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Park DY, Vemmou E, An S, Nikolakopoulos I, Regan CJ, Cambi BC, Frampton J, Vij A, Brilakis E, Nanna MG. Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction. Int J Cardiol Heart Vasc 2023; 45:101186. [PMID: 36852085 PMCID: PMC9957744 DOI: 10.1016/j.ijcha.2023.101186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Background Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). Methods We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. Results A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9 % from 6,180 in 2008 to 25,330 in 2019 (P-trend < 0.001). The percentage of IVUS use in PCIs increased from 3.4 % in 2008 to 8.7 % in 2019 (P-trend < 0.001). The number of OCT-guided PCIs increased 548.4 % from 246 in 2011 to 1,595 in 2019 (P-trend < 0.001). The percentage of OCT guidance in all PCIs increased from 0.0 % in 2008 to 0.6 % in 2019 (P-trend < 0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95 % confidence interval 0.60-0.72, p < 0.001). Conclusions Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.
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Key Words
- BMS, Bare-metal stent
- CI, Confidence interval
- DES, Drug-eluting stent
- HCUP, Healthcare Cost and Utilization Project
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-10-PCS, International Classification of Diseases, 10th Revision, Procedural Coding System
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- ICD-9-PCS, International Classification of Diseases, 9th Revision, Procedural Coding System
- IVUS
- IVUS, Intravascular ultrasound
- Imaging
- Intravascular
- MI, Myocardial infarction
- Myocardial infarction
- NIS, National Inpatient Sample
- NSTEMI, Non-ST-elevation myocardial infarction
- OCT
- OCT, Optical coherence tomography
- PCI
- PCI, Percutaneous coronary intervention
- STEMI, ST-elevation myocardial infarction
- Trend
- U.S, United States
- aOR, Adjusted odds ratio
- cOR, Crude odds ratio
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Evangelia Vemmou
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Seokyung An
- Department of Biomedical Science, Seoul National University, Seoul, Republic of Korea
| | | | | | - Brian C. Cambi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Emmanouil Brilakis
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Corresponding author at: Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
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2
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Olsen MB, Gregersen I, Sandanger Ø, Yang K, Sokolova M, Halvorsen BE, Gullestad L, Broch K, Aukrust P, Louwe MC. Targeting the Inflammasome in Cardiovascular Disease. JACC Basic Transl Sci 2022; 7:84-98. [PMID: 35128212 PMCID: PMC8807732 DOI: 10.1016/j.jacbts.2021.08.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Received: 06/01/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023]
Abstract
Development of cardiovascular disease and inflammation are heavily intertwined, and inflammasome activation is thought play an important role in this interaction. This review provides an overview of preclinical and clinical studies supporting inflammasomes as a therapeutic target in atherosclerosis and heart failure. Future studies exploring direct inflammasome inhibition, either NLRP3 or the lesser-studied inflammasomes, are also discussed.
The pathogenesis of cardiovascular disease (CVD) is complex and multifactorial, and inflammation plays a central role. Inflammasomes are multimeric protein complexes that are activated in a 2-step manner in response to infection or tissue damage. Upon activation the proinflammatory cytokines, interleukins-1β and -18 are released. In the last decade, the evidence that inflammasome activation plays an important role in CVD development became stronger. We discuss the role of different inflammasomes in the pathogenesis of CVD, focusing on atherosclerosis and heart failure. This review also provides an overview of existing experimental studies and clinical trials on inflammasome inhibition as a therapeutic target in these disorders.
