Independent Predictors Of Multivessel Disease Research Articles

Clinical decision-making in patients with non-ST-segment-elevation myocardial infarction: more than risk stratification.

This study aims to explore the association between risk stratification and total occlusion (TO) of the culprit artery and multivessel disease (MVD) in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and to obtain more data on clinical decision-making in addition to risk stratification. We retrospectively collected data from 835 patients with NSTEMI admitted to our hospital between 1 January 2016 and 1 August 2022. All patients underwent percutaneous coronary intervention (PCI) within 72 h of admission. We excluded patients with a history of cardiac arrest, myocardial infarction, coronary artery bypass grafting, or PCI. Univariate and multivariate regression analyses were performed to determine the predictors of acute TO and MVD. A total of 349 (41.8%) patients presented with a TO culprit vessel, whereas 486 (58.2%) had a patent culprit vessel. Thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk stratifications were similar between the two groups of patients (P = 0.712 and 0.991, respectively). The TO infarct vessel was more commonly observed in the left circumflex artery. Patients with TO were more likely to develop MVD (P = 0.004). Univariate and multivariate linear regression analyses were performed to evaluate the role of variables in the presence of TO and MVD in patients with NSTEMI. Regional wall motion abnormalities (RWMAs) [odds ratio (OR) = 4.022; confidence interval (CI): 2.782-5.813; P < 0.001] were significantly linked to TO after adjusting for potentially related variables. Furthermore, age (OR = 1.032; CI: 1.018-1.047; P < 0.001), hypertension (OR = 1.499; CI: 1.048-2.144; P = 0.027), and diabetes mellitus (OR = 3.007; CI: 1.764-5.125; P < 0.001) were independent predictors of MVD in patients with NSTEMI. TIMI and GRACE risk scores were related to MVD prevalence in the multivariate logistic regression model. Patients with a TO culprit vessel had a higher risk of out-of-hospital cardiac death after a 2-year follow-up compared with those without a TO culprit vessel (P = 0.022). TIMI and GRACE risk scores were not associated with a TO of the culprit artery; however, they correlated with the prevalence of MVD in patients with NSTEMI. RWMA is an independent predictor of acute TO in patients with NSTEMI. Patients with a TO culprit vessel had worse clinical outcomes than those without a TO culprit vessel.

The diagnostic value of SPECT CZT quantitative myocardial blood flow in high-risk patients

BackgroundThe objective of this study was to evaluate the accuracy of global MBF and MFR quantitation performed by myocardial perfusion scintigraphy (MPS) for the detection of multivessel coronary artery disease (CAD). Methods52 CAD patients underwent CZT MPS, with the evaluation of MBF and MFR, followed by invasive coronary angiography (ICA). According to MPS and ICA results, all patients were divided into three groups: (1) non-obstructive CAD and normal MPS scan (control group) (n = 7), (2) one vessel disease (1VD) (n = 16), (3) multivessel disease (MVD) (n = 29). ResultsGlobal absolute MBF and MFR were significantly reduced in MVD patients as compared to those with 1VD [0.93 (IQR 0.76; 1.39) vs 1.94 (1.37; 2.21) mL·min−1·g−1, P = .00012] and [1.4 (IQR 1.02; 1.85) vs 2.3 (1.8; 2.67), P = .0 004], respectively. The Syntax score correlated with global stress MBF (ρ = − 0.64; P < .0001) and MFR (ρ = − 0.53; P = .0003). ROC analysis showed higher sensitivity and specificity for stress MBF and MFR compared with semiquantitative MPS stress evaluation. Multivariate regression analysis showed that only stress MBF [OR (95% CI) 0.59 (0.42-0.82); P < .0003] was an independent predictor of MVD. ConclusionsQuantitative myocardial blood flow values assessed with the use of CZT camera may identify high-risk patients, such as those with multivessel disease.

