Diffuse Vessel Disease Research Articles

Predictors of bail-out stenting in patients with small vessel disease treated with drug-coated balloon percutaneous coronary intervention.

Drug-coated balloons (DCBs) have showncomparable results with drug-eluting stents in small vessel disease (SVD) percutaneous coronary intervention (PCI) in terms of target vessel revascularization and a reduced incidence of myocardial infarction. However, the relatively high rate of bail-out stenting (BOS) still represents a major drawback of DCB PCI. The aim of the study was to investigate the clinical, anatomic, and procedural features predictive of BOS after DCB PCI in SVD. We included all consecutive patients undergoing PCI at our institution between January 2020 and May 2022 who were treated with DCB PCI of a de novo lesion in a coronary vessel with a reference vessel diameter (RVD) between 2.0and 2.5 mm. Angiographic success was defined as a residual stenosis <30% without flow-limiting dissection. Patients who did not meet these criteria underwent BOS. A total of 168 consecutive patients and 216 coronary stenoses were included. The rate of bail-out stent was 13.9%. On multivariate analysis, DCB/RVD ratio (odds ratio [OR]: 4.39, 95% confidence interval [CI]: 1.71-11.29, p < 0.01), vessel tortuosity (OR: 7.00, 95%CI: 1.66-29.62, p < 0.01), distal vessel disease (OR: 5.66, 95%CI: 2.02-15.83, p < 0.01), and high complexity (Grade C of ACC/AHA classification) coronary stenoses (OR: 6.31, 95%CI: 1.53-26.04, p = 0.01) were independent predictors of BOS. BOS isnot an infrequent occurrence in DCB PCI of small vessels and is correlated with vessel tortuosity, distal diffuse vessel disease, higher lesion complexity, andballoon diameter oversizing.

A Comparative Angiographic Severity of Coronary Artery Disease in Diabetic and Non Diabetics in a Tertiary Cardiac Centre

Introduction: Diabetes is a major risk factor for various cardiovascular diseases including coronary artery disease. Coronary atherosclerosis is not only more prevalent in diabetic patients but is also more severe. Diabetics are more prone to multi vessel involvement as well as associated with poor outcomes to acute coronary events. Methods: This is a hospital based descriptive cross-sectional study including 300 patients (diabetic and non-diabetic) undergoing coronary angiography at Sahid Gangalal National Heart Centre over a period of one year (January to December 2016). Results: Out of the total 300 patients studied at angiography, majority (68.3%, 205 patients) were male with the age group ranging from 29 to 86 years of age. Significant number of diabetics had associated risk factor as hypertension (88%) as the most common. Brahmins and Madhesi (27% each) ethnic group of origin formed the major group studied. Significant coronary artery disease defined as >50 % stenosis was evident in 118 patients (78.7%) among diabetics whereas it was present in 99 patients (66%, p value 0.01, significant). Maximum number of diabetic patients had presence of triple vessel disease ( 52 patients, 34.7 %) followed by double vessel and single vessel disease ( 25.3 % and 18.7 %) respectively as well as more number of diffuse vessel disease (28 % ,p value 0.006 ) . The mean Gensini score studied was 33.07±28.7 with the highest Gensini score of 126. Diabetic group of patients had a higher Gensini scores (37.2 ± 28.4) as compared to non-diabetic (28.9 ± 28.6, p value <0.05). Conclusion: Diabetic patients had higher total Gensini scores at angiogram which reflect greater severity of coronary artery disease as compared to non-diabetics as well as higher incidence of triple vessel disease and diffuse coronary artery disease.

Extent of coronary artery disease is associated with myocardial infarction and mortality in patients with diabetes mellitus.

Purpose: We examined risk of myocardial infarction and all-cause death associated with the extent of coronary artery disease ascertained by coronary angiography in patients with diabetes mellitus. We hypothesized that risks of myocardial infarction and death were associated with extent of coronary artery disease in diabetes patients.Patients and methods: We conducted a cohort study of patients with type 1 and type 2 diabetes, who underwent coronary angiography from 2004 to 2012. Patients were stratified according to extent of coronary artery disease: 0-, 1-, 2- or 3-vessel disease or diffuse vessel disease. Endpoints were myocardial infarction, all-cause death, and major adverse cardiovascular events (MACE), defined as the composite of myocardial infarction, cardiac death, or ischemic stroke. Adjusted incidence and mortality rate ratios (IRRsadj) were calculated using patients with 0-vessel disease as the reference group. Median follow-up was 3 years for a total of 45,164 person-years.Results: The study included 12,594 diabetes patients. Of these, 3,147 (25.0%) had 0-vessel disease, 1,195 (9.5%) had diffuse vessel disease, 3,001 (23.8%) had 1-vessel disease, 2,220 (17.6%) had 2-vessel disease, and 3,031 (24.1%) had 3-vessel disease. The myocardial infarction rate was 0.4 per 100 person-years (95% CI: 0.3–0.5) in patients with 0-vessel disease. Using patients with 0-vessel disease as reference, the risk of myocardial infarction increased according to the number of diseased vessels (diffuse vessel disease: 1.4 per 100 person-years, IRRadj 3.87, 95% CI: 2.41–6.23; 1-vessel disease: 1.9 per 100 person-years, IRRadj 4.99, 95% CI: 3.33–7.46; 2-vessel disease: 2.7 per 100 person-years, IRRadj 7.14, 95% CI: 4.78–10.65; and 3-vessel disease: 4.3 per 100 person-years, IRRadj 11.42, 95% CI: 7.76–16.82; ptrend<0.001). Similar associations were observed for all-cause death and MACE.Conclusion: The extent of coronary artery disease is a major risk factor for myocardial infarction and death in patients with diabetes mellitus.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry.

Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

Coronary artery disease and risk of adverse cardiac events and stroke

Patients with acute myocardial infarction are at increased risk of ischaemic stroke. Previous myocardial infarction is an important part of risk assessment for ischaemic stroke. However, there is a lack of information regarding the association between the severity and extent of coronary artery disease and long-term risk of ischaemic stroke. A cohort study of coronary angiographies performed in western Denmark from 1 January 2003 to 31 December 2012. Patients were stratified according to the number of vessels affected by obstructive coronary artery disease (lumen narrowing ≥50%) at the time of angiography: zero-, one-, two- or three-vessel disease and diffuse vessel disease. We followed patients for a maximum of 7 years. Endpoints were all-cause death, cardiac death, myocardial infarction and ischaemic stroke. Cumulative risks and crude and adjusted rate ratios were estimated. The study population included 78 195 patients. Of these, 32 061 (41·0%) had zero-vessel disease, 6205 (7·9%) had diffuse vessel disease, 20 202 (25·8%) had one-vessel disease, 10 675 (13·7%) had two-vessel disease, and 9038 (11·6%) had three-vessel disease. Median follow-up was 3·6 years (interquartile range 1·7-6·0 years). Increasing severity of obstructive coronary artery disease was associated with an increasing risk of all-cause death, cardiac death, myocardial infarction (MI) and ischaemic stroke during follow-up. The presence and extent of coronary artery disease was associated with an incremental risk of not only death, cardiac death, myocardial infarction, but also ischaemic stroke over a 7-year period.

Can QT dispersion predict multi-vessel coronary artery disease in patients with acute coronary syndrome?

Objective. This study was planned to evaluate relation between QT dispersion (QTd) and multi-vessel coronary artery disease in acute coronary syndrome. Methods. This study included 225 consecutive patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Three groups were defined as single vessel, two vessels, and three vessels. Echocardiographic, biochemical and electrocardiographic parameters of the three groups were compared. Results. QTd, corrected QT dispersion (QTcd) and corrected QT max values significantly increased in patients with three-vessel disease compared to the patients with single-vessel disease group (60±27 vs 45±28 ms, 68±32 vs 50±32 ms and 471±52 vs 443±48 ms; p =0.002, p = 0 .001 and p =0.001, respectively). In addition, QTd and QTcd were statistically more increased in patients with two-vessels disease than single-vessel disease group (57±29 vs 45±28 ms; p =0.045, and 63±32 vs 50±32 ms; p =0.046, respectively). Conclusion. In patient with acute coronary syndrome and diffuse vessel disease, changes in the myocardial cells due to ischemia cause more of the QT dispersion in the patients with multi-vessel disease than those with single-vessel disease.

Platelet non-responsiveness to dual antiplatelet therapy and relation to coronary disease among diabetes patients

Aggregation to ADP 20 μmol/L (%) 4 [0,10] 0 [0,0] b0.001 Aggregation to collagen 5 μmol/L (%) 22 [16,40] 16 [10,32] b0.001 Plasma P-selectin (pg/mL) 62.2±25.7 60.7±20.4 0.78 Random blood glucose (mm Hg) 8.3±4.3 9.0±4.2 0.54 Platelet count (10/mm) 276±71 274±59 0.83 Patients with Type II diabetes mellitus have higher rates of first and recurrent cardiovascular events and greater tendency towards diffuse and small vessel coronary artery disease (CAD). A key factor in the development and pathogenesis of both diffuse vessel disease and increased rate of cardiovascular events may be higher platelet reactivity compared to non-diabetics [1,2]. Biochemical studies and in vitro platelet aggregation tests of diabetes patients have shown platelet activity and reactivity to vary with poor metabolic control, presence of hypertension and smoking [3–7]. Aspirin therapy alone may not be effective in reducing platelet activation and aggregation. So would a dual antiplatelet regime be more effective in reducing platelet activation and aggregation? Around 10–20% of the general non-diabetic population are presumed to be non-responsive, or resistant, to dual aspirin– clopidogrel therapy who were more likely to suffer severe angina pectoris, recurrent atherothrombotic events following acute MI and increased in-stent thrombosis post-coronary stenting [8–15]. We conducted a pilot study to investigate the prevalence of resistance to clopidogrel as add-on antiplatelet therapy among type II diabetes patients, and the association of double antiplatelet resistance to extent of coronary disease. 35 Type II diabetes patients were recruited consecutively from a single out-patient cardiology clinic along with 19 nondiabetes patients who acted as controls. All patients had