigan B, Berry C, Collison D, Corcoran D, Eteiba H, Good R, McEntegart M, Watkins S, McClure JD, Mangion K, Ford TJ, Petrie MC, Hood S, Rocchiccioli P, Shaukat A, Lindsay M, Oldroyd KG. Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial. Heart 2020; 106:758-764. [PMID: 32114516 PMCID: PMC7229900 DOI: 10.1136/heartjnl-2019-316075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION There is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (GZFFR artery) values (0.75-0.80). The prevalence of ischaemia is unknown. We wished to define the prevalence of ischaemia in GZFFR artery and assess whether PCI is superior to optimal medical therapy (OMT) for angina control. METHODS We enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ). RESULTS 104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target GZFFR artery. Of 89 patients with invasive physiology data, 26 (28%) had coronary flow velocity reserve <2.0 in the target GZFFR artery. After 3 months of follow-up, compared with patients treated with OMT only, patients treated by PCI and OMT had greater improvements in SAQ angina frequency (21 (28) vs 10 (23); p=0.026) and quality of life (24 (26) vs 11 (24); p=0.008) though these differences were no longer significant at 12 months. CONCLUSIONS Non-invasive evidence of major ischaemia is uncommon in patients with GZFFR artery. Compared with OMT alone, patients randomised to undergo PCI reported improved symptoms after 3 months but these differences were no longer significant after 12 months. TRIAL REGISTRATION NUMBER NCT02425969.
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Affiliation(s)
- Barry Hennigan
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom .,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK.,Cardiology Department, The Mater Private Hospital Cork, Cork, Ireland
| | - Colin Berry
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Damien Collison
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - David Corcoran
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Hany Eteiba
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Richard Good
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Margaret McEntegart
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Stuart Watkins
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - John D McClure
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Kenneth Mangion
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Thomas Joseph Ford
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Stuart Hood
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Paul Rocchiccioli
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Aadil Shaukat
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mitchell Lindsay
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G Oldroyd
- Cardiology Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
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24
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Maznyczka AM, McCartney PJ, Eteiba H, Greenwood JP, Muir DF, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, Oldroyd KG, Lindsay M, McEntegart M, Rocchiccioli JP, Shaukat A, Good R, Watkins S, Robertson K, Malkin C, Martin L, Gillespie L, Weir RA, Ford TJ, Petrie MC, Murphy A, Petrie CJ, Ramparsad N, Wetherall K, Fox KA, Ford I, McConnachie A, Berry C. One-Year Outcomes After Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention: The T-TIME Randomized Trial. Circ Cardiovasc Interv 2020; 13:e008855. [PMID: 32069113 DOI: 10.1161/circinterventions.119.008855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (J.P.G.)
| | - Douglas F Muir
- James Cook University Hospital NHS Trust, Middlesbrough, United Kingdom (D.F.M., C.M.)
| | - Saqib Chowdhary
- Manchester University NHS Foundation Trust, United Kingdom (S.C.)
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom (C.A.)
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust, United Kingdom (J.M.C.)
| | - Andrew Wragg
- Barts and The London Hospital, London, United Kingdom (A.W.)
| | - Nick Curzen
- University Hospital Southampton Foundation Trust and School of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - J Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Christopher Malkin
- James Cook University Hospital NHS Trust, Middlesbrough, United Kingdom (D.F.M., C.M.)
| | - Lynn Martin
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | | | - Robin A Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom (R.A.W.)
| | - Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
| | - Aengus Murphy
- University Hospital Monklands, NHS Lanarkshire, United Kingdom (A.M., C.J.P.)
| | - Colin J Petrie
- University Hospital Monklands, NHS Lanarkshire, United Kingdom (A.M., C.J.P.)
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Keith A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.F.)
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing (N.R., K.W., I.F., A.M.), University of Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre (A.M.M., P.J.M., K.G.O., T.J.F., M.C.P., C.B.), University of Glasgow, United Kingdom.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.M.M., P.J.M., H.E., K.G.O., M.L., M.M., J.P.R., A.S., R.G., S.W., K.R., L.M., M.C.P., C.B.)
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25
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Ford TJ, Khan A, Docherty KF, Jackson A, Morrow A, Sidik N, Rocchiccioli P, Good R, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Petrie M, Berry C, Oldroyd KG, McEntegart M. Sex differences in procedural and clinical outcomes following rotational atherectomy. Catheter Cardiovasc Interv 2020; 95:232-241. [PMID: 31264314 PMCID: PMC7027486 DOI: 10.1002/ccd.28373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/16/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
Abstract
AIM Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA). METHODS AND RESULTS From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001). CONCLUSION Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.
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Affiliation(s)
- Thomas J. Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
- Gosford HospitalNSWAustralia
| | - Adnan Khan
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Kieran F. Docherty
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Alice Jackson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Novalia Sidik
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mark Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Keith G. Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
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26
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Maznyczka AM, McCartney PJ, Oldroyd KG, Lindsay M, McEntegart M, Eteiba H, Rocchiccioli P, Good R, Shaukat A, Robertson K, Kodoth V, Greenwood JP, Cotton JM, Hood S, Watkins S, Macfarlane PW, Kennedy J, Tait RC, Welsh P, Sattar N, Collison D, Gillespie L, McConnachie A, Berry C. Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction. J Am Heart Assoc 2020; 9:e014066. [PMID: 31986989 PMCID: PMC7033872 DOI: 10.1161/jaha.119.014066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. Methods and Results A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. Conclusions In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02257294.
