1
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Januszek R, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Wanha W, Wojakowski W, Bryniarski K, Legutko J, Kambis M, Di Mario C, Bartus K, Bartus S. Procedural outcomes and annual operator volume among patients treated with percutaneous coronary intervention of chronic total occlusions – analysis based on a large national registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2070] [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
It has been demonstrated that low operator and institutional volume is associated with poorer procedural and long-term clinical outcomes in general population of patients treated with percutaneous coronary interventions (PCI).
Purpose
The aim of the current study was to assess the relationship between operator volume and procedural outcomes of patients treated with PCI within chronic total occlusion (CTO).
Methods
Data for conducting the current analysis were obtained from the national registry of percutaneous coronary interventions (ORPKI) maintained in cooperation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study covered data obtained from the registry from January 2014 to December 2020. To investigate the association between operator and all periprocedural complications, coronary artery perforation (CAP) and TIMI flow grade 2/3 after PCI in the presence of confounding and clustering effects, we used multivariable, mixed effects logistic regression modelling.
Results
During the investigated period, there were 162 active CathLabs, at which 747,033 PCI procedures were performed during the time of observation. Of those 14,924 were CTO-PCI procedures. Considering the number of CTO-PCIs performed annually by individual operators during the analyzed 7 years we assessed differences between four groups (≤10; >10≤20; >20≤30 and >30 procedures). We demonstrated by nonlinear relationship with annualised CTO-PCI operator volume that operators performing more than 40 PCI with CTO per year have lower number of the overall periprocedural complications (Fig. 1) including CAP, as well greater procedural success rates (Fig. 2) compared to operators performing less procedures (p<0.0001).
Conclusions
High-volume CTO operators achieve a greater procedural success with a lower frequency of periprocedural complications. This study suggests that the cut-off of 50 CTO-PCIs per year recommended in the EuroCTO Consensus remains a reasonable compromise to optimize outcome and maintain local availability. Special CTO training programs and a higher annual case load might increase the overall quality of CTO PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Januszek
- University Hospital of Krakow , Krakow , Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce , Kielce , Poland
| | | | - S Surowiec
- University Hospital of Krakow , Krakow , Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | | | - J Legutko
- Jagiellonian University , Krakow , Poland
| | - M Kambis
- University Heart Center Freiburg-Bad Krozingen , Bad Krozingen , Germany
| | - C Di Mario
- Careggi University Hospital , Florence , Italy
| | - K Bartus
- Jagiellonian University , Krakow , Poland
| | - S Bartus
- Jagiellonian University , Krakow , Poland
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2
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Angelini F, Franchin L, Bocchino PP, De Filippo O, Morici N, Wanha W, Savonitto S, Trabattoni D, Cerrato E, Barbieri L, De Luca L, Fortuni F, Capodanno D, D'Ascenzo F, De Ferrari GM. In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2804] [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: 11/14/2022] Open
Abstract
Abstract
Objective
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
Methods
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
Results
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). [Figure 1] After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI 1.03–1.11, p-value <0.001), lower SBP (OR 0.98 per mmHg reduction, 95% CI 1.01–1.03, p-value 0.001) and being not independent at home (OR 2.56, 95% CI 1.25–5.26, p-value 0.01) resulted independent predictors of in-hospital mortality. [Figure 2] A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
Conclusion
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- F Angelini
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - L Franchin
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - P P Bocchino
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - O De Filippo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - N Morici
- Niguarda hospital, Cardiology, Milan, Italy
| | - W Wanha
- University of Silesia, Cardiology, Katowice, Poland
| | - S Savonitto
- Alessandro Manzoni Hospital, Cardiology, Lecco, Italy
| | - D Trabattoni
- Monzino Cardiology Center, IRCCS, Cardiology, Milan, Italy
| | - E Cerrato
- Degli Infermi Hospital, Cardiology, Rivoli, Italy
| | | | - L De Luca
- S. Camillo-Forlanini Hospital, Cardiology, Rome, Italy
| | - F Fortuni
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | | | - F D'Ascenzo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - G M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
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3
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Januszek R, Bil J, Figatowski T, Tomasiewicz B, Desperak P, Niezgoda P, Reczuch K, Kubica J, Gil RJ, Bartus S, Gasior M, Witkowski A, Jaguszewski M, Wojakowski W, Wanha W. Duration of dual antiplatelet therapy and long-term outcomes following drug-eluting balloon or drug-eluting stents for treatment of in-stent restenosis (DAPT-Dragon Registry). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2141] [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: 11/12/2022] Open
Abstract
Abstract
Objectives
The aim of the DAPT-DRAGON registry was to asses long-term outcomes and the length of dual antiplatelet therapy (DAPT) in patients treated with percutaneous coronary intervention (PCI) due to drug-eluting stent in stent restenosis (DES-ISR) with drug-eluting balloons (DEB) or thin-DES.
