Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis

Gaffar, Rouan; Habib, Bettina; Filion, Kristian B.; Reynier, Pascal; Eisenberg, Mark J.

doi:10.1161/jaha.116.005381

Cited by 30 publications

(26 citation statements)

References 42 publications

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“…Both females and males, had better outcomes in terms of mortality, MACE and overall complications when complete revascularization was performed. [21][22][23][24] In addition, 90-day follow-up data from the PROTECT II trial showed a significant decrease in major adverse 30-day survival rates Secondary outcomes such as major adverse cardiac events, dialysis requirement, bleeding within 72 hr, blood transfusion, dysrhythmia were similar in both cohorts. 25 Complete revascularization is often achieved with CABG surgery and has been shown to be associated with long-term mortality benefits.…”

Section: Discussionmentioning

confidence: 99%

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Alraies

Kaki

Kajy

et al. 2019

Cathet Cardio Intervent

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Objective To assess the in‐hospital and short‐term outcome differences between males and females who underwent high‐risk PCI with mechanical circulatory support (MCS). Background Sex differences have been noted in several percutaneous coronary intervention (PCI) series with females less likely to be referred for PCI due increased risk of adverse events. However, data on sex differences in utilization and outcomes of high‐risk PCI with MCS is scarce. Methods Using the cVAD Registry, we identified 1,053 high‐risk patients who underwent PCI with MCS using Impella 2.5 or Impella CP. Patients with cardiogenic shock were excluded. A total of 792 (75.21%) males and 261 (24.79%) females were included in the analysis with median follow‐up of 81.5 days. Results Females were more likely to be African American, older (72.05 ± 11.66 vs. 68.87 ± 11.17, p < .001), have a higher prevalence of diabetes (59.30 vs. 49.04%, p = .005), renal insufficiency (35.41 vs. 27.39%, p = .018), and peripheral vascular disease (31.89 vs. 25.39%, p of .05). Women had a higher mean STS score (8.21 ± 8.21 vs. 5.04 ± 5.97, p < .001) and lower cardiac output on presentation (3.64 ± 1.30 vs. 4.63 ± 1.49, p < .001). Although women had more comorbidities, there was no difference in in‐hospital mortality, stroke, MI or need for recurrent revascularization compared to males. Females were more likely to have multivessel revascularization than males. Ejection fraction improved in both males and females at the time of discharge (26.59 to 31.40% and 30.75 to 36.05%, respectively, p < .0001). However, females had higher rate of bleeding requiring transfusion compared with males (9.58 vs. 5.30%, p = .019). Conclusion Female patients undergoing high PCI were older and had more comorbidities but had similar outcomes compared to males.

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Section: Discussionmentioning

confidence: 99%

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Alraies

Kaki

Kajy

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Early percutaneous coronary intervention (PCI) can restore blood flow to ischemic myocardium, decrease infarct size, and reduce mortality and complications [1], but about 10-30% of patients exhibit no-reflow or slowreflow phenomena after PCI, which seriously affects prognosis [2]. The main cause of no-reflow or slow-reflow after PCI is coronary microembolism (CME) [3], resulting in myocardial cell necrosis and apoptosis, ventricular remodeling, malignant arrhythmia, and cardiac failure [4].…”

Section: Introductionmentioning

confidence: 99%

Granulocyte colony-stimulating factor attenuates myocardial remodeling and ventricular arrhythmia susceptibility via the JAK2-STAT3 pathway in a rabbit model of coronary microembolization

