RESUMEN
Low-density lipoprotein cholesterol (LDL-C) levels are recommended according to the patient's risk factors based on guidelines. In patients achieving low LDL-C levels, the need for statins is uncertain, and the plaque characteristics of patients not treated with statins are unclear. In addition, the difference in plaque characteristics with and without statins is unclear in similarly high LDL levels. We evaluate the impact of statins on plaque characteristics on optical coherence tomography (OCT) in patients with very low LDL-C levels and high LDL-C levels. A total of 173 stable angina pectoris patients with 173 lesions undergoing OCT before percutaneous coronary intervention were evaluated. We divided the LDL-C levels into three groups: < 70 mg/dL (n = 48), 70 mg/dL ≤ LDL-C < 100 mg/dL (n = 71), and ≥ 100 mg/dL (n = 54). Among patients with LDL-C < 70 mg/dL, patients not treated with statins showed a significantly higher C-reactive protein level (0.27 ± 0.22 mg/dL vs. 0.15 ± 0.19 mg/dL, p = 0.049), and higher incidence of thin-cap fibroatheromas (TCFAs; 44% [7/16] vs. 13% [4/32], p = 0.021) than those treated with statins. Among patients with LDL-C level ≥ 100 mg/dL, patients treated with statins showed a significantly higher prevalence of familial hypercholesterolemia (FH) (38% [6/16] vs. 5% [2/38], p = 0.004), lower incidence of TCFAs (6% [1/16] vs. 39% [15/38], p = 0.013), healed plaques (13% [2/16] vs. 47% [18/38], p = 0.015), and higher incidence of fibrous plaques (75% [12/16] vs. 42% [16/38], p = 0.027) than patients not treated with statins. While patients achieved a low LDL-C, patients not treated with statins had high plaque vulnerability and high systemic inflammation. While patients had a high LDL-C level with a high prevalence of FH, patients treated with statins had stable plaque characteristics.
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Angina Estable , LDL-Colesterol , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Placa Aterosclerótica , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Masculino , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Femenino , LDL-Colesterol/sangre , Angina Estable/tratamiento farmacológico , Angina Estable/sangre , Angina Estable/diagnóstico , Persona de Mediana Edad , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Anciano , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Intervención Coronaria Percutánea/métodos , Estudios Retrospectivos , Factores de Riesgo , Biomarcadores/sangre , Resultado del Tratamiento , Angiografía CoronariaRESUMEN
The cardiac prognosis of patients with frailty and malnutrition remains poorly investigated. This study aimed to investigate the impact of frailty and malnutrition on cardiac prognosis by combining the clinical frailty scale (CFS) and the geriatric nutritional risk index (GNRI) in patients who underwent percutaneous coronary intervention (PCI). In this study, 608 patients who underwent PCI for stable angina pectoris between January 2018 and December 2020 were included. CFS scores of ≥ 4 were defined as high CFS and patients with these scores were considered frail. GNRI scores of ≤ 98.0 were defined as low GNRI and patients with these scores were considered to have malnutrition. Patients were categorized into low-risk (n = 267, low CFS and high GNRI), intermediate-risk (n = 200, high CFS or low GNRI), and high-risk (n = 141, high CFS and low GNRI) groups. Major adverse clinical events (MACEs), including all-cause death, nonfatal myocardial infarction, revascularization, hospitalization for heart failure, and stroke, were assessed. The median follow-up period was 529 days. During the follow-up, MACEs were found in 135 patients. The high-risk group were older (77.0 ± 9.2 vs 71.4 ± 10.7 vs 65.0 ± 10.1 years, p < 0.001), had higher prevalence rates of chronic kidney disease [61.7% (87/141) vs 37.5% (75/200) vs 16.9% (45/267); p < 0.001] and heart failure [47.5% (67/141) vs 22.5% (45/200) vs 12.4% (33/267), p < 0.001], and had higher C-reactive protein levels (1.64 ± 2.66 vs 1.00 ± 2.02 vs 0.34 ± 0.90 mg/dL; p < 0.001) than the intermediate-risk and low-risk groups. The high-risk group [hazard ratio (HR), 4.39; 95% confidence interval (CI), 2.87-6.72; p < 0.001] was an independent predictor of MACEs. In conclusion, patients with both frailty and malnutrition had a higher risk of MACEs after PCI than patients with frailty or malnutrition. Post-PCI patients should be evaluated for combined frailty and malnutrition.
