Assuntos
Angina Estável , Ruptura Cardíaca Pós-Infarto , Doenças das Valvas Cardíacas , Insuficiência da Valva Mitral , Intervenção Coronária Percutânea , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Músculos Papilares/diagnóstico por imagem , Angina Estável/diagnóstico por imagem , Angina Estável/cirurgia , Intervenção Coronária Percutânea/efeitos adversosRESUMO
Studies on the outcomes of de novo three-vessel coronary artery disease (3VD) are limited. This study evaluated the outcomes after coronary revascularization in patients with 3VD treated by percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (2ndDES) in comparison with coronary artery bypass grafting (CABG). We analyzed 853 patients undergoing either PCI or CABG for 3VD between 2010 and 2014. Of them, this study included 298 undergoing PCI with 2ndDES alone (PCI group) and 171 undergoing CABG (CABG group). The primary outcome measure was a composite of all-cause death, non-fatal myocardial infarction (MI), or stroke. The secondary outcome measures were cardiac death, MI, stroke, and target vessel revascularization (TVR). Propensity matching was used to adjust a cohort of patients with similar baseline characteristics. Between the PCI and CABG groups, no significant differences were found in the 3-year cumulative incidence of the primary outcome measure (14.9% vs. 12.9%, p = 0.60). After propensity score matching, no significant differences were found in the incidences of primary outcome measure (13.0% vs. 12.8%, p = 0.95), cardiac death, MI, and stroke (3.5% vs. 2.7%, p = 0.72; 1.2% vs. 0.0%, p = 0.31; and 4.9% vs. 3.1%, p = 0.35), whereas that of TVR was significantly higher in the PCI group (24.5 vs. 7.1%, p < 0.01). Compared with CABG, PCI with second-generation DES was not associated with higher risk of clinical outcomes, but was associated with a higher risk of TVR in the treatment of 3VD.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Idoso , Idoso de 80 Anos ou mais , Estenose Coronária/terapia , Feminino , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/epidemiologiaRESUMO
BACKGROUND: Little is known of the relationship between optical coherence tomography (OCT) findings and recurrent restenosis after paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent in-stent restenosis (DES-ISR). To identify the predictors of recurrent restenosis after PCB angioplasty, we investigated quantitative and qualitative OCT findings during PCB angioplasty for DES-ISR. MethodsâandâResults: In all, 222 DES-ISR lesions treated by PCB angioplasty with OCT assessment and followed-up angiographically at 6 months were divided into restenotic and non-restenotic lesions on the basis of the presence or absence of restenosis at follow-up. There was a significantly higher proportion of the heterogeneous tissue pattern in restenotic than non-restenotic lesions (26.5% vs. 11.0%, respectively; P=0.02). The OCT-derived post-procedural minimal lumen and stent areas were significantly smaller in restenotic lesions, but the intima area was similar in both groups. Post-procedural stent underexpansion, defined as a stent diameter : size of the previous stent ratio <1.0, was more frequently observed in restenotic than non-restenotic lesions (33.3% vs. 17.4%, respectively; P=0.02). Multivariate analysis identified a heterogeneous tissue pattern (odds ratio [OR] 2.92; 95% confidence interval [CI] 1.32-6.47; P=0.006) and post-procedural stent underexpansion (OR 2.36; 95% CI 1.15-4.85; P=0.04) as independent predictors of recurrent restenosis. CONCLUSIONS: The heterogeneous tissue pattern and insufficient post-procedural minimal lumen area, caused primarily by stent underexpansion, may be associated with restenosis after PCB angioplasty for DES-ISR.