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Key Words
- ACS, acute coronary syndrome
- AIM2, absent in melanoma 2
- ASC, apoptosis associated speck-like protein
- ATP, adenosine triphosphate
- CAD, coronary artery disease
- CRP, C-reactive protein
- CVD, cardiovascular disease
- DAMP, damage associated molecular pattern
- GSDMD, gasdermin-D
- GSDMD-NT, gasdermin-D N-terminal
- HF, heart failure
- HFpEF, HF with preserved ejection fraction
- HFrEF, HF with reduced ejection fraction
- IL, interleukin
- IL-1
- LDL, low-density lipoprotein
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- NF-κB, nuclear factor κB
- NLR, NOD-like receptor
- NLRP3
- NLRP3, NOD-like receptor family pyrin domain containing 3
- NOD, nucleotide-binding oligomerization domain
- PRR, pattern recognition receptor
- STEMI, ST-elevation myocardial infarction
- TLR, toll-like receptor
- atherosclerosis
- cardiovascular disease
- heart failure
- inflammasome
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Affiliation(s)
- Maria Belland Olsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Øystein Sandanger
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Section of Dermatology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kuan Yang
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Marina Sokolova
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Bente E Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Lars Gullestad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Center, Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Cardiac Research Center, Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Mieke C Louwe
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
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3
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Elkaryoni A, Drummond AP, Elgendy IY, Bontu S, Polancich M, Walsh E, Porcaro K, Allen S, Syed M, Steen LH, Lopez JJ, Darki A. ST-Elevation Myocardial Infarction Transferred from Non-acute Care Hospitals (from a Nationwide Cohort Sample). Am J Cardiol 2021; 157:152-153. [PMID: 34404505 DOI: 10.1016/j.amjcard.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
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4
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Rodrigo SF, Van Exel HJ, Van Keulen N, Van Winden L, Beeres SLMA, Schalij MJ. Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned. Int J Cardiol Heart Vasc 2021; 36:100858. [PMID: 34466654 PMCID: PMC8382985 DOI: 10.1016/j.ijcha.2021.100858] [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: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation. METHODS The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated. RESULTS A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR program. Factors independently associated with CR referral included age (50-60 year vs. > 70 year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs. > 20 km: OR 3.1, CI 1.20-7.72). CONCLUSIONS Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina.
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Key Words
- ACS, Acute coronary syndrome
- CI, Confidence interval
- CR, Cardiac rehabilitation
- CVA, Cerebrovascular accident
- Cardiac rehabilitation
- DBC, Diagnosis treatment combination (Diagnose behandel combinatie)
- EPD, Electronic patient dossier
- LV, Left ventricular
- NSTEMI, Non ST-elevation myocardial infarction
- OR, Odds ratio
- Patient participation
- Referral
- SES, Socio-economic status
- STEMI, ST-elevation myocardial infarction
- Secondary prevention
- TIA, Transient ischemic attack
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Affiliation(s)
- Sander F Rodrigo
- Basalt Rehabilitation, Leiden, the Netherlands
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole Van Keulen
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Loes Van Winden
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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5
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Kumar A, Zhou L, Huded CP, Moennich LA, Menon V, Puri R, Reed GW, Nair R, Khatri JJ, Krishnaswamy A, Lincoff AM, Ellis SG, Ziada KM, Kapadia SR, Khot UN. Prognostic implications and outcomes of cardiac arrest among contemporary patients with STEMI treated with PCI. Resusc Plus 2021; 7:100149. [PMID: 34345872 PMCID: PMC8319445 DOI: 10.1016/j.resplu.2021.100149] [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: 03/06/2021] [Revised: 05/08/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI). Methods We reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI. Results Male gender, cerebrovascular disease, chronic kidney disease, in-hospital STEMI, left main or left anterior descending culprit vessel, and initial TIMI 0 or 1 flow were independent predictors for CA. CA patients had longer door-to-balloon-time (106 [83,139] vs. 97 [74,121] minutes, p = 0.003) and greater incidence of cardiogenic shock (48.0% vs. 5.9%, p < 0.001), major bleeding (25.0% vs. 9.4%, p < 0.001), and 30-day mortality (16.2% vs. 4.1%, p < 0.001). Risk score for 30-day mortality based on presenting characteristics provided excellent prognostic accuracy (area under the curve = 0.902). However, over long-term follow-up of 4.5 ± 2.4 years among hospital survivors, CA did not portend any additional mortality risk (HR: 1.01, 95% CI: 0.56–1.82, p = 0.97). Conclusions In a contemporary cohort of STEMI patients undergoing primary PCI, CA occurs in >10% of patients and is an important mechanism of mortality in patients with in-hospital STEMI. While CA is associated with adverse outcomes, it carries no additional risk of long-term mortality among survivors highlighting the need for strategies to improve the in-hospital care of STEMI patients with CA.
