Impact of Diabetes Mellitus on Intravascular Ultrasound‐Guided Provisional Stenting in Coronary Bifurcation Lesions J‐REVERSE Sub‐Study

Yamawaki, Masahiro; Terashita, Daisuke; Takahashi, Hidetoshi; Shinke, Toshiro; Fujii, Kenichi; Shimada, Yoshihisa; Takeda, Yoshihiro; Yamada, Shinichiro; Kinoshita, Yoshihisa; Murasato, Yoshinobu

doi:10.1111/joic.12353

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Em relação à hiperglicemia perioperatória, ela constitui um fator de risco independente para piores desfechos 17 , fazendo com que a condição clínica de DM tenha repercussões cardiovasculares de grande importância no que diz respeito a fatores de risco bem como prognósticos, como foi demonstrado por Yamawaki et al 18 Ademais, é importante salientar que esta revisão integrativa possui algumas limitações.…”

Section: Discussionunclassified

Os riscos perioperatórios de pacientes com Diabetes Mellitus submetidos à cirurgia cardíaca: uma revisão integrativa

Silva¹,

Ferreira²,

Varjão³

et al. 2023

Braz. J. Hea. Rev.

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Apesar dos avanços dos tratamentos das doenças cardíacas, a cirurgia cardíaca (CC) ainda se faz indispensável no tratamento de certas patologias. Nesse caso, o diabetes mellitus (DM) pode estar associado a graves complicações perioperatórias. O objetivo foi identificar e avaliar os riscos e eventos no período perioperatório de pacientes com DM submetidos à CC. A busca foi feita nos bancos de dados do PubMed, Cochrane Library e Biblioteca Virtual em Saúde. Foram incluídos estudos originais de natureza qualitativa ou quantitativa disponíveis na Internet que foram publicados entre 2015 e 2021. Foram excluídos estudos duplicados, dissertações, teses, livros e aqueles que não se adequaram à pergunta de pesquisa. Como parte dos resultados, cerca de 58% dos estudos selecionados avaliaram o pré-operatório, 8%, o intraoperatório e 83%, o pós-operatório. As comorbidades pré-operatórias mais comuns foram hipertensão arterial sistêmica e doença renal. Acerca dos eventos pós-operatórios, observaram-se prolongamento da hospitalização, infecções, menor sobrevida, hiperglicemia e lesão renal aguda. Os achados deste estudo corroboram a hipótese da associação do DM como risco independente para complicações em CC.

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Section: Discussionunclassified

Os riscos perioperatórios de pacientes com Diabetes Mellitus submetidos à cirurgia cardíaca: uma revisão integrativa

Silva¹,

Ferreira²,

Varjão³

et al. 2023

Braz. J. Hea. Rev.

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“…Diabetes was the only variant that independently affected MACE. Yamawaki et al (31) showed that diabetes is associated with less lumen gain and higher late-loss with stenting using DES, due to inhomogeneous vascular healing. We hypothesize these remains true when using BVS To conclude, the use of BVS to treat bifurcation lesions using multiple stenting techniques is feasible with low rate of serious adverse effects, albeit on the long run, the rate of re-intervention remains high.…”

Section: Discussionmentioning

confidence: 99%

Use of Bioresorbable Vascular Scaffold technology in treating coronary bifurcation lesions: A report about long-term clinical results and review of available literature