Background
Data regarding the duration of DAPT in patients with DES-ISR treated with PCI is still undergoing research and observation, and the adequate duration of DAPT in this group of patients is not unambiguously sanctioned.
Methods
Overall, 1,367 consecutive patients with DES-ISR who underwent PCI with DEB or DES, were entered into the multi-center DAPT-DRAGON Registry (Fig. 1). The mean age was 66.7±9 years (70.5% males). The median follow-up was 3.3 years. There were 34.1% patients with chronic coronary syndrome, 35.2% with unstable angina, 2.9% with ST segment elevation myocardial infarction and 27.7% with non-ST segment elevation myocardial infarction (MI). We assessed selected study endpoints according to the duration of DAPT (≤3 vs. >3 months and ≤6 vs. >6 months), before and after propensity score matching (PSM): stroke, target lesion revascularization (TLR), target vessel revascularization (TVR), MI, death and device-oriented composite endpoints (DOCE).
Results
Among predictors of increased DOCE rate before PSM, we demonstrated: PCI with DEB vs. DES (p<0.001), recurrent ISR (p=0.002), treatment with glycoprotein IIb/IIIa inhibitor during PCI (p<0.001), lower left ventricle ejection fraction (p=0.004) and extent of stenosis (p<0.001). Pairwise contrast analysis considering type of PCI (thin-DES vs. DEB) and duration of DAPT (≤6 vs. >6 months) before PSM revealed superiority of thin-DES+DAPT >6 months vs. DEB+DAPT >6 months for DOCE (p<0.001), TVR (p=0.02) and TLR (p=0.01). After PSM analysis, the length of DAPT (≤3 vs. >3 months) had no significant influence on assessed long-term outcomes, while the percentage of stroke free survival was significantly lower in the group of patients with DAPT ≤6 months vs. >6 months (p=0.01; Fig. 2).
Conclusions
Long-term treatment with DAPT (>6 months) in patients with DES-ISR with DES implantation is related to better long-term outcomes in terms of lower rate of DOCE, TVR and TLR compared to PCI with DEB. DAPT >6 months is related to a greater rate of strokes, independently of the type of treatment (thin-DES and DEB) compared to DAPT ≤6 months.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- R Januszek
- University Hospital of Krakow, Krakow, Poland
| | - J Bil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | | | - P Desperak
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - P Niezgoda
- Nicolaus Copernicus University, Bydgoszcz, Poland
| | - K Reczuch
- Wroclaw Medical University, Wroclaw, Poland
| | - J Kubica
- Nicolaus Copernicus University, Bydgoszcz, Poland
| | - R J Gil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - M Gasior
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - A Witkowski
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | | | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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4
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Sabatowski K, Malinowski KP, Reczuch K, Dobrzycki S, Lesiak M, Hawranek M, Gil RJ, Witkowski A, Wojakowski W, Lekston A, Gasior M, Wanha W, Legutko J, Bartus S, Januszek R. Gender distribution in patients treated with rotablation – analysis of 5,177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2140] [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: 11/15/2022] Open
Abstract
Abstract
Background
Patients undergoing percutaneous coronary intervention (PCI) procedures using rotational atherectomy (RA) are a special group of patients characterised by the presence of massive calcifications in the coronary arteries. Due to a significant increase regarding the frequency of these procedures in recent years and the distinctiveness of this narrow group of patients among all patients undergoing PCIs, we have characterised the group according to gender.
Aims
The aim of analysis was to assess the gender percentage share in following years and differences between both groups of Polish patients undergoing PCI with rotational RA between 2014 and 2020.
Methods
Based on the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), we analysed 751,113 patients treated with PCI between 2014 and 2020. Then, we extracted 5,177 (0.7%) treated with PCI and RA, 3,552 of them (68.6%) were males. Selected indices among the two groups were compared using the t-test for continuous variables, the χ2 test or the likelihood-ratio test for nominal variables where appropriate. To compare means of samples in the following years, one-way ANOVA test was used.
Results
The results of the study indicate an upward RA tendency in successive years (p<0.001). Moreover, this tendency and its increase was greater between the years 2016–2019 (Fig. 1). Almost twice as many RA procedures pertain to men, while the percentage share did not undergo a significant change in following years (Fig. 2). The mean age was 72±9 years in the overall group. In the total group, there were 2,873 patients (55.49%) with chronic coronary syndrome, 1,033 (19.95%) with unstable angina, 654 (12.63%) with non-ST segment elevation myocardial infarction (NSTEMI) and 494 (9.54%) with ST segment elevation myocardial infarction (STEMI).
