Frequency Of Major Cardiovascular Events Research Articles

Impact of Systolic and Diastolic Blood Pressure on Cardiovascular Health Outcomes

Background: One well-known risk factor for cardiovascular (CV) disease that significantly raises morbidity and mortality rates globally is hypertension. Optimising treatment options requires an understanding of the distinct effects of diastolic and systolic blood pressure on CV outcomes. The study aims to examine into how the effects of both systolic hypertension (SH) and diastolic hypertension (DH) affected the frequency of major CV events, such as hemorrhagic, ischemic, and myocardial infarction (MI). Methods: A retrospective cohort research comprising 180 patients was carried out, with automated oscillometric cuffs being used to measure blood pressure. The burdens of SH and DH, which were determined as continuous variables from weighted average blood pressure, were the main predictors. A composite of ischemic stroke, MI, or hemorrhagic stroke was the main result. Logistic regression and bivariate and multivariable Cox survival analyses were included in the statistical studies. Results: The study population had average age of 65.4 years, with 52% males and 48% females. During the observation period, 45 composite outcome events occurred (25% incidence rate). Bivariate Cox analysis showed significant associations between SH burden (HR: 1.45, p<0.001) and diastolic hypertension burden (HR: 1.30, p=0.015) with the composite outcome. Multivariable analysis confirmed these associations, with consistent findings in logistic regression models. Conclusion: Both SH and DH burdens are significant predictors of adverse CV outcomes. Effective management of both blood pressure components is essential for reducing the risk of ischemic stroke, MI, and hemorrhagic stroke. Recommendations: To lower the risk of significant CV events, clinicians should monitor and treat both systolic and diastolic blood pressure in individuals with hypertension. Subsequent studies ought to investigate the underlying mechanisms of these correlations and assess the effectiveness of focused interventions. Keywords: Hypertension, Cardiovascular Outcomes, Diastolic Blood Pressure, Systolic Blood Pressure.

Major cardiovascular events in patients presenting with acute stroke: a 5-year follow-up study in patients who had ischaemic stroke and stroke mimics

ObjectivesThe long-term acute stroke outcome has not been well studied in the Middle-Eastern population. The primary objective of our study is to compare the long-term outcome of acute ischaemic stroke...

Clinical characteristics and prognosis in patients with multi-vessel coronary spasm – comparison with those in patients with single-vessel coronary spasm

Abstract Background We have sometimes experienced patients with vasospastic angina (VSA), who showed multi-vessel spasm (MVS) on coronary angiography (CAG) and spasm provocation test (SPT). However, it has not been clarified what clinical characteristics VSA patients with MVS have or whether such patients have poor prognosis. Therefore, we compared the clinical characteristics and prognosis in VSA patients with MVS with those in VSA patients with single-vessel spasm (SVS). Methods One hundred and fifty-two patients (mean age: 67 yrs, 74 men and 78 women) with VSA, in which presence of coronary spasm was assessed in both left coronary artery (LCA) and right coronary artery (RCA) on SPT, were subjected. We defined VSA as the presence of more than 90% narrowing of the epicardial coronary artery on angiograms, accompanied by the usual chest symptoms and/or ischemic ST-T changes on electrocardiogram. On SPT, MVS was defined as the presence of spasm on ≥ two major coronary arteries. Base on the presence of MVS, patients were divided into the following 2 groups: MVS group and SVS group. The frequencies of conventional coronary risk factors, the average times of anginal attack (per month), the findings of SPT such as spasm provocation induced by low dose of acetylcholine (LDA) and total occlusion due to coronary spasm (TOC), the number of coronary vasodilators at discharge, and the major cardiovascular events (MACE) including death of any cause and readmission due to heart failure, acute coronary syndrome and unstable angina, were compared in the two groups. Results There were 98 patients (64%) in the MVS group and 54 patients (36%) in the SVS groups. The frequencies of conventional coronary risk factors and the average times of anginal attacks (4/month in both groups) were not different in the two groups. The frequencies of LDA (33% in MVS and 17% in SVS, p<0.05) and TOC (12% in MVS, 0% in SVS, p<0.01) were higher in the MVS group than in the SVS group. The average numbers of coronary vasodilators was higher in the MVS group (1.1±0.4) than in the SVS group (0.9±0.4, p<0.01). The frequency of MACE did not differ in the two groups as follows (figure). Conclusions These findings suggest that there was no clinical characteristic, suggesting the presence of MVS in VSA patients. Such patients may have higher VSA activity on SPT and have more aggressive medications, leading to the similar prognosis in VSA patient with SVS. Funding Acknowledgement Type of funding sources: None.