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Affiliation(s)
- Anirudh Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Leon Zhou
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Chetan P Huded
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Laurie Ann Moennich
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Grant W Reed
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Ravi Nair
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Jaikirshan J Khatri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - A Michael Lincoff
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Stephen G Ellis
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Khaled M Ziada
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
| | - Umesh N Khot
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH United States
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6
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Takahashi N, Dohi T, Endo H, Takeuchi M, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Miyauchi K, Minamino T. Coronary lipid-rich plaque characteristics in Japanese patients with acute coronary syndrome and stable angina: A near infrared spectroscopy and intravascular ultrasound study. Int J Cardiol Heart Vasc 2021; 33:100747. [PMID: 33748401 PMCID: PMC7957086 DOI: 10.1016/j.ijcha.2021.100747] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asians have a much lower incidence of adverse coronary events than Caucasians. We sought to evaluate the characteristics of coronary lipid-rich plaques (LRP) in Asian patients with acute coronary syndrome (ACS) and stable angina (SA). We also aimed to identify surrogate markers for the extent of LRP. METHODS We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed. RESULTS The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385-745] vs. 361 [174-527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95-8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001). CONCLUSIONS We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.
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Key Words
- ACS, acute coronary syndrome
- Asian
- CI, confidence interval
- CKD, chronic kidney disease
- IL-6, interleukin-6
- IQR, interquartile range
- IVUS, intravascular ultrasound
- Intracoronary imaging
- LCBI
- LCBI, lipid core burden index
- LDL-C, low-density lipoprotein cholesterol
- LRP, lipid-rich plaque
- Lipid core burden index
- MDA-LDL, malondialdehyde-modified LDL
- MLA, minimum lumen area
- NIRS
- NIRS, near infrared spectroscopy
- NSTE-ACS, non-ST elevation acute coronary syndrome
- OR, odds ratio
- PCI, percutaneous coronary intervention
- PCSK9, proprotein convertase subtilisin / kexin type 9
- SA, stable angina
- STEMI, ST-elevation myocardial infarction
- TNF-α, tumor necrosis factor-α
- Vulnerable plaque
- hs-CRP, high-sensitive C reactive protein
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Affiliation(s)
- Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Japan Agency for Medical Research and Development Core Research for Evolutionary Medical Science and Technology (AMEDCREST), Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, Japan
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7
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Dannenberg L, Afzal S, Czychy N, M'Pembele R, Zako S, Helten C, Mourikis P, Zikeli D, Ahlbrecht S, Trojovsky K, Benkhoff M, Barcik M, Wolff G, Zeus T, Kelm M, Polzin A. Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI. Int J Cardiol Heart Vasc 2021; 33:100750. [PMID: 33763519 PMCID: PMC7973296 DOI: 10.1016/j.ijcha.2021.100750] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Background Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. Methods We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. Results 524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01–8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36–9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52–2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12–5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26–3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden’s index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24). Conclusion In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events.