Asunto(s)
Fragilidad , Insuficiencia Cardíaca , Desnutrición , Intervención Coronaria Percutánea , Humanos , Anciano , Estado Nutricional , Pronóstico , Intervención Coronaria Percutánea/efectos adversos , Fragilidad/complicaciones , Fragilidad/diagnóstico , Fragilidad/epidemiología , Evaluación Nutricional , Factores de Riesgo , Desnutrición/complicaciones , Desnutrición/diagnóstico , Desnutrición/epidemiología , Insuficiencia Cardíaca/complicaciones , Evaluación GeriátricaRESUMEN
Lipoprotein(a) [Lp(a)] is a reliable lipid marker for atherosclerosis. However, the clinical relevance of Lp(a) to lower-extremity peripheral artery disease (LE-PAD) and coronary artery disease (CAD) in the same patient has not been investigated. Patients who received primary percutaneous coronary intervention for the acute coronary syndrome (ACS) were enrolled. Patients who received hemodialysis, required multidisciplinary treatments, or had incomplete medical history were excluded. A total of 175 patients were divided into two groups according to whether they had LE-PAD (n = 21) or did not (n = 154), and three multivariable logistic regression models were used to assess if Lp(a) level is associated with LE-PAD prevalence. In addition, serum Lp(a) levels were compared among three groups according to the severity of LE-PAD (none, unilateral, or bilateral) and CAD. Serum Lp(a) levels were significantly higher in patients with LE-PAD than in those without (31.0 mg/dL vs. 13.5 mg/dL, p = 0.002). After adjusting for confounding factors, higher Lp(a) levels were independently associated with the prevalence of LE-PAD in all three models (p < 0.001 for all). With respect to LE-PAD severity, serum Lp(a) levels were significantly higher in the bilateral LE-PAD groups than in the group with no LE-PAD (p = 0.005 for all), whereas Lp(a) was not associated with CAD severity. Though Lp(a) levels are associated with the prevalence and severity of LE-PAD, are not associated with the severity of CAD among patients with ACS.
Asunto(s)
Síndrome Coronario Agudo , Lipoproteína(a) , Extremidad Inferior , Enfermedad Arterial Periférica , Humanos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Lipoproteína(a)/sangre , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Factores de Riesgo , Biomarcadores/sangre , Extremidad Inferior/irrigación sanguíneaRESUMEN
Dynamic coronary roadmap (DCR) is a novel technology that creates a real-time overlay of the coronary arteries in percutaneous coronary intervention (PCI) and has the potential to reduce the contrast volume. However, the efficacy of DCR in terms of clinical outcomes in patients with chronic kidney disease (CKD) remains to be fully elucidated.This single center retrospective study enrolled 275 patients with CKD who underwent PCI, and divided them into a DCR group (n = 124) and Non-DCR group (n = 151). Propensity score matching was performed to minimize the differences in baseline characteristics in 113 patient pairs. The primary endpoint was a composite outcome of all-cause death, hospitalization for heart failure, nonfatal myocardial infarction, or the introductory rate of dialysis within 2 years. The secondary endpoints were contrast medium volume, the incidence of contrast-induced acute kidney injury (CI-AKI), and the introductory rate of dialysis within 2 years.Although there was no significant difference in the success rate (DCR group: 99.1% versus Non-DCR group: 98.2%; P = 0.561), contrast volume (92.20 mL versus 115.97 mL; P = 0.002) was significantly lower in the DCR group. CI-AKI incidence was 0.9% versus 6.2% in the DCR and Non-DCR groups, respectively (P = 0.031). The composite outcome defined as primary endpoint occurred in 10 patients in the DCR group and 20 patients in the Non-DCR group (8.8% versus 17.7%; P = 0.049).From the perspective of acute and long-term clinical outcomes, DCR use may be effective for patients with CKD.
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Lesión Renal Aguda , Intervención Coronaria Percutánea , Insuficiencia Renal Crónica , Humanos , Estudios Retrospectivos , Intervención Coronaria Percutánea/efectos adversos , Factores de Riesgo , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/inducido químicamente , Resultado del Tratamiento , Medios de Contraste/efectos adversosRESUMEN
Coronary artery calcium (CAC) score is a robust prognostic tool to predict cardiac events. Although patients with congestive heart failure (CHF) occasionally undergo non-contrast computed tomography (NCCT), the prognostic utility of CAC by NCCT is not widely known. We aimed to determine if CAC measured on NCCT is associated with all-cause mortality (ACM) among patients with CHF. We identified 550 patients admitted due to CHF who underwent NCCT. Patients were categorized into three groups according to CAC scores 0, 1-999, and ≥ 1000. The multivariate Cox proportional hazards model was used to assess if CAC by NCCT was associated with ACM after adjusting for traditional coronary artery disease (CAD) risk factors, brain natriuretic peptide and left ventricular ejection fraction (LVEF). In a subset of 245 patients with invasive coronary angiography (ICA), the associations between CAC scores and ACM were assessed in the multivariate Cox proportional hazards model. Further, we assessed if CAC increased statin use at discharge. During a mean follow-up of 3.3 ± 3.1 years, ACM occurred in 168 patients (30.55%). Compared with patients with CAC 0, those with CAC ≥ 1000 (HR 1.564, 95% CI 0.969-2.524, P = 0.067) were more likely to experience ACM, while those with CAC score 1-999 (HR 0.971, 95% CI 0.673-1.399, P = 0.873) were not. Similarly, a trend toward significance was observed in patients with LVEF < 40% (HR 2.124, 95% CI 0.929-4.856, P = 0.074). In the sub-analysis, patients with CAC ≥ 1000 had increased ACM compared to those with CAC 0, only if ICA ≥ 50% (HR 3.668, 95% CI 1.141-11.797, P = 0.029). Multivariate logistic regression revealed that statin use at discharge was increased with ICA ≥ 50%, but not CAC. The CAC score measured by NCCT tended to be associated with ACM among CHF patients. Statin use was not increased by CAC on NCCT.
