Background Patients with non‐ST‐elevation myocardial infarction (NSTEMI) have worse long‐term prognoses than those with ST‐elevation myocardial infarction (STEMI). Hypothesis It may be attributable to more extended coronary atherosclerotic disease burden in patients with NSTEMI. Methods This study consisted of consecutive 231 patients who underwent coronary intervention for myocardial infarction (MI). To assess the extent and severity of atherosclerotic disease burden of non‐culprit coronary arteries, two scoring systems (Gensini score and synergy between percutaneous coronary intervention with Taxus and cardiac surgery [SYNTAX] score) were modified by subtracting the score of the culprit lesion: the non‐culprit Gensini score and the non‐culprit SYNTAX score. Results Patients with NSTEMI had more multi‐vessel disease, initial thrombolysis in myocardial infarction (TIMI) flow grade 2/3, and final TIMI flow grade 3 than those with STEMI. As compared to STEMI, patients with NSTEMI had significantly higher non‐culprit Gensini score (16.3 ± 19.8 vs. 31.2 ± 25.4, p < 0.001) and non‐culprit SYNTAX score (5.8 ± 7.0 vs. 11.1 ± 9.7, p < 0.001). Conclusions Patients with NSTEMI had more advanced coronary atherosclerotic disease burden including non‐obstruction lesions, which may at least in part explain higher incidence of cardiovascular events in these patients.
Background: Peripheral artery disease (PAD) is often accompanied by heart failure with preserved ejection fraction (HFpEF). Left ventricular (LV) diastolic dysfunction is related to HFpEF. The aim of this study was to compare LV diastolic function between patients with or without PAD. Methods: One thousand one hundred twenty-one patients (male 56%, mean age 68 AE 13 years) with available preserved LV systolic function assessed by echocardiography (ejection fraction !50%) were enrolled from a single-center database between January 2013 and May 2015. PAD was defined as ankle brachial index <0.9 or previous history of lower extremity bypass and/or endovascular therapy. Diagnosis of LV diastolic dysfunction was based on the American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The prevalence of LV diastolic dysfunction was compared between patients with PAD and those without PAD.Multivariate analysis was performed by logistic regression analyses to assess predictors of LV diastolic dysfunction. Results: Two hundred patients (18%) had PAD. Patients with PAD had higher E/e 0 (15.3 AE 7.4 vs 11.8 AE 5.5, p < 0.01), tricuspid regurgitation velocity (2.37 AE 0.33 vs 2.19 AE 0.28 m/s, p < 0.01), left atrial volume index (40.6 AE 20.2 vs 32.1 AE 13.6 mL/m 2 [ 1 _ T D $ D I F F ] , p < 0.01), and lower e 0 (5.68 AE 1.70 vs 6.38 AE 2.07 cm/s, p < 0.01) than patients without PAD. The prevalence of LV diastolic dysfunction was higher (31% vs 12%, p < 0.01) in patients with PAD compared to patients without PAD. Multivariate analysis showed that PAD was an independent predictor of LV diastolic dysfunction (adjusted odds ratio: 1.77, 95% confidence interval: 1.13-2.65, p = 0.01). Conclusion:The prevalence of LV diastolic dysfunction was higher in patients with PAD than patients without PAD.
High levels of lipoprotein(a) [Lp(a)] are a risk factor for peripheral artery disease (PAD). However, the relationship between Lp(a) levels and the severity of femoropopliteal lesions in patients with PAD has not been systematically studied. This study aimed to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD. Methods: We retrospectively analyzed a single-center database including 108 patients who underwent endovascular therapy for de novo femoropopliteal lesions and measured the Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [Lp(a) 30 mg/dL; 77 patients] and high Lp(a) [Lp(a) ≥ 30 mg/dL; 31 patients] groups. Trans-Atlantic Inter-Society Consensus (TASC) II classification, calcification [referring to the peripheral arterial calcium scoring system (PACSS) classification], and lesion length were compared between the groups.Results: The prevalence of TASC II class D (13% vs 38%, P 0.01) and severe calcification (PACSS 4) (6% vs 23%, P 0.02) was significantly higher and the lesion length longer (123 88 mm vs 175 102 mm, P 0.01) in the high Lp(a) group than in the low Lp(a) group. In multivariate analysis, Lp(a) ≥ 30 was an independent predictor for the prevalence of TASC II class D (HR 3.67, 95% CI 1.27-10.6, P 0.02) and PACSS 4 (HR 4.97, 95% CI 1.27-19.4, P 0.02). Conclusion:The prevalence of TASC II class D and severe calcification of femoropopliteal lesions was higher in patients with high Lp(a) than those with low Lp(a). severity 10) . However, the association between Lp(a) levels and angiographic severity of lesions in patients with PAD has not been systematically studied. AimThis study aimed to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal (FP) lesions in patients with PAD. Methods Study Design and ParticipantsWe conducted a retrospective analysis using aCopyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.
Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (bare-metal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5-2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75-60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.
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