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Affiliation(s)
- Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Keith Robertson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Vivek Kodoth
- Leeds University and Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - James M Cotton
- Wolverhampton University Hospital NHS Trust Wolverhampton United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | | | - Julie Kennedy
- Electrocardiology Group Royal Infirmary Glasgow United Kingdom
| | - R Campbell Tait
- Department of Haematology Royal Infirmary Glasgow United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Damien Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,West of Scotland Heart and Lung Centre Golden Jubilee National Hospital, Clydebank Glasgow United Kingdom
| | - Lynsey Gillespie
- Project Management Unit Greater Glasgow and Clyde Health Board Glasgow United Kingdom
| | - Alex McConnachie
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom.,Robertson Centre for Biostatistics Institute of Health and Wellbeing, University of Glasgow Glasgow United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
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27
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Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, McCartney P, Corcoran D, Collison D, Rush C, Stanley B, McConnachie A, Sattar N, Touyz RM, Oldroyd KG, Berry C. Ischemia and No Obstructive Coronary Artery Disease: Prevalence and Correlates of Coronary Vasomotion Disorders. Circ Cardiovasc Interv 2019; 12:e008126. [PMID: 31833416 PMCID: PMC6924940 DOI: 10.1161/circinterventions.119.008126] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Determine the prevalence and correlates of microvascular and vasospastic angina in patients with symptoms and signs of ischemia but no obstructive coronary artery disease (INOCA). METHODS Three hundred ninety-one patients with angina were enrolled at 2 regional centers over 12 months from November 2016 (NCT03193294). INOCA subjects (n=185; 47%) had more limiting dyspnea (New York Heart Association classification III/IV 54% versus 37%; odds ratio [OR], 2.0 [1.3-3.0]; P=0.001) and were more likely to be female (68% INOCA versus 38% in coronary artery disease; OR, 1.9 [1.5 to 2.5]; P<0.001) but with lower cardiovascular risk scores (ASSIGN score median 20% versus 24%; P=0.003). INOCA subjects had similar burden of angina (Seattle Angina Questionnaire) but reduced quality of life compared with coronary artery disease; subjects (EQ5D-5 L index 0.60 versus 0.65 units; P=0.041). RESULTS An interventional diagnostic procedure with reference invasive tests including coronary flow reserve, microvascular resistance, and vasomotor responses to intracoronary acetylcholine (vasospasm provocation) was performed in 151 INOCA subjects. Overall, 78 (52%) had isolated microvascular angina, 25 (17%) had isolated vasospastic angina, 31 (20%) had both, and 17 (11%) had noncardiac chest pain. Regression analysis showed inducible ischemia on treadmill testing (OR, 7.5 [95% CI, 1.7-33.0]; P=0.008) and typical angina (OR, 2.7 [1.1-6.6]; P=0.032) were independently associated with microvascular angina. Female sex tended to associate with a diagnosis of microvascular angina although this was not significant (OR, 2.7 [0.9-7.9]; P=0.063). Vasospastic angina was associated with smoking (OR, 9.5 [2.8-32.7]; P<0.001) and age (OR, 1.1 per year, [1.0-1.2]; P=0.032]. CONCLUSIONS Over three quarters of patients with INOCA have identifiable disorders of coronary vasomotion including microvascular and vasospastic angina. These patients have comparable angina burden but reduced quality of life compared to patients with obstructive coronary artery disease. Microvascular angina and vasospastic angina are distinct disorders that may coexist but differ in associated clinical characteristics, symptoms, and angina severity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03193294.
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Affiliation(s)
- Thomas J. Ford
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Richard Good
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Paul Rocchiccioli
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Margaret McEntegart
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Stuart Watkins
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Hany Eteiba
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Aadil Shaukat
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Mitchell Lindsay
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Keith Robertson
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Stuart Hood
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Ross McGeoch
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Robert McDade
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - David Corcoran
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Damien Collison
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Naveed Sattar
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Rhian M. Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Keith G. Oldroyd
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Colin Berry
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
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28
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Ford TJ, Stanley B, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, McCartney P, Corcoran D, Collison D, Rush C, Sattar N, McConnachie A, Touyz RM, Oldroyd KG, Berry C. 1-Year Outcomes of Angina Management Guided by Invasive Coronary Function Testing (CorMicA). JACC Cardiovasc Interv 2019; 13:33-45. [PMID: 31709984 PMCID: PMC8310942 DOI: 10.1016/j.jcin.2019.11.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023]
Abstract
Objectives The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without obstructive coronary artery disease. Background Medical therapy for angina guided by invasive coronary vascular function testing holds promise, but the longer-term effects on quality of life and clinical events are unknown among patients without obstructive disease. Methods A total of 151 patients with angina with symptoms and/or signs of ischemia and no obstructive coronary artery disease were randomized to stratified medical therapy guided by an interventional diagnostic procedure versus standard care (control group with blinded interventional diagnostic procedure results). The interventional diagnostic procedure–facilitated diagnosis (microvascular angina, vasospastic angina, both, or neither) was linked to guideline-based management. Pre-specified endpoints included 1-year patient-reported outcome measures (Seattle Angina Questionnaire, quality of life [EQ-5D]) and major adverse cardiac events (all-cause mortality, myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up. Results Between November 2016 and December 2017, 151 patients with ischemia and no obstructive coronary artery disease were randomized (n = 75 to the intervention group, n = 76 to the control group). At 1 year, overall angina (Seattle Angina Questionnaire summary score) improved in the intervention group by 27% (difference 13.6 units; 95% confidence interval: 7.3 to 19.9; p < 0.001). Quality of life (EQ-5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 95% confidence interval: 0.03 to 0.19; p = 0.010). After a median follow-up duration of 19 months (interquartile range: 16 to 22 months), major adverse cardiac events were similar between the groups, occurring in 9 subjects (12%) in the intervention group and 8 (11%) in the control group (p = 0.803). Conclusions Stratified medical therapy in patients with ischemia and no obstructive coronary artery disease leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography. (Coronary Microvascular Angina [CorMicA]; NCT03193294)
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; Gosford Hospital, NSW Health, Gosford, Australia
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ross McGeoch
- University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Robert McDade
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Damien Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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Maznyczka A, McCartney P, Oldroyd KG, McEntegart M, Lindsay M, Eteiba H, Rocchiccioli P, Good R, Shaukat A, Kodoth V, Greenwood J, Robertson K, Cotton J, McConnachie A, Berry C. P2707Invasive coronary physiology during primary percutaneous coronary intervention in patients treated with intracoronary alteplase or placebo: the double-blind T-TIME physiology substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impaired microcirculatory reperfusion worsens prognosis post-primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Intracoronary (IC) alteplase targets persisting thrombus post-reperfusion & distal embolisation. In the T-TIME trial microvascular obstruction on cardiac magnetic resonance (CMR) did not differ with IC alteplase vs placebo.