Asunto(s)
Enfermedad de la Arteria Coronaria , Insuficiencia Cardíaca , Calcificación Vascular , Calcio , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Humanos , Pronóstico , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Tomografía Computarizada por Rayos X , Calcificación Vascular/complicaciones , Calcificación Vascular/diagnóstico por imagen , Función Ventricular IzquierdaRESUMEN
The phenomenon to heal neointimal rupture or thrombus after coronary stenting occurs as well as in native coronary artery. We investigated clinical characteristics and neointimal vulnerability of healed neointima by optical coherence tomography (OCT). We treated 67 lesions by percutaneous coronary intervention for in-stent restenosis (ISR) and conducted OCT examinations. Healed neointima was defined as neointima having one or more layers with different optical densities and a clear demarcation from underlying components. ISR with healed neointima was found in 49% (33/67) of the lesions. Compared to ISR without healed neointima, ISR with healed neointima showed significantly longer stent age (102 ± 72 vs. 31 ± 39 months, P < 0.001), lower frequency of dual antiplatelet therapy [42% (14/33) vs. 74% (25/34), P = 0.017], lower use of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACE-I or ARB) [61% (20/33) vs. 91% (31/34), P = 0.028], lower usage of second-generation drug-eluting stents (DESs) [36% (12/33) vs. 63% (22/34), P = 0.029], higher usage of thick-strut stents [42% (14/33) vs. 15% (5/34), P = 0.012], larger neointimal area (6.8 ± 2.6 vs. 5.2 ± 1.8 mm2, P = 0.005), higher incidence of thin-cap fibroatheroma [58% (19/33) vs. 21% (7/34), P = 0.002], neointimal rupture [45% (15/33) vs. 9% (3/34), P = 0.001], and lower incidence of stent underexpansion [15% (5/33) vs. 44% (15/34), P = 0.010]. In conclusions, ISR with healed neointima was associated with neointimal vulnerability, stent age, stent type, stent strut thickness, stent expansion, antiplatelet therapy, and use of ACE-I or ARB.
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Angina Estable , Reestenosis Coronaria , Intervención Coronaria Percutánea , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Constricción Patológica , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/etiología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Humanos , Neointima/patología , Intervención Coronaria Percutánea/efectos adversos , Tomografía de Coherencia ÓpticaRESUMEN
Glasgow prognostic score (GPS) has been used to evaluate inflammatory response and nutritional status. This study aimed to investigate the impact of nutritional status on cardiac prognosis by using GPS in patients after undergoing percutaneous coronary intervention (PCI). We included 862 patients who underwent PCI for stable angina pectoris between 2015 and 2018. We used the original cutoff values, which were an albumin (Alb) level of 3.5 g/dl and a C-reactive protein (CRP) level of 0.3 mg/dl. We categorized them into the three groups: originally defined GPS (od-GPS) 0 (high Alb and low CRP), 1 (low Alb or high CRP), and 2 (low Alb and high CRP). Major adverse clinical events (MACEs) included all-cause death, nonfatal myocardial infarction, revascularization, and hospitalization for heart failure. The median follow-up period was 398.5 days. During the follow-up, MACEs occurred in 136 patients. Od-GPS 2 had higher prevalence rates in terms of chronic kidney disease (CKD; 31.7% [229/722] vs. 44.9% [53/118] vs. 63.6% [14/22], p < 0.001), hemodialysis (6.4% [46/722] vs. 14.4% [17/118] vs. 31.8% [7/22], p < 0.001), and heart failure cases (HF; 9.1% [66/722] vs. 14.4% [17/118] vs. 27.3% [6/22], p = 0.007), with higher creatinine (1.17 ± 1.37 mg/dl vs. 1.89 ± 2.60 mg/dl vs. 3.49 ± 4.01 mg/dl, p < 0.001) and brain natriuretic peptide levels (104.1 ± 304.6 pg/ml vs. 242.4 ± 565.9 pg/ml vs. 668.1 ± 872.2 pg/ml, p < 0.001) and lower low-density lipoprotein cholesterol (101.5 ± 32.9 mg/dl vs. 98.2 ± 28.8 mg/dl vs. 77.1 ± 24.3 mg/dl, p = 0.002) than od-GPS 0 and 1.Od-GPS 2 (HR 2.42; 95% CI 1.16-5.02; p = 0.018), od-GPS 1 (HR 2.09; 95% CI 1.40-3.13; p < 0.001), diabetes (HR 1.41; 95% CI 1.00-1.99; p = 0.048), CKD (HR 2.10; 95% CI 1.49-2.96; p < 0.001), and HF (HR 1.64; 95% CI 1.05-2.56; p = 0.029) were independent predictors of MACEs. A scoring system using CRP and Alb levels with a milder definition than GPS suitably predicted the risk of MACEs in the patients who underwent PCI.