Influence of incomplete revascularisation on the outcomes of coronary artery bypass grafting in patients with ischaemic heart disease

Background. At the present time there is no agreement regarding effect of revascularisation volume on long-term results of coronary artery bypass grafting. According to some reports, incomplete revascularisation, compared with complete revascularisation, affects survival and increases the frequency of adverse cardiovascular events. Other researchers do not find such differences.Aim. This study aimed to assess the influence of incomplete revascularisation on the long-term results of coronary bypass surgery and to determine its predictors.Methods. A total of 243 patients with coronary artery disease who underwent microscope-assisted coronary artery bypass surgery were categorised into two groups. Group I included those with complete revascularisation (n = 152), while group II included those with incomplete revascularisation (n = 91). When assigning patients to groups, the volume of achieved myocardial revascularisation was determined according to the patency of grafts. The groups were compared by the late survival and by the frequency of major cardiovascular events. Logistic regression was used to analyse predictors of incomplete revascularisation.Results. The median of follow-up (interquartile range) was 802 days (426–1487 days). Survival in group 1 at 1, 3 and 5 years after surgery was 98%, 98% and 89%, respectively, while in group 2, it was 90%, 86%, and 86%, respectively (p = 0.024). Freedom from major cardiovascular events (death, myocardial infarction, repeated revascularisation, stroke) in group 1 after 1, 3 and 5 years was 91%, 89% and 77%, respectively, and in group 2, it was 78%, 68% and 68%, respectively (p = 0.005). It was revealed that diabetes mellitus (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.01–2.09), arteriosclerosis of arteries of two or more localisations (OR = 1.63, CI = 1.15–2.31), number of lesions in circumflex artery system (OR = 2.48, CI = 1.86–3.31), number of lesions in anterior descending artery system (OR = 1.61, CI = 1.14–2.28) and the diameter of the target coronary artery is less than 1.5 mm (OR = 1.3, CI = 1.22–2.38) are independent predictors of incomplete myocardial revascularisation during coronary artery bypass grafting. Male gender (OR = 0.61, CI = 0.41–0.91) and increased body mass index were associated with a reduced risk of incomplete revascularisation (OR = 0.96, CI = 0.93–0.99).Conclusion. Incomplete revascularisation worsens the prognosis after coronary bypass surgery, and is accompanied by an increase in the frequency of adverse cardiovascular events and a decrease in long-term survival. The risk of incomplete revascularisation increases in patients with diabetes mellitus, common manifestations of atherosclerosis, number of lesions in the left coronary system, as well as with a small diameter of the target coronary arteries. Male gender and increased body mass index were associated with a reduced risk of incomplete revascularisation. Received 15 June 2020. Revised 23 July 2020. Accepted 24 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

ЭКЗОПРОТЕЗИРОВАНИЕ ВОСХОДЯЩЕЙ АОРТЫ ПРИ ХИРУРГИЧЕСКОЙ КОРРЕКЦИИ ПОРОКА АОРТАЛЬНОГО КЛАПАНА

Objective: To study the results of surgical treatment of patients with ascending aorta dilatation and aortic valve disease. Methods: Echocardiographic examination was performed in all patients before surgery, within 1 month after surgery, and in the long-term period - once a year. Computed tomography was performed in patients from the main group as a control research method within 1 month after surgery and in the long-term period – once a year. Results: The results of surgical treatment of 255 patients with aortic valve disease and ascending aorta dilatation from 40 to 55 mm in the early postoperative and long-term periods with an average follow-up period of 3 years were analyzed. The wrapping method of the ascending aorta, performed in 93 patients, led to a significant decrease in the ascending aorta diameter from 45.47±2.96 mm to 35.98±3.88 mm, preventing the progression of its dilatation and aneurysm formation. The method showed a lower risk of complications in the early postoper- ative period compared to ascending aorta replacement. In the long-term follow-up, the frequency of major cardiovascular events and overall survival after aorta wrapping and aorta replacement in combination with correction of the aortic valve pathology did not differ significantly. After aorta wrapping, according to com- puted tomography, during the observation period, there were no complications from the ascending aorta in the form of dissection, intimal defects, wrap dislocation, aorta kinking; there was no significant calcification of the xenopericardial wrap. Conclusion: Ascending aorta wrapping can be performed as an alternative method of surgical treatment of the ascending aorta dilatation in aortic valve surgery in a certain cohort of patients with good results in the early postoperative and long-term follow-up periods.