Purpose
To prospectively determine if index of microcirculatory resistance (IMR) is lower & coronary flow reserve (CFR) or resistive reserve ratio (RRR) are higher (improved) with IC alteplase, & to provide mechanistic insights.
Methods
A pre-planned substudy of the main protocol. From 2016–2017, STEMI patients from 3 UK hospitals ≤6 hrs ischaemic time were randomised in a 1:1:1 dose-ranging, double-blind design. Following standard care reperfusion, alteplase (10 or 20mg) or placebo was infused over 5–10 mins proximal to the culprit lesion pre-stenting. IMR (primary outcome), CFR & RRR (secondary outcomes) were measured in the culprit artery post-PCI. Physiology results were obscured from clinicians acquiring the data, to maintain blinding. CMR was performed 2 days & 3 months post-STEMI. Subgroup analyses were prespecified including by ischaemic time (<2 hours, 2–4 hrs, >4 hrs) & IMR threshold >32.
Results
In 144 patients (mean age 59 yrs, 80% male), IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo (Table). Patients with ischaemic time <2 hrs had a dose related increase in CFR (placebo 1.2 [IQR 1.1–1.7], alteplase 10mg 1.4 [IQR 1.0–1.8], alteplase 20mg 2.0 [IQR 1.8–2.3] p=0.01 for interaction) & RRR (placebo 1.5 [IQR 1.3–1.9], alteplase 10mg 1.6 [1.1–2.2], alteplase 20mg 2.2 [2.0–2.6], p=0.03 for interaction). In subjects with post-PCI IMR>32, % ST-resolution at 60 mins was worse with alteplase 10mg vs placebo (23.1±53.9 vs 50.9±31.5) & in those with IMR≤32% ST-resolution at 60 mins was better with alteplase 20mg vs placebo (68.0±30.7 vs 39.1±43.2), p=0.002 for interaction. The CMR findings in the substudy & overall trial populations were consistent.
Main results Placebo Alteplase 10mg Alteplase 20mg (n=53) (n=41) (n=50) IMR, median (IQR) 33.0 (17.0–57.0) 22.0 (17.0–42.0) 37.0 (20.0–57.8) p=0.15 p=0.78 CFR, median (IQR) 1.3 (1.1–1.8) 1.4 (1.1–1.9) 1.5 (1.1–2.0) p=0.92 p=0.74 RRR, median (IQR) 1.6 (1.3–2.2) 1.6 (1.4–2.6) 1.8 (1.3–2.4) p=0.69 p=0.81 P-values for comparison of alteplase with placebo.
Conclusions
In acute STEMI with ischaemic time ≤6 hrs, IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo. In those with shorter ischaemic times (<2 hrs) CFR & RRR, but not IMR, were improved with alteplase. We observed interactions between alteplase dose, ischaemic time & mechanisms of effect.
Acknowledgement/Funding
Dr Maznyczka is funded by a fellowship from the British Heart Foundation (FS/16/74/32573). T-TIME was funded by grant 12/170/4 from NIHR-EME
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Affiliation(s)
- A Maznyczka
- University of Glasgow, Glasgow, United Kingdom
| | - P McCartney
- University of Glasgow, Glasgow, United Kingdom
| | - K G Oldroyd
- University of Glasgow, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M Lindsay
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - P Rocchiccioli
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - V Kodoth
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Greenwood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Robertson
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - J Cotton
- New Cross Hospital, Wolverhampton, United Kingdom
| | | | - C Berry
- University of Glasgow, Glasgow, United Kingdom
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McCartney P, Maznyczka A, Eteiba H, McEntegart M, Greenwood JP, Schmitt M, Maredia N, McCann GP, Fairbairn T, McAlindon E, Oldroyd KG, Orchard V, Radjenovic A, McConnachie A, Berry C. 6030Effects of adjunctive treatment with low-dose alteplase during primary percutaneous coronary intervention according to ischaemic time. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Microvascular obstruction affects half of patients with acute ST-segment elevation myocardial infarction and confers an adverse prognosis.
Purpose
We aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intra-coronary alteplase infused early after coronary reperfusion associates with ischaemic time.
Methods
We conducted a prospective, multicentre, parallel group, 1:1:1 randomised, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischaemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified sub-group of interest. Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the UK were enrolled with follow up to 3 months. Patients with acute myocardial infarction due to occlusion of a major coronary artery presenting ≤6 hours from symptom onset were randomly assigned to treatment with placebo, alteplase 10mg or alteplase 20mg. The primary outcome was the amount of microvascular obstruction disclosed by cardiac magnetic resonance imaging at 2–7 days. Secondary outcomes included infarct size, myocardial haemorrhage, left ventricular ejection fraction, and troponin T area-under-the curve.
Results
440 patients were randomized (figure), the primary endpoint was achieved in 396 (90%), seventeen (3.9%) withdrew and all other patients were followed up to 3 months. In the primary analysis, the amount of microvascular obstruction did not differ between the groups. Their ischaemic times were: ≤2 hours, n=98; ≥2–<4 hours, n=215; and ≥4–6 hours, n=83.
In patients with an ischaemic time ≥4 hours, treatment with alteplase (10 mg, n=26; 20 mg, n=30) was associated with a dose dependent increase in the amount (mean) of microvascular obstruction (% left ventricular mass) compared to placebo (n=27) 1.14 vs. 3.11 vs. 5.20; mean difference on square root scale 0.81 (95% CI 0.21, 1.42), p=0.009. The interaction test between ischaemic time and treatment (active vs. placebo) was not statistically significant p=0.06, however when the interaction was assessed for a trend across treatment groups this did reach statistical significance, p=0.018.
