RESUMEN
AIMS: The present analysis from the Functional Assessment in Elderly Myocardial Infarction Patients with Multivessel Disease (FIRE) trial aims to explore the significance of pre-admission physical activity and assess whether the benefits of physiology-guided complete revascularization apply consistently to sedentary and active older patients. METHODS AND RESULTS: Patients aged 75 years or more with myocardial infarction (MI) and multivessel disease were randomized to receive physiology-guided complete revascularization or culprit-only strategy. The primary outcome was a composite of death, MI, stroke, or any revascularization within a year. Secondary endpoints included the composite of cardiovascular death or MI, as well as single components of the primary endpoint. Pre-admission physical activity was categorized into three groups: (i) absent (sedentary), (ii) light, and (iii) vigorous. Among 1445 patients, 692 (48%) were sedentary, whereas 560 (39%) and 193 (13%) performed light and vigorous physical activity, respectively. Patients engaging in light or vigorous pre-admission physical activity exhibited a reduced risk of the primary outcome compared with sedentary individuals [light hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.55-0.91 and vigorous HR 0.14, 95% CI 0.07-0.91, respectively]. These trends were also observed for death, cardiovascular death, or MI. When comparing physiology-guided complete revascularization vs. culprit-only strategy, no significant interaction was observed for primary and secondary endpoints when stratified by sedentary or active status. CONCLUSION: In older patients with MI, pre-admission physical activity emerges as a robust and independent prognostic determinant. Physiology-guided complete revascularization stands out an effective strategy in reducing ischaemic adverse events, irrespective of pre-admission physical activity status. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03772743.
The Functional Assessment in Elderly Myocardial Infarction Patients with Multivessel Disease (FIRE) trial has shown that physiology-guided complete revascularization reduces ischaemic adverse events in older patients with myocardial infarction (MI) and multivessel disease. Older patients who engage in light or vigorous physical activity before hospitalization for MI have a reduced risk of the primary composite outcome of death, MI, stroke, or ischaemia-driven revascularization. These benefits extend to all secondary cardiovascular outcomes as well. In the present subanalysis of the FIRE trial, we find that the positive prognosis associated with physiology-guided complete revascularization holds true even for patients with a sedentary lifestyle. This means that this type of revascularization can effectively reduce ischaemic adverse events in older patients with MI and multivessel disease, regardless of their physical activity levels.
Asunto(s)
Infarto del Miocardio , Intervención Coronaria Percutánea , Angiografía Coronaria , Vasos Coronarios , Humanos , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/efectos adversos , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. OBJECTIVE: This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. METHODS: The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. RESULTS: One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. CONCLUSION: Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
Asunto(s)
Anomalías de los Vasos Coronarios/complicaciones , Hipertensión Arterial Pulmonar/complicaciones , Enfermedades Vasculares/congénito , Adulto , Anomalías de los Vasos Coronarios/epidemiología , Anomalías de los Vasos Coronarios/mortalidad , Vasos Coronarios/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Hipertensión Arterial Pulmonar/epidemiología , Hipertensión Arterial Pulmonar/mortalidad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/mortalidadRESUMEN
There are many underlying mechanisms for cocaine-associated myocardial infarction, and the culprit must be elucidated for appropriate therapeutic management. Optical coherence tomography provides unique insights when angiography alone has limited diagnostic value; it also aids in the decision between conservative management and revascularization strategy and guides coronary interventions.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Vasos Coronarios/diagnóstico por imagen , Revascularización Miocárdica , Infarto del Miocardio con Elevación del ST , Trombectomía/métodos , Tomografía de Coherencia Óptica/métodos , Adulto , Trastornos Relacionados con Cocaína/diagnóstico , Angiografía Coronaria/métodos , Stents Liberadores de Fármacos , Electrocardiografía/métodos , Humanos , Masculino , Revascularización Miocárdica/instrumentación , Revascularización Miocárdica/métodos , Selección de Paciente , Infarto del Miocardio con Elevación del ST/inducido químicamente , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Choque/etiología , Choque/fisiopatología , Choque/terapia , Detección de Abuso de Sustancias/métodosRESUMEN
This image series shows how bypass grafts may tent the vessel to which they are anastomosed, potentially changing the expected course of the native coronary vessel. This fact must be taken into account during CTO-PCI, and this case emphasizes the importance of careful analysis of coronary anatomy with several angiographic projections.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Puente de Arteria Coronaria/efectos adversos , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/cirugía , Oclusión de Injerto Vascular/terapia , Vena Safena/trasplante , Anciano , Angina de Pecho/diagnóstico , Angina de Pecho/etiología , Cateterismo Cardíaco/métodos , Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Stents Liberadores de Fármacos , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate the 9-month safety and efficacy of polymer-free sirolimus eluting drug eluting stents in septuagenarians and octogenarians. METHODS: An all-comer, worldwide single armed trial (ClinicalTrials.gov Identifier NCT02629575) was conducted to demonstrate the safety and efficacy of an ultra-thin strut, polymer-free sirolimus eluting stent (PF-SES). The primary endpoint was the 9-month target revascularization rate (TLR). Secondary endpoints included the rates of major adverse cardiac events (MACE), stent thrombosis (ST) and bleeding (BARC) in septuagenarians (≥70 years, <80 years), and in octogenarians (≥80 years) to be compared to the younger patient group (<70 years). RESULTS: A total of 1607 patients were treated with PF-SES in the sub-70-year-old age group, 694 in septuagenarians, and 371 in the octogenarian patient group. At 9 months, the MACE rates were 7.2% in octogenarians, 5.3% in septuagenarians, and 3.0% in the younger patient group (P = 0.001). These were mostly driven by all-cause mortality (4.4% vs 1.9% vs 0.6%, P < 0.001) while the TLR rates were only numerically lower in the younger age group (P = 0.080). BARC 1-5 bleeding events were more frequent in the older age group (1.9% vs 2.7% vs 4.6%, P = 0.012) whereas the rates for ST were not different (0.7% vs 0.6% vs 0.6%, P = 0.970). CONCLUSIONS: In octogenarians treated with PF-SES, the rates for MACE, overall mortality, and bleeding are higher as compared to the younger age groups. However, the rates for TLR and ST were not significantly different across the investigated age groups. PF-SES are safe and effective in octogenarians.
Asunto(s)
Oclusión Coronaria/cirugía , Stents Liberadores de Fármacos , Inmunosupresores/uso terapéutico , Polímeros , Sirolimus/uso terapéutico , Factores de Edad , Anciano , Anciano de 80 o más Años , Oclusión Coronaria/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 53-year-old man underwent percutaneous coronary intervention of a chronic total occlusion of the circumflex artery. A mini-crush stent technique with two drug-eluting stents was performed. To the best of our knowledge, this is the first case of coronary artery aneurysm affecting a bifurcated chronic total occlusion treated with a two-stent technique.