Influence of practice patterns on outcome among countries enrolled in the SYNTAX trial: 5-year results between percutaneous coronary intervention and coronary artery bypass grafting†

Milojevic, Milan; Head, Stuart J.; Mohr, Friedrich W.; Morice, Marie Claude; Dawkins, Keith D.; Holmes, David R.; Serruys, Patrick W.; Kappetein, Arie Pieter

doi:10.1093/ejcts/ezx104

Cited by 17 publications

(7 citation statements)

References 26 publications

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“…The poor prognosis observed at 1 year is likely to be because of the morbidity and mortality associated with renal disease, rather than a lack of treatment efficacy because the rates of all-cause mortality observed across the different stages of renal disease in the current study are similar to those observed with other cardiovascular therapies. 16,17 A recent analysis of patients undergoing transcatheter aortic valve replacement demonstrated a 1-year all-cause mortality rate of 22% in stage 3 renal disease and 31% in stage 4 or 5 renal disease. 16,17 In the setting of percutaneous coronary intervention, 5-year all-cause mortality in patients with chronic renal disease is 27% when compared with 11% in those with normal renal function.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 A recent analysis of patients undergoing transcatheter aortic valve replacement demonstrated a 1-year all-cause mortality rate of 22% in stage 3 renal disease and 31% in stage 4 or 5 renal disease. 16,17 In the setting of percutaneous coronary intervention, 5-year all-cause mortality in patients with chronic renal disease is 27% when compared with 11% in those with normal renal function. 16,17 Furthermore, there also seems to be a significant decrease in all-cause mortality over time in patients who undergo mitral valve surgery.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 In the setting of percutaneous coronary intervention, 5-year all-cause mortality in patients with chronic renal disease is 27% when compared with 11% in those with normal renal function. 16,17 Furthermore, there also seems to be a significant decrease in all-cause mortality over time in patients who undergo mitral valve surgery. 3,4 One large single-center study of patients undergoing mitral valve surgery reported persistently lower survival rates over time in patients on dialysis versus those not on dialysis (59.2% versus 89.5% at 1-year, 42.3% versus 84.4% at 2 years, and 28.9% versus 78.4% at 5 years follow-up).…”

Section: Discussionmentioning

confidence: 99%

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Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease

Shah

Villablanca

Vemulapalli

et al. 2019

Circ: Cardiovascular Interventions

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BACKGROUND: Renal disease is associated with poor prognosis despite guideline-directed cardiovascular therapy, and outcomes by sex in this population remain uncertain. METHODS AND RESULTS: Patients (n=5213) who underwent a MitraClip procedure in the National Cardiovascular Data Registry Transcatheter Valve Therapy registry were evaluated for the primary composite outcome of all-cause mortality, stroke, and new requirement for dialysis by creatinine clearance (CrCl). Centers for Medicare and Medicaid Services–linked data were available in 63% of patients (n=3300). CrCl was <60 mL/min in 77% (n=4010) and <30 mL/min in 23% (n=1183) of the cohort. Rates of primary outcome were higher with lower CrCl (>60 mL/min, 1.4%; 30–<60 mL/min, 2.7%; <30 mL/min, 5.2%; dialysis, 7.8%; P<0.001), and all low CrCl groups were independently associated with the primary outcome (30–<60 mL/min: adjusted odds ratio, 2.32; 95% CI, 1.38–3.91; <30 mL/min: adjusted odds ratio, 4.44; 95% CI, 2.63–7.49; dialysis: adjusted hazards ratio, 4.52; 95% CI, 2.08–9.82) when compared with CrCl >60 mL/min. Rates of 1-year mortality were higher with lower CrCl (>60 mL/min, 13.2%; 30–<60 mL/min, 18.8%; <30 mL/min, 29.9%; dialysis, 32.3%; P<0.001), and all low CrCl groups were independently associated with 1-year mortality (30–<60 mL/min: adjusted hazards ratio, 1.50; 95% CI, 1.13–1.99; <30 mL/min: adjusted hazards ratio, 2.38; 95% CI, 1.78–3.20; adjusted hazards ratio: dialysis, 2.44; 95% CI, 1.66–3.57) when compared with CrCl >60 mL/min. CONCLUSIONS: The majority of patients who undergo MitraClip have renal disease. Preprocedural renal disease is associated with poor outcomes, particularly in stage 4 or 5 renal disease where 1-year mortality is observed in nearly one-third. Studies to determine how to further optimize outcomes in this population are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease

Shah

Villablanca

Vemulapalli

et al. 2019

Circ: Cardiovascular Interventions

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“…The surgical community may be somewhat underinformed on this topic [12], despite the availability of previously published guidelines on specific drugs [13][14][15]. Therefore, the EACTS Clinical Guideline Committee determined that there was a need to produce an updated guideline focusing on the main pharmacological classes involved in the perioperative treatment and prevention of adverse events in patients undergoing adult cardiac surgery.…”

Section: Level Of Evidence Cmentioning

confidence: 99%

2017 EACTS Guidelines on perioperative medication in adult cardiac surgery

Sousa-Uva¹,

Head²,

Milojevic³

et al. 2017

European Journal of Cardio-Thoracic Surgery

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307

206

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Disclaimer 2017: The EACTS Guidelines represent the views of the EACTS and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The EACTS is not responsible in the event of any contradiction, discrepancy and/or ambiguity between these Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS Guidelines do not in any way whatsoever override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do EACTS Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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“…The lack of substantial evidence has led to significant variation in clinical patterns and outpatient medication strategy worldwide. 1 Although the surgeon's experience and volume undoubtedly are pivotal for the success of treatment, 2,3 numerous recent studies suggest that optimal perioperative medical therapy contributes significantly to improved either short-or long-term survival and health-related quality of life. [4][5][6][7][8] However, adherence to effective therapeutic strategies remains poor, even in well-controlled surgical trials, resulting in high rates of postoperative severe complications and deaths in suboptimally treated patients.…”

mentioning

confidence: 99%