RÉSUMÉ
BACKGROUND: The hyperaemic stenosis resistance (HSR) index was introduced to provide a more comprehensive indicator of the haemodynamic severity of a coronary lesion. HSR combines both the pressure drop across a lesion and the flow through it. As such, HSR overcomes the limitations of the more traditional fractional flow reserve (FFR) or coronary flow reserve (CFR) indices. AIMS: We aimed to identify the diagnostic and prognostic value of HSR and evaluate the clinical implications. METHODS: Patients with chronic coronary syndromes (CCS) and obstructive coronary artery disease were selected from the multicentre ILIAS Registry. For this study, only patients with combined Doppler flow and pressure measurements were included. RESULTS: A total of 853 patients with 1,107 vessels were included. HSR more accurately identified the presence of inducible ischaemia compared to FFR and CFR (area under the curve 0.71 vs 0.66 and 0.62, respectively; p<0.005 for both). An abnormal HSR measurement was an independent and important predictor of target vessel failure at 5-year follow-up (hazard ratio 3.80, 95% confidence interval: 2.12-6.73; p<0.005). In vessels deferred from revascularisation, HSR seems to identify more accurately those vessels that may benefit from revascularisation rather than FFR and/or CFR. CONCLUSIONS: The present study affirms the theoretical advantages of the HSR index for the detection of ischaemia-Âinducing coronary lesions in a large CCS population. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry], ClinicalTrials.gov: NCT04485234).
Sujet(s)
Angor stable , Fraction du flux de réserve coronaire , Enregistrements , Humains , Mâle , Femelle , Sujet âgé , Adulte d'âge moyen , Angor stable/physiopathologie , Angor stable/thérapie , Angor stable/diagnostic , Fraction du flux de réserve coronaire/physiologie , Sténose coronarienne/physiopathologie , Sténose coronarienne/diagnostic , Pronostic , Maladie des artères coronaires/physiopathologie , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/thérapie , Résultat thérapeutique , Résistance vasculaire/physiologie , CoronarographieRÉSUMÉ
Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1-354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.
Sujet(s)
Fibrillation auriculaire , Pontage aortocoronarien , Intervention coronarienne percutanée , Humains , Fibrillation auriculaire/diagnostic , Fibrillation auriculaire/épidémiologie , Fibrillation auriculaire/physiopathologie , Fibrillation auriculaire/étiologie , Études prospectives , Intervention coronarienne percutanée/effets indésirables , Mâle , Incidence , Femelle , Pontage aortocoronarien/effets indésirables , Sujet âgé , Adulte d'âge moyen , Facteurs de risque , Facteurs temps , Résultat thérapeutique , Maladie des artères coronaires/chirurgie , Maladie des artères coronaires/thérapie , Maladie des artères coronaires/diagnostic , Rythme cardiaque , Angor stable/diagnostic , Angor stable/physiopathologie , Angor stable/épidémiologie , Angor stable/chirurgie , Angor stable/thérapie , Appréciation des risques , Syndrome coronarien aigu/thérapie , Syndrome coronarien aigu/diagnostic , Syndrome coronarien aigu/chirurgie , Syndrome coronarien aigu/épidémiologie , TélémétrieRÉSUMÉ
BACKGROUND: Placebo-controlled evidence from ORBITA-2 (Objective Randomised Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina-2) found that percutaneous coronary intervention (PCI) in stable coronary artery disease with little or no antianginal medication relieved angina, but residual symptoms persisted in many patients. The reason for this was unclear. OBJECTIVES: This ORBITA-2 secondary analysis investigates the relationship between presenting symptoms and disease severity (anatomic, noninvasive, and invasive ischemia) and the ability of symptoms to predict the placebo-controlled efficacy of PCI. METHODS: Prerandomization symptom severity and nature were assessed using the ORBITA smartphone application and symptom and quality of life questionnaires including the World Health Organization Rose angina questionnaire (Rose). Disease severity was assessed using quantitative coronary angiography, stress echocardiography, fractional flow reserve, and instantaneous wave-free ratio. Bayesian ordinal regression was used. RESULTS: At prerandomization, the median number of daily angina episodes was 0.8 (Q1-Q3: 0.4-1.6), 64% had Rose angina, quantitative coronary angiography diameter stenosis was 61% (Q1-Q3: 49%-74%), stress echocardiography score was 1.0 (Q1-Q3: 0.0-2.7), fractional flow reserve was 0.63 (Q1-Q3: 0.49-0.75), and instantaneous wave-free ratio was 0.78 (Q1-Q3: 0.55-0.87). There was little relationship between symptom severity and nature and disease severity: angina symptom score with quantitative coronary angiography ordinal correlation coefficient: 0.06 (95% credible interval [CrI]: 0.00-0.08); stress echocardiography: 0.09 (95% CrI: 0.02-0.10); fractional flow reserve: 0.04 (95% CrI: -0.03 to 0.07); and instantaneous wave-free ratio: 0.04 (95% CrI: -0.01 to 0.07). However, Rose angina and guideline-based typical angina were strong predictors of placebo-controlled PCI efficacy (angina symptom score: OR: 1.9; 95% CrI: 1.6-2.1; probability of interaction [PrInteraction] = 99.9%; and OR: 1.8; 95% CrI: 1.6-2.1; PrInteraction = 99.9%, respectively). CONCLUSIONS: Although symptom severity and nature were poorly associated with disease severity, the nature of symptoms powerfully predicted the placebo-controlled efficacy of PCI.