Wang

Zhang

et al. 2020

BMC Cardiovasc Disord

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Background: Coronary microembolization (CME) has a poor prognosis, with ventricular arrhythmia being the most serious consequence. Understanding the underlying mechanisms could improve its management. We investigated the effects of granulocyte colony-stimulating factor (G-CSF) on connexin-43 (Cx43) expression and ventricular arrhythmia susceptibility after CME. Methods: Forty male rabbits were randomized into four groups (n = 10 each): Sham, CME, G-CSF, and AG490 (a JAK2 selective inhibitor). Rabbits in the CME, G-CSF, and AG490 groups underwent left anterior descending (LAD) artery catheterization and CME. Animals in the G-CSF and AG490 groups received intraperitoneal injection of G-CSF and G-CSF + AG490, respectively. The ventricular structure was assessed by echocardiography. Ventricular electrical properties were analyzed using cardiac electrophysiology. The myocardial interstitial collagen content and morphologic characteristics were evaluated using Masson and hematoxylin-eosin staining, respectively. Results: Western blot and immunohistochemistry were employed to analyze the expressions of Cx43, G-CSF receptor (G-CSFR), JAK2, and STAT3. The ventricular effective refractory period (VERP), VERP dispersion, and inducibility and lethality of ventricular tachycardia/fibrillation were lower in the G-CSF than in the CME group (P < 0.01), indicating less severe myocardial damage and arrhythmias. The G-CSF group showed higher phosphorylated-Cx43 expression (P < 0.01 vs. CME). Those G-CSF-induced changes were reversed by A490, indicating the involvement of JAK2. G-CSFR, phosphorylated-JAK2, and phosphorylated-STAT3 protein levels were higher in the G-CSF group than in the AG490 (P < 0.01) and Sham (P < 0.05) groups. Conclusion: G-CSF might attenuate myocardial remodeling via JAK2-STAT3 signaling and thereby reduce ventricular arrhythmia susceptibility after CME.

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“…ACS including unstable angina pectoris(UA),non-ST-elevated myocardial infarction(NSTEMI)and ST-elevated myocardial infarction(-STEMI) is associated with substantial morbidity and mortality rate [1,2], and thus becomes the foucs of treatment. Coronary revascularization is an effective treatment for acute coronary syndrome [3,4] including percutancous coronary intervention (PCI), coronary artery bypass grafting (CABG) and hybrid coronary revascularization (HCR). SYNTAX score mainly conducts quantitative analysis according to the anatomical characteristics of coronary artery, such as location, length, stenosis degree, bifurcation, etc., which is a comprehensive assessment method for evaluating the severity of coronary artery lesion [5,6].…”

Section: Introductionmentioning

confidence: 99%

Prognosis evaluation of universal acute coronary syndrome: the interplay between SYNTAX score and ApoB/ApoA1

Wang¹,

Wang²,

Li³

et al. 2020

BMC Cardiovasc Disord

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Background: Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. SYNTAX and SYNTAX II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/ apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNT AX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method: Three hundred ninety-six patients with ACS undergoing percutaneous coronary intervention(PCI)and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results: ① Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium/ high risk group (p = 0.011). Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group (p = 0.032). ② Compared with SYNTAX II low-risk group, cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group (p = 0.001, p<0.001 respectively). ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group (p = 0.019, p = 0.023 respectively). ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group (p = 0.023, p = 0.044 respectively). ⑤ Logistic regression analysis showed that apoB/ apoA1 was an independent predictor of MACCE events in hospital and 5 years (p = 0.038, p = 0.016 respectively), SYNTAX score was an independent predictor of MACCE events in 1 year (medium-risk group: p = 0.02; high-risk group: p = 0.015) SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs (p = 0.003). Conclusions: ① SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

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Optimal Timing of Complete Revascularization in Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis

Cited by 30 publications

References 42 publications

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Sex‐related difference in the use of percutaneous left ventricular assist device in patients undergoing complex high‐risk percutaneous coronary intervention: Insight from the cVAD registry

Granulocyte colony-stimulating factor attenuates myocardial remodeling and ventricular arrhythmia susceptibility via the JAK2-STAT3 pathway in a rabbit model of coronary microembolization

Prognosis evaluation of universal acute coronary syndrome: the interplay between SYNTAX score and ApoB/ApoA1

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