Two-year clinical outcomes in stable angina and acute coronary syndrome after percutaneous coronary intervention of left main coronary artery disease

Hyun, Dae Young; Jeong, Myung Ho; Sim, Doo Sun; Jeong, Yun Ah; Cho, Kyung Hoon; Kim, Min Chul; Kim, Hyun Kuk; Jeong, Hae Chang; Park, Keun Ho; Hong, Young Joon; Kim, Jun Han; Ahn, Youngkeun; Kang, Jung Chaee

doi:10.3904/kjim.2014.373

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…In the present study, ACS was associated with long‐term mortality and more comorbid illnesses, but once these differences were adjusted for, ACS did not independently confer elevated mortality risk. This finding is in line with previous studies 11,12 . Chronic kidney disease stage ≥ 3, high EuroSCORE II, and laser atherectomy use were independents predictors of long‐term mortality, with the latter probably reflecting the complexity of CAD, as the laser is usually reserved for resistant severely calcified and uncrossable lesions and/or calcified resistant instant restenosis 13 …”

Section: Discussionsupporting

confidence: 88%

“…This finding is in line with previous studies. 11,12 Chronic kidney disease stage ≥ 3, high Euro-SCORE II, and laser atherectomy use were independents predictors of long-term mortality, with the latter probably reflecting the complexity of CAD, as the laser is usually reserved for resistant severely calcified and uncrossable lesions and/or calcified resistant instant restenosis. 13 The SYNTAX score is an angiographic tool used to grade the complexity of CAD.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of percutaneous coronary intervention in high‐risk patients turned down for surgical revascularization

Farag

Al‐Atta

Ibrahem

et al. 2022

Cathet Cardio Intervent

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Aims There are limited data on outcomes of PCI in surgical turndown patientsespecially in those presenting with ACS. Methods and Results A retrospective analysis of prospectively collected data of patients who were turned down for CABG and had PCI between 2013 and 2020. All consecutive patients (449), ACS (n = 245) and no‐ACS (n = 204) were included. In‐hospital complications occurred in 28 patients (6.2%). At 30 days, 27 patients (6.0%) died (18 patients in the ACS group [7.3%] vs. 9 patients in the no‐ACS group [4.4%], p = 0.23). Following multivariate analysis, no significant difference in long‐term mortality was observed between the two groups (median follow‐up of 4 [2–6] years, hazard ratio [HR]: 1.08, 95% confidence interval [CI]: 0.75–1.58, p = 0.667). In propensity score‐matched analysis, the adjusted mortality risk was also not different between the groups (HR: 0.74, 95% CI: 0.25–1.26, p = 0.374). Independent predictors of mortality included chronic kidney disease stage ≥ 3 (HR: 1.64, 95% CI: 1.13–2.39, p = 0.009), high European System for Cardiac Operative Risk Evaluation II (HR: 1.02, 95% CI: 1.00–1.05, p = 0.035), and laser atherectomy use (HR: 3.35, 95% CI: 1.32–8.54, p = 0.011). Conclusions PCI in surgical patients turndown patients appears safe. ACSpresentation was associated with more comorbid illnesses; however, afteradjustment, ACS did not independently confer additional risk of mortality.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of percutaneous coronary intervention in high‐risk patients turned down for surgical revascularization

Farag

Al‐Atta

Ibrahem

et al. 2022

Cathet Cardio Intervent

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“…We have found patients with HTA to be at more than 3 times higher risk of suffering from cardiovascular symptoms during the follow-up period after AMI. In the previous studies, somewhat lower hazard risk ratio was found for these patients to experience major adverse cardiovascular events [22,23], but it may rise to 5 times higher risk in patients with unspecified chest pain [24]. Therefore, patients on antihypertensive drugs, such as calcium channel blockers, were associated with worse prognosis, as well.…”