Sujet(s)
Maladie des artères coronaires , Intervention coronarienne percutanée , Humains , Mâle , Femelle , Intervention coronarienne percutanée/méthodes , Adulte d'âge moyen , Maladie des artères coronaires/thérapie , Maladie des artères coronaires/diagnostic , Sujet âgé , Résultat thérapeutique , Coronarographie , Indice de gravité de la maladie , Angor stable/thérapie , Angor stable/diagnostic , Angor stable/physiopathologie , Qualité de vieRÉSUMÉ
SOURCE CITATION: Rajkumar CA, Foley MJ, Ahmed-Jushuf F, et al; ORBITA-2 Investigators. A placebo-controlled trial of percutaneous coronary intervention for stable angina. N Engl J Med. 2023;389:2319-2330. 38015442.
Sujet(s)
Angor stable , Intervention coronarienne percutanée , Adulte , Humains , Angor stable/chirurgie , Angor stable/diagnostic , Tolérance à l'effort , Résultat thérapeutiqueRÉSUMÉ
AIMS: Identifying patients with vulnerable plaque who have poor prognosis among those with coronary artery disease (CAD) is crucial to deciding future therapeutic interventions. We previously reported that male CAD patients with low anti-apolipoprotein B-100 autoantibody (anti-apoB-100 Ab) levels were at an increased risk of developing unstable plaque lesions. This study focused on the autoantibodies against lipoprotein lipase (LPL), a key enzyme in triglyceride metabolism, which is another risk factor for atherosclerosis, and investigated their association with plaque characteristics. METHODS: We measured serum anti-LPL Ab levels using a homemade enzyme-linked immunosorbent assay in 80 male CAD patients. Coronary plaque properties were evaluated using iMAP®-intravascular ultrasound. RESULTS: Serum anti-LPL Ab levels were not correlated with plaque burden but were significantly negatively and positively correlated with fibrotic and necrotic plaques, respectively. High-risk patients with low anti-apoB-100 Ab levels were divided into groups according to their anti-LPL Ab levels. The group with high anti-LPL Ab levels exhibited more necrotic plaques and fewer fibrotic plaques as well as higher remnant-like lipoprotein particle levels than the group with low anti-LPL Ab levels. CONCLUSIONS: Serum anti-LPL Ab levels can serve as a marker of plaque instability in CAD patients and can help identify higher-risk cases when combined with anti-apoB-100 Ab levels.
Sujet(s)
Angor stable , Autoanticorps , Marqueurs biologiques , Maladie des artères coronaires , Lipoprotein lipase , Plaque d'athérosclérose , Humains , Mâle , Lipoprotein lipase/sang , Plaque d'athérosclérose/sang , Marqueurs biologiques/sang , Angor stable/sang , Angor stable/diagnostic , Angor stable/immunologie , Autoanticorps/sang , Autoanticorps/immunologie , Adulte d'âge moyen , Maladie des artères coronaires/sang , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/immunologie , Sujet âgé , Pronostic , Apolipoprotéine B-100/sang , Facteurs de risqueRÉSUMÉ
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.