Assuntos
Angioplastia Coronária com Balão , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Stents Farmacológicos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Paclitaxel/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência ÓpticaRESUMO
BACKGROUND: Data on bleeding events in Japanese patients with acute coronary syndrome (ACS) are insufficient. In addition, the efficacy and safety of a maintenance dose of prasugrel 2.5 mg/day in high bleeding risk patients are unknown.MethodsâandâResults:We prospectively enrolled 1,167 consecutive patients with suspected ACS and undergoing percutaneous coronary intervention. The maintenance dose of prasugrel 2.5 mg/day was prescribed for patients with a low body weight (≤50 kg), elderly (≥75 years), or renal insufficiency (eGFR ≤30 mL/min/1.73 m2). In-hospital events were assessed in 992 ACS patients treated with drug-eluting stents. Excluding 29 in-hospital deaths, out-of-hospital events were assessed in 963 ACS patients. The primary safety outcome measure was major bleeding (Bleeding Academic Research Consortium types 3 and 5). The incidence of in-hospital major bleeding was 3.4%. Multivariate analysis showed that being elderly, low body weight, renal insufficiency, stroke history, femoral approach, and mechanical support usage were independent predictors of in-hospital major bleeding. The cumulative 1-year incidence of out-of-hospital major bleeding was not significantly different between the prasugrel 2.5 mg/day (n=284) and 3.75 mg/day (n=487) groups (1.6% vs. 0.7%, log-rank P=0.24). That of out-of-hospital definite or probable stent thrombosis was 0% in both groups. CONCLUSIONS: The maintenance dose of adjusted prasugrel 2.5 mg/day seems to be one option in ACS patients at high bleeding risk.
Assuntos
Síndrome Coronariana Aguda/complicações , Hemorragia/induzido quimicamente , Cloridrato de Prasugrel/administração & dosagem , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Hemorragia/prevenção & controle , Hospitalização , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Cloridrato de Prasugrel/efeitos adversos , Prognóstico , Estudos Prospectivos , Fatores de Risco , Stents/efeitos adversos , Trombose/etiologiaRESUMO
BACKGROUND: Little is known about the impact of stent type on the prognosis of vasospastic angina (VSA) in patients who undergo stent implantation.MethodsâandâResults:We evaluated consecutive patients undergoing coronary angiography with positive (n=650; VSA) and negative (n=2,872; non-VSA) ergonovine testing. Among them, 304 patients undergoing stent implantation for organic stenosis were classified for comparison into 3 respective VSA and non-VSA groups based on stent type (68 and 78 with bare-metal stent [BMS]; 21 and 49 with sirolimus-eluting stent [SES]; 26 and 62 with newer generation drug-eluting stent [N-DES]). The primary outcome was defined as target lesion revascularization, target vessel revascularization, emergency coronary angiography, and cardiac death. The 2-year cumulative incidence of the primary outcome was significantly higher in the VSA group than non-VSA group after SES implantation (38.1% vs. 16.1%, P=0.03), whereas there were no differences between the 2 groups after both BMS implantation and N-DES implantation. The difference in the percent diameter stenosis from mid-term to late-term follow-up was significantly higher in the VSA group than non-VSA group (10.0% vs. 2.3%, P=0.045) after SES implantation, whereas there were no differences between the 2 groups after both BMS implantation and N-DES implantation. CONCLUSIONS: The impact of VSA on clinical and angiographic outcomes was observed only in SES implantation, but not after N-DES or BMS implantation.
Assuntos
Angina Pectoris/terapia , Estenose Coronária/terapia , Vasoespasmo Coronário/terapia , Stents/normas , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/diagnóstico por imagem , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/diagnóstico por imagem , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Stents Metálicos Autoexpansíveis , Resultado do TratamentoRESUMO
BACKGROUND: Very long-term angiographic results after sirolimus-eluting stent (SES) implantation have not been clarified. This study investigated serial angiographic results of early (<1year), late (1-5years), and very late (>5years) follow-up after SES implantation and the progression process to very late SES failure. METHODS: We analyzed 631 lesions undergoing serial coronary angiography at early, late, and very late follow-up after SES implantation. The results of 205 lesions undergoing very late target lesion revascularization (VL-TLR; TLR beyond 5years) for acute coronary syndrome (ACS; 83) and non-ACS (122) were evaluated in comparison with 426 non-TLR lesions as a control group. RESULTS: Non-TLR lesions showed no attenuated decline of minimum lumen diameter from postprocedure (2.51±0.47mm), early (2.37±0.58mm), late (2.22±0.60mm), up to very late (2.01±0.63mm) follow-up. In VL-TLR lesions, compared to non-TLR lesions, late lumen loss (LLL) from postprocedure to early follow-up was similar, but delayed LLL from early to late follow-up was significantly larger (0.25±0.48mm vs. 0.15±0.46mm, p=0.01). Although the delayed LLL was significantly larger in non-ACS lesions (0.29±0.44mm) than in non-TLR lesions (p<0.01), it was similar in ACS (0.19±0.52mm) and non-TLR lesions (p=0.54). Very delayed LLL from late to very late follow-up was 1.65±0.82mm in ACS lesions and 1.10±0.76mm in non-ACS lesions. CONCLUSIONS: Progression of in-stent luminal narrowing did not attenuate beyond 5years after SES implantation. In very late SES failure, stent-related ACS lesions showed gradual luminal narrowing and subsequent rapid progression beyond 5years, whereas non-ACS lesions had progressive luminal narrowing within 5years.