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Insuficiencia Cardíaca , Intervención Coronaria Percutánea , Insuficiencia Renal Crónica , Insuficiencia Cardíaca/etiología , Humanos , Japón/epidemiología , Intervención Coronaria Percutánea/efectos adversos , Pronóstico , Insuficiencia Renal Crónica/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Heart rate (HR) is a useful predictor of cardiovascular disease, especially in acute coronary syndrome (ACS). However, it is unclear whether there is an association between HR and clinical outcomes after resuscitation from out-of-hospital cardiac arrest (OHCA) due to ACS. The aim of this study was to investigate the impact of HR on clinical outcome in individuals resuscitated from OHCA due to ACS.MethodsâandâResults:Data from 3,687 OHCA patients between October 2002 and October 2014 were retrospectively analyzed. We divided 154 patients diagnosed with ACS into 2 groups: those with tachycardia (HR >100 beats/min, n=71) and those without tachycardia (HR ≤100 beats/min, n=83) after resuscitation. The primary endpoint was 1-year mortality and the secondary endpoint was neurological injury at discharge according to cerebral performance category score. Overall, mean HR was 95.6 beats/min. There were several significant differences in patient characteristics, indicating poor general condition of patients with tachycardia. Mortality at 1-year was 41.6%, and neurological injury at discharge was observed in 44.1% of individuals. In the multivariate analysis, tachycardia after resuscitation was an independent predictor of both 1-year mortality (hazard ratio, 2.66; 95% CI: 1.20-5.85; P=0.03) and neurological injury at discharge (odds ratio, 2.65; 95% CI: 1.27-5.55; P=0.04). CONCLUSIONS: In patients who recovered from OHCA due to ACS, tachycardia after resuscitation predicted poor clinical outcome.
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Síndrome Coronario Agudo/terapia , Arritmias Cardíacas/fisiopatología , Reanimación Cardiopulmonar , Frecuencia Cardíaca , Paro Cardíaco Extrahospitalario/terapia , Intervención Coronaria Percutánea , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Anciano , Arritmias Cardíacas/diagnóstico por imagen , Arritmias Cardíacas/mortalidad , Reanimación Cardiopulmonar/efectos adversos , Electrocardiografía , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/fisiopatología , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The relationship between frailty and plaque characteristics is unclear and was investigated by optical coherence tomography (OCT) in this study. One hundred and four patients undergoing OCT before percutaneous coronary intervention were evaluated. Frailty was defined as a clinical frailty scale score of â§6. Frailty was found in 16% of the patients (17/104). Compared with the nonfrail patients, frail patients showed significantly lower body mass index (BMI; 20.8 ± 4.0 kg/m2 vs. 25.0 ± 3.9 kg/m2, P < 0.001), less dyslipidemia [47% (8/17) vs. 75% (65/87), P = 0.023], lower triglycerides levels (95 ± 42 mg/dL vs. 147 ± 81 mg/dL, P < 0.001), less use of statin [29% (5/17) vs. 60% (52/87), P = 0.021], more lipid-rich plaque [82% (14/17) vs. 46% (40/87), P = 0.006] on OCT, more thin-cap fibroatheromas [TCFAs; 71% (12/17) vs. 26% (23/87), P < 0.001], more plaque rupture [53% (9/17) vs. 25% (22/87), P = 0.023], and significantly higher adverse clinical outcomes (death, acute myocardial infarction, acute heart failure, acute coronary syndrome, or target lesion revascularization) [24% (4/17) vs. 6% (5/87), P = 0.007]. The multivariable analysis showed that frailty was one of the independent predictors of TCFAs (odds ratio 8.95, 95% CI 2.40-33.32, P = 0.001). In conclusion, frailty was associated with high plaque vulnerability due to more lipid-rich plaque, TCFAs and plaque rupture on OCT regardless of low BMI, less dyslipidemia and low triglycerides levels, and frail patients had higher adverse clinical outcomes.