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Key Words
- AF, Atrial fibrillation
- Bleeding
- DAPT
- DAPT, Dual antiplatelet medication
- GRACE, Global Registry of Acute Coronary Events
- MACCE
- MACCE, Major adverse cardiac and cerebrovascular events
- PARIS, Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients
- PCI, percutaneous coronary intervention
- PD, PRECISE-DAPT, PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy
- ROC, Receiver operating characteristic
- STEMI, ST-elevation myocardial infarction
- Scores
- TIA, Transient ischemic attack
- TIMI
- TIMI, Thrombolysis in myocardial infarction
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Affiliation(s)
- Lisa Dannenberg
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Shazia Afzal
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Natalia Czychy
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, University Hospital Duesseldorf, Germany
| | - Saif Zako
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Carolin Helten
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Philipp Mourikis
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Dorothee Zikeli
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Samantha Ahlbrecht
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Kajetan Trojovsky
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Marcel Benkhoff
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Maike Barcik
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Georg Wolff
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Tobias Zeus
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Malte Kelm
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Amin Polzin
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
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Miyagi T, Ishimine T, Nakazato J, Taniguchi N, Yagi N, Takahashi T, Tengan T, Wake M. Coronary Artery Embolism Caused by BioGlue Surgical Adhesive After Type A Acute Aortic Dissection Repair. JACC Case Rep 2021; 3:53-57. [PMID: 34317468 PMCID: PMC8305680 DOI: 10.1016/j.jaccas.2020.11.012] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
Coronary artery embolism due to BioGlue surgical adhesive after repair of type A acute aortic dissection is a rare condition. We report a case of BioGlue coronary artery embolism after type A acute aortic dissection repair confirmed using intravascular ultrasound imaging and pathological examination. It was successfully treated with percutaneous coronary intervention. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Tadayoshi Miyagi
- Division of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Tohru Ishimine
- Division of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Jun Nakazato
- Division of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Naoki Taniguchi
- Division of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Nobuhito Yagi
- Division of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Takanori Takahashi
- Division of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Toshiho Tengan
- Division of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Minoru Wake
- Division of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
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9
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Kristono GA, Holley AS, Hally KE, Brunton-O'Sullivan MM, Shi B, Harding SA, Larsen PD. An IL-6-IL-8 score derived from principal component analysis is predictive of adverse outcome in acute myocardial infarction. Cytokine X 2020; 2:100037. [PMID: 33604561 PMCID: PMC7885891 DOI: 10.1016/j.cytox.2020.100037] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Many studies have shown that elevated biomarkers of inflammation following acute myocardial infarction (AMI) are associated with major adverse cardiovascular events (MACE). However, the optimal way of measuring the complex inflammatory response following AMI has not been determined. In this study we explore the use of principal component analysis (PCA) utilising multiple inflammatory cytokines to generate a combined cytokine score that may be predictive of MACE post-AMI. Methods Thirteen inflammatory cytokines were measured in plasma of 317 AMI patients, drawn 48-72 h following symptom onset. Patients were followed-up for one year to determine the incidence of MACE. PCA was used to generate a combined score using six cytokines that were detectable in the majority of patients (IL-1β, -6, -8, and -10; MCP-1; and RANTES), and using a subset of cytokines that were associated with MACE on univariate analysis. Multivariate models using baseline characteristics, elevated individual cytokines and PCA-derived scores determined independent predictors of MACE. Results IL-6 and IL-8 were significantly associated with MACE on univariate analysis and were combined using PCA into an IL-6-IL-8 score. The combined cytokine score and IL-6-IL-8 PCA-derived score were both significantly associated with MACE on univariate analysis. In multivariate models IL-6-IL-8 scores (OR = 2.77, p = 0.007) and IL-6 levels (OR = 2.18, p = 0.035) were found to be independent predictors of MACE. Conclusion An IL-6-IL-8 score derived from PCA was found to independently predict MACE at one year and was a stronger predictor than any individual cytokine, which suggests this may be an appropriate strategy to quantify inflammation post-AMI. Further investigation is required to determine the optimal set of cytokines to measure in this context.