Females were significantly older in comparison to males [75.2±8.3 vs. 70.5±9.2, p<0.001], more often diabetics [613 (37.72%) vs. 1,068 (30.07%), p<0.001], less often smokers [173 (10.6%) vs. 635 (17.9%), p<0.001] and were significantly more often treated due to acute coronary syndrome [780 (48.8%) vs. 1,401 (40.5%), p<0.001]. Considering periprocedural complications among females, there were more cardiac arrests [13 (0.8%) vs. 10 (0.28%), p=0.01] and deaths [11 (0.68%) vs. 6 (0.17%), p=0.006] when compared to males.
Conclusion
The percentage of RA among overall PCIs has been still growing in recent years in Poland. The majority of patients treated with RA are men. Gender distribution did not change significantly among patients treated with PCI and RA during the analysed period of time.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - K Reczuch
- Military Hospital of Wroclaw, Wroclaw, Poland
| | - S Dobrzycki
- Medical University of Bialystok, Bialystok, Poland
| | - M Lesiak
- Poznan University of Medical Sciences, Poznan, Poland
| | - M Hawranek
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - R J Gil
- Grochowski Hospital, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - A Witkowski
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Lekston
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - M Gasior
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - R Januszek
- University Hospital of Krakow, Krakow, Poland
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5
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Kowalowka A, Kowalewski M, Wanha W, Kolodziejczak M, Mariani S, Li T, Stefaniak S, Los A, Hudziak D, Gocol R, Suwalski P, Rogowski J, Jemielity M, Wojakowski W, Deja M. Long-term survival benefit of SAVR over TAVR in low-risk elective patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2207] [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: 11/14/2022] Open
Abstract
Abstract
Background
Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term.
Purpose
Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis.
Methods
We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).
Results
Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2).
Conclusions
TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2
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Affiliation(s)
- A Kowalowka
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
| | - M Kowalewski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Kolodziejczak
- Nicolaus Copernicus University, Department of Anaesthesiology and Intensive Care, Bydgoszcz, Poland
| | - S Mariani
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - T Li
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - S Stefaniak
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - A Los
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - D Hudziak
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - R Gocol
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - P Suwalski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - J Rogowski
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - M Jemielity
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Deja
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
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Staszczak B, Malinowski KP, Siudak Z, Wanha W, Surdacki A, Wojakowski W, Legutko J, Bartus K, Bartus S, Januszek R. Frequency and predictors of coronary angiography and percutaneous coronary intervention related stroke. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2153] [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: 11/14/2022] Open
Abstract
Abstract
Background
Acute stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, although potentially life-threatening and often leading to serious disability, characterised by high morbidity and mortality rate. However, particular data on periprocedural complications, predictors, prognosis and the type of coronary intervention has not yet been adequately investigated.
Aim
The aim of the present study was to assess the relationship between the type of coronary procedure [coronary angiography (CA) and PCI] and incidence of stroke as well as predictors of stroke.
Material and methods
This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2019 and included 1,177,161 coronary procedures. Among them, 650,674 patients underwent isolated CA and 526,487 underwent PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) refers to patients admitted for CA and 57 (0.011%) in patients qualified for PCI. Subsequently, the mentioned groups were analysed for similarities and compared. Multivariate analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.
Results
The amount of patients with periprocedural stroke was higher in a group treated with isolated CA during the analysed time. The mean age of the patients, who developed cerebral stroke, was significantly higher in the overall group (71.4±10.6 vs. 66.7±10.8; p<0.001). Patients with stroke, in comparison to non-stroke group, were treated more often from femoral access for CA (p<0.001) and PCI (p=0.04), they had a history of prior stroke for CA (p<0.001) and PCI (p<0.001) more often, and acute myocardial infarction at admission for CA (p<0.001) and PCI (p=0.01). They were also more frequently transported directly to the catheterisation laboratory for CA (p<0.001) and PCI (p=0.002). Predictors of periprocedural stroke, assessed by multivariate analysis for CA, are presented at Fig. 1 and for PCI at Fig. 2.
