Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents　― Results From the HOST-EXAM Trial ―

Won, Ki‐Bum; Shin, Eun‐Seok; Kang, Jeehoon; Yang, Han–Mo; Park, Kyung Woo; Han, Kyoo‐Rok; Moon, Keon-Woong; Oh, Seok; Kim, Ung; Rhee, Moo-Yong; Kim, Doo-Il; Kim, Song-Yi; Lee, Sung-Yun; Han, Jung‐Kyu; Koo, Bon‐Kwon; Kim, Hyo–Soo

doi:10.1253/circj.cj-22-0344

Cited by 3 publications

(6 citation statements)

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“…According to our cox regression results, low BMI increased the risk of both bleeding and ischemia. Referring to previous studies, physicians should take care when treating patients with a low BMI in this study population [26,27]. Hemoglobin < 9 g/dL, high Killip class, low LVEF and multivessel disease also increased the risk of ischemia.…”

Section: Discussionmentioning

confidence: 84%

“…Continuous variables were presented as mean ± standard deviation, and categorical variables were expressed as number of cases (percentages). Baseline characteristics and clinical ndings were chosen based on previous studies [5][6][7][20][21][22][23][24][25][26][27]; these included age, sex, systolic blood pressure, body mass index (BMI), Killip class, hypertension, dyslipidemia, previous MI, previous heart failure, previous cerebrovascular accident, smoking, ST-segment elevation myocardial infarction (STEMI), multivessel disease including left main coronary artery disease, transradial approach for PCI, TIMI ow, successful PCI, left ventricular ejection fraction (LVEF), MDRD eGFR, hemoglobin, P2Y12 reaction units and medications included a maintained dose of ticagrelor, prescription of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), beta blockers, and calcium channel blockers. PSM and cox regression analyses were performed to identify the bleeding and ischemic risks between the two groups.…”

Section: Discussionmentioning

confidence: 99%

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Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Lee

Jeong

Ahn

et al. 2023

Preprint

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Background: The risk of bleeding and ischemia in patients with acute myocardial infarction (AMI) who have undergone percutaneous coronary intervention (PCI) is a common concern for physicians, with added conflict over prescribing a potent P2Y12 inhibitor. In particular, elderly East Asian patients with diabetes mellitus (DM) invoke a heightened concern. Methods: We analyzed 839 patients who were enrolled in the Korea Acute Myocardial Infarction Registry-V, older than 75 years, with DM, had an AMI, and had undergone PCI. Propensity score matching (PSM) and cox regression analyses were performed to compare the bleeding and ischemic risks between the two groups. After PSM, 699 patients (ticagrelor: clopidogrel = 233:466) were analyzed. Patients with Bleeding Academic Research Consortium (BARC) type ≥2 bleed and those at ischemic risk were analyzed based on major adverse cardiac and cerebrovascular events. Results: Cox regression analyses showed the type of antiplatelet therapy did not affect the incidence of BARC type ≥2 bleeds (HR, 1.67; 95% CI: 0.86–3.22). Use of the transradial approach for PCI, use of statins, and successful PCI lowered the risk of bleeding. In contrast, low body mass index (BMI) increased the risk of bleeds. In the aspect of ischemia, there was no difference based on the antiplatelet agents used (HR, 1.00; 95% CI: 0.68–1.46). Low BMI, hemoglobin <9 g/dL, high Killip class, left ventricular ejection fraction <40%, and multivessel disease increased ischemic risk. Post thrombolysis in myocardial infarction flow grade ≥3, use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, beta blockers and statins decreased the risk. Conclusions: In this Korean prospective cohort study, there was no difference in the risks for bleeding and ischemia, based on the use of ticagrelor or clopidogrel, in elderly Korean patients with DM. To determine the optimal antiplatelet agents for these patients, large scale randomized controlled trials are warranted. Trial registration: KCT0008355

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Lee

Jeong

Ahn

et al. 2023

Preprint

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“…In addition to CHADS 2 score ≥2, CHA 2 DS 2 -VASc score ≥5, and CHA 2 DS 2 -VASc-HS score ≥7 (cut-off values determined according to the single Cox proportional hazard model [see below]; Table 3 ), the following patient characteristics were measured at the index PCI: mean estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD) Stage 5D (CKD5D: hemodialysis), 15 , 16 CKD from Stage 3b to 5, excluding 5D (CKD Stage 3b to 5 exp 5D), 2 , 17 serum hemoglobin (Hb) levels, anemia (Hb <13 g/dL in males, <12 g/dL in females), 2 , 17 body mass index (BMI), and low BMI (BMI ≤18.4 kg/m 2 ). 18 …”