Furthermore, a higher proportion of patients presenting ≥4–6 hours treated with 20 mg of alteplase had myocardial haemorrhage (59.3%) compared to the placebo group (28.0%), odds ratio 3.81 (95% CI 1.19, 12.25), p=0.025. The amount of haemorrhage was also greater; estimated mean difference 3.49 (95% CI 1.22, 5.75), p=0.0026. No between-treatment group differences for myocardial haemorrhage were observed in patients presenting with shorter ischaemic times.
Study flow diagram
Conclusions
In patients presenting with an ischaemic time ≥4 hours, adjunctive treatment with low-dose intra-coronary alteplase during primary PCI was associated with increases in microvascular obstruction and myocardial haemorrhage. The mechanism may involve haemorrhagic transformation within the infarct core.
Acknowledgement/Funding
NIHR EME programme (reference: 12/170/45); British Heart Foundation (BHF reference FS/16/74/32573)
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Affiliation(s)
- P McCartney
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - A Maznyczka
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - M Schmitt
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - N Maredia
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - G P McCann
- University Hospital of Leicester, Leicester, United Kingdom
| | - T Fairbairn
- Cardiothoracic Centre Trust of Liverpool, Liverpool, United Kingdom
| | - E McAlindon
- New Cross Hospital, Wolverhampton, United Kingdom
| | - K G Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - V Orchard
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Radjenovic
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
| | - A McConnachie
- University of Glasgow, Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, UK, Glasgow, United Kingdom
| | - C Berry
- University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom
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Collison D, Corcoran D, Carrick D, Mangion K, Hennigan B, Sidik N, Ford T, Robertson K, Shaukat A, Rocchiccioli P, Watkins S, Lindsay M, Eteiba H, Oldroyd K, Berry C, McEntegart M. TCT-591 A Comparison of Clinical and Coronary Physiology Characteristics in Patients With and Without Type 4a Myocardial Infarction Following High Speed Rotational Atherectomy–Assisted Percutaneous Coronary Intervention. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ford T, Morrow A, Adamson C, Rocchiccioli JP, Shaukat A, Lindsay M, Good R, Watkins S, Eteiba H, Robertson K, Sidik N, Collison D, McCartney P, Berry C, Oldroyd K, McEntegart M. TCT-249 Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) study. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cacciottolo TM, Perikari A, van der Klaauw A, Henning E, Stadler LKJ, Keogh J, Farooqi IS, Tenin G, Keavney B, Ryan E, Budd R, Bewley M, Coelho P, Rumsey W, Sanchez Y, McCafferty J, Dockrell D, Walmsley S, Whyte M, Liu Y, Choy MK, Tenin G, Abraham S, Black G, Keavney B, Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz R, Oldroyd K, Berry C, Gazdagh G, Diver L, Marshall J, McGowan R, Ahmed F, Tobias E, Curtis E, Parsons C, Maslin K, D'Angelo S, Moon R, Crozier S, Gossiel F, Bishop N, Kennedy S, Papageorghiou A, Fraser R, Gandhi S, Prentice A, Inskip H, Godfrey K, Schoenmakers I, Javaid MK, Eastell R, Cooper C, Harvey N, Watt ER, Howden A, Mirchandani A, Coelho P, Hukelmann JL, Sadiku P, Plant TM, Cantrell DA, Whyte MKB, Walmsley SR, Mordi I, Forteath C, Wong A, Mohan M, Palmer C, Doney A, Rena G, Lang C, Gray EH, Azarian S, Riva A, Edwards H, McPhail MJW, Williams R, Chokshi S, Patel VC, Edwards LA, Page D, Miossec M, Williams S, Monaghan R, Fotiou E, Santibanez-Koref M, Keavney B, Badat M, Mettananda S, Hua P, Schwessinger R, Hughes J, Higgs D, Davies J. Scientific Business Abstracts of the 113th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2019; 112:724-729. [PMID: 31505685 DOI: 10.1093/qjmed/hcz175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Perikari
- University of Cambridge Metabolic Research Laboratories
| | | | - E Henning
- University of Cambridge Metabolic Research Laboratories
| | - L K J Stadler
- University of Cambridge Metabolic Research Laboratories
| | - J Keogh
- University of Cambridge Metabolic Research Laboratories
| | - I S Farooqi
- University of Cambridge Metabolic Research Laboratories
| | - G Tenin
- From University of Manchester
| | | | - E Ryan
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - R Budd
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - M Bewley
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - P Coelho
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - W Rumsey
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - Y Sanchez
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - J McCafferty
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - D Dockrell
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - S Walmsley
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - M Whyte
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - Y Liu
- From the University of Manchester
| | - M-K Choy
- From the University of Manchester
| | - G Tenin
- From the University of Manchester
| | | | - G Black
- From the University of Manchester
| | | | - T Ford
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Good
- Golden Jubilee National Hospital
| | - P Rocchiccioli
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - M McEntegart
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - H Eteiba
- Golden Jubilee National Hospital
| | | | | | | | - S Hood
- Golden Jubilee National Hospital
| | | | - R McDade
- Golden Jubilee National Hospital
| | - N Sidik
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - P McCartney
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Corcoran
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Collison
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - C Rush
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Touyz
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
| | - K Oldroyd
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - Colin Berry
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - G Gazdagh
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - L Diver
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - J Marshall
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - R McGowan
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow
| | - E Tobias
- Academic Unit of Medical Genetics and Clinical Pathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, University of Glasgow
| | - E Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - R Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - F Gossiel
- Academic Unit of Bone Metabolism, University of Sheffield
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - A Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - R Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | - S Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | | | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - I Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | | | - A Howden
- School of Life Sciences, University of Dundee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E H Gray
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Azarian
- Institute of Hepatology, Foundation for Liver Research
| | - A Riva
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - H Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - M J W McPhail
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Chokshi
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - V C Patel
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - L A Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - D Page
- University of Manchester
- Manchester Metropolitan University
| | - M Miossec
- Manchester Metropolitan University
- University of Newcastle
| | | | | | | | | | | | - M Badat
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya
| | - P Hua
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - R Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Hughes
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - D Higgs
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Davies
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
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Ford T, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, Sattar N, Oldroyd K, Touyz R, Berry C. 50 Ischaemia and No Obstructive Coronary Artery Disease (INOCA): prevalence and predictors of coronary vasomotion disorders. Interv Cardiol 2019. [DOI: 10.1136/heartjnl-2019-bcs.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maznyczka AM, Carrick D, Carberry J, Mangion K, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Ford I, Welsh P, Sattar N, Oldroyd KG, Berry C. Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction. Open Heart 2019; 6:e000979. [PMID: 31168381 PMCID: PMC6519583 DOI: 10.1136/openhrt-2018-000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI). Methods Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up. Results In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation. Conclusion There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women. Trial registration number NCT02072850.