Assuntos
Síndrome Coronariana Aguda/cirurgia , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/etiologia , Vasos Coronários/cirurgia , Stents Farmacológicos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Falha de Prótese , Sirolimo/administração & dosagem , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Data on outcomes of non-left main coronary bifurcation lesions treated with the 2-stent strategy using 2nd-generation drug-eluting stents (DES) are insufficient.MethodsâandâResults:The 2-year outcomes and predictors of target lesion revascularization (TLR) in 356 patients with 364 non-left main coronary bifurcation lesions treated with the 2-stent strategy using 2nd-generation DES were retrospectively evaluated. The primary outcome measure was defined as TLR. The median follow-up duration was 3.6 years (interquartile range, 2.7-4.9 years). A 2-year clinical follow-up was achieved in 99.2%. The 2-year cumulative incidence of TLR was 9.2%. Multiple stents implanted in either the main branch (adjusted odds ratio [OR] 3.01; 95% confidence interval [CI]: 1.37-6.62; P=0.006) or the side branch (adjusted OR 4.55; 95% CI: 1.99-10.4; P<0.001) and the culprit in the left anterior descending artery and its diagonal branch (adjusted OR 0.33; 95% CI: 0.15-0.75: P=0.008) were independent predictors of TLR within 2 years. CONCLUSIONS: The 2-year outcomes for the 2-stent strategy using 2nd-generation DES in non-left main coronary bifurcation lesions were acceptable. Coronary bifurcation location in the left anterior descending artery and its diagonal branch is protective against TLR, whereas multiple stents implanted in either the main branch or the side branch was associated with TLR.
Assuntos
Vasos Coronários/patologia , Stents Farmacológicos , Revascularização Miocárdica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A relationship between serum polyunsaturated fatty acids (PUFAs) and cardiovascular disease has been reported; however, the existence of a relationship between serum PUFAs and extent of vessel disease (VD) in patients with ST elevation myocardial infarction (STEMI) remains unclear.Between July 2011 and June 2015, 866 consecutive STEMI patients underwent emergent percutaneous coronary intervention, 507 of whom were enrolled and classified into three groups according to the initial angiograms: 1VD, 294 patients; 2VD, 110 patients; and 3VD/left main trunk disease (LMTD), 103 patients. Serum levels of PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid, and other laboratory data during hospitalization were evaluated.The serum EPA level in the 3VD/LMTD group was significantly lower than that in the 1VD group (55.5 ± 22.1 versus 66.2 ± 28.7, P = 0.002) and was slightly lower than that in the 2VD group (55.5 ± 22.1 versus 65.2 ± 28.9, P = 0.0167). Multivariate adjustment analysis revealed that age ≥ 70 years (odds ratio, 1.72; 95% confidence interval, 1.03-2.89; P = 0.038) and a low serum EPA level (odds ratio, 0.98; 95% confidence interval, 0.99-1.00; P = 0.023) were independent risk factors for 3VD/LMTD, while a low serum DHA level was not.A low serum EPA level may be more strongly related than a low serum DHA level to the extent of VD in STEMI patients. Age ≥ 70 years and a low serum EPA level may be independent risk factors for 3VD/LMTD.