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Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Fragilidad/diagnóstico , Evaluación Geriátrica , Placa Aterosclerótica , Tomografía de Coherencia Óptica , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Estenosis Coronaria/complicaciones , Estenosis Coronaria/terapia , Femenino , Fragilidad/complicaciones , Estado Funcional , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Rotura EspontáneaRESUMEN
The dynamic coronary roadmap (DCR) is a novel technology that creates a dynamic, motion-compensated, real-time overlay of the coronary arteries on a fluoroscopic image. Whether the DCR reduces contrast volume and enables safe and effective treatment was examined. A total of 146 patients undergoing percutaneous coronary intervention (PCI) from June 2017 to September 2017 in our hospital were retrospectively evaluated. Chronic total occlusion lesions, acute coronary syndrome, and hemodialysis patients were excluded. Patients were divided into the control group (PCI without DCR, 92 patients, 103 lesions) and the DCR group (38 patients, 43 lesions). The primary endpoint was contrast medium volume, and secondary endpoints were radiation dose, fluoroscopy time, and clinical success rate. There was no significant difference in the success rate (100% vs. 100%, P = 1.000) between the groups. Fluoroscopy time (16.3 ± 11.2 min. vs. 11.4 ± 5.5 min, P = 0.007) and contrast medium volume (152.1 ± 73.0 ml vs. 118.8 ± 49.7 ml, P = 0.006) were significantly lower in the DCR group than in the control group. DCR use during PCI was associated with a significant reduction in contrast volume and fluoroscopy time compared to a control group despite similar clinical, lesion, and procedural characteristics.
Asunto(s)
Angiografía Coronaria , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/diagnóstico por imagen , Intervención Coronaria Percutánea , Interpretación de Imagen Radiográfica Asistida por Computador , Anciano , Anciano de 80 o más Años , Medios de Contraste/administración & dosificación , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Stents Liberadores de Fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Valor Predictivo de las Pruebas , Dosis de Radiación , Exposición a la Radiación , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Irregular protrusion on optical coherence tomography (OCT) is associated with clinical events and target lesion revascularization. We investigated clinical and procedure characteristics, plaque characteristics, slow flow after stent implantation, and clinical outcomes with irregular protrusion using OCT. Eighty-four lesions in 76 patients undergoing OCT before percutaneous coronary intervention were evaluated. Irregular protrusion was defined as protrusion of material with an irregular surface into the lumen between stent struts with a maximum height of ≥100 µm. Lesions with irregular protrusion were found in 56% (47/84). Compared with lesions without irregular protrusion, those with irregular protrusion had significantly higher low-density lipoprotein cholesterol (LDL-C) levels (108 ± 31 mg/dl vs. 95 ± 25 mg/dl, P = 0.044); a tendency toward decreased use of statins [44% (19/43) vs. 67% (22/33), P = 0.065]; significantly larger reference vessel diameter (3.12 ± 0.53 mm vs. 2.74 ± 0.63 mm, P = 0.004); more frequent slow flow after stent implantation [38% (18/47) vs. 11% (4/37), P = 0.006]; higher incidence of thin-cap fibroatheromas [TCFAs; 49% (23/47) vs. 5% (2/37), P < 0.001]; plaque rupture [40% (19/47) vs. 16% (6/37), P = 0.018]; and a tendency higher incidence of 1-year adverse clinical outcomes (death, acute myocardial infarction, acute coronary syndrome, or target lesion revascularization) [12% (5/43) vs. 0% (0/33), P = 0.075]. In conclusion, irregular protrusion on OCT was associated with high plaque vulnerability, higher LDL-C, less frequent use of statin, larger vessel diameter, slow flow after stent implantation, and 1-year adverse clinical outcomes.
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Vasos Coronarios/diagnóstico por imagen , Intervención Coronaria Percutánea/efectos adversos , Placa Aterosclerótica/diagnóstico por imagen , Stents/efectos adversos , Anciano , Anciano de 80 o más Años , Estenosis Coronaria/terapia , Vasos Coronarios/patología , Femenino , Humanos , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tomografía de Coherencia ÓpticaRESUMEN
The progression of renal dysfunction reduces serum albumin and deteriorates the binding capacity of protein-bound uremic toxins. We evaluated the prognostic implications of serum indoxyl sulfate (IS) and albumin levels in patients with cardiovascular disease.We prospectively enrolled 351 consecutive patients undergoing percutaneous revascularization for coronary artery disease or peripheral artery disease. The primary endpoint was all-cause mortality. Patients were assigned to four groups according to the median levels of serum IS (0.1 mg/dL) and albumin (3.9 g/dL).During the median follow-up time of 575 days, 16 patients died. The IS level was significantly higher in nonsurvivors (0.33 versus 0.85 mg/dL, P < 0.05). On the Kaplan-Meier curve, the high IS/low albumin group presented the highest mortality rate (log-rank test, P < 0.01). Cox proportional hazard analysis revealed that high IS/low albumin (hazard ratio (HR): 5.33; 95% confidence interval (CI): 1.71-16.5; P < 0.01), diastolic pressure (HR: 0.94; 95% CI: 0.91-0.98; P < 0.01), prior stroke (HR: 4.54; 95% CI: 1.33-15.4; P = 0.01), and left ventricular ejection fraction (LVEF) (HR: 0.92; 95% CI: 0.88-0.96; P < 0.001) were associated with increased mortality. Furthermore, the combination of IS and albumin levels significantly conferred an additive value to LVEF for predicting mortality (C-statistic: 0.69 versus 0.80; P < 0.001; net reclassification improvement: 0.83; P < 0.001; integrated discrimination improvement: 0.02; P = 0.02).A lower albumin level adds potentiating effects on IS as a prognostic factor for cardiovascular disease.