Section: Methodsmentioning

confidence: 99%

“…This was a retrospective observational cohort study that enrolled consecutive patients who underwent elective procedures for de novo coronary lesions between January 18 The following angiographic and lesion characteristics were evaluated at the index PCI: lesions located in the 4 main coronary arteries (left anterior descending artery, left circumflex artery, right coronary artery, and left main coronary artery); American College of Cardiology (ACC)/ American Heart Association (AHA) lesion characteristics, diffuse lesion length (>20 mm; based on visual estimation using IVUS), and balloon length (diffuse); 19 proximal tortuosity; moderate or severe calcification (calcification); 20 coronary angiography (QCA; defined below) together with angina presumably due to the target vessel or objective signs of ischemia; and/or (2) TLR with %DS >70. The need for TLR was determined based on clinical symptoms, visual and quantitative angiographic outcomes, physiological examinations, and IVUS assessment.…”

Section: Study Design Population and Percutaneous Coronary Interventi...mentioning

confidence: 99%

Prognostic Impacts of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis

et al. 2023

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Background: The prognostic impact of CHADS 2 , CHA 2 DS 2 -VASc, and CHA 2 DS 2 -VASc-HS scores on clinical outcomes after drug-eluting stent (DES) placement has not been fully elucidated. Methods and Results: The present study was a retrospective, non-randomized, single-center, and lesion-based study. Target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization, occurred in 7.1% of 872 consecutive de novo coronary lesions in 586 patients. These patients were electively and exclusively treated by DESs from January 2016 to January 2022 until July 2022 with a mean (±SD) observational interval of 411±438 days. Multivariate Cox proportional hazard analysis revealed that CHA 2 DS 2 -VASc-HS scores ≥7 (hazard ratio [HR] 1.800; 95% CI 1.06–3.05; P=0.029) was a significant predictor of cumulative TLF among 24 variables evaluated. CHADS 2 scores ≥2 (HR 3.213; 95% CI 1.32–7.80; P=0.010) and CHA 2 DS 2 -VASc scores ≥5 (HR 1.980; 95% CI 1.10–3.55; P=0.022) were also significant in the multivariate analysis. Pairwise comparisons of receiver operating characteristic curves for CHADS 2 score ≥2, CHA 2 DS 2 -VASc score ≥5, and CHA 2 DS 2 -VASc-HS score ≥7 showed they were equivalent in terms of predicting the incidence of TLF, with areas under the curve of 0.568, 0.575, and 0.573, respectively. Conclusions: All 3 cardiocerebrovascular thromboembolism risk scores were strong predictors of the incidence of cumulative mid-term TLF after elective DES placement, with cut-off values of 2, 5, and 7, respectively, and equivalent prognostic impacts.

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“…Последние годы активно обсуждается так называемый парадокс ожирения, когда пациенты с избыточной массой тела и небольшими степенями ожирения имеют лучшие отдаленные результаты после ЧКВ, чем пациенты без ожирения [14,15]. Такие же результаты получены для пациентов с ОКС для 30-дневного прогноза и отдаленных результатов [16].…”

Section: рис 2 Roc-кривая модели для определения норт; Auc -площадь п...unclassified

Analysis of Factors of High and Low Platelet Residual Reactivity During Clopidogel Treatment in the Subacute Period of Myocardial Infarction