Assuntos
Doença da Artéria Coronariana/sangue , Vasos Coronários/diagnóstico por imagem , Ácidos Graxos Ômega-3/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaAssuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Valvuloplastia com Balão/instrumentação , Cateteres Cardíacos , Remoção de Dispositivo/efeitos adversos , Artéria Femoral/lesões , Substituição da Valva Aórtica Transcateter/instrumentação , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Angiografia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Valvuloplastia com Balão/efeitos adversos , Ecocardiografia , Desenho de Equipamento , Falha de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgiaRESUMO
BACKGROUND: Characteristics and prognosis of hemodialysis patients with severe aortic stenosis have not yet been well defined. METHODS AND RESULTS: The CURRENT AS (contemporary outcomes after surgery and medical treatment in patients with severe aortic stenosis) registry, a Japanese multicenter registry, enrolled 3815 consecutive patients with severe aortic stenosis. There were 405 hemodialysis patients (initial aortic valve replacement [AVR] group: N=135 [33.3%], and conservative group: N=270) and 3410 nonhemodialysis patients (initial AVR group: N=1062 [31.1%], and conservative group: N=2348). The median follow-up duration after the index echocardiography was 1361 days, with 90% follow-up rate at 2 years. The cumulative 5-year incidence of all-cause death was significantly higher in hemodialysis patients than in nonhemodialysis patients in both the entire cohort (71% versus 40%, P<0.001) and in the initial AVR group (63.2% versus 17.9%, P<0.001). Among hemodialysis patients, the initial AVR group as compared with the conservative group was associated with significantly lower cumulative 5-year incidences of all-cause death (60.6% versus 75.5%, P<0.001) and sudden death (10.2% versus 31.7%, P<0.001). Nevertheless, the rate of aortic valve procedure-related death, which predominantly occurred within 6 months of the AVR procedure, was markedly higher in the hemodialysis patients than in the nonhemodialysis patients (21.2% and 2.3%, P<0.001). CONCLUSIONS: Among hemodialysis patients with severe aortic stenosis, the initial AVR strategy as compared with the conservative strategy was associated with significantly lower long-term mortality risk, particularly the risk for sudden death, although the effect size for the survival benefit of the initial AVR strategy was smaller than that in the nonhemodialysis patients.
Assuntos
Estenose da Valva Aórtica/terapia , Fármacos Cardiovasculares/uso terapêutico , Implante de Prótese de Valva Cardíaca , Nefropatias/terapia , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Fármacos Cardiovasculares/efeitos adversos , Causas de Morte , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Japão , Nefropatias/complicações , Nefropatias/diagnóstico , Nefropatias/mortalidade , Masculino , Fatores de Proteção , Sistema de Registros , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUNDS: The difference in clinical presentations (acute coronary syndrome [ACS] and stable coronary artery disease [SCAD]) and related angiographic morphologies of sirolimus-eluting stent (SES) failure requiring target lesion revascularization (TLR) during early-term (<1year), late-term (1-5years), and very late-term periods (>5years) remains unknown. METHODS: Among 4484 lesions undergoing SES implantation, clinically-driven TLR was performed on 105 lesions during early-term, 169 lesions during late-term, and 147 lesions during very late-term period. Angiographic morphological patterns were divided into focal or non-focal patterns and stent-edge or stent-body patterns. RESULTS: The proportion of ACS substantially increased in very late TLR lesions (57.1%) from early (40.0%, p=0.01) and late TLR lesions (36.7%, p<0.001). The proportions of both stent-edge and non-focal patterns were higher in very late TLR lesions than in early and late TLR lesions. Although the stent-edge pattern tended to be more prevalent in SCAD lesions than in ACS lesions during the early- and late-term periods, it was more frequently observed in ACS lesions than in SCAD lesions during the very late-term period (65.5% vs. 47.6%, p=0.04). The non-focal pattern was more frequent in ACS lesions than in SCAD lesions during all 3 periods. However, the proportion of the non-focal pattern in ACS lesions was extremely high during the very late-term (90.5%) compared with the early- (47.6%, p<0.001) and late-term periods (48.4%, p<0.001). CONCLUSIONS: Stent-related ACS became more common beyond 5years after SES implantation. Stent-edge and non-focal patterns were the main angiographic morphologies of very late SES failure, particularly causing ACS.
Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Stents Farmacológicos/tendências , Intervenção Coronária Percutânea/tendências , Falha de Prótese/tendências , Síndrome Coronariana Aguda/cirurgia , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/efeitos adversos , Seguimentos , Humanos , Intervenção Coronária Percutânea/instrumentação , Estudos Retrospectivos , Sirolimo/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Efficacy and safety data on biodegradable polymer-coated biolimus-eluting stent (BP-BES) are currently limited to 5â years. We evaluated longer term (8-10â years) clinical and angiographic outcomes after BP-BES implantation. METHODS: Between 2005 and 2008, 243 patients (301 lesions) underwent BP-BES implantation. The primary clinical outcome measure was defined as any target lesion revascularisation (TLR). Absolute serial angiographic studies without any concomitant TLR within 2â years after the procedure were performed in 55 patients (65 lesions) at postprocedure, mid-term (within 1â year), late term (between 1 and 2â years) and very late term (beyond 2â years). RESULTS: The median follow-up duration was 9.4â years (IQR 8.2-10.2â years). The 8-year cumulative incidence of any TLR was 20.3%. The increase rate was approximately 7% per year in the first 2â years, but decelerated to approximately 1.2% per year beyond 2â years after the procedure. The minimal lumen diameter significantly decreased from postprocedure (2.63±0.44â mm) to mid-term (2.43±0.59â mm, p=0.002) and from late term (2.27±0.63â mm) to very late term (1.98±0.73â mm, p=0.002). The 8-year cumulative incidences of definite or probable stent thrombosis (ST) and major bleeding (Bleeding Academic Research Consortium (BARC) ≥3) were 0.5% and 12.0%, respectively. Definite ST was none within 10â years in the entire cohort. CONCLUSIONS: The long-term clinical outcomes after BP-BES implantation were favourable, although angiographic late progression of luminal narrowing did not reach a plateau. The incidence of ST remained notably low, whereas that of major bleeding gradually increased.
Assuntos
Implantes Absorvíveis , Materiais Revestidos Biocompatíveis , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Previsões , Polímeros , Sirolimo/análogos & derivados , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Imunossupressores/farmacologia , Masculino , Revascularização Miocárdica/métodos , Desenho de Prótese , Estudos Retrospectivos , Sirolimo/farmacologia , Resultado do TratamentoRESUMO
BACKGROUND: There are currently inadequate data about whether late restenosis occurs after drug-eluting stent (DES) implantation in patients with DES restenosis. METHODS AND RESULTS: We collected data for 608 patients who received revascularization for DES restenosis between 2004 and 2012 and analyzed 688 lesions: 359 lesions treated with a first-generation DES (first DES) and 329 lesions treated with a second-generation DES (second DES). Two serial angiographic follow-ups were routinely planned for the patients (at 8 and 20 months after the procedure). Early follow-up angiography was performed for 620 lesions (90.1%), and recurrent restenosis occurred in 84 lesions (25.8%) in the first DES group and in 72 lesions (24.5%) in the second DES group (P=0.78). Target lesion revascularization was performed for 69 lesions (21.2%) in the first DES group and for 48 lesions (16.3%) in the second DES group (P=0.15). Late follow-up angiography was performed for 438 (87.1%) of the remaining 503 lesions (excluding target lesion revascularization lesions), and late restenosis was found in 35 lesions (15.8%) in the first DES group and in 28 lesions (14.7%) in the second DES group (P=0.79). Nonfocal-type restenosis, percentage diameter stenosis after the procedure, previous stent size ≤2.5 mm, and right coronary artery ostial lesion were independent predictors of early restenosis. Nonfocal-type restenosis, percentage diameter stenosis at early follow-up, and stent fracture were independent predictors of late restenosis. CONCLUSIONS: Late restenosis occurs after both first DES implantation and second DES implantation for DES restenosis.