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Síndrome Cardiorrenal/sangre , Enfermedades Cardiovasculares/sangre , Indicán/sangre , Albúmina Sérica/análisis , Toxinas Biológicas/sangre , Anciano , Síndrome Cardiorrenal/mortalidad , Enfermedades Cardiovasculares/mortalidad , Enfermedad de la Arteria Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Intervención Coronaria Percutánea/métodos , Enfermedad Arterial Periférica/terapia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Volumen Sistólico/fisiologíaRESUMEN
In patients with ST-segment elevation myocardial infarction (STEMI), it is unclear if combined assessment of left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF) improves prediction of major adverse cardiac events (MACE). We analyzed data from 266 STEMI patients who underwent successful percutaneous coronary intervention and subsequent left ventriculography (LVG). Patients were divided into 4 groups, as follows: Group 1, LVEDP < 21 mmHg and LVEF ≥ 55%; Group 2, LVEDP < 21 mmHg and LVEF < 55%; Group 3, LVEDP ≥ 21 mmHg and LVEF ≥ 55%; and Group 4, LVEDP ≥ 21 mmHg and LVEF < 55%. Multivariate Cox proportional hazards analysis was used to determine if LVEDP and LVEF were associated with MACE (including cardiac death, non-fatal myocardial infarction, and heart failure requiring hospitalization). Change in LV parameters was assessed in the subset of 183 patients who underwent serial LVG (mean interval 6.3 ± 1.6 months). During a mean follow-up of 43 ± 31 months, 29 patients (10.9%) had a MACE. As compared to Group 1, MACE risk was significantly higher in Group 3 [hazard ratio (HR) 3.26; 95% confidence interval (CI) 1.05-10.0] and Group 4 (HR 3.99; 95% CI 1.44-11.0), but not in Group 2 (HR 0.46, 95% CI 0.54-3.96). In sub-analyses, LV end-systolic volume index after PCI was significantly higher in Group 4 than in the other groups and remained higher during follow-up. Combined LVEDP/LVEF assessment was useful in predicting MACE after successful PCI for STEMI patients and could facilitate risk stratification, as it predicts LV remodeling.
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Predicción , Infarto del Miocardio con Elevación del ST/fisiopatología , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Ventriculografía de Primer Paso/métodos , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Pronóstico , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/cirugíaRESUMEN
This study was designed to clarify the influence of pericoronary adipose tissue (PAT) on plaque vulnerability using coronary computed tomography angiography (CCTA). A total of 103 consecutive patients who underwent CCTA and subsequent percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS) for coronary artery disease were enrolled. The PAT ratio was calculated as the sum of the perpendicular thickness of the visceral layer between the coronary artery and the pericardium, or the coronary artery and the surface of the heart at the PCI site, divided by the PAT thickness without a plaque in the same vessel. PAT ratios were divided into low, mid and high tertile groups. Epicardial adipose tissue (EAT) thickness was measured at the eight points surrounding the heart. Multivariate logistic analysis was performed to determine whether the PAT ratio is predictive of vulnerable plaques (positive remodeling, low attenuation and/or spotty calcification) on CCTA or echo-attenuated plaque on IVUS. The Hounsfield unit of obstructive plaques >50% was lower in the high PAT group than in the mid and low PAT groups (47.5 ± 28.8 vs. 53.1 ± 29.7 vs. 64.7 ± 27.0, p = 0.04). In multivariate logistic analysis, a high PAT ratio was an independent, associated factor of vulnerable plaques on CCTA (OR: 3.55, 95% CI: 1.20-10.49), whereas mean EAT thickness was not (OR: 1.22, 95% CI: 0.82-1.83). We observed a similar result in predicting echo-attenuated plaque on IVUS. PAT ratio on CCTA was an associated factor of vulnerable plaques, while EAT was not. These results support the important concept of local effects of cardiac adipose tissue on plaque vulnerability.
