Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease

Lee, Ren Jen; Shih, Ko Nien; Lee, Shih Huang; Shyu, Kou Gi; Chiu, Chiung Zuan; Lin, Sheng-Chou; Hung, Huei Fong; Liou, Jer Young; Cheng, Jian; Kuan, Peiliang

doi:10.1007/s00380-006-0948-7

Cited by 13 publications

(3 citation statements)

References 22 publications

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“…Several cohort studies have consistently demonstrated that a low hemoglobin level at admission is a powerful predictor for mortality and morbidity in patients with coronary artery disease [1,2] especially when admitted for an ACS [3][4][5][6]. Hemoglobin levels may also decrease during the hospital stay.…”

Section: Introductionmentioning

confidence: 98%

Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

et al. 2011

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In this work, we analyzed the prognostic significance of changes in hemoglobin during intensive care unit (ICU) stay in patients with acute coronary syndromes (ACS). We prospectively enrolled 591 patients (62 ± 14 years old, 73% male, 48% ST elevated myocardial infarction) free of blood cell transfusion or bleeding events. Changes in hemoglobin between admission and ICU discharge were obtained. The primary endpoint was death or hospitalization for MI within 6 months. Hemoglobin decreased from 13.65 ± 1.77 to 13.17 ± 1.74 g/dl, p < 0.0001 in the whole population. The end point was reached in 43 patients at a mean follow-up of 180 (range 2-180 days). A decrease in hemoglobin ≥0.9 g/dl (32% of the population) was associated with adverse clinical outcomes (HR 2.37, 95% CI (1.30-4.35), p = 0.005, respectively). In multivariate analysis, age >77 year-old (p = 0.0016), Killip class ≥2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline ≥0.9 g/dl (p < 0.0001) were independently associated with outcome. Hemoglobin decline and anemia both provided additional prognostic information on top of the GRACE score, as demonstrated by a systematic improvement in model global fit, discrimination, and calibration. Hemoglobin decline is frequent during ICU stay in non-bleeding ACS patients. A decline in hemoglobin ≥0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.

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Section: Introductionmentioning

confidence: 98%

Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

et al. 2011

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“…28 However, the overall outcomes of DES treatment varied according to the patient's clinical or angiographic profile. 29,30 For patients at high surgical risk in Taiwan, the incidence of mortality and repeat revascularization was 9% and 25%, respectively, over 2 years of follow-up. 30 Recently, the Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization (MAIN-COMPARE) study analyzed data from 2240 patients with unprotected left main coronary artery disease treated at 12 medical centers in Korea.…”

Section: Left Main Coronary Artery Stenosismentioning

confidence: 99%

“…29,30 For patients at high surgical risk in Taiwan, the incidence of mortality and repeat revascularization was 9% and 25%, respectively, over 2 years of follow-up. 30 Recently, the Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization (MAIN-COMPARE) study analyzed data from 2240 patients with unprotected left main coronary artery disease treated at 12 medical centers in Korea. 31 Of these, 318 were treated with BMS, 784 were treated with DES, and 1138 underwent coronary artery bypass graft (CABG) surgery.…”

Section: Left Main Coronary Artery Stenosismentioning

confidence: 99%

Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia

Park

Kim

2008

Circulation

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I n the last 3 decades, there has been a revolutionary change in the treatment of coronary artery disease. Through advances in equipment and technical skills, percutaneous coronary intervention (PCI) is being applied to increasingly more complex patients and lesions. In particular, coronary stenting has emerged as an effective strategy to prevent recurrence after PCI. However, restenosis in the stented segment remained a major issue in coronary stenting. 1 The recent introduction of drug-eluting stents (DES) has dramatically reduced restenosis rates compared with bare metal stent (BMS) use. Large randomized clinical trials have confirmed the benefits of DES over BMS in terms of decreasing the incidence of in-stent restenosis and the need for repeat revascularization. 2-4 As a result, there has been a very rapid worldwide shift in the treatment of coronary stenosis from BMS to DES, including in most Asian countries. However, concern remains over late-occurring stent thrombosis after DES implantation. [5][6][7] The prevalence of coronary artery disease has increased considerably in Asian countries over the past several decades as a result of shifts toward a more "westernized" lifestyle. Accordingly, PCI with stents is a common procedure in Asia, with Ͼ300 000 cases performed each year. 8,9 The present article describes the current status of DES use in Asian countries using both published and unpublished data. A few randomized studies have been performed in Asian countries, allowing the examination of pertinent registries to explore issues relating to DES in Asian countries. However, this review article cannot cover the disparities of patient demographics, practice pattern, and outcomes in all the different Asian countries because of a striking lack of published data. In addition, within the scope of the current review, the majority of data may reflect the performance of advanced centers in which PCI is practiced by experienced operators. Use of DES in AsiaAlthough several types of DES are now available in Asian countries, 3 have been used the most: the sirolimus-eluting (SES; Cypher, Johnson & Johnson Cordis, Miami, Fla), paclitaxel-eluting (PES; Taxus, Boston Scientific, Natick, Mass), and zotarolimus-eluting (Medtronic Vascular, Inc, Santa Rosa, Calif) stents. These 3 DES slowly release potent antiproliferative drugs into the tissue from a nonresorbable polymer matrix completely covering the stent struts. The findings of large randomized clinical trials showing the restenosis reduction efficacy of these stents have led to their use in Asian countries. 2-4,10 These DES typically cost about US $2000 to $3000 compared with about US $700 to $1000 for a BMS. Some other DES were made by homegrown medical companies in China and India with proprietary DES designs.The penetration rate of DES use is diverse across countries, depending on the economic status, patient or physician preference, and availability of medical reimbursement and marketing. In developed countries such as Japan and Korea, DES make up almost 90% of co...

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Influence of diabetes on >10-year outcomes after percutaneous coronary intervention

et al. 2008

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There are few reports showing the relationship between diabetes and the long-term outcome following percutaneous coronary intervention (PCI) in Asians. As well, the association between glycosylated hemoglobin (HbA1c) level and outcome remains controversial. In this analysis, 748 Japanese patients including 298 with diabetes (DM) and 450 without diabetes (non-DM) who underwent PCI from 1984 to 1992 were evaluated over the long term. The mean follow-up was 12.0 +/- 3.6 years. There were 47 (15.8%) total deaths in DM and 41 (9.1%) in non-DM [hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.11-2.65, P = 0.013] and 28 (9.4%) cardiovascular deaths in DM and 19 (4.2%) in non-DM (HR 2.09, 95% CI 1.14-3.81, P = 0.016). Among DM, increased HbA1c was associated with both total (HR 1.25, 95% CI 1.03-1.53, P = 0.024) and cardiovascular (HR 1.30, 95% CI 1.00-1.69, P = 0.048) mortality. Even in Asians, DM showed an increased mortality following PCI. Among DM, increased HbA1c level was also associated with mortality.

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Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease

Cited by 13 publications

References 22 publications

Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia

Influence of diabetes on >10-year outcomes after percutaneous coronary intervention

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