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Key Words
- ACS, Acute coronary syndrome
- AF, Atrial fibrillation
- AMI, Acute myocardial infarction
- AUC, Area under the curve
- Acute myocardial infarction
- BMI, Body mass index
- CAD, Coronary artery disease
- CBA, Cytometric bead array
- CHF, Chronic heart failure
- CI, Confidence interval
- CVD, Cardiovascular disease
- Cytokine score
- EFA, Exploratory factor analysis
- ELISA, Enzyme-linked immunosorbent assay
- GDF-15, Growth differentiation factor-15
- GM-CSF, Granulocyte-macrophage colony-stimulating factor
- HTN, Hypertension
- IFNγ, Interferon gamma
- IL-(number), Interleukin-(number)
- IQR, Interquartile range
- Interleukin-6
- Interleukin-8
- MACE, Major adverse cardiovascular events
- MCP-1, Monocyte chemoattractant protein-1
- MFI, Mean fluorescence intensity
- MI, Myocardial infarction
- Major adverse cardiovascular events
- NSTEMI, Non-ST elevation myocardial infarction
- OR, Odds ratio
- PCA, Principal component analysis
- PCI, Percutaneous coronary intervention
- Principal component analysis
- RANTES, Regulated upon activation normal T-cell expressed and secreted
- ROC, Receiver operator characteristic
- STEMI, ST-elevation myocardial infarction
- TGF-β1, Tumour growth factor-beta 1
- TIA, Transient ischaemic attack
- TNF-α, Tumour necrosis factor alpha
- TRAIL-R2, Tumour necrosis factor-related apoptosis-inducing ligand receptor 2
- TnT, Troponin T
- VEGF, Vascular endothelial growth factor
- h, Hours
- p, P-value
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Affiliation(s)
- Gisela A Kristono
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.,Wellington Cardiovascular Research Group, New Zealand
| | - Ana S Holley
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.,Wellington Cardiovascular Research Group, New Zealand
| | - Kathryn E Hally
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.,Wellington Cardiovascular Research Group, New Zealand.,School of Biological Sciences, Victoria University of Wellington, New Zealand
| | - Morgane M Brunton-O'Sullivan
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.,Wellington Cardiovascular Research Group, New Zealand
| | - Bijia Shi
- Wellington Cardiovascular Research Group, New Zealand.,Cardiology Department, Capital and Coast District Health Board, New Zealand
| | - Scott A Harding
- Wellington Cardiovascular Research Group, New Zealand.,Cardiology Department, Capital and Coast District Health Board, New Zealand
| | - Peter D Larsen
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand.,Wellington Cardiovascular Research Group, New Zealand
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10
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Kaolawanich Y, Boonyasirinant T. Impact of aortic stiffness by velocity-encoded magnetic resonance imaging on late gadolinium enhancement to predict cardiovascular events. Int J Cardiol Heart Vasc 2020; 30:100635. [PMID: 33015313 PMCID: PMC7522332 DOI: 10.1016/j.ijcha.2020.100635] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Abstract
Background Increased aortic stiffness has been established as a marker in various cardiovascular diseases. Previous reports revealed a significant correlation between aortic stiffness and myocardial scarring using the late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR). However, prognostic data concerning aortic stiffness combining myocardial scarring remains limited. Method A total of 402 patients who had undergone clinical CMR for the evaluation of cardiac function, LGE, and aortic pulse wave velocity (PWV) using velocity encoded-CMR (VE-CMR) were included. Patients were classified into 4 groups using mean PWV and the presence of LGE as elevated or non-elevated PWV and positive or negative LGE. Patients received follow-up for major adverse cardiovascular events (MACE) comprising cardiovascular death, non-fatal myocardial infarction, hospitalization for heart failure, coronary revascularization, and ischemic stroke. Predictors of MACE and hard cardiac events (cardiovascular death or non-fatal myocardial infarction) were evaluated. Results During the average follow-up period of 47.7 months, 58 MACE occurred. Patients who had elevated PWV and positive LGE experienced the highest rate of MACE compared to the group with non-elevated PWV and negative LGE (HR 11.90, p < 0.001). Among patients who had LGE, those who had elevated PWV experienced a 2.4-times higher rate of MACE compared to those who had non-elevated PWV. Multivariate analysis showed that PWV and LGE were independent predictors of MACE and hard cardiac events. PWV had excellent intra- and inter-observer reproducibility (intra-: ICC = 0.98, p < 0.001, inter-: ICC = 0.97, p < 0.001). Conclusion Aortic stiffness using VE-CMR had prognostic value to predict cardiovascular events, with the added benefits of LGE.