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Tejido Adiposo/patología , Calcinosis/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Placa Aterosclerótica/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Enfermedad de la Arteria Coronaria/terapia , Femenino , Humanos , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Intervención Coronaria Percutánea , Curva ROC , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The efficacy and safety of direct oral anticoagulants (DOAC) with antiplatelet therapy compared to warfarin are unclear. The subjects were 280 patients who received antiplatelet therapy with oral anticoagulation (OAC) for the treatment of or protection from thromboembolism between January 2012 and September 2015. Among the 280 subjects, 79 (28.2%) received dual therapy (OAC plus aspirin or P2Y12 inhibitor) with DOAC, 75 (26.8%) dual therapy with warfarin, 46 (16.4%) triple therapy (OAC plus aspirin and P2Y12 inhibitor) with DOAC, and 80 (28.6%) triple therapy with warfarin.Compared to triple therapy with warfarin, triple therapy with DOAC had slightly lower bleeding (3.5 versus 12.0/100 persons-years, HR: 0.24, 95%CI: 0.03 to 1.96, P = 0.183), and similar benefit outcomes (cardiac death, acute myocardial infarction or stroke) and thromboembolism (7.0 versus 10.5, HR: 0.53, 95%CI: 0.10 to 2.75, P = 0.453; 7.0 versus 7.5, HR: 0.96, 95%CI: 0.18 to 5.22, P = 0.964, respectively). Compared to dual therapy with warfarin, dual therapy with DOAC had slightly lower bleeding (3.0 versus 8.4, HR: 0.38, 95%CI: 0.07 to 2.18, P = 0.279), and similar benefit outcomes and thromboembolism (4.6 versus 4.2, HR: 1.66, 95%CI: 0.30 to 9.25, P = 0.565; 4.6 versus 1.4, HR: 3.11, 95%CI: 0.23 to 42.84, P = 0.397, respectively). Bleeding mainly occurred after 3 months (16/17, 94.1%).Triple therapy and dual therapy with DOAC were not inferior to triple therapy and dual therapy with warfarin in terms of major bleeding, benefit outcomes, and thromboembolism. Bleeding mainly occurred in the late phase.
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Aspirina/administración & dosificación , Enfermedad de la Arteria Coronaria/cirugía , Intervención Coronaria Percutánea , Tromboembolia/prevención & control , Warfarina/administración & dosificación , Administración Oral , Anciano , Anticoagulantes/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Incidencia , Japón/epidemiología , Masculino , Inhibidores de Agregación Plaquetaria/administración & dosificación , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia/epidemiología , Tromboembolia/etiologíaRESUMEN
OBJECTIVES: We examined the long-term outcomes of implanting a different type of drug-eluting stent (DES), including second-generation DES, for treatment of DES-in stent restenosis (ISR). BACKGROUND: Treatment for DES-ISR has not been standardized. METHODS: The subjects were 80 patients with 89 lesions underwent DES implantation for DES-ISR. The patients were divided into the group of patients receiving the same DES for DES-ISR (Homo-stent: 24 patients, 25 lesions) and a different DES for DES-ISR (Hetero-stent: 56 patients, 64 lesions). The primary endpoint was survival free of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization (TVR). The secondary endpoint was late loss at 8-12 months follow-up. In the subgroup of patients who were treated with second-generation DES for DES-ISR, we also assessed the survival free of MACE. RESULTS: During a mean follow-up of 45.1 ± 21.2 months, 26 patients experienced MACE. There was no significant difference in the survival free of MACE (Log rank P = 0.17). In the sub-analysis of second generation DES, MACE was significantly higher in the Homo-stent group compared to the Hetero-stent group (Log rank P = 0.04). Late loss was significantly higher in the Homo-stent group than in the Hetero-stent group (0.86 ± 1.03 vs. 0.38 ± 0.74 mm, P = 0.03). This trend was prominent in the first-generation DES group. CONCLUSIONS: Although there was no significant difference in MACE between the Hetero-stent and the Homo-stent groups including both first and second-generation DES, the sub-analysis demonstrated different DES implantation for DES-ISR significantly improved the MACE rate among patients treated with second-generation DES. (J Interven Cardiol 2016;29:311-318).
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Reestenosis Coronaria/cirugía , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea/métodos , Complicaciones Posoperatorias , Anciano , Angiografía Coronaria/métodos , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
It has been reported that coronary vasa vasorum is associated with plaque vulnerability, and low-echoic structures in grayscale intravascular ultrasound (IVUS) are consistent pathologically with vasa vasorum. However, the association of low-echoic structures with plaque composition and no-reflow phenomenon during percutaneous coronary intervention (PCI) is unclear. We investigated plaque composition in virtual histology IVUS (VH-IVUS) and no-reflow phenomenon during PCI of low-echoic structures.A total of 106 lesions being treated by VH-IVUS before PCI were included in this study. Low-echoic structure was defined as a small tubular structure exterior to media without a connection to the vessel lumen in ≥ 3 consecutive crosssectional IVUS images. Lesions with low-echoic structures were found in 42% (45/106).Lesions with low-echoic structures were more prevalent in acute coronary syndrome (ACS) patients (53% [24/45] versus 20% [12/61], P < 0.001), had more positive remodeling (49% [22/45] versus 21% [13/61], P = 0.003), a larger number of VH-IVUS derived thin-cap fibroatheromas (VH-TCFAs) (0.64 ± 0.53 versus 0.05 ± 0.22, P < 0.001), more VH-TCFAs with a baseline plaque burden of 70% or more and minimal luminal area of 4.0 mm(2) or less (29% [13/45] versus 2% [1/61], P < 0.001), and more frequent no-reflow phenomenon after stent implantation and more final TIMI flow grade 0/1/2 (38% [17/45] versus 5% [3/61], P < 0.001; 9% [4/45] versus 0% [0/61], P = 0.03) than lesions without low-echo structures.Lesions with low-echoic structures in grayscale IVUS had high plaque vulnerability and were more prevalent in ACS patients, positive remolding, and VH-TCFAs, and they had more frequent no-reflow phenomenon during PCI than lesions without low-echoic structures.
