Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects With Stable Ischemic Heart Disease

Bangalore, Sripal; Pursnani, Seema; Kumar, Sunil; Bagos, Pantelis G.

doi:10.1161/circulationaha.112.131961

Cited by 88 publications

(48 citation statements)

References 53 publications

(46 reference statements)

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“…However, all coronary revascularizations in SATURN were adjudicated by a centralized clinical events committee. Despite the inherent risk attributable to coronary revascularization per se, 38 revascularization improves the morbidity and mortality of these patients. 3 The 2.3% absolute difference in event-free survival at 24 months might have become more pronounced, had a greater number of patients been studied, and followed up for a longer duration.…”

Section: Discussionmentioning

confidence: 99%

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Puri

Nissen

Shao

et al. 2014

ATVB

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Objectives— Patients with acute coronary syndromes (ACS) display diffuse coronary atheroma instability and heightened risk of early and late recurrent coronary events. We compared the long-term antiatherosclerotic efficacy of high-intensity statins in patients with ACS when compared with stable disease. Approach and Results— Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The overall effect of high-intensity statins on the change in coronary percent atheroma volume and major adverse cardiovascular events (death/nonfatal myocardial infarction/coronary revascularization) were evaluated in this post hoc analysis. When compared with non-ACS patients (n=678), patients with ACS (n=361) were younger, actively smoking, and have had a previous myocardial infarction (all P <0.001). At baseline, patients with ACS exhibited lower high-density lipoprotein cholesterol (43.5±11 versus 45.8±11 mg/dL; P =0.002), a higher apolipoprotein B: apolipoprotein A-1 ratio (0.90±0.24 versus 0.83±0.24; P <0.001) and greater percent atheroma volume (37.3±8.5% versus 35.9±8.1%; P =0.01) when compared with non-ACS patients. Despite similar achieved levels of lipid and inflammatory markers after high-intensity statin therapy, patients with ACS demonstrated greater percent atheroma volume regression than non-ACS patients (−1.46±0.14 versus −0.89±0.13; P =0.003). After propensity-weighted multivariable adjustment, baseline percent atheroma volume ( P <0.001) and an ACS clinical presentation ( P =0.02) independently associated with plaque regression. The 24-month major adverse cardiovascular events–free survival was similar between patients with ACS and non-ACS (90.6 versus 92.9%; P =0.25). Conclusions— Long-term high-intensity statin therapy caused greater plaque regression and comparable major adverse cardiovascular events rates in ACS when compared with non-ACS patients. Despite a higher clinical risk profile, patients with ACS harbor a more modifiable disease substrate and seem to benefit the most from potent statin therapy.

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Section: Discussionmentioning

confidence: 99%

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Puri

Nissen

Shao

et al. 2014

ATVB

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“…This is in marked contrast to the prognostic significance of spontaneous MI, especially when stratified by infarct size. 15,[35][36][37][38] In general, spontaneous MIs are associated with greater degrees of myonecrosis when compared with PMI. This may explain the more profound prognostic implications of spontaneous MIs.…”

Section: Death (%)mentioning

confidence: 99%

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Herrmann

Lennon

Jaffe³

et al. 2014

Circ: Cardiovascular Interventions

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Background-There is controversy about the diagnostic and prognostic significance of percutaneous coronary interventionrelated myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold. Methods and Results-We evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08-1.43; P=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05-1.60; P=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59-12.9; P<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27-14.6; P=0.002). The cumulative mortality rate was 0.6% at 91 days. Conclusions-A significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB. (Circ Cardiovasc Interv. 2014;7:533-542.)

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“…18 On the other hand, two additional meta-analyses comprising 7,200 and 8,000 patients found no difference in mortality in patients treated with PCI compared to optimal medical therapy. 19,20 The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME 2) trial examined patients with stable CAD for whom PCI was being considered. Approximately 1,200 patients underwent invasive coronary angiography with measurement of fractional flow reserve (FFR) in all coronary stenosis.…”

Section: Evaluation Of Patients With Stable Cadmentioning

confidence: 99%

Diagnostic usefulness of myocardial perfusion imaging in patients reluctant to undergo angiography

Narang¹,

Singh²,

Patel³

2016

RRCC

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Abstract:Patients with known or suspected coronary artery disease are often referred for ischemic testing to aid in risk assessment and guide management when symptoms develop. Invasive coronary angiography and percutaneous intervention are typically reserved for patients with symptoms refractory to medical management. The use of noninvasive modalities with myocardial perfusion imaging is a powerful diagnostic and prognostic tool for patients reluctant to undergo angiography. This review focuses on evaluation of coronary artery disease with myocardial perfusion imaging using single-photon emission computerized tomography, positron emission tomography, myocardial contrast echocardiography, cardiovascular magnetic resonance, and cardiovascular computerized tomography.

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Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects With Stable Ischemic Heart Disease

Abstract: Background-Contemporary

Cited by 88 publications

References 53 publications

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Diagnostic usefulness of myocardial perfusion imaging in patients reluctant to undergo angiography

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