Predictors of unfavorable long-term prognosis after percutaneous coronary intervention in patients with chronic obstructive pulmonary disease and acute coronary syndrome

Aim. Тo determine independent predictors of unfavorable cardiovascular long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndrome and concomitant chronic obstructive pulmonary disease. Methods. 119 patients with acute coronary syndrome after percutaneous coronary intervention and concomitant chronic obstructive pulmonary disease were included in prospective cohort study. During follow-up up to 36 month the frequency of major cardiovascular events (cardiovascular death, myocardial infarction, stroke, repeat myocardial revascularization) were registered. The predictors of combined end point were identified by Cox regression through forward stepwise mode. Results. Independent variables as major cardiovascular events predictors were determined: main coronary arteries stenosis number, ankle-brachial index, glomerular filtration rate according to the CKD-EPI formula, frequent COPD exacerbations, functional residual lung capacity, 6-minute walk test distance. Conclusion. Functional residual lung capacity as a lung hyperinflation indicator and frequent COPD exacerbations are among independent predictors of major cardiovascular events in long-term follow-up period after percutaneous coronary intervention in patients with acute coronary syndrome and concomitant chronic obstructive pulmonary disease.

Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica.

Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. Approach and Results: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect.

Cardiovascular events reported in randomized controlled trials in restless legs syndrome

ObjectiveEvaluate the frequency of cardiovascular adverse events reported in randomized controlled trials (RCT) in Restless Leg Syndrome (RLS). MethodsDatabases were searched up to October 2015. Randomized, double-blind, placebo-controlled trials of patients with RLS were included if quantitative data were extractable. The primary outcome was cardiovascular adverse events defined as cardiac diseases, blood pressure abnormalities, syncope, cerebrovascular diseases, thromboembolic events, and sudden death. The pooled estimated prevalence of cardiovascular (CV) adverse events (AE) and respective 95% confidence interval (CI) was determined by using a meta-analysis. ResultsIn sum, 28 RCT (2515 participants in the placebo arm and 4223 participants in the intervention arm) reported CV AE. The pooled estimated prevalence of CV AE was 0.61% (95% CI 0.31 to 0.91; I2 = 0%) in the placebo arm and 0.68% (95%CI 0.40 to 0.96; I2 = 18.25%) in the intervention arm. The frequency of major CV events (myocardial infarction, stroke and peripheral artery disease) was 0.49% (95%CI 0.22 to 0.77; I2 = 0%) and 0.33% (95% CI 0.16 to 0.50; I2 = 0%) in the placebo and intervention arm, respectively. ConclusionsThe frequency of major cardiovascular events in the RLS trials is not negligible, particularly when considering the young age of these patients.

Bioabsorbable vascular endoproteases for the treatment of patients with coronary heart disease and type 2 diabetes mellitus