Conclusions
Based on the large national registry, PCI is associated with fewer risk factors and lower rate of periprocedural strokes than isolated CA.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- B Staszczak
- University Hospital of Krakow, Krakow, Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce, Kielce, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Surdacki
- University Hospital of Krakow, Krakow, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - K Bartus
- Jagiellonian University, Krakow, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - R Januszek
- University Hospital of Krakow, Krakow, Poland
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7
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Abdirashid M, D'Ascenzo F, Helft G, Boccuzzi G, Capodanno D, Giustetto C, Muscoli S, Wojakowski W, Wanha W, Protasiewicz M, Smolka G, Huczek Z, Kuliczowki W, Chieffo A, Rinaldi M. P972A subgroup analysis from the RAIN-CARDIOGROUP VII study: incidence of adverse events after DAPT cessation in patients treated with ultrathin stents in ULM or coronary bifurcations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0566] [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
Introduction
Incidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with ultrathin stents in unprotected left main (ULM) or coronary bifurcation remain undefined.
Methods
All consecutive patients presenting with a critical lesion of an ULM or a lesion involving a main coronary bifurcation and treated with very thin strut stents were included. MACE (a composite end point of cardiovascular death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) was the primary endpoint, while target vessel revascularization (TVR) was the secondary endpoint. Moreover, type and occurrence of ST and occurrence of ST, CV death and MI during DAPT or after DAPT discontinuation were also evaluated. All analyses were performed according to length of DAPT dividing the patients in 3 groups: short DAPT (3-months), intermediate DAPT (3–12 months) and long DAPT (12-months).
Results
117 patients were discharged with an indication for DAPT≤3 months (median 1:1–2.5), 200 for DAPT between 3 and 12 months (median 8:7–10) and 1958 with 12 months DAPT. After 12.8 months (8–20), MACE was significantly higher in the 3-month group compared to 3–12 and 12-month groups (9.4% vs. 4.0% vs. 7.2%, p≤0.001), mainly driven by MI (4.4% vs. 1.5% vs. 3%, p≤0.001) and overall ST (4.3% vs. 1.5% vs. 1.8%, p≤0.001). ST post DAPT cessation were comparable (1.7% vs. 0% vs. 0.7%, p=0.42) with a median time to ST post DAPT discontinuation of 1.67 months (0.48–4.7). At multivariate analysis, DAPT of 12-months compared to 3-months reduces the risk of overall ST (OR 0.103: 0.019–0.0563, 95% CI) while only a trend was noted for DAPT between 3 and 12 months (OR 0.61: 0.186–2.005, 95% CI). When analysed by stent strategy a 2-stent strategy predicted ST post DAPT cessation (OR 3.241: 1.048–10.026, 95% CI), which was reduced by use of FKB (OR 0.101:0.01–0.872, 95% CI).
Conclusion
Even stents with very thin strut when implanted in real-life ULM or coronary bifurcation patients discharged with short DAPT have a relevant risk of ST, which remains high although not significant after DAPT cessation. The correct identification before PCI of the more fragile patients who may receive a shorter DAPT regimen could help identify the safest PCI technique: provisional stenting and use of final kissing balloon (FKB) are the safest options.
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Affiliation(s)
- M Abdirashid
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - G Helft
- University Pierre & Marie Curie Paris VI, Cardiology, Paris, France
| | - G Boccuzzi
- San Giovanni Bosco Hospital of Turino, Cardiology, Turin, Italy
| | - D Capodanno
- University Hospital Vittorio Emanuele, Cardiology, Catania, Italy
| | - C Giustetto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
| | - S Muscoli
- San Raffaele Hospital of Milan (IRCCS), Cardiology, Milan, Italy
| | - W Wojakowski
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - W Wanha
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - M Protasiewicz
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - G Smolka
- Medical University of Silesia, Cardiology, Katowice, Poland
| | - Z Huczek
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - W Kuliczowki
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - A Chieffo
- San Raffaele Hospital of Milan (IRCCS), Cardiology, Milan, Italy
| | - M Rinaldi
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Cardiology, Turin, Italy
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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9
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Veulemanns V, Wanha W, Kubica J, De Cillis E, Bortone AS, Pestrichella V, Zeus T, Jung C, Lauten A, Kelm M, Bliden K, Tantry U, Wojakowski W, Gurbel PA, Navarese EP. P1674Vascular Complications with Transcatheter Aortic Valve Replacement devices. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1674] [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: 11/12/2022] Open
Affiliation(s)
- V Veulemanns
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - W Wanha
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - J Kubica
- Collegium Medicum, Department of Cardiology Nicolaus Copernicus University, Bydgoszcz, Poland
| | - E De Cillis
- A.O.U. Policlinico Consorziale, U.O.C. Cardiologia Ospedaliera, Bari, Italy
| | - A S Bortone
- University of Bari, Department of Interventional Cardiology, Bari, Italy
| | | | - T Zeus
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - C Jung
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - A Lauten
- Campus Benjamin Franklin, Charité, Department of Cardiology, Berlin, Germany