Пронько,

Снежицкий,

Копыцкий

2023

Кардиология В Беларуси

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Цель. Оценка факторов, определяющих высокую и низкую остаточную реактивность тромбоцитов (ВОРТ и НОРТ) при приеме клопидогрела у пациентов в подострый период инфаркта миокарда (ИМ). Материалы и методы. Обследовано 405 пациентов с ИМ в возрасте от 31 года до 74 лет, 322 мужчины и 83 женщины. Группа 1 – пациенты с НОРТ – 37 человек, группа 2 – пациенты с оптимальной реактивностью тромбоцитов – 263 человека, группа 3 – пациенты с ВОРТ – 105 человек. Исследования проводились на 12–14-е сутки ИМ: агрегометрия на агрегометре Multiplate (Германия) с несколькими индукторами агрегации, общий анализ крови и тромбоцитарные индексы на гемоанализаторе Sysmex XS-500i (Япония), определение растворимого лиганда CD40 (sСD40L) и sP-селектина, фактора фон Виллебранда (ФВ) и эндотелина-1 – у 145 человек на иммуноферментном анализаторе Sunrise TECAN (Австрия), эндотелийзависимая вазодилатация (ЭЗВД) методом реовазографии на «Импекард-М» (Беларусь) у 345 человек. Результаты. При проведении однофакторного линейного регрессионного анализа выявлены следующие факторы, независимо влияющие на значение ADP-test: возраст (β=–0,36, 95% ДИ –0,58 – –0,16; р=0,0006); продолжительность ИБС (β=–0,4, 95% ДИ –0,76 – –0,04; р=0,028); скорость оседания эритроцитов (СОЭ) (β=0,32, 95% ДИ 0,17–0,47; р=0,00003); количество лейкоцитов (β=1,22, 95% ДИ 0,23–2,21; р=0,015); количество тромбоцитов (β=0,06, 95% ДИ 0,038–0,083; р<0,000001); тромбокрит (β=54,4, 95% ДИ 32,3–76,5; р=0,000002); TRAP-test (β=0,4, 95% ДИ 0,33–0,46; р<0,000001). Для определения вероятности развития ВОРТ и НОРТ были построены уравнения множественной бинарной логистической регрессии. Выводы. Маркерами ВОРТ являются индекс массы тела (ИМТ), курение, СОЭ, количество тромбоцитов и TRAP-test (чувствительность – 74,5%, специфичность – 74,3%, точность – 74,3%, площадь под ROC-кривой – 0,819 (95% ДИ 0,772–0,867) для данной модели). Маркерами НОРТ являются ИМТ, количество тромбоцитов, ширина распределения тромбоцитов по объему (PDW), уровень холестерина и ЭЗВД (чувствительность – 79,17%, специфичность – 78,15%, точность – 78,23%, площадь под ROC-кривой – 0,794 (95% ДИ 0,697–0,892) для данной модели). Purpose. Evaluation of markers that determine high and low residual platelet reactivity (HRPR and LRPR) when taking clopidogrel in patients in the subacute period of myocardial infarction (MI). Materials and methods. 405 patients with MI aged 31 to 74 years, 322 men and 83 women, were examined. Group 1 – patients with LRPR – 37 people, group 2 – patients with optimal platelet reactivity – 263 people, group 3 – patients with HRPR – 105 people. Studies were carried out on the 12–14th day of MI: aggregometry on the Multiplate aggregometer (Germany) with several aggregation inducers, blood test and platelet indices on the Sysmex XS-500i hemoanalyzer, Japan, determination of soluble CD40 ligand (sСD40L) and sP-selectin, von Willebrand factor (VWF) and endothelin-1 – in 145 people on the enzyme immunoassay analyzer Sunrise TECAN, Austria, endothelium-dependent vasodilation (EDVD) by the method of rheovasography on "Impekard-M" (Belarus) in 345 people. Results. When conducting a one-way linear regression analysis, the following factors were identified that independently affect the value of the ADP-test: age (β=–0.36, 95% CI –0.58 – –0.16; p=0.0006); duration of CAD (β=–0.4, 95% CI –0.76 – –0.04; p=0.028); erythrocyte sedimentation rate (ESR) (β=0.32, 95% CI 0.17–0.47; p=0.00003); white blood cell count (β=1.22, 95% CI 0.23–2.21; p=0.015); platelet count (β=0.06, 95% CI 0.038–0.083; p<0.000001); thrombocrit (β=54.4, 95% CI 32.3–76.5; p=0.000002); TRAP-test (β=0.4, 95% CI 0.33–0.46; p<0.000001). Multiple binary logistic regression equations were constructed to determine the probability of developing HRPR and LRPR. Conclusions. HRPR markers are body mass index (BMI), smoking, ESR, platelet count and TRAP-test (sensitivity – 74.5%, specificity – 74.3%, accuracy – 74.3%, area under the ROC-curve – 0.819 (95% CI 0.772–0.867) for this model). LRPR markers are BMI, platelet count, platelet distribution width (PDW), cholesterol level and EDVD (sensitivity – 79.17%, specificity – 78.15%, accuracy – 78.23%, area under the ROC-curve – 0.794 (95% CI 0.697– 0.892) for this model).

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Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents　― Results From the HOST-EXAM Trial ―

Cited by 3 publications

References 17 publications

Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Prognostic Impacts of CHADS<sub>2</sub>, CHA<sub>2</sub>DS<sub>2</sub>-VASc, and CHA<sub>2</sub>DS<sub>2</sub>-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis

Analysis of Factors of High and Low Platelet Residual Reactivity During Clopidogel Treatment in the Subacute Period of Myocardial Infarction

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Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents ― Results From the HOST-EXAM Trial ―

Cited by 3 publications

References 17 publications

Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Risk of bleeding and ischemia in elderly East Asian patients with diabetes mellitus treated with either clopidogrel or ticagrelor: From Korea Acute Myocardial Infarction Registry-V

Prognostic Impacts of CHADS<sub>2</sub>, CHA<sub>2</sub>DS<sub>2</sub>-VASc, and CHA<sub>2</sub>DS<sub>2</sub>-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis

Analysis of Factors of High and Low Platelet Residual Reactivity During Clopidogel Treatment in the Subacute Period of Myocardial Infarction

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Body Mass Index and Major Adverse Events During Chronic Antiplatelet Monotherapy After Percutaneous Coronary Intervention With Drug-Eluting Stents　― Results From the HOST-EXAM Trial ―