Aim. To evaluate efficiency of endovascular intervention in patients with type 2 diabetes mellitus with the use of bioabsorbable vascular endoproteases and everolimus-coated stents. Material and methods. A total of 143 patients were initially selected for the study of whom 125 were randomized into 2 groups, one including 57 patients with implanted bioabsorbable vascular endoproteases, the other comprised of 68 patients treated with the use of everolimus-coated stents. Inclusion criteria: primary lesion of coronary arteries, stable angina of effort (II-III FC), myocardial ischemia (>10%) confirmed in functional tests, compensated and subcompensated DM2, stenosis of middle and distal segments of the main coronary arteries (≥70%) diagnosed by digital angiography. Exclusion criteria: the target artery not more than 4 mm in diameter, acute coronary syndrome, excess vascular tortuosity, marked calcinosis of coronary arteries, bifurcation lesion, left coronary trunk lesion, history of myocardial revascularization. Criteria for the assessment of immediate outcomes: frequency of major cardiovascular events (death, myocardial infarction, emergency secondary intervention). Criteria for the assessment of long-term outcomes: frequency of major cardiovascular events (death, myocardial infarction, secondary intervention), frequency of in-scaffold/in-stent restenosis or stent thrombosis. Results of biobsorbable scaffold implantation were controlled using optical coherence tomography in the end of surgery and during 12 month during follow-up. Results. A total of 63 bioabsorbable vascular endoprostheses and 102 everolimus-coated stents were implanted to patients of groups 1 and 2 respectively. Mean diameter of the endoprostheses was 2.88±0.06 and 2.68±0.12 mm respectively (р>0,05). The intervention was regarded as technically successful in 100% cases. The overall frequency of major cardiovascular complications during hospitalization in patients of groups 1 and 2 was 3.5 and 2.94% respectively. Long-term outcomes could be estimated in 41 patients of group 1 and 52 ones in group 2. All patients survived for 12 months. The frequency of non-fatal MI was 4.9 and 3.8% in groups 1 and 2 respectively (р>0,05), the cause being progression of atherosclerosis in other arteries. Frequency of in-stent restenosis was 2.4 and 1.9% (р>0,05). Cases of late stent thrombosis were absent whereas coherence tomography revealed severe intravascular volume depletion to 0.14±0.19 and 0.12±0,23 mm in groups 1 and 2 respectively (р>0,05). Conclusion. Bioabsorbable endoprostheses implanted to patients with coronary heart disease and type 2 diabetes mellitus and stenosis of middle and distal segments of the main coronary arteries within 12 months after surgery proved as efficient and safe as everolimus-coated stents.

Clinical outcomes of left main crossover stenting for ostial left anterior descending artery acute myocardial infarction.

Percutaneous coronary interventions to ostial left anterior descending artery (LAD)-acute myocardial infarction (AMI) were challenging, especially in crossover stenting from left main trunk (LMT) to LAD. The clinical outcomes of ostial LAD-AMI that needed crossover stenting were not well investigated. The objective of this study was to compare the clinical outcomes of LMT crossover stenting with those of ostial LAD just proximal (jp) stenting. Between January 2009 and March 2016, 1499 patients were diagnosed as AMI in our institution. Among them, 76 ostial LAD-AMIs were included in this study, and divided into 30 LMT crossover stenting (the crossover group) and 46 jp stenting (the jp stenting group). The primary endpoint was major cardiovascular events (MACE) defined as the composite of cardiac death, acute myocardial infarction (AMI), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). The frequency of MACE was comparable between the 2 groups (16.7% in the crossover group and 21.7% in the jp stenting group, P=0.587). Similarly, the frequency of cardiac death was comparable between the 2 groups (6.7% in the crossover group and 13.0% in the jp stenting group, P=0.376). The frequencies of TLR (6.7% in the crossover group and 6.5% in the jp stenting group, P=0.980) and TVR (10.0% in the crossover group and 8.7% in the jp stenting group, P=0.848) were not significantly different between the 2 groups. In conclusion, the clinical outcomes of the crossover stenting were comparable to the jp stenting in the stenting strategy for ostial LAD-AMI. LMT-LAD crossover stenting would be the acceptable strategy for ostial LAD-AMI.

Effects of low-dose aspirin on endothelial function in hypertensive patients.

It has been reported that administration of low-dose aspirin significantly reduces the frequency of major cardiovascular events in patients with hypertension and coronary artery disease. It is generally considered that the preventative effects of long-term aspirin administration on major cardiovascular events are due to the inhibition of platelet aggregation. It is not known whether administration of low-dose aspirin restores endothelium-dependent vasodilatation, and this study was undertaken to prove or disprove this question in patients with hypertension. Flow-mediated endothelium-dependent dilatation and glyceryl trinitrate-induced endothelium-independent dilatation were investigated in 18 hypertensive patients and 10 normotensive control subjects. In the hypertensive patients, flow-mediated dilatation was investigated and cyclic guanosine monophosphate plasma (cGMP) was measured before and at 8 weeks after the administration of 162 mg of aspirin. Flow-mediated dilatation before aspirin administration was more reduced in the hypertensive patients than in the control subjects (6.4+/-2.0% vs. 11.3+/-2.3%, p <0.0001). Glyceryl trinitrate-induced dilatation before aspirin administration was similar in hypertensive patients and control subjects. Flow-mediated dilatation after aspirin administration was improved compared with that before aspirin administration (10.4+/-3.5% vs. 6.4+/-2.0%, p<0.0004). The cGMP product after aspirin administration was significantly higher than that before aspirin administration. Administration of low-dose aspirin may restore the endothelium-dependent vasodilatation in hypertensive patients. Furthermore, increased nitric oxide production may play a partial role in the improvement in endothelial function induced by administration of low-dose aspirin.

