The Incidence and Possible Predictors of Coronary Restenosis

Filatova, Alina; Romasov, I V; Потехина, А В; Osokina, A.K.; Ноева, Е А; Arefieva, T. I.; Барабанова, Е. А.; Меркулов, Е. В.; Samko, A N; Проваторов, С И

doi:10.18087/cardio.2020.2.n621

Cited by 3 publications

(3 citation statements)

References 36 publications

(40 reference statements)

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“…20 Moreover, hs-CRP levels were higher in patients with ISR and values 2 mg/L may serve as a useful predictor of ISR. 21 In the past years, hs-CRP emerged as a certified biomarker for the measurement of the inflammatory risk, both in primary and secondary prevention. 22 Targeting different inflammatory pathways may represent promising new therapeutic approaches for the atherosclerotic disease.…”

Section: Myocardial Infarction: Beyond Thrombosismentioning

confidence: 99%

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Colchicine Use in Acute Coronary Syndromes: An Update

Țăpoi¹,

Benchea²,

Siriopol

et al. 2021

Angiology

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Coronary artery disease is the leading cause of death worldwide, and its main pathological substrate is represented by atherosclerosis. Inflammation is a major promoter of the atherosclerotic process and is involved in both the initiation and progression of atherosclerosis, as well as in the occurrence of fatal complications. Until the present moment, Colchicine Cardiovascular Outcomes Trial is the largest trial to demonstrate a major benefit of low-dose colchicine on major adverse cardiac events in patients with recent myocardial infarction (MI), but the mechanisms behind this relation are not completely known. The purpose of this review is to emphasize the possible pathways through which colchicine improves the clinical outcomes in the acute setting of acute coronary syndromes by referring to the results of the studies published in the past 5 years. Aside from its stated systemic anti-inflammatory effect, colchicine could be a valuable addition to the therapeutic approach of acute MI by reducing the infarct size, stabilizing the coronary plaque, as well as reducing platelet aggregation. Moreover, colchicine may improve endothelial function, reduce the transcoronary release of cytokines, and prevent a rise in inflammatory markers after percutaneous coronary intervention, thus diminishing the residual inflammatory risk.

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Section: Myocardial Infarction: Beyond Thrombosismentioning

confidence: 99%

“…20 Moreover, hs-CRP levels were higher in patients with ISR and values ≥2 mg/L may serve as a useful predictor of ISR. 21…”

Section: Myocardial Infarction: Beyond Thrombosismentioning

confidence: 99%

Colchicine Use in Acute Coronary Syndromes: An Update

Țăpoi¹,

Benchea²,

Siriopol

et al. 2021

Angiology

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“…In-stent restenosis continues to pose a significant problem even in the age of drug-eluted stents (DES), although compared to bare-metal stents (BMS), DES proved to reduce restenosis and postpone later revascularization by a total percent of 50%–70% ( 3 ). The incidence rate of ISR in the case of DES, although lower than BMS remains as high as 10% ( 6 ). For this reason, ISR has been thoroughly studied throughout the years, in order to find out the best approach to prevent and treat restenosis.…”

Section: Introductionmentioning

confidence: 99%

In-stent restenosis in acute coronary syndrome—a classic and a machine learning approach

Scafa-Udriște,

Itu,

Puiu

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn acute coronary syndrome (ACS), a number of previous studies tried to identify the risk factors that are most likely to influence the rate of in-stent restenosis (ISR), but the contribution of these factors to ISR is not clearly defined. Thus, the need for a better way of identifying the independent predictors of ISR, which comes in the form of Machine Learning (ML).ObjectivesThe aim of this study is to evaluate the relationship between ISR and risk factors associated with ACS and to develop and validate a nomogram to predict the probability of ISR through the use of ML in patients undergoing percutaneous coronary intervention (PCI).MethodsConsecutive patients presenting with ACS who were successfully treated with PCI and who had an angiographic follow-up after at least 3 months were included in the study. ISR risk factors considered into the study were demographic, clinical and peri-procedural angiographic lesion risk factors. We explored four ML techniques (Random Forest (RF), support vector machines (SVM), simple linear logistic regression (LLR) and deep neural network (DNN)) to predict the risk of ISR. Overall, 21 features were selected as input variables for the ML algorithms, including continuous, categorical and binary variables.ResultsThe total cohort of subjects included 340 subjects, in which the incidence of ISR observed was 17.68% (n = 87). The most performant model in terms of ISR prediction out of the four explored was RF, with an area under the receiver operating characteristic (ROC) curve of 0.726. Across the predictors herein considered, only three predictors were statistically significant, precisely, the number of affected arteries (≥2), stent generation and diameter.ConclusionML models applied in patients after PCI can contribute to a better differentiation of the future risk of ISR.