Sujet(s)
Angor stable , Cholestérol LDL , Maladie des artères coronaires , Vaisseaux coronaires , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase , Plaque d'athérosclérose , Tomographie par cohérence optique , Humains , Tomographie par cohérence optique/méthodes , Mâle , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/usage thérapeutique , Femelle , Cholestérol LDL/sang , Angor stable/traitement médicamenteux , Angor stable/sang , Angor stable/diagnostic , Adulte d'âge moyen , Vaisseaux coronaires/imagerie diagnostique , Vaisseaux coronaires/anatomopathologie , Sujet âgé , Maladie des artères coronaires/sang , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/traitement médicamenteux , Intervention coronarienne percutanée/méthodes , Études rétrospectives , Facteurs de risque , Marqueurs biologiques/sang , Résultat thérapeutique , CoronarographieRÉSUMÉ
The coronary sinus Reducer (CSR) is an hourglass-shaped device which creates an artificial stenosis in the coronary sinus. Whilst placebo-controlled data show an improvement in angina, these results are unreplicated and are the subject of further confirmatory research. The mechanism of action of this unintuitive therapy is unknown. The Coronary Sinus Reducer Objective Impact on Symptoms, MRI Ischaemia, and Microvascular Resistance (ORBITA-COSMIC) trial is a randomised, placebo-controlled, double-blind trial investigating the efficacy of the CSR. Patients with (i) established epicardial coronary artery disease, (ii) angina on maximally tolerated antianginal medication, (iii) evidence of myocardial ischaemia and (iv) no further options for percutaneous coronary intervention or coronary artery bypass grafting will be enrolled. Upon enrolment, angina and quality-of-life questionnaires, treadmill exercise testing and quantitative stress perfusion cardiac magnetic resonance (CMR) imaging will be performed. Participants will record their symptoms daily on a smartphone application throughout the trial. After a 2-week symptom assessment phase, participants will be randomised in the cardiac catheterisation laboratory to CSR or a placebo procedure. After 6 months of blinded follow-up, all prerandomisation tests will be repeated. A prespecified subgroup will undergo invasive coronary physiology assessment at prerandomisation and follow-up. The primary outcome is stress myocardial blood flow on CMR. Secondary outcomes include angina frequency, quality of life and treadmill exercise time. (ClinicalTrials.gov: NCT04892537).
Sujet(s)
Angor stable , Maladie des artères coronaires , Sinus coronaire , Intervention coronarienne percutanée , Humains , Angor stable/diagnostic , Qualité de vie , Sinus coronaire/chirurgie , Résultat thérapeutique , Maladie des artères coronaires/thérapieRÉSUMÉ
BACKGROUND: Diabetes mellitus (DM) and hypertension are well-known atherosclerosis risk factors. Furthermore, renal dysfunction is a crucial risk factor for patients with coronary artery disease (CAD), and managing renal function in these patients is complicated because of comorbid conditions and potential side effects during treatment. Therefore, this study aimed to investigate the effect of medications for hypertension on renal function after percutaneous coronary intervention (PCI) between patients with and without DM with statins. METHODS: In 297 consecutive patients undergoing PCI for stable angina pectoris, cystatin C (CysC) was evaluated at baseline and 9 months after PCI, and the percent change in CysC (%CysC) was calculated. The association of worsening renal function (WRF: %CysC ≥ 0) and baseline characteristics, including medications, was assessed. RESULTS: Among 297 hypertensive patients with statins, 196 and 101 were with and without DM, respectively. Angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker, and ß-blocker were prescribed in 56 (29%), 82 (42%), and 91 (46%) patients in the DM group, and 20 (20%), 52 (51%), and 52 (51%) in the non-DM group, respectively. The patients with WRF after PCI were 100 (51%) and 59 (58%) in the DM and non-DM groups (p = 0.261). Additionally, the %CysC had no significant differences between groups [median: 0%, interquartile range (IQR): -7.9% to 8.5% vs. median: 1.1%, IQR: -6.6% to 9.6%, p = 0.521]. Multivariate logistic analysis for WRF using relevant factors from univariate analysis showed that only ß-blocker [odds ratio (OR): 2.76, 95% confidence interval (CI): 1.03-7.90, p = 0.048] was independently associated with WRF in the DM group whereas ACEI (OR: 0.07, 95% CI: 0.01-0.47, p = 0.012) was negatively correlated with WRF in the non-DM group. CONCLUSION: The ß-blocker was the independent risk factor for WRF in patients with DM in the late phase after PCI for stable angina pectoris, while the use of ACEI had a renoprotective effect in patients without DM.