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Key Words
- Aortic stiffness
- CI, confidence interval
- CMR, cardiovascular magnetic resonance
- Cardiovascular magnetic resonance imaging
- FOV, field of view
- HR, hazard ratio
- LA, left atrial/atrium
- LGE, late gadolinium enhancement
- LVEF, left ventricular ejection fraction
- Late gadolinium enhancement
- MACE, major adverse cardiovascular events
- PWV, pulse wave velocity
- Prognosis
- SD, standard deviation
- STEMI, ST-elevation myocardial infarction
- T, tesla
- TE, echo time
- TR, repetition time
- VE, velocity-encoded
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Affiliation(s)
- Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thananya Boonyasirinant
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Yousefzai R, Bhimaraj A. Misdiagnosis in the COVID-19 Era: When Zebras Are Everywhere, Don't Forget the Horses. JACC Case Rep 2020; 2:1614-1619. [PMID: 32342051 PMCID: PMC7184023 DOI: 10.1016/j.jaccas.2020.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
We describe a patient who presented with respiratory failure, chest pain, and fever. In the COVID-19 pandemic era, the focus was diverted to the coronavirus infection, and ST-segment elevation myocardial infarction was missed. Although we need to be vigilant in the diagnosis of COVID-19, we should not forget about the common disorders. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rayan Yousefzai
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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12
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Meier D, Skalidis I, De Bruyne B, Qanadli SD, Rotzinger D, Eeckhout E, Collet C, Muller O, Fournier S. Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale. Int J Cardiol Heart Vasc 2020; 27:100496. [PMID: 32181323 PMCID: PMC7063126 DOI: 10.1016/j.ijcha.2020.100496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 11/02/2022]
Abstract
Background In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS). Aims The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS. Methodology We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared. Potential significance In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.
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Key Words
- ACS, Acute coronary syndrome
- AE, Adverse Event
- Acute coronary syndrome
- CMRI, Cardiac Magnetic resonance imaging
- CT, Computed tomography
- Coronary computed tomography
- ECG, Electrocardiogram
- ED, Emergency department
- FFR, Fractional Flow Reserve
- FFR-CT
- FFR-CT, FFR derived from coronary CT
- Fractional Flow Reserve
- Hs-Tn, High-sensitive troponins
- MACE, Major adverse cardiac events
- MI, Myocardial infraction
- NSTE-ACS, Acute coronary syndromes without ST-segment elevation
- NSTEMI, Non-ST-elevation myocardial infarction
- PCI, Percutaneous Coronary Intervention
- STEMI, ST-elevation myocardial infarction
- URL, Upper Range Limit
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ioannis Skalidis
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center Aalst, Aalst, Belgium
| | - Salah Dine Qanadli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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13
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Ritschel VN, Seljeflot I, Arnesen H, Halvorsen S, Weiss T, Eritsland J, Andersen GØ. IL-6 signalling in patients with acute ST-elevation myocardial infarction. Results Immunol 2013; 4:8-13. [PMID: 24707455 DOI: 10.1016/j.rinim.2013.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 12/30/2022]
Abstract
Cytokines of the IL-6 family have been related to infarct size and prognosis in patients with myocardial infarction. The aims of the present study were to elucidate possible associations between myocardial necrosis and left ventricular impairment and members of the IL-6 transsignalling system including soluble (s) IL-6R and (s) glycoprotein 130 (sgp130) in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI. In blood samples from 1028 STEMI patients, collected in-hosptial, we found significant correlations between peak TnT and IL-6 and CRP (p < 0.001, all) and between IL-6 and CRP and LV ejection fraction and NT-proBNP (p < 0.001, all). On the contrary, no significant associations were found between peak TnT and sgp130 or sIL-6R. Furthermore sgp130 was significantly elevated in diabetic patients and also associated with the glucometabolic state. In conclusion, circulating levels of IL-6 and CRP, but not the soluble forms of the receptor (sIL-6R) or the receptor signalling subunit (sgp130) were associated with the extent of myocardial necrosis. The biological importance of the IL-6/gp130-mediated signalling pathways in patients with acute myocardial infarction and dysglycemia should be further elucidated.
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Affiliation(s)
- Vibeke N Ritschel
- Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Faculty of Medicine, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Faculty of Medicine, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Faculty of Medicine, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
| | - Thomas Weiss
- 3rd Medical Department for Cardiology and Emergency Medicine, Wilhelminenhospital, 1160 Vienna, Austria
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
| | - Geir Ø Andersen
- Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway ; Center of Heart Failure Research, University of Oslo, Ullevål, Kirkeveien 166, N-0450 Oslo, Norway
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