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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko YA, Ejaz K, Alvi Z, Jaber WA, Nicholson WJ, Quyyumi AA. Long-Term Outcomes in Patients With Chronic Total Occlusion. Am J Cardiol 2024; 214:59-65. [PMID: 38195045 PMCID: PMC10947430 DOI: 10.1016/j.amjcard.2023.12.052] [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] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Patel K, Yadalam A, DeStefano R, Desai S, Almuwaqqat Z, Ko YA, Alras Z, Martini MA, Ejaz K, Alvi Z, Varounis C, Murtagh G, Gupta D, Book W, Quyyumi AA. High sensitivity troponin I as a biomarker for cardiac allograft vasculopathy: Evaluation of diagnostic potential and clinical utility. Clin Transplant 2024; 38:e15168. [PMID: 37882497 PMCID: PMC10841445 DOI: 10.1111/ctr.15168] [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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Cardiac allograft vasculopathy (CAV) limits long-term survival in heart transplant (HTx) recipients. The use of biomarkers in CAV surveillance has been studied, but none are used in clinical practice. The predictive value of high-sensitivity troponin I (hsTnI) has not been extensively investigated in HTx recipients. METHODS HTx patients undergoing surveillance coronary angiograms and enrolled in the Emory Cardiovascular Biobank had plasma hsTnI measured. CAV grade was assessed using ISHLT nomenclature. Multivariable cumulative link mixed modeling was performed to determine association between hsTnI level and CAV grade. Patients were followed for adverse outcomes over a median 10-year period. Kaplan-Meier survival analysis and Cox proportional hazard modeling were performed. RESULTS Three hundred and seventy-two angiograms were analyzed in 156 patients at a median 8.9 years after transplant. hsTnI levels were positively correlated with concurrent CAV grade after adjustment for age, age at transplant, sex, BMI, hypertension, diabetes, hyperlipidemia, estimated glomerular filtration rate, and history of acute cellular rejection (p = .016). In an adjusted Cox proportional hazard model, initial hsTnI level above the median (4.9 pg/mL) remained a predictor of re-transplantation or death (hazard ratio 1.82; 95% confidence interval 1.16-2.90; p = .01). CONCLUSION An elevated hsTnI level reflects severity of CAV and is associated with poor long-term outcomes in patients with HTx.
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Affiliation(s)
- Krishan Patel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Adithya Yadalam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Robert DeStefano
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Shivang Desai
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Zahran Alras
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Mohamed Afif Martini
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Zain Alvi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | | | - Gillian Murtagh
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Divya Gupta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Wendy Book
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko Y, Alkhoder A, Ejaz K, Alvi Z, Rahbar A, Murtagh G, Jaber WA, Nicholson WJ, Quyyumi AA. High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization. J Am Heart Assoc 2023; 12:e031431. [PMID: 37929763 PMCID: PMC10727412 DOI: 10.1161/jaha.123.031431] [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] [Received: 06/16/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin-I (hsTn-I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn-I than patients without CTO, (2) hsTn-I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn-I levels will have a survival benefit from CTO revascularization. Methods and Results In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn-I level and incident event rates in patients with CTO. HsTn-I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). An elevated hsTn-I level was associated with higher adverse event rates (adjusted all-cause mortality hazard ratio, 1.19 [95% CI, 1.08-1.32]; P=0.030) for every doubling of hsTn-I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn-I level, CTO revascularization was associated with substantially lower all-cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08-0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with a low (
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Affiliation(s)
- Daniel A. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Vardhmaan Jain
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Matthew E. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Nishant Vatsa
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Shivang R. Desai
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Malika Elhage Hassan
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Yi‐An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Ayman Alkhoder
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Kiran Ejaz
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Zain Alvi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Alireza Rahbar
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | | | - Wissam A. Jaber
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - William J. Nicholson
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
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Füller D, Liu C, Ko YA, Alkhoder AA, Desai SR, Almuwaqqat Z, Patel SA, Ejaz K, Kauser T, Martini MA, Alvi Z, Mehta PK, Sperling LS, Quyyumi AA. Soluble urokinase Plasminogen Activator Receptor (suPAR) mediates the effect of a lower education level on adverse outcomes in patients with coronary artery disease. Eur J Prev Cardiol 2023:zwad311. [PMID: 37788634 DOI: 10.1093/eurjpc/zwad311] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
AIMS To investigate whether the adverse impact of lower educational attainment on mortality risk in patients with coronary artery disease (CAD) is mediated by activation of inflammatory and immune pathways, estimated as elevated suPAR levels. METHODS In 3,164 patients undergoing coronary angiography, we investigated multivariable associations between suPAR and educational attainment and assessed the relationship between a lower educational level (defined as high school degree or less as highest educational qualification) and outcomes using Cox proportional hazard and Fine and Gray's sub-distribution competing risk models. Potential mediating effect through suPAR and hs-CRP was assessed using mediation analysis. RESULTS 1,814 patients (57.3%) had achieved a higher (≥college), and 1,350 patients (42.7%) a lower (≤high school) education level. SuPAR levels were 9.0% [95% CI 6.3-11.8, p ≤0.0001] higher in patients with lower compared to higher educational qualifications after covariate adjustment. Lower educational attainment was associated with a higher risk of cardiovascular death after adjustment for demographic, clinical, and behavioral covariates, including CAD severity and heart failure history, medication use, and hs-CRP levels (HR 1.26 [95% CI 1.02-1.55, p=0.03]). However, after adjustment for suPAR levels, the effect of a lower educational level on cardiovascular death became insignificant. Values were similar for all-cause death. SuPAR levels mediated 49% and hs-CRP levels 17% of the cardiovascular death risk attributable to lower educational attainment. CONCLUSION Circulating suPAR levels importantly mediate the effects of lower educational attainment on mortality, indicating the importance of systemic inflammation and immune dysregulation as biologic mediators of adverse social determinants of health.
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Affiliation(s)
- David Füller
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ayman A Alkhoder
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shivang R Desai
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shivani A Patel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Tanveer Kauser
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohamed Afif Martini
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zain Alvi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Puja K Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Laurence S Sperling
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Patel K, Yadalam A, DeStefano R, Almuwaqqat Z, Desai S, Alkhoder A, Ejaz K, Alvi Z, Book W, Gupta D, Quyyumi A. Lipoprotein(a) Levels Predict Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.060] [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: 04/05/2023] Open
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Desai S, Behbahani-Nejad O, Dicken F, Park J, Beydoun N, Alras Z, Alkhoder A, Alvi Z, Faridizad R, Kauser T, Martini MA, Ejaz K, Liu C, Ko YA, Quyyumi AA. C-PEPTIDE CORRELATES WITH ADVERSE EVENTS IN A DIVERSE, HIGH-RISK CORONARY ARTERY DISEASE COHORT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01661-3] [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: 03/07/2023]
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Alvi Z, Mahmood A, Ali U, Rasul S, Arif S, Maqsood T, Ahmed S, Ishtiaq S. EP-1011: Therapeutic effects of whole brain radiotherapy with carboplatin in management of brain metastasis. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33317-x] [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: 10/23/2022]
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Alvi Z, Mahmood A, Rasool S, Ali U, Arif S, Ishtiaq S, Maqsood T. PO-107: Role of Honey in Prevention of Radiation Induced Mucositis in Head and Neck Cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34726-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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