Recurrent angina after coronary angioplasty: mechanisms, diagnostic and therapeutic options

Izzo, Paolo; Gaglione, Antonio; Brunetti, Natale Daniele

doi:10.1177/2048872612449111

Cited by 41 publications

(30 citation statements)

References 124 publications

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“…In many patients with ischemic heart disease, microvascular dysfunction is increasingly becoming recognized as an important mechanism of angina, in addition to the more classic obstructive atherosclerosis mechanism [34]. Microvascular dysfunction is particularly prominent in patients with recurrent angina after PCI [35]. By improving endothelial function, ivabradine may contribute to maintaining coronary dilation, hence preventing microvascular dysfunction and the recurrence of angina attacks after coronary intervention.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Werdan

Perings²,

Köster³

et al. 2016

Cardiology

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Objectives: The efficacy of ivabradine has been demonstrated in different subpopulations of stable angina patients in randomized clinical trials. This study explored its effectiveness in subpopulations seen in clinical practice as they often differ from those of randomized trials. Methods: Data were pooled from three German observational studies with similar inclusion criteria (stable angina and heart rate ≥60 bpm). All patients received 2.5, 5, or 7.5 mg b.i.d. of ivabradine for 4 months, with or without concomitant beta-blocker. Antianginal effectiveness was analyzed in subpopulations defined by gender, age, heart rate, angina severity, use of concomitant beta-blocker, previous percutaneous coronary intervention procedure, and comorbidities (including previous myocardial infarction and diabetes). Results: Treatment data were available on 8,555 patients, where therapy with ivabradine was associated with a significant reduction in the frequency of angina attacks and consumption of short-acting nitrates of 87%. Effectiveness was maintained in all investigated subpopulations, with a reduction in antianginal parameters of 82-90%. Clinical status (Canadian Cardiovascular Society class) and quality of life were also improved. Ivabradine was well tolerated in all subgroups. Conclusions: Ivabradine is effective and safe in all subpopulations of angina patients seen in clinical practice, independent of age, comorbidities, and use of beta-blocker.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Werdan

Perings²,

Köster³

et al. 2016

Cardiology

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“…In Puymirat et al [13] LCX and LAD are the most common vessels involved. In the present study out of 4181 patients ,9366 lesions were stented with BMS , stainless steel BMS was used in [15,16] In the present study 17 (0.88%) patients had repeat STEMI,11(0.56%) patients had repeat NSTEMI. In Puymirat et al [13] study, 8% patients had non-fatal MI after coronary revascularization.…”

Section: Discussionmentioning

confidence: 99%

Role of BMS in Des ERA

Rao²

2016

Ind J Car Dis Wom

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BACKGROUND: DES has gained significant importance in coronary interventions due to its superiority of decrease in target vessel revascularization when compared to BMS. In this DES era , we want to study the role of BMS as it is more economical . MATERIAL AND METHODS: We have analyzed acute coronary syndrome (ACS) and chronic stable angina patients who underwent BMS implantation between January 2011 to March 2011 under government health scheme of Andhra Pradesh. RESULTS: We retrospectively analyzed the cardiac events in 4181 BMS implanted patients. 1938 (46.4%) patients were followed for 365 days. More men than women with 40 to 69 years were there. ST elevation MI was the common presenting symptom in 1902patients(45.49% ). 1881 patients (44.98%) were diabetic. Single vessel disease was more common 2522(60.32%) ,Multivessel disease was seen in 210 patients (5.02%).LAD being the common vessel involved followed by RCA. Primary PCI was done in 320 patients(7.65%). Out of 4181 patients , 9366 lesions were stented with BMS , stainless steel BMS was used in 4988(53.26%) and cobalt chromium BMS was used in 4378 (46.74%) patients. Out of 4181 patients ,1938 patients (46.4%) were followed up of 1yr, post PCI 686 (35.4%) patients had worsening angina, 226(11.66%) patients had worsening heart failure, 17 (0.88%)patients had repeat STEMI, 11(0.56%)patients had repeat NSTEMI, 16(0.82%) patients had subacute stent thrombosis, 27(1.39%) patients developed late stent thrombosis, 51 patients (2.63%)underwent repeat target vessel revascularization(TVR). 52 (2.68%)patients died due to cardiac cause with in one year of follow up . CONCLUSIONS: Our study show that even in present era of DES , BMS implantation is effective and associated with less mortality and less stent thrombosis and less chances of target vessel revascularization with the limitations (as it was telephonic follow up).

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“…Restenosis can be asymptomatic posing athreat to timely interventionor can be symptomatic with a long list of noncardiac etiology to exclude (2)(3)(4). In both the cases GSMPI is recommended as a tool for detection (5,6) by virtue of its higher accuracy in comparison to exercise electrocardiogram (7,8). GSMPI has been an associate to management of ischemic heart disease (IHD) in Bangladesh for past 20 years (9).…”

Section: Introductionmentioning

confidence: 99%

Role of Gated SPECT MPI in Follow-up of Patients afterCoronary Revascularization

Sarker¹,

Nasreen²,

Nisa³

et al. 2019

Bangladesh J. Nuclear Med.

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Objective: Gated SPECT myocardial perfusion imaging (GSMPI) is a preferred modality for non invasive assessment following coronary revascularization (CR) of both symptomatic and asymptomatic patients. This study was conducted to observe the impact of GSMPI results on further management of patients who after CR had underwent GSMPI at National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Patients and methods: Record files of GSMPI of all patients who underwent GSMPI over a period of 31 months from June 2011 to December 2013 at NINMAS for assessment of perfusion after CR were selected from the Nuclear Cardiology Divisional archive of patient studies in order to retrieve their clinical and demographic data including the contact numbers. The results of GSMPI scan were categorized as normal scan (NS) and perfusion defect (PD) which included reversible and/or fixed PD. All the contact numbers were called up by a nuclear medicine physician who conducted a semi-structured telephonic interview either with the patients or with a concerned family member. Management strategies adopted after GSMPI were categorized as conservative (CM) and interventional (IM).Cramer’s V (φc) test were done to find strength of relation among patients’ symptoms, scan findings and management strategies. Results: Follow up data of 55 patients (54M, 1F) among 68 (66M, 2F) were available who underwent MPI for the purpose of post CR assessment. MPI was performed in between six months to 13 years after CR (mean 43.8 ± 48.2 months). Categorically 33 patients had percutaneous transluminal coronary angioplasty (PTCA) with stent, 16 patients had coronary artery by-pass grafting (CABG) and 6 patients had both CABG & PTCA. There were 38PD (27symptomatic) and 17NS(12 symptomatic).Since all patients (n=12) who had fixed PD were symptomatic, a strong relation was found between being symptomatic and fixed perfusion defect (φc> 0.3). Symptoms were found to be weakly related with reversible PD i.e. ischemia (φc< 0.2). Management strategies were conservative in 44 (30 symptomatic and 28 PD) and interventional in 11 (nine symptomatic and 10 PD). Management strategies were found to be weakly related with symptoms (φc< 0.2) but moderately related with perfusion status (φc = 0.24). Conclusions: While symptoms were observed to be poorly related with perfusion status following CR, GSMPI guided to choose further interventional management strategies with rationality in lower proportion of patients. Bangladesh J. Nuclear Med. 22(1): 30-35, Jan 2019

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Recurrent angina after coronary angioplasty: mechanisms, diagnostic and therapeutic options

Cited by 41 publications

References 124 publications

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Role of BMS in Des ERA

Role of Gated SPECT MPI in Follow-up of Patients afterCoronary Revascularization

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