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Affiliation(s)
- Annette Marie Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Hood
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Davie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Ahmed Mahrous
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Carrick D, Haig C, Maznyczka AM, Carberry J, Mangion K, Ahmed N, Yue May VT, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Welsh P, Sattar N, Wetherall K, Oldroyd KG, Berry C. Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction. Hypertension 2019; 72:720-730. [PMID: 30012869 PMCID: PMC6080885 DOI: 10.1161/hypertensionaha.117.10786] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.
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Affiliation(s)
- David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Annette M Maznyczka
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Nadeem Ahmed
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Vannesa Teng Yue May
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ify Mordi
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Aleksandra Radjenovic
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Paul Welsh
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Naveed Sattar
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
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Mangion K, Carrick D, Clerfond G, Rush C, McComb C, Oldroyd KG, Petrie MC, Eteiba H, Lindsay M, McEntegart M, Hood S, Watkins S, Davie A, Auger DA, Zhong X, Epstein FH, Haig CE, Berry C. Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction. Eur J Radiol 2019; 112:121-129. [PMID: 30777200 PMCID: PMC6390173 DOI: 10.1016/j.ejrad.2019.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 01/28/2023]
Abstract
Objective We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per −1% peak strain, 1.05–1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per −1% peak strain, 1.03–1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per −1% peak strain, 1.04–1.12, p < 0.001, feature-tracking: 1.06 per −1% peak strain, 1.04–1.08, p < 0.001). Conclusions Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Guillaume Clerfond
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Los Angeles, CA, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Caroline E Haig
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
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McCartney PJ, Eteiba H, Maznyczka AM, McEntegart M, Greenwood JP, Muir DF, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, Oldroyd KG, Lindsay M, Rocchiccioli JP, Shaukat A, Good R, Watkins S, Robertson K, Malkin C, Martin L, Gillespie L, Ford TJ, Petrie MC, Macfarlane PW, Tait RC, Welsh P, Sattar N, Weir RA, Fox KA, Ford I, McConnachie A, Berry C. Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA 2019; 321:56-68. [PMID: 30620371 PMCID: PMC6583564 DOI: 10.1001/jama.2018.19802] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Microvascular obstruction commonly affects patients with acute ST-segment elevation myocardial infarction (STEMI) and is associated with adverse outcomes. OBJECTIVE To determine whether a therapeutic strategy involving low-dose intracoronary fibrinolytic therapy with alteplase infused early after coronary reperfusion will reduce microvascular obstruction. DESIGN, SETTING, AND PARTICIPANTS Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the United Kingdom within 6 hours of STEMI due to a proximal-mid-vessel occlusion of a major coronary artery were randomized in a 1:1:1 dose-ranging trial design. Patient follow-up to 3 months was completed on April 12, 2018. INTERVENTIONS Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145) by manual infusion over 5 to 10 minutes. The intervention was scheduled to occur early during the primary PCI procedure, after reperfusion of the infarct-related coronary artery and before stent implant. MAIN OUTCOMES AND MEASURES The primary outcome was the amount of microvascular obstruction (% left ventricular mass) demonstrated by contrast-enhanced cardiac magnetic resonance imaging (MRI) conducted from days 2 through 7 after enrollment. The primary comparison was the alteplase 20-mg group vs the placebo group; if not significant, the alteplase 10-mg group vs the placebo group was considered a secondary analysis. RESULTS Recruitment stopped on December 21, 2017, because conditional power for the primary outcome based on a prespecified analysis of the first 267 randomized participants was less than 30% in both treatment groups (futility criterion). Among the 440 patients randomized (mean age, 60.5 years; 15% women), the primary end point was achieved in 396 patients (90%), 17 (3.9%) withdrew, and all others were followed up to 3 months. In the primary analysis, the mean microvascular obstruction did not differ between the 20-mg alteplase and placebo groups (3.5% vs 2.3%; estimated difference, 1.16%; 95% CI, -0.08% to 2.41%; P = .32) nor in the analysis of 10-mg alteplase vs placebo groups (2.6% vs 2.3%; estimated difference, 0.29%; 95% CI, -0.76% to 1.35%; P = .74). Major adverse cardiac events (cardiac death, nonfatal MI, unplanned hospitalization for heart failure) occurred in 15 patients (10.1%) in the placebo group, 18 (12.9%) in the 10-mg alteplase group, and 12 (8.2%) in the 20-mg alteplase group. CONCLUSIONS AND RELEVANCE Among patients with acute STEMI presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given during the primary percutaneous intervention did not reduce microvascular obstruction. The study findings do not support this treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02257294.