| | - M Kelm
- University Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Düsseldorf, Germany
| | - K Bliden
- Sinai Hospital of Baltimore, Sinai Center for Thrombosis Research, Baltimore, United States of America
| | - U Tantry
- Sinai Hospital of Baltimore, Sinai Center for Thrombosis Research, Baltimore, United States of America
| | - W Wojakowski
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - P A Gurbel
- Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development, Fairfax, Virginia, United States of America
| | - E P Navarese
- Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development, Fairfax, Virginia, United States of America
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Veulemans V, Wanha W, Lauten A, De Cillis E, Bortone AS, Pestrichella V, Zeus T, Jung C, Ochala A, Gurbel PA, Wojakowski W, Kelm M, Kubica J, Navarese EP. P4581Short- and long-term mortality in patients with diabetes mellitus after TAVR: Results of an international multicenter registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4581] [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: 11/14/2022] Open
Affiliation(s)
- V Veulemans
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - W Wanha
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - A Lauten
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - E De Cillis
- Polyclinic Hospital of Bari, U.O.C. Cardiologia Ospedaliera, A.O.U., Bari, Italy
| | - A S Bortone
- University of Bari, Department of Interventional Cardiology, Bari, Italy
| | | | - T Zeus
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - C Jung
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - A Ochala
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - P A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Interventional Cardiology and Cardiovascular Medicine Research, Falls Church, VA, United States of America
| | - W Wojakowski
- Medical University of Silesia, Division of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Kelm
- Heinrich Heine University Hospital, Division of Cardiology, Pulmunology and Vascular Medicine, Düsseldorf, Germany
| | - J Kubica
- Nicolaus Copernicus University (NCU), Department of Cardiology, Bydgoszcz, Poland
| | - E P Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Interventional Cardiology and Cardiovascular Medicine Research, Falls Church, VA, United States of America
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11
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Jadczyk T, Baranski K, Syzdol M, Nabialek E, Wanha W, Kurzelowski R, Ratajczak MZ, Kucia M, Dolegowska B, Niewczas M, Zejda J, Wojakowski W. Bioactive Sphingolipids, Complement Cascade, and Free Hemoglobin Levels in Stable Coronary Artery Disease and Acute Myocardial Infarction. Mediators Inflamm 2018; 2018:2691934. [PMID: 30116144 PMCID: PMC6079520 DOI: 10.1155/2018/2691934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery are associated with a pathogen-free inflammatory response (sterile inflammation). Complement cascade (CC) and bioactive sphingolipids (BS) are postulated to be involved in this process. AIM The aim of this study was to evaluate plasma levels of CC cleavage fragments (C3a, C5a, and C5b9), sphingosine (SP), sphingosine-1-phosphate (S1P), and free hemoglobin (fHb) in AMI patients treated with primary percutaneous coronary intervention (pPCI) and stable coronary artery disease (SCAD) undergoing CABG. PATIENTS AND METHODS The study enrolled 37 subjects (27 male) including 22 AMI patients, 7 CABG patients, and 8 healthy individuals as the control group (CTRL). In the AMI group, blood samples were collected at 5 time points (admission to hospital, 6, 12, 24, and 48 hours post pPCI) and 4 time points in the CABG group (6, 12, 24, and 48 hours post operation). SP and S1P concentrations were measured by high-performance liquid chromatography (HPLC). Analysis of C3a, C5a, and C5b9 levels was carried out using high-sensitivity ELISA and free hemoglobin by spectrophotometry. RESULTS The plasma levels of CC cleavage fragments (C3a and C5b9) were significantly higher, while those of SP and S1P were lower in patients undergoing CABG surgery in comparison to the AMI group. In both groups, levels of CC factors showed no significant changes within 48 hours of follow-up. Conversely, SP and S1P levels gradually decreased throughout 48 hours in the AMI group but remained stable after CABG. Moreover, the fHb concentration was significantly higher after 24 and 48 hours post pPCI compared to the corresponding postoperative time points. Additionally, the fHb concentrations increased between 12 and 48 hours after PCI in patients with AMI. CONCLUSIONS Inflammatory response after AMI and CABG differed regarding the release of sphingolipids, free hemoglobin, and complement cascade cleavage fragments.
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Affiliation(s)
- T. Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - K. Baranski
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - M. Syzdol
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - E. Nabialek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - W. Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - R. Kurzelowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - M. Z. Ratajczak
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, USA
| | - M. Kucia
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, USA
| | - B. Dolegowska
- Department of Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - M. Niewczas
- Department of Sport, Faculty of Physical Education, University of Rzeszow, Rzeszow, Poland
| | - J. Zejda
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - W. Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
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