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Hybrid revascularization of the heart and brain: which carotid endarterectomy is preferable?

Казанцев

Виноградов

Artyukhov

et al. 2021

Annals of Clinical and Experimental Neurology

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The aim of this study was to analyse the inpatient and long-term results of hybrid surgery, incorporating percutaneous coronary intervention (PCI) and different types of carotid endarterectomy (CEA). Materials and methods. A prospective, open-label cohort comparison study was conducted in 20182020 and included 363 patients with atherosclerosis of both the internal carotid artery (ICA) and coronary artery, who underwent hybrid revascularization of the brain and myocardium. All patients were divided into four groups based on the revascularization strategy: group 1 (n = 107; 29.5%) PCI + eversion CEA; group 2 (n = 98; 27%) PCI + classic CEA with patch angioplasty; group 3 (n = 72; 19.8%) PCI + glomus-sparing CEA according to R.A. Vinogradov; and group 4 (n = 86; 23.7%) PCI + glomus-sparing CEA according to A.N. Kazantsev. The follow-up period was 20.8 8.0 months. The patient received a loading dose of clopidogrel (300 mg) before the PCI, and the procedure was then performed in an endovascular operating room. A radial artery catheter was inserted, and the patient received 10,000 IU of intravenous heparin before the procedure. After the PCI, the patient was taken to the vascular operating room, where they underwent the CEA. The patient received 5,000 IU of intravenous heparin before artery clamping. Glomus-sparing CEA according to A.N. Kazantsev was performed as follows: an arteriotomy was conducted along the internal edge of the external carotid artery (ECA), adjacent to the carotid sinus and 23 cm above the ostium, and extending to the common carotid artery (CCA) (also 23 cm below the ECA ostium), depending on the size of the atherosclerotic plaque. The ICA was transected in the area bound by the ECA and CCA walls. Eversion CEA of the ICA was performed, followed by open CEA of the ECA and CCA. The ICA was implanted in its previous position in the preserved area. Results. No mortality was recorded during the inpatient follow-up period. All cases of myocardial infarction occurred after eversion and classic CEA: 3 in group 1 (2.8%) and 1 in group 2 (1.02%); р = 0.2. No ischaemic stroke was recorded only in patients who underwent CAE according to A.N. Kazantsev (р = 0.66); however, ischaemic stroke occurred in two patients in group 1 (1.8%), in two patients in group 2 (2.04%) and in one patient in group 3 (1.38%). The highest number of cardiovascular events occurred in group 1, due to carotid glomus injury, which led to poorly controlled hypertension during the inpatient stay. This tendency influenced the composite endpoints (death + myocardial infarction + ischaemic stroke), which were highest in group 1 (5 or 4.6%) compared to 3 (3.06%), 1 (1.38%) and 0 in groups 24, respectively (р = 0.18). The groups were comparable in the frequency of long-term complications. However, the incidence of ICA restenosis was lowest and no ECA thrombosis/occlusion was observed after glomus-sparing CEA according to R.A. Vinogradov and A.N. Kazantsev. Conclusion. A hybrid PCI + CEA for brain revascularization should be glomus-sparing. CEA according to A.N. Kazantsev was characterized by lack of procedural arteriotomy complications. This procedure enables blood pressure monitoring in the postoperative period, thus minimizing the risk of cardiovascular complications.

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The Incidence and Possible Predictors of Coronary Restenosis

Cited by 3 publications

References 36 publications

Colchicine Use in Acute Coronary Syndromes: An Update

Colchicine Use in Acute Coronary Syndromes: An Update

In-stent restenosis in acute coronary syndrome—a classic and a machine learning approach

Hybrid revascularization of the heart and brain: which carotid endarterectomy is preferable?

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