Effect and Clinical Outcomes of Vaccination in COVID-19-positive Patients with Previous Coronary Revascularization

Relation of Previous Coronary Artery Bypass Grafting and/or Percutaneous Coronary Intervention to Perioperative Cardiovascular Outcomes in Patients Who Underwent Noncardiac Surgery

Background: Coronary heart disease the leading cause of mortality worldwide and regular physical activity is a comprehensive management strategy for these patients. We investigated the parameters that influence regular physical activity in patients with a history of coronary revascularization. Methods: We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. A questionnaire was filled out with each patient to collect the data of engagement in regular physical activity, demographics, clinical characteristics, and dietary adherence. Results: We enrolled 202 consecutive outpatients (age 61.3±11.2 years, 73% males). The median duration after revascularization was 60 months. One hundred and 4 (51%) patients had previous percutaneous coronary intervention, 67 (33%) patients had coronary by-pass graft surgery, and 31 (15%) patients had both of the revascularization procedures. Of all, 46 (23%) patients were engaging in regular physical activity with a median of 2 days per week. Patients were classified into two subgroups according to their physical activity habits. There was no significant difference in age, comorbid conditions or revascularization type between subgroups. In the univariate regression analysis, absence of regular physical activity was associated with female gender, low education level, unemployment, low household income, implantation of bare metal stent (vs. drug eluted stent) and absence of regular follow-up visits. Stepwise multivariate regression analysis concluded that low education level (p=0.01, OR=3.26, 95%CI: 1.31 -8.11), and absence of regular follow-up visits (p=0.04, OR=2.95, 95%CI: 1.01-8.61) were independent predictors of non-adherence of regular physical activity in study subjects. Conclusion: Regular physical activity rates were lower in outpatients with a history of previous coronary revascularization. Education level and regular follow-up visits could influence physical activity adherence in these patients.

Coronary revascularization and adverse events in joint arthroplasty

Parameters influencing the physical activity of patients with a history of coronary revascularization

Parameters influencing the physical activity of patients with a history of coronary revascularization

Evaluation of Mediterranean diet adherence in patients with a history of coronary revascularization

Evaluación de la adherencia a la dieta mediterránea en pacientes con antecedentes de revascularización coronaria

Objective:Although safety concerns still remain among patients undergoing unanticipated noncardiac surgery after prior percutaneous coronary intervention (PCI), it has not been directly compared with coronary artery bypass grafting (CABG). The objective of this study was to compare clinical outcomes after noncardiac surgery in patients with prior (>6 months) coronary revascularization by PCI or CABG.Methods:From February 2010 to December 2015, 413 patients with a history of coronary revascularization, scheduled for noncardiac surgery were identified. Patients were divided into PCI group and CABG group and postoperative clinical outcome was compared between 2 groups. The primary outcome was composite of all-cause death, myocardial infarction, and stroke in 1-year follow-up.Results:The 413 patients were divided according to prior coronary revascularization types: 236 (57.1%) into PCI and 177 (42.9%) into CABG group. In multivariate analysis within 1-year follow-up, there was no significant difference in clinical outcome which was composite of all-cause death, myocardial infarction, and stroke (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 0.76-2.93; P = .24). The same result was present in propensity-matched population analysis (HR: 1.43; 95% CI: 0.68-3.0; P = .34).Conclusions:In patients undergoing noncardiac surgery with prior coronary revascularization by PCI or CABG performed on an average of 42 months after PCI and 50 months after CABG, postoperative clinical outcome at 1-year follow-up is comparable.

> The essence of strategy is choosing what not to do. > > —Michael Porter, Harvard Economist Clinicians must evaluate on a daily basis patients with symptoms of possible coronary artery disease (CAD). Decades of progress in various technologies used for cardiovascular imaging have produced a wide array of choices, and consequently selecting the best test for a given patient has become increasingly complex. Anatomic techniques to evaluate for CAD include invasive coronary angiography (ICA) or coronary computed tomographic angiography (CTA). However, functional approaches evaluate the myocardial response to exercise or pharmacological stress, often together with imaging. When considering the available functional imaging tests, stress echocardiography and nuclear myocardial perfusion imaging are commonly available and well-established techniques. However, there are now emerging data that stress cardiac magnetic resonance imaging (CMR) may offer comparable, or in some cases superior, diagnostic accuracy.1 More recently, the CE-MARC 2 trial (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2) suggested that CMR and nuclear myocardial perfusion imaging may decrease the rate of unnecessary ICA (defined as invasive angiography that results in nonobstructive or nonflow limiting disease) when compared with clinical evaluation using the NICE guideline (National Institute for Health and Care Excellence).2 Importantly, among patients randomized to the NICE guideline group, ≈35% underwent immediate ICA as directed by the guidelines. CE-MARC 2 also demonstrated a strategy of CMR was safe, as the event rate observed in this trial was extremely low and did not differ between the groups compared. These findings, together with others,3,4 suggest that in stable patients who do not have prior known CAD, noninvasive testing should be performed before invasive angiography. See Article by Pontone et al Aside from increasing the yield of detecting obstructive CAD on invasive angiography, there are many other important ways in which …