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Síndrome Coronario Agudo , Complicaciones Intraoperatorias , Fenómeno de no Reflujo , Placa Aterosclerótica , Ultrasonografía Intervencional/métodos , Vasa Vasorum , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Anciano , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/fisiopatología , Masculino , Persona de Mediana Edad , Fenómeno de no Reflujo/diagnóstico , Fenómeno de no Reflujo/etiología , Fenómeno de no Reflujo/fisiopatología , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/patología , Placa Aterosclerótica/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Vasa Vasorum/diagnóstico por imagen , Vasa Vasorum/patología , Vasa Vasorum/fisiopatologíaRESUMEN
OBJECTIVES: We assessed the relation between coronary plaque composition and angiographic calcification by using virtual histology intravascular ultrasound (VH-IVUS). BACKGROUND: The plaque vulnerability according to angiographic calcification is unclear. METHODS: Subjects were 140 consecutive patients (145 lesions) undergoing VH-IVUS before percutaneous coronary intervention. Subjects were divided into 4 groups: no calcification group (n = 27), spotty group (n = 65) that had calcium deposits under 90° in grayscale IVUS, intermediate group (n = 37) had calcium deposits with 90° or more and under 180°, and extensive group (n = 16) had calcium deposits with 180° or more. RESULTS: The number of VH thin-cap fibroatheromas in spotty group was significantly larger than no calcification group, intermediate group, and extensive group (0.66 ± 0.71 vs 0.22 ± 0.42 [P < 0.01], 0.32 ± 0.48 [P < 0.05], 0.13 ± 0.34 [P < 0.01], respectively). Spotty group without angiographic calcification had significantly larger %necrotic core than with angiographic calcification (24.5 ± 6.7% vs 19.9 ± 7.2%, P < 0.05). Intermediate group without angiographic calcification had significantly larger necrotic core area than with angiographic calcification (2.5 ± 0.9 mm(2) vs 1.7 ± 0.9 mm(2) , P < 0.05). Extensive group with angiographic calcification had significantly larger %dense calcium than without angiographic calcification (18.3 ± 4.0% vs 13.4 ± 4.4%, P < 0.05). CONCLUSIONS: Lesions with spotty calcification was highly vulnerable in VH-IVUS. Spotty or intermediate plaque calcification without angiographic calcification was more vulnerable than those with angiographic calcification. Extensive plaque calcification with angiographic calcification had more dense calcium than those without angiographic calcification.
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Enfermedad de la Arteria Coronaria/diagnóstico , Placa Aterosclerótica/diagnóstico por imagen , Ultrasonografía Intervencional , Calcificación Vascular/diagnóstico por imagen , Anciano , Estudios de Cohortes , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Placa Aterosclerótica/cirugía , Calcificación Vascular/cirugíaRESUMEN
The antiplatelet drug prasugrel inhibits platelet aggregation early after oral administration. This study examined whether prasugrel is effective in inhibiting infarct size and can reduce the incidence of major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). This study was a single-center, prospective, randomized pilot study. Among 80 ACS patients treated at our institution between August 2014 and September 2015, 76 ACS patients who underwent stenting and achieved thrombolysis in myocardial infarction flow grade 3 were assigned to receive aspirin plus prasugrel (prasugrel group; n = 37) or aspirin plus clopidogrel (clopidogrel group; n = 39). The primary endpoint was survival free of MACE. The secondary endpoint was the evaluation of infarct size defined as the area under the curve (AUC) of troponin I, calculated using the linear trapezoidal method. During follow-up (mean, 1262.4 ± 599.6 days), 14 patients showed MACE. No significant differences in CYP2C19 genotype were seen between groups. AUC of troponin I up to 72 hours after intervention tended to be smaller in the prasugrel group (1,927.1 ± 2,189.3 ng/mL) than in the clopidogrel group (3,186.0 ± 3,760.1 ng/mL, p = 0.08). Cumulative incidence of MACE was significantly higher in the clopidogrel group (log-rank test; p = 0.02). Compared with clopidogrel, prasugrel was associated with reduced infarct size and lower frequency of long-term outcomes among ACS patients undergoing stenting.