Sujet(s)
Angor stable , Maladie des artères coronaires , Diabète , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase , Hypertension artérielle , Intervention coronarienne percutanée , Humains , Études de cohortes , Études rétrospectives , Intervention coronarienne percutanée/effets indésirables , Angor stable/diagnostic , Angor stable/thérapie , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase/effets indésirables , Diabète/diagnostic , Diabète/traitement médicamenteux , Hypertension artérielle/diagnostic , Hypertension artérielle/traitement médicamenteux , Hypertension artérielle/étiologie , Maladie des artères coronaires/thérapie , Maladie des artères coronaires/traitement médicamenteux , Facteurs de risque , Inhibiteurs de l'enzyme de conversion de l'angiotensine/effets indésirables , Rein/physiologie , Résultat thérapeutiqueRÉSUMÉ
OBJECTIVES: Physical activity presents an important cornerstone in the management and care of coronary artery disease (CAD) patients following percutaneous coronary intervention (PCI) and research in older patients continues to be overlooked. This study evaluated differences in physical activity, inactivity and sleep of CAD patients following PCI for acute coronary syndrome consisting of ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) and elective admission of stable angina patients over 12â months. METHODS: This was an observational, longitudinal study. Fifty-eight patients were recruited (STEMI, n â =â 20, NSTEMI, n â =â 18 and stable angina, n â =â 20) and completed 7-day monitoring (physical activity, inactivity and sleep) using wrist-worn tri-axial accelerometers (GENEActiv, ActivInsights Ltd, Kimbolton, Cambridgeshire, UK) upon discharge from a tertiary centre and repeated measurements at 3â months ( n â =â 43), 6â months ( n â =â 40) and 12â months ( n â =â 33). RESULTS: Following PCI, CAD patients showed a general trend of increasing light and moderate-vigorous physical activity over the 12-month follow-up. Time in inactivity remained high but decreased over time. Sleep duration and sleep efficiency remained consistent. NSTEMI patients spent less time asleep, more time inactive and less time in light and moderate-vigorous physical activity in comparison to STEMI and stable angina patients. Differences between the groups over time were minimal. CONCLUSION: These findings suggest that older patients with CAD spend long periods in inactivity but the increasing trend of both light and moderate-vigorous physical activity over time presents a positive change in behaviour in the year following PCI.
Sujet(s)
Angor stable , Maladie des artères coronaires , Infarctus du myocarde , Infarctus du myocarde sans sus-décalage du segment ST , Intervention coronarienne percutanée , Infarctus du myocarde avec sus-décalage du segment ST , Humains , Sujet âgé , Maladie des artères coronaires/thérapie , Intervention coronarienne percutanée/effets indésirables , Études longitudinales , Angor stable/diagnostic , Angor stable/thérapie , Facteurs de risque , Exercice physique , Sommeil , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Currently, in the majority of patients with stable angina pectoris (SAP) treatment consists of optimal medical treatment, potentially followed by coronary angiography and subsequent coronary revascularisation if necessary". Recent work questioned the effectiveness of these invasive procedures in reducing re-events and improving prognosis. The potential of exercise-based cardiac rehabilitation on clinical outcomes in patients with coronary artery disease is well-known. However, in the modern era, no studies compared the effects of cardiac rehabilitation versus coronary revascularisation in patients with SAP. METHODS: In this multicentre randomised controlled trial, 216 patients with stable angina pectoris and residual anginal complaints under optimal medical treatment will be randomised to: 1) usual care (i.e., coronary revascularisation), or 2) a 12-month cardiac rehabilitation (CR) programme. CR consists of a multidisciplinary intervention, including education, exercise training, lifestyle coaching and a dietary intervention with a stepped decline in supervision. The primary outcome will be anginal complaints (Seattle Angina Questionnaire-7) following the 12-month intervention. Secondary outcomes include cost-effectiveness, ischemic threshold during exercise, cardiovascular events, exercise capacity, quality of life and psychosocial wellbeing. DISCUSSION: In this study, we will examine the hypothesis that multidisciplinary CR is at least equally effective in reducing anginal complaints as the contemporary invasive approach at 12-months follow-up for patients with SAP. If proven successful, this study will have significant impact on the treatment of patients with SAP as multidisciplinary CR is a less invasive and potentially less costly and better sustainable treatment than coronary revascularisations. TRIAL REGISTRATION: Netherlands Trial Register, NL9537. Registered 14 June 2021.