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Affiliation(s)
- Peter J. McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | - Annette M. Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | - John P. Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Douglas F. Muir
- James Cook University Hospital NHS Trust, Middlesbrough, United Kingdom
| | - Saqib Chowdhary
- South Manchester Hospitals NHS Trust, Manchester, United Kingdom
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - James M. Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom
| | - Andrew Wragg
- Barts and the London Hospital, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton Foundation Trust, Southampton, United Kingdom
| | - Keith G. Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - J. Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Aadil Shaukat
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Richard Good
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Keith Robertson
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Malkin
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Lynn Martin
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | | | - Thomas J. Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Mark C. Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
| | - Peter W. Macfarlane
- Electrocardiography Core Laboratory, University of Glasgow, Glasgow, United Kingdom
| | - R. Campbell Tait
- Department of Haematology, Royal Infirmary, Glasgow, United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Robin A. Weir
- University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Keith A. Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Clydebank, United Kingdom
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Ford TJ, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz RM, Oldroyd KG, Berry C. Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. J Am Coll Cardiol 2018; 72:2841-2855. [PMID: 30266608 DOI: 10.1016/j.jacc.2018.09.006] [Citation(s) in RCA: 377] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with angina symptoms and/or signs of ischemia but no obstructive coronary artery disease (INOCA) pose a diagnostic and therapeutic challenge. OBJECTIVES The purpose of this study was to test whether an interventional diagnostic procedure (IDP) linked to stratified medicine improves health status in patients with INOCA. METHODS The authors conducted a randomized, controlled, blinded clinical trial of stratified medical therapy versus standard care in patients with angina. Patients with angina undergoing invasive coronary angiography (standard care) were recruited. Patients without obstructive CAD were immediately randomized 1:1 to the intervention group (stratified medical therapy) or the control group (standard care, IDP sham procedure). The IDP consisted of guidewire-based assessment of coronary flow reserve, index of microcirculatory resistance, fractional flow reserve, followed by vasoreactivity testing with acetylcholine. The primary endpoint was the mean difference in angina severity at 6 months (assessed by the Seattle Angina Questionnaire summary score). RESULTS A total of 391 patients were enrolled between November 25, 2016, and November 12, 2017. Coronary angiography revealed obstructive disease in 206 (53.7%). One hundred fifty-one (39%) patients without angiographically obstructive CAD were randomized (n = 76 intervention group; n = 75 blinded control group). The intervention resulted in a mean improvement of 11.7 U in the Seattle Angina Questionnaire summary score at 6 months (95% confidence interval [CI]: 5.0 to 18.4; p = 0.001). In addition, the intervention led to improvements in the mean quality-of-life score (EQ-5D index 0.10 U; 95% CI: 0.01 to 0.18; p = 0.024) and visual analogue score (14.5 U; 95% CI: 7.8 to 21.3; p < 0.001). There were no differences in major adverse cardiac events at the 6-month follow-up (2.6% controls vs. 2.6% intervention; p = 1.00). CONCLUSIONS Coronary angiography often fails to identify patients with vasospastic and/or microvascular angina. Stratified medical therapy, including an IDP with linked medical therapy, is routinely feasible and improves angina in patients with no obstructive CAD. (CORonary MICrovascular Angina [CorMicA]; NCT03193294).
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; University of New South Wales, Sydney, New South Wales, Australia. https://twitter.com/TomJFord
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ross McGeoch
- University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Robert McDade
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Damien Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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Ford TJ, Rocchiccioli P, Good R, McEntegart M, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Hood S, Yii E, Sidik N, Harvey A, Montezano AC, Beattie E, Haddow L, Oldroyd KG, Touyz RM, Berry C. Systemic microvascular dysfunction in microvascular and vasospastic angina. Eur Heart J 2018; 39:4086-4097. [PMID: 30165438 PMCID: PMC6284165 DOI: 10.1093/eurheartj/ehy529] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/17/2018] [Accepted: 08/23/2018] [Indexed: 12/20/2022] Open
Abstract
Aims Coronary microvascular dysfunction and/or vasospasm are potential causes of ischaemia in patients with no obstructive coronary artery disease (INOCA). We tested the hypothesis that these patients also have functional abnormalities in peripheral small arteries. Methods and results Patients were prospectively enrolled and categorised as having microvascular angina (MVA), vasospastic angina (VSA) or normal control based on invasive coronary artery function tests incorporating probes of endothelial and endothelial-independent function (acetylcholine and adenosine). Gluteal biopsies of subcutaneous fat were performed in 81 subjects (62 years, 69% female, 59 MVA, 11 VSA, and 11 controls). Resistance arteries were dissected enabling study using wire myography. Maximum relaxation to ACh (endothelial function) was reduced in MVA vs. controls [median 77.6 vs. 98.7%; 95% confidence interval (CI) of difference 2.3-38%; P = 0.0047]. Endothelium-independent relaxation [sodium nitroprusside (SNP)] was similar between all groups. The maximum contractile response to endothelin-1 (ET-1) was greater in MVA (median 121%) vs. controls (100%; 95% CI of median difference 4.7-45%, P = 0.015). Response to the thromboxane agonist, U46619, was also greater in MVA (143%) vs. controls (109%; 95% CI of difference 13-57%, P = 0.003). Patients with VSA had similar abnormal patterns of peripheral vascular reactivity including reduced maximum relaxation to ACh (median 79.0% vs. 98.7%; P = 0.03) and increased response to constrictor agonists including ET-1 (median 125% vs. 100%; P = 0.02). In all groups, resistance arteries were ≈50-fold more sensitive to the constrictor effects of ET-1 compared with U46619. Conclusions Systemic microvascular abnormalities are common in patients with MVA and VSA. These mechanisms may involve ET-1 and were characterized by endothelial dysfunction and enhanced vasoconstriction. Clinical trial registration ClinicalTrials.gov registration is NCT03193294.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Adam Harvey
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Augusto C Montezano
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Elisabeth Beattie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Laura Haddow
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, GJNH, Agamemnon St, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow, UK
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Mangion K, Carrick D, Carberry J, Mahrous A, McComb C, Oldroyd KG, Eteiba H, Lindsay M, McEntegart M, Hood S, Petrie MC, Watkins S, Davie A, Zhong X, Epstein FH, Haig CE, Berry C. Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation Myocardial Infarction. Radiology 2018; 290:329-337. [PMID: 30457480 DOI: 10.1148/radiol.2018181253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
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Affiliation(s)
- Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Ahmed Mahrous
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Christie McComb
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Hany Eteiba
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mitchell Lindsay
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Hood
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Watkins
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Andrew Davie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Xiaodong Zhong
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Frederick H Epstein
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Caroline E Haig