Prior myocardial infarction and prognostic outcome in patients with unstable angina in a postdischarge follow-up.

The authors investigated how a previous myocardial infarction (MI) affects the prognosis of unstable angina pectoris in patients with maintained or slightly reduced left ventricular performance. From January 1991 to August 1993, 131 patients hospitalized with the diagnosis of Braunwald's class II-III unstable angina and ejection fraction > 40% were included. The enrolled patients were divided into two groups: (1) group I: unstable angina with prior MI (n = 70, 49 men, 21 women, aged between fifty-one and eighty years, mean: 65.7 +/- 8.5 years, Braunwald's class III: 71.4%), (2) group II: unstable angina with previous infarction (n = 61, 31 men, 30 women, aged between forty-nine and eighty, mean: 66.3 +/- 7.9 years, Braunwald's class III: 83.6%). The follow-up varied between six and twenty-four months. The frequency of major cardiovascular events (deaths, MI, reinfarction, heart failure, and recurrent unstable angina) and the number of revascularization procedures (percutaneous transluminal coronary angioplasty [PTCA] and coronary artery bypass grafting [CABG]) established during follow-up were evaluated. Hospitalization was 10.1 +/- 2.9 days in group I and 8.6 +/- 2.6 days in group II (P < 0.01). The duration of the follow-up was comparable between the two groups. Based upon predischarge noninvasive evaluation, patients in both groups were selected to undergo coronary and ventricular angiography: 38 of 70 (55.7%) in group I and 39 of 61 (62.3%) in group II; among them, 52.9% in group I and 24.6% in group II (P < 0.05) were submitted to coronary revascularization, while the others received medical treatments: 33 of 70 in group I and 46 of 61 in group II (P < 0.05). In the subset of patients submitted to angiography, the severity of coronary disease did not differ between the groups, and group I showed a statistically lower ejection fraction than group II (P < 0.005). The frequency of major cardiovascular events demonstrated a mortality rate of 2.9% in group I and 1.6% in group II. Acute MI/reinfarction accounted for 2.9% of the cases in group I and 3.3% in group II. Heart failure was present in 2.9% of group I. Recurrence of unstable angina was diagnosed in 11.4% of group I and 6.5% of group II. CABG and PTCA were performed, respectively in 7.1% and 5.7% in group I and in 6.6% and 4.9% in group II. During follow-up 75.7% of patients in group I and 80.3% in group II were asymptomatic. No significant differences in the frequency of cardiovascular events were reported between the two groups. As result of more aggressive therapeutic approaches following the detection of residual ischemia in patients with prior infarction, the authors conclude that the prognosis of unstable angina in the group with previous infarction does not seem to differ from that of unstable angina in the absence of prior necrosis in patients whose left ventricular function is maintained or slightly decreased.

Systolic blood pressure as a predictor for cardiovascular disease in diabetes. A 5-year longitudinal study.

Diabetic patients suffer from atherosclerotic diseases more often and at an earlier stage than nondiabetic persons. The factors predisposing those with diabetes to premature arteriosclerosis are not fully clarified. Data from a 5-year follow-up of 615 diabetic outpatients of the Schwabing Study are reported. Forty-six (8.5%) died from a cardiovascular cause of death, 13 (2.4%) suffered from stroke, 68 (12.5%) showed electrocardiographic changes indicative of significant coronary heart disease, and 11 (2.0%) exhibited an ischemic foot lesion. Univariate and multiple logistic analyses of baseline variables revealed systolic blood pressure as the most consistent risk factor for these events. The frequency of major cardiovascular events was as high in men as in women. It is concluded that systolic blood pressure has been seriously underestimated as a predictor for macrovascular events.