Sujet(s)
Angor stable , Réadaptation cardiaque , Maladie des artères coronaires , Humains , Réadaptation cardiaque/effets indésirables , Réadaptation cardiaque/méthodes , Angor stable/diagnostic , Angor stable/thérapie , Qualité de vie , Maladie des artères coronaires/imagerie diagnostique , Maladie des artères coronaires/thérapie , Exercice physique , Résultat thérapeutique , Essais contrôlés randomisés comme sujet , Études multicentriques comme sujetRÉSUMÉ
As society ages, the number of older adults with stable ischemic heart disease continues to rise. Older adults exhibit the greatest morbidity and mortality from stable angina. Furthermore, they suffer a higher burden of comorbidity and adverse events from treatment than younger patients. Given that older adults were excluded or underrepresented in most randomized controlled trials of stable ischemic heart disease, evidence for management is limited and hinges on subgroup analyses of trials and observational studies. This review aims to elucidate the current definitions of aging, assess the overall burden and clinical presentations of stable ischemic heart disease in older patients, weigh the available evidence for guideline-recommended treatment options including medical therapy and revascularization, and propose a framework for synthesizing complex treatment decisions in older adults with stable angina. Due to evolving goals of care in older patients, it is paramount to readdress the patient's priorities and preferences when deciding on treatment. Ultimately, the management of stable angina in older adults will need to be informed by dedicated studies in representative populations emphasizing patient-centered end points and person-centered decision-making.
Sujet(s)
Angor stable , Ischémie myocardique , Humains , Sujet âgé , Angor stable/diagnostic , Angor stable/épidémiologie , Angor stable/thérapie , Résultat thérapeutique , Comorbidité , Essais contrôlés randomisés comme sujetRÉSUMÉ
OBJECTIVE: We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. METHODS: The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0-19), n = 117] and critical stenosis group [Gensini score ≥20, n = 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. RESULTS: Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (ρ) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (ρ = -0.433, p < 0.001). A 4D GLS value of ≥ -17 had 84.9% sensitivity and 97.4% specificity, GAS ≥ -31 (90.9% sensitivity, 78.6% specificity), GCS ≥ -17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score ≥20. CONCLUSION: The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.
Sujet(s)
Angor stable , Maladie des artères coronaires , Échocardiographie tridimensionnelle , Humains , Maladie des artères coronaires/complications , Maladie des artères coronaires/diagnostic , Angor stable/diagnostic , Débit systolique , Sténose pathologique , Fonction ventriculaire gauche , Valeur prédictive des tests , Échocardiographie/méthodes , Reproductibilité des résultats , Échocardiographie tridimensionnelle/méthodesRÉSUMÉ
Background Although physiology-based assessment of coronary artery stenosis using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are established methods of guiding coronary revascularization, its clinical outcome in long-term deferral needs further evaluation, especially with acute coronary syndrome as a clinical presentation. The aim was to evaluate the long-term clinical outcome of deferral of revascularization based on iFR or FFR. Methods and Results This is a substudy of the iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trial, where patients deferred from revascularization from each study arm were selected. Nine hundred eight patients deferred from coronary revascularization with iFR (n=473) and FFR (n=435) were followed for 5 years. The national quality registry, SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), was used for patient data collection and clinical follow-up. The end point was major adverse cardiac events and their individual components all-cause death, cardiovascular death, noncardiovascular death, nonfatal myocardial infarction, and unplanned revascularization. No significant difference was found in major adverse cardiac events (iFR 18.6% versus FFR 16.8%; adjusted hazard ratio, 1.08 [95% CI, 0.79-1.48]; P=0.63) or their individual components. Conclusions No differences in clinical outcomes after 5-year follow-up were noted when comparing iFR versus FFR as methods for deferral of coronary revascularization in patients presenting with stable angina pectoris and acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166736.