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
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McEntegart M, Corcoran D, Carrick D, Clerfond G, Sidik N, Collison D, Robertson KR, Shaukat A, Watkins S, Rocchicholi PR, Eteiba H, Petrie MP, Lindsay MM, Oldroyd KG, Berry C. Incidence of procedural myocardial infarction and cardiac magnetic resonance imaging-detected myocardial injury following percutaneous coronary intervention with rotational atherectomy. EUROINTERVENTION 2018; 14:819-823. [PMID: 29741483 DOI: 10.4244/eij-d-17-01077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ford T, Jackson A, Docherty K, Khan A, Alam R, Yii E, Eteiba H, Lindsay M, Watkins S, Good R, Hood S, Shaukat A, Petrie M, Robertson K, Oldroyd K, Berry C, Rocchiccioli P, McEntegart M. TCT-405 Sex Differences and Outcomes Following Rotational Atherectomy: Do Women Receive Optimal Care? J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yew SN, Carrick D, Corcoran D, Ahmed N, Carberry J, Teng Yue May V, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Oldroyd KG, Berry C. Coronary Thermodilution Waveforms After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognosis. J Am Heart Assoc 2018; 7:e008957. [PMID: 30371237 PMCID: PMC6201480 DOI: 10.1161/jaha.118.008957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/30/2018] [Indexed: 02/07/2023]
Abstract
Background Invasive measures of microvascular resistance in the culprit coronary artery have potential for risk stratification in acute ST-segment-elevation myocardial infarction. We aimed to investigate the pathological and prognostic significance of coronary thermodilution waveforms using a diagnostic guidewire. Methods and Results Coronary thermodilution was measured at the end of percutaneous coronary intervention, (PCI) and contrast-enhanced cardiac magnetic resonance imaging (MRI) was intended on day 2 and 6 months later to assess left ventricular (LV) function and pathology. All-cause death or first heart failure hospitalization was a pre-specified outcome (median follow-up duration 1469 days). Thermodilution recordings underwent core laboratory assessment. A total of 278 patients with acute ST-segment elevation myocardial infarction EMI (72% male, 59±11 years) had coronary thermodilution measurements classified as narrow unimodal (n=143 [51%]), wide unimodal (n=100 [36%]), or bimodal (n=35 [13%]). Microvascular obstruction and myocardial hemorrhage were associated with the thermodilution waveform pattern ( P=0.007 and 0.011, respectively), and both pathologies were more prevalent in patients with a bimodal morphology. On multivariate analysis with baseline characteristics, thermodilution waveform status was a multivariable associate of microvascular obstruction (odds ratio [95% confidence interval]=5.29 [1.73, 16.22];, P=0.004) and myocardial hemorrhage (3.45 [1.16, 10.26]; P=0.026), but the relationship was not significant when index of microvascular resistance (IMR) >40 or change in index of microvascular resistance (5 per unit) was included. However, a bimodal thermodilution waveform was independently associated with all-cause death and hospitalization for heart failure (odds ratio [95% confidence interval]=2.70 [1.10, 6.63]; P=0.031), independent of index of microvascular resistance>40, ST-segment resolution, and TIMI (Thrombolysis in Myocardial Infarction) Myocardial Perfusion Grade. Conclusions The thermodilution waveform in the culprit coronary artery is a biomarker of prognosis and may be useful for risk stratification immediately after reperfusion therapy.
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Affiliation(s)
- Shu Ning Yew
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Nadeem Ahmed
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Vannesa Teng Yue May
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Mark C. Petrie
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Stuart Hood
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Andrew Davie
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Ahmed Mahrous
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Ify Mordi
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Ian Ford
- Robertson Centre for BiostatisticsUniversity of GlasgowUnited Kingdom
| | - Keith G. Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- West of Scotland Heart and Lung CentreGolden Jubilee National HospitalGlasgowUnited Kingdom
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Ford TJ, Layland J, Stanley B, Carberry J, May VTY, Eteiba H, Lindsay MM, Petrie MC, Watkins S, Shaukat A, Oldroyd KG, Curzen N, McConnachie A, McEntegart M, Berry C. P6432Overlooked prognostic markers in NSTEMI: insights from the BHF FAMOUS-NSTEMI trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T J Ford
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - J Layland
- St Vincent's Hospital, Melbourne, Australia
| | - B Stanley
- University of Glasgow, Glasgow, United Kingdom
| | - J Carberry
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - V T Y May
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - M M Lindsay
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - M C Petrie
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - S Watkins
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - K G Oldroyd
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - M McEntegart
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - C Berry
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
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Haig C, Carrick D, Carberry J, Mangion K, Maznyczka A, Wetherall K, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ahmed N, Teng Yue May V, Ford I, Radjenovic A, Welsh P, Sattar N, Oldroyd KG, Berry C. Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial Infarction: New Pathophysiological Insights. JACC Cardiovasc Imaging 2018; 12:993-1003. [PMID: 30031700 PMCID: PMC6547246 DOI: 10.1016/j.jcmg.2018.05.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/25/2023]
Abstract
Objectives The aim of this study was to mechanistically investigate associations among cigarette smoking, microvascular pathology, and longer term health outcomes in patients with acute ST-segment elevation myocardial infarction (MI). Background The pathophysiology of myocardial reperfusion injury and prognosis in smokers with acute ST-segment elevation MI is incompletely understood. Methods Patients were prospectively enrolled during emergency percutaneous coronary intervention. Microvascular function in the culprit artery was measured invasively. Contrast-enhanced magnetic resonance imaging (1.5-T) was performed 2 days and 6 months post-MI. Infarct size and microvascular obstruction were assessed using late gadolinium enhancement imaging. Myocardial hemorrhage was assessed with T2* mapping. Pre-specified endpoints included: 1) all-cause death or first heart failure hospitalization; and 2) cardiac death, nonfatal MI, or urgent coronary revascularization (major adverse cardiovascular events). Binary logistic regression (odds ratio [OR] with 95% confidence interval [CI]) with smoking status was used. Results In total, 324 patients with ST-segment elevation MI were enrolled (mean age 59 years, 73% men, 60% current smokers). Current smokers were younger (age 55 ± 11 years vs. 65 ± 10 years, p < 0.001), with fewer patients with hypertension (52 ± 27% vs. 53 ± 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In Myocardial Infarction) flow grade (≥2 vs. ≤1, p = 0.024) and ST-segment resolution (none vs. partial vs. complete, p = 0.010) post–percutaneous coronary intervention. On day 1, smokers had higher circulating C-reactive protein, neutrophil, and monocyte levels. Two days post-MI, smoking independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to 5.37; p = 0.003). After a median follow-up period of 4 years, smoking independently predicted all-cause death or heart failure events (OR: 2.20; 95% CI: 1.07 to 4.54) and major adverse cardiovascular events (OR: 2.79; 95% CI: 2.30 to 5.99). Conclusions Smoking is associated with enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and longer term adverse cardiac outcomes. Inflammation and irreversible myocardial hemorrhage post-MI represent mechanistic drivers for adverse long-term prognosis in smokers. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction. [BHF MR-MI]; NCT02072850)
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Affiliation(s)
- Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Annette Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ify Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Nadeem Ahmed
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Vannesa Teng Yue May
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom.