Elabbassi¹,

Ma²,

Hatala³

2019

BLL

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INTRODUCTION: BVS proved safe in humans. ABSORB trials showed them performing similar to Drug Eluting Stents in simple coronary interventions. We assessed a registry of 63 patients with bifurcation lesions, treated by BVS and followed their outcomes up-to 5 years. METHODS: Patients who satisfi ed the inclusion criteria were included. Data about contact information, baseline characteristics, fi ndings of coronary angiogram, details of their interventional treatment; short and long-term outcomes up till 5 years was collected. RESULTS: Acute feasibility of implantation in bifurcation was high (98 %). Rate of stent thrombosis, acute or sub-acute, was 3.1 %. Rate of re-intervention was 38 %. The average time for an event to occur was 1.6 ± 0.8 years. Over 5 years, 56 % had developed MACE. Patients with MACE were more likely females, hypertensive, smokers, with acute presentations (p = NS), and diabetic (72 % vs 33 % non-diabetic; p = 0.002). Patients treated with hybrid strategy of BVS and DES were more likely to develop MACE (64 % vs 49 % for others; P = ns). Patients treated by simple provisional stenting were less likely to develop MACE (45 % vs 60.5 %; p = ns). The average SYNTAX score of MACE patients was 27 vs 20; p = 0.06). Diabetes was independently associated with MACE. Hypertension was of borderline statistical signifi cance (2-sided Log rank for Hypertension p = 0.06, for Diabetes p=0.01). DISCUSSION: The use of multiple stenting strategies to treat true bifurcation lesions using BVS is feasible with low rate of serious adverse events, albeit on the long run, the rate of re-intervention is high and stringent follow up is required (Tab.

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“…Some have shown promising results and for many investigators may represent the device of choice for future treatment of bifurcation stenoses. [20][21][22][23] Although there are promising studies on the role of intravascular ultrasound, optical coherence tomography, and fractional flow reserve in the context of percutaneous treatment of bifurcations, these modalities have not been routinely incorporated into clinical practice yet. 24 The main limitations of the study were its retrospective nature, inclusion of patients conditioned to the decision of the operator, with potential selection bias, non-identification of the PCI techniques used, and the adjunct pharmacotherapy in use by the patients.…”

Section: Journal Of Transcatheter Interventionsmentioning

confidence: 99%

Percutaneous coronary intervention in bifurcation lesions: independent predictors of in-hospital death

Oliveira¹,

Correia²,

Oliveira³

2019

J Transcat Intervent

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Background: Bifurcation lesions remain a challenge and little is known about the characteristics and outcomes of percutaneous coronary intervention over the last decade with the increasing use of drug-eluting stents. The objective of this study was to identify the patient profile and the in-hospital outcomes as well as the predictors of in-hospital death over time. Methods: An observational, retrospective study that evaluated patients undergoing percutaneous coronary intervention for bifurcation lesions between 2006 and 2016. Patients were divided into three groups: 2006-2008 (Group 1), 2009-2011 (Group 2), and 2012-2016 (Group 3). We used multiple logistic regression analysis to identify independent predictors of in-hospital death. Results: A total of 36,608 patients were included, and Group 3 patients were older, with a higher number of comorbidities, more stable clinical presentation and lesions treated with longer stent length and smaller stent size. The success of the procedure was higher (96.1% vs. 97.4% vs. 98.1%; p<0.0001) and the mortality lower (1.2% vs. 0.7% vs. 0.6%; p<0.0001) in the most recently treated group. In the multiple logistic regression analysis, female sex, left main coronary artery lesions, primary percutaneous coronary intervention, rescue percutaneous coronary intervention, procedures performed between 2006-2008 and use of glycoprotein IIb/IIIa inhibitors were variables independently associated with in-hospital mortality. Conclusions: Female sex, acute clinical presentation, emergency percutaneous coronary intervention, and greater anatomical complexity were associated with in-hospital mortality in patients undergoing coronary bifurcation treatment. Advances in contemporary treatment possibly contributed to the clinical outcome improvement in these patients.

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Impact of Diabetes Mellitus on Intravascular Ultrasound‐Guided Provisional Stenting in Coronary Bifurcation Lesions J‐REVERSE Sub‐Study

Abstract: Despite IVUS optimization for coronary bifurcation, DM is potentially associated with smaller luminal gain, higher late-loss, and inhomogeneous vascular healing with frequent thrombus attachment in the proximal MV.

Cited by 5 publications

References 23 publications

Os riscos perioperatórios de pacientes com Diabetes Mellitus submetidos à cirurgia cardíaca: uma revisão integrativa

Os riscos perioperatórios de pacientes com Diabetes Mellitus submetidos à cirurgia cardíaca: uma revisão integrativa

Use of Bioresorbable Vascular Scaffold technology in treating coronary bifurcation lesions: A report about long-term clinical results and review of available literature

Percutaneous coronary intervention in bifurcation lesions: independent predictors of in-hospital death

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