Sujet(s)
Syndrome coronarien aigu , Angor stable , Maladie des artères coronaires , Sténose coronarienne , Fraction du flux de réserve coronaire , Humains , Syndrome coronarien aigu/diagnostic , Syndrome coronarien aigu/chirurgie , Angor stable/diagnostic , Angor stable/chirurgie , Études de suivi , Coronarographie , Sténose coronarienne/diagnostic , Sténose coronarienne/thérapie , Cathétérisme cardiaque , Valeur prédictive des tests , Indice de gravité de la maladie , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/chirurgieRÉSUMÉ
OBJECTIVE: Establishing appropriate percutaneous coronary intervention (PCI) in stable angina pectoris (SAP) has become a distinctive performance measure worldwide. Clinical guidelines call for documenting ischaemia in patients with SAP prior to elective PCI. The Japanese Ministry of Health, Labour and Welfare introduced a new reimbursement policy in April 2018 to promote the appropriate and judicious implementation of PCI. The 2018 reimbursement changes clarified the required proof of ischaemia. Tests to evaluate functional ischaemia and coronary stenosis have been added as a requirement for reimbursement. We examined whether this reimbursement revision had an impact on PCI procedures for SAP in Japan. METHODS: We used administrative claims data in Japan's Diagnosis Procedure Combination database from April 2014 through March 2020. We used interrupted time series analyses with a control to ascertain the impacts on elective PCI procedures before and after the Japanese reimbursement revision. The primary outcome was the change in elective PCI procedures per month. Emergent PCI procedures served as a control group. RESULTS: A total of 773 240 PCI procedures were identified between April 2014 and March 2020: 388 817 and 180 462 elective PCIs before and after the reimbursement revision, respectively. After the 2018 reimbursement revision, significant trend changes were found in elective PCI procedures per month (-106.3, 95% CI -155.8 to -56.8, p<0.01), while the number of emergent PCIs remained stable throughout the study period. CONCLUSIONS: After revising the reimbursement tariff for elective PCIs in 2018, there was a significant reduction in elective PCI procedures per month.
Sujet(s)
Angor stable , Intervention coronarienne percutanée , Humains , Intervention coronarienne percutanée/méthodes , Japon/épidémiologie , Angor stable/diagnostic , Angor stable/épidémiologie , Angor stable/chirurgie , Résultat thérapeutiqueSujet(s)
Angor stable , Maladies du rein , Humains , Protéine C-réactive , Albumines , Angor stable/diagnosticRÉSUMÉ
OBJECTIVE: We aimed to investigate the safety of drug-coated balloon (DCB)-only angioplasty compared to drug-eluting stent (DES), as part of routine clinical practice. BACKGROUND: The recent BASKETSMALL2 trial demonstrated the safety and efficacy of DCB angioplasty for de novo small vessel disease. Registry data have also demonstrated that DCB angioplasty is safe; however, most of these studies are limited due to long recruitment time and a small number of patients with DCB compared to DES. Therefore, it is unclear if DCB-only strategy is safe to incorporate in routine elective clinical practice. METHODS: We compared all-cause mortality and major cardiovascular endpoints (MACE), including unplanned target lesion revascularisation (TLR) of all patients treated with DCB or DES for first presentation of stable angina due to de novo coronary artery disease between 1st January 2015 and 15th November 2019. Data were analysed with Cox regression models and cumulative hazard plots. RESULTS: We present 1237 patients; 544 treated with DCB and 693 treated with DES for de novo, mainly large-vessel coronary artery disease. On multivariable Cox regression analysis, only age and frailty remained significant adverse predictors of all-cause mortality. Univariable, cumulative hazard plots showed no difference between DCB and DES for either all-cause mortality or any of the major cardiovascular endpoints, including unplanned TLR. The results remained unchanged following propensity score-matched analysis. CONCLUSION: DCB-only angioplasty, for stable angina and predominantly large vessels, is safe compared to DES as part of routine clinical practice, in terms of all-cause mortality and MACE, including unplanned TLR.