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Carberry J, Carrick D, Haig C, Ahmed N, Mordi I, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay M, Davie A, Mahrous A, Ford I, Sattar N, Welsh P, Radjenovic A, Oldroyd KG, Berry C. Persistence of Infarct Zone T2 Hyperintensity at 6 Months After Acute ST-Segment-Elevation Myocardial Infarction: Incidence, Pathophysiology, and Prognostic Implications. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006586. [PMID: 29242240 PMCID: PMC5753833 DOI: 10.1161/circimaging.117.006586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence and clinical significance of persistent T2 hyperintensity after acute ST-segment-elevation myocardial infarction (STEMI) is uncertain. METHODS AND RESULTS Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI: NCT02072850). Two hundred eighty-three STEMI patients (mean age, 59±12 years; 75% male) had cardiac magnetic resonance with T2 mapping performed at 2 days and 6 months post-STEMI. Persisting T2 hyperintensity was defined as infarct T2 >2 SDs from remote T2 at 6 months. Infarct zone T2 was higher than remote zone T2 at 2 days (66.3±6.1 versus 49.7±2.1 ms; P<0.001) and 6 months (56.8±4.5 versus 49.7±2.3 ms; P<0.001). Remote zone T2 did not change over time (mean change, 0.0±2.7 ms; P=0.837), whereas infarct zone T2 decreased (-9.5±6.4 ms; P<0.001). At 6 months, T2 hyperintensity persisted in 189 (67%) patients, who were more likely to have Thrombus in Myocardial Infarction flow 0 or 1 in the culprit artery (P=0.020), incomplete ST-segment resolution (P=0.037), and higher troponin (P=0.024). Persistent T2 hyperintensity was associated with NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration (0.57 on a log scale [0.42-0.72]; P=0.004) and the likelihood of adverse left ventricular remodeling (>20% change in left ventricular end-diastolic volume; 21.91 [2.75-174.29]; P=0.004). Persistent T2 hyperintensity was associated with all-cause death and heart failure, but the result was not significant (P=0.051). ΔT2 was associated with all-cause death and heart failure (P=0.004) and major adverse cardiac events (P=0.013). CONCLUSIONS Persistent T2 hyperintensity occurs in two thirds of STEMI patients. Persistent T2 hyperintensity was associated with the initial STEMI severity, adverse remodeling, and long-term health outcome. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
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Affiliation(s)
- Jaclyn Carberry
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - David Carrick
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Caroline Haig
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Nadeem Ahmed
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ify Mordi
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Margaret McEntegart
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Mark C Petrie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Hany Eteiba
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Stuart Hood
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Stuart Watkins
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Mitchell Lindsay
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Andrew Davie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ahmed Mahrous
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Ian Ford
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Naveed Sattar
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Paul Welsh
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Aleksandra Radjenovic
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Keith G Oldroyd
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.)
| | - Colin Berry
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (J.C., D.C., N.A., I.M., M.M., M.C.P., H.E., S.H., S.W., M.L., A.D., A.M., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Scotland; and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank (D.C., S.W., C.B.).
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Carberry J, Carrick D, Haig C, Ahmed N, Mordi I, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay M, Davie A, Mahrous A, Ford I, Sattar N, Welsh P, Radjenovic A, Oldroyd KG, Berry C. Persistent Iron Within the Infarct Core After ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Remodeling and Health Outcomes. JACC Cardiovasc Imaging 2017; 11:1248-1256. [PMID: 29153575 PMCID: PMC6130225 DOI: 10.1016/j.jcmg.2017.08.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022]
Abstract
Objectives This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI). Background The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood. Methods Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T2* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T2* signal <20 ms. Results A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T2* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]). Conclusions Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)
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Affiliation(s)
- Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Nadeem Ahmed
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ify Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Stuart Hood
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Andrew Davie
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ahmed Mahrous
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
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Mangion K, Clerfond G, Rush C, Carrick D, McComb C, Gao H, Luo X, Eteiba H, Lindsay M, McEntegart M, Hood S, Petrie M, Oldroyd K, Watkins S, Davie A, Zhong X, Haig C, Berry C. SEGMENTAL CIRCUMFERENTIAL STRAIN DERIVED FROM DENSE PREDICTS IMPROVEMENT OF LEFT VENTRICULAR FUNCTION POST ST ELEVATION MYOCARDIAL INFARCTION: THE BHF MR-MI STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Carberry J, Carrick D, Haig C, Ahmed N, May VT, McEntegart M, Eteiba H, Lindsay MM, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Oldroyd K, Berry C. PROGNOSTIC SIGNIFICANCE OF CO-EXISTING PERSISTENT EDEMA AND HEMORRHAGE AT 6 MONTHS IN SURVIVORS OF ST-ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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