Section: Discussionmentioning

confidence: 93%

One-Year Cardiovascular Outcome in Patients on Clopidogrel Anti-Platelet Therapy After Acute Myocardial Infarction

et al. 2018

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The aim of this study was to determine the risk factors in patients on clopidogrel anti-platelet therapy after acute myocardial infarction, for cardiovascular mortality, re-hospitalization and admission to emergency care unit. We followed 175 patients on dual antiplatelet therapy, with clopidogrel and acetylsalicylic acid, for 1 year after acute myocardial infarction, both STEMI and NSTEMI. Beside demographic and clinical characteristics, genetic ABCB1, CYP2C19 and CYP2C9 profile was analyzed using Cox-regression analysis. End-points used were: mortality, re-hospitalization and emergency care visits, all related to cardiovascular system. During the accrual and follow-up period, 8 patients (4.6%) died, mostly as a direct consequence of an acute myocardial infarction. Re-hospitalization was needed in 27 patients (15.4%), in nine patients (33.3%) with the diagnosis of re-infarction. Thirty-two patients (18.3%) were admitted to emergency care unit due to cardiovascular causes, up to 15 times during the follow-up. NSTEMI was an independent predictor of all three events registered (mortality OR=7.4, p<0.05; re-hospitalization OR=2.8, p<0.05); emergency care visit OR=2.4, p<0.05). Other significant predictors were related to kidney function (urea and creatinine level, creatinine clearance), co-morbidities such as arterial hypertension and decreased left ventricular ejection fraction, as well as clopidogrel dosing regimen. As a conclusion, it may be suggested that one of the most significant predictors of cardiovascular events (mortality, re-hospitalization and emergency care visits) is NSTEMI. Besides, clopidogrel administration according to up-to-date guidelines, with high loading doses and initial doubled maintenance doses, improves 1-year prognosis in patients with AMI.

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“…Management of acute coronary syndrome (ACS) including ST-segment elevation myocardial infarction (STEMI) and non-STEMI, [ 6 ] and also several types of nonsevere multivessel coronary artery diseases (MVCADs), [ 7 ] and unprotected left main coronary artery diseases (ULMCAD) is nowadays possible with PCI. [ 8 ] Even though PCI might be an acceptable choice in most of the patients, certain patients’ conditions and the extent of coronary lesions might restrict its use, thereby shifting its place to coronary artery bypass surgery (CABG). [ 9 ]…”

Section: Introductionmentioning

confidence: 99%

Application of the SYNTAX score in interventional cardiology

et al. 2017

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Background:Should the SYNTAX score be integrated in Interventional Cardiology? Should it really be considered as a vital decision-making tool in percutaneous coronary intervention (PCI)? To confirm the importance of this score, we aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients who were allotted a low versus a high SYNTAX score.Methods:Randomized controlled trials and observational studies which were published from January 2007 to January 2017 were identified from MEDLINE, EMBASE, and the Cochrane databases using the searched terms ‘SYNTAX score and percutaneous coronary intervention.’ Adverse cardiovascular outcomes were considered as the major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the statistical parameters, and the main analysis was carried out by the RevMan 5.3 software.Results:Sixteen studies with a total number of 19,751 participants (8589 participants with a low versus 11,162 participants with a high SYNTAX score) were included. Current results showed mortality to be significantly higher with a higher SYNTAX score (RR 2.09, 95% CI 1.78–2.46, P = .00001). Cardiac death also significantly favored a low SYNTAX score (RR 2.08, 95% CI 1.66–2.61, P = .00001. Similarly, myocardial infarction, major adverse cardiac events, repeated revascularization, and stent thrombosis were significantly higher following a high SYNTAX score (RR 1.71, 95% CI 1.45–2.03, P = .00001; RR 2.03, 95% CI 1.81–2.26, P = .00001; RR 1.96, 95% CI 1.69–2.28, P = .00001; and RR 3.16, 95% CI 2.17–4.59, P = .00001, respectively). Even when patients with ST-segment elevation myocardial infarction were separately analyzed, a low SYNTAX score was still significantly associated with lower adverse outcomes.Conclusions:This analysis is a confirmatory piece of evidence to show that the application of the SYNTAX score in Interventional Cardiology is apparently relevant. The use of this scoring system to grade patients with coronary artery disease and to further guide for revascularization should be encouraged.

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Two-year clinical outcomes in stable angina and acute coronary syndrome after percutaneous coronary intervention of left main coronary artery disease

Cited by 4 publications

References 18 publications

Clinical outcomes of percutaneous coronary intervention in high‐risk patients turned down for surgical revascularization

Clinical outcomes of percutaneous coronary intervention in high‐risk patients turned down for surgical revascularization

One-Year Cardiovascular Outcome in Patients on Clopidogrel Anti-Platelet Therapy After Acute Myocardial Infarction

Application of the SYNTAX score in interventional cardiology

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