Sujet(s)
Angor stable , Angioplastie coronaire par ballonnet , Maladie des artères coronaires , Resténose coronaire , Endoprothèses à élution de substances , Humains , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/chirurgie , Paclitaxel , Endoprothèses à élution de substances/effets indésirables , Angor stable/diagnostic , Angor stable/chirurgie , Résultat thérapeutique , Angioplastie coronaire par ballonnet/effets indésirables , Angioplastie coronaire par ballonnet/méthodes , Matériaux revêtus, biocompatiblesSujet(s)
Angor stable , Maladies du rein , Humains , Protéine C-réactive , Albumines , Angor stable/diagnosticRÉSUMÉ
AIMS: The association of dairy products with cardiovascular disease and mortality risk remains heavily debated. We aimed to investigate the association between intake of total dairy and dairy products and the risk of acute myocardial infarction (AMI), stroke, and cardiovascular and all-cause mortality. METHODS AND RESULTS: We included 1929 patients (80% men, mean age 62 years) with stable angina pectoris from the Western Norway B-vitamin Intervention Trial. Dietary data were obtained via a 169-item food frequency questionnaire. Risk associations were estimated using Cox proportional hazard regression models adjusted for relevant covariates. Non-linear associations were explored visually. The mean (±SD) dairy intake in the study population was 169 ± 108 g/1000 kcal. Median follow-up times were 5.2, 7.8, and 14.1 years for stroke, AMI, and mortality, respectively. Higher intake of total dairy and milk were positively associated with stroke risk [HR (95% CI): 1.14 (1.02, 1.27) and 1.13 (1.02, 1.27), cardiovascular mortality 1.06 (1.00, 1.12) and 1.07 (1.01, 1.13)] and all-cause mortality [1.07 (1.03, 1.11) and 1.06 (1.03, 1.10)] per 50 g/1000 kcal. Higher cheese intake was inversely associated with AMI risk [0.92 (0.83, 1.02)] per 10 g/1000 kcal. Butter was associated with increased AMI risk [1.10 (0.97, 1.24)] and all-cause mortality [1.10 (1.00, 1.20) per 5 g/1000 kcal. CONCLUSION: Higher dairy and milk consumption were associated with increased risk of mortality and stroke. Cheese was associated with decreased, and butter with increased, risk of AMI. Dairy is a heterogenous food group with divergent health effects and dairy products should therefore be investigated individually.
Sujet(s)
Angor stable , Maladies cardiovasculaires , Infarctus du myocarde , Accident vasculaire cérébral , Mâle , Humains , Adulte d'âge moyen , Femelle , Animaux , Angor stable/diagnostic , Produits laitiers/effets indésirables , Lait , Régime alimentaire/effets indésirables , Beurre/effets indésirables , Infarctus du myocarde/diagnostic , Infarctus du myocarde/épidémiologie , Accident vasculaire cérébral/diagnostic , Accident vasculaire cérébral/épidémiologie , Facteurs de risqueRÉSUMÉ
BACKGROUND: The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. METHODS: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097-1140 days), and the primary endpoint was cardiac death at 3 years. RESULTS: The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and ST-segment elevation myocardial (STEMI) in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53-0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65-1.44, p = 0.884). CONCLUSIONS: There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.
Sujet(s)
Angor stable , Endoprothèses à élution de substances , Infarctus du myocarde , Infarctus du myocarde sans sus-décalage du segment ST , Intervention coronarienne percutanée , Infarctus du myocarde avec sus-décalage du segment ST , Mâle , Humains , Femelle , Infarctus du myocarde/étiologie , Infarctus du myocarde avec sus-décalage du segment ST/diagnostic , Infarctus du myocarde avec sus-décalage du segment ST/chirurgie , Intervention coronarienne percutanée/effets indésirables , Angor instable/diagnostic , Angor instable/thérapie , Angor stable/diagnostic , Angor stable/thérapie , Enregistrements , Mort , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Plaque healing may serve a vital function in the natural progression of atherosclerotic disease. This study sought to investigate predictors and morphological characteristics of healed plaque (HP) among angina pectoris (AP) patients. METHODS: Patients who presented with AP and received preintervention optical coherence tomography (OCT) imaging were consecutively selected for this single-center retrospective observational study. Patient's demographic and clinical information was collected from the hospital's electronic medical records. Coronary angiograms and OCT images were compared via offline software. RESULTS: A total of 390 patients were chosen as the final study population. HP was identified in 186 patients (47.7%) and was relatively less in cases of unstable angina pectoris (UAP) than in stable angina pectoris (SAP) (89/233 [38.2%] vs. 97/157[61.8%]). The HP group had greater prevalence rates of previous myocardial infarction and SAP and higher levels of triglycerides and uremia (median, 1.67 vs. 1.31 mmol/L [p = .01] and 364.22 ± 91.80 vs. 341.53 ± 77.64 µmol/L [p = .01], respectively). Using multivariate analysis, SAP and long lesion length were shown to be stand-alone indicators of HP. HP presented with more severe stenosis as well as a longer lesion length and had more vulnerable and more complex features. In HP lesions, UAP patients had more plaque ruptures and thrombosis, whereas SAP patients had lower uric acid levels and more multiple HPs(≥3 HPs). CONCLUSION: Clinical presentation of SAP and long lesion length were strong predictors for HP in patients with AP. Patients with HP presented with more severe stenosis, longer lesion lengths, greater inflammation, and vulnerability.