Coexistence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) raises questions regarding the safety and efficacy of TAVI in this subset of patients. To evaluate the impact of previous coronary revascularization in terms of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on clinical outcomes after TAVI. A total of 507 consecutive patients who underwent TAVI were divided into: non-revascularization (NR), post-PCI and post-CABG groups. The endpoints were established according to VARC-2 definitions. Patients with previous coronary revascularization (36.7% of the population) were younger, more often male and their EuroSCORE II risk evaluation was significantly higher (NR 7.9% vs. post-PCI 8.0% vs. post-CABG 20.5%, p < 0.0001). Patients after PCI or CABG prior to TAVI had similar 30-day all-cause mortality rates as those without coronary revascularization at baseline (NR vs. post-PCI vs. post-CABG: 8.1% vs. 5.5% vs. 6.8%, respectively; p = 0.6). There were no differences in 12-month all-cause mortality rates between groups (NR vs. post-PCI vs. post-CABG: 15.3% vs. 14.2% vs. 16.9%, respectively; log-rank p = 0.67). In the Cox proportional-hazards regression model, acute kidney injury stage 2-3 (HR = 3.7, 95% CI: 2.14-6.33; p < 0.001) and post-TAVI stroke (HR = 3.5, 95% CI: 1.57-7.8; p = 0.002) were independently correlated with 1-year mortality. TAVI seems to be a safe and effective procedure for the treatment of severe AS in patients with previous coronary revascularization.

Nonutilization of Statins in a Community-based Population with a History of Coronary Revascularization

Risk factors contributing to 30-day and 1-year mortality event scores following major lower extremity amputation for limb ischemia.

Routine preoperative resting echocardiography does not predict adverse cardiopulmonary events after bariatric surgery.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels prior to transcatheter aortic valve implantation (TAVI) are known to be associated with outcomes of patients undergoing TAVI. However, little has been known about the NT-proBNP response after TAVI. Therefore, we aimed to clarify the role of the NT-proBNP response and identify the determinants of the NT-proBNP nonresponse among patients with severe aortic stenosis (AS) and heart failure (HF) undergoing TAVI. We examined 717 patients with severe AS and HF undergoing TAVI. NT-proBNP nonresponders were defined as patients whose NT-proBNP levels decreased by ≤30%. Mean NT-proBNP levels decreased from 7698 ± 7853pg/mL (baseline) to 4523± 5173pg/mL (post-TAVI); 269 patients (38%) were nonresponders. Female gender and prevalence of diabetes mellitus (DM), chronic kidney disease (CKD), atrial fibrillation (AF), and history of coronary artery revascularization were more common for NT-proBNP nonresponders. Permanent pacemaker implantation rate was higher for NT-proBNP nonresponders. In addition to the baseline NT-proBNP level>7500pg/smL (hazard ratio [HR], 1.8; p = 0.03), NT-proBNP nonresponse (HR 2.3; p = 0.001) was associated with lower survival rates. Baseline NT-proBNP level≤7500pg/mL (OR 3.2; p < 0.001), female gender (odds ratio [OR], 1.5; p = 0.049), DM (OR 1.6; p = 0.016), CKD (OR 1.8; p = 0.001), AF (OR 2.4; p < 0.001), history of coronary revascularization (OR 1.7; p = 0.003), and permanent pacemaker implantation after TAVI (OR 1.7; p = 0.034) were independent determinants of NT-proBNP nonresponse. In "conclusion", NT-proBNP response is important for long-term survival after TAVI. We should consider the aforementioned determinants, particularly permanent pacemaker implantation, as risk factors for NT-proBNP nonresponse.

Background: Empagliflozin and dapagliflozin are the most widely prescribed sodium–glucose cotransporter-2 inhibitors (SGLT2i) with established cardioprotective benefits across the spectrum of heart failure (HF). However, direct comparative data remain limited, particularly in patients with a history of coronary revascularization—a population at persistently high cardiovascular (CV) risk. This study aimed to compare the long-term cardiovascular outcomes of empagliflozin versus dapagliflozin in revascularized HF patients who had undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: This retrospective cohort study included 631 HF patients who had undergone coronary revascularization (CABG or PCI) and were treated with an SGLT2 inhibitor (353 dapagliflozin, 278 empagliflozin) between 2014 and 2022 at a tertiary cardiovascular center. Patients were stratified by left ventricular ejection fraction (LVEF ≥ 50%: HFpEF; LVEF < 50%: HFrEF/HFmrEF). The primary outcomes were all-cause mortality, cardiac mortality, major adverse cardiovascular events (MACE), cardiac MACE, and HF-related hospitalization. Cox regression analyses—including time-dependent covariates—were performed to identify independent predictors of cardiac MACE. Results: Baseline demographic, clinical, and biochemical characteristics were comparable between groups. During a mean follow-up of 19.6 ± 1.5 months, there were no significant differences between dapagliflozin and empagliflozin in all-cause mortality (19.3% vs. 19.8%), cardiac mortality (11.0% vs. 12.2%), MACE (25.8% vs. 26.3%), cardiac MACE (23.8% vs. 21.9%), or hospitalization (23.8% vs. 23.7%) (all p > 0.05). Subgroup analyses by LVEF yielded consistent findings. In time-adjusted Cox modeling, age (HR = 2.089; 95% CI: 1.723–2.533; p < 0.001) and atrial fibrillation (AF) (log-rank p = 0.030) were identified as significant predictors of cardiac MACE, while creatinine and NT-proBNP lost significance after adjustment. Both age and AF showed time-varying hazard effects, with risk attenuation over time. Conclusions: In this real-world cohort of revascularized HF patients, empagliflozin and dapagliflozin demonstrated comparable long-term cardiovascular outcomes, supporting a class effect of SGLT2 inhibitors in this high-risk population. Beyond pharmacologic comparison, age and AF emerged as dynamic predictors of cardiac MACE, highlighting the importance of longitudinal, time-dependent risk assessment in heart failure management following coronary revascularization.