PREDICTORS OF MULTIVESSEL CORONARY ARTERY DISEASE IN YOUNG PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Objectives: Premature coronary artery disease (CAD) is on the rise in our population, and multivessel disease (MVD) is no longer an uncommon finding in young patients. Therefore, aim of this study was to determine the predictors of MVD in young patients who presented with ST-Segment Elevation Myocardial Infarction (STEMI). Methodology: For this study, we enrolled 294 young adult (18-40 years) patients with STEMI. MVD was diagnosed based on angiography. Demographic characteristics and baseline risk profiles were considered for the univariate and multivariate analyses to determine the predictors of MVD. Results: Out of 294 patients, 90.5% (266) were males, and the mean age was 35.45 ± 4.07 years. Our 24.1% (71) patients were hypertensive (HTN), and 36.1% (106) were smokers. A total of 94 patients had MVD. Patients with MVD were older and more likely to have diabetes (DM) and HTN than their counterparts. Only age and DM were found to be significant independent predictors of MVD. The risk of developing MVD was higher in diabetics, with adjusted odds ratios (ORs) [95% CI] of 2.47 [1.23-4.97; p=0.011]. Conclusion: In conclusion, we showed that age and DM are independent predictors of MVD in a young Pakistani adult population presenting with STEMI. However, none of the other risk factors, such as obesity, male gender or smoking, were found to be significantly associated with MVD in Pakistani adults with premature CAD. Although significantly associated, HTN does not prove to be an independent predictor of multivessel CAD in young adults.

Relation entre la rigidité artérielle et la sévérité du statut coronaire après un syndrome coronaire aigu

BackgroundThe association between arterial stiffness (AS) and stable coronary artery disease (CAD) has been previously demonstrated. Whether increased arterial stiffness is associated with severe CAD in patients with acute coronary syndrome (ACS) is less explored. AimWe aim to investigate the relationship between AS parameters and the extent and severity of CAD in patients with ACS. MethodsThe study population consisted of 275 patients with ACS. We measured various AS parameters including pulse wave velocity (PWV), augmentation index (AIx), and central pulse pressure (cPP). CAD extent and severity was evaluated by the number of vessels with greater than 70% stenosis. ResultsThe study population was predominantly men (77, 5%) with an average age of 56, 4±10, 6 years. One hundred and fifteen patients were diabetic and 97 were hypertensive. One hundred fifty patients were admitted for ST elevation myocardial infarction (54, 5%) and 37, 5% for non ST elevation myocardial infarction. Thirty six percent of patients had single vessel disease and 47, 6% of the study population had multivessel disease. At the multivariate analysis, a positive correlation was observed between the number of coronary vessels disease and PWV. PWV (OR=1,272; IC95% [1,090; 1,483]; p=0,002) and cPP (OR=1,071; IC95% [1,024; 1,121]; p=0,003) were also independent predictors of multivessel disease. ConclusionIn patient with ACS, PWV is correlated with the extent of coronary artery disease, as measured by the number of vessels disease. PWV and cPP were also independent predictors of multivessel disease.

The detection of multivessel coronary artery disease: the value of quantitative myocardial blood flow and coronary flow reserve assessment

Abstract Background/Introduction The recent Cadmium-Zinc-Telluride (CZT) camera for MPS allows evaluating absolute MBF and CFR, possibly increasing the accuracy in detecting of multivessel CAD. Purpose To evaluate the accuracy of myocardial blood flow (MBF) and coronary flow reserve (CFR) quantitation performed by myocardial perfusion scintigraphy (MPS) for the detection of multivessel coronary artery disease (CAD). Methods Fifty-two patients with suspected or known CAD were enrolled in the study. All patients underwent CZT MPS, with the evaluation of MBF and CFR, followed by invasive coronary angiography. According to MPS and coronary angiography results, patients were divided into three groups. 1) non-obstructive CAD and normal MPS scan (control group) (n=7), 2) one vessel disease (1VD) (n=16), with significant coronary stenosis (≥70%) in one major epicardial coronary artery, 3) multivessel disease (MVD) group (n=29), with two or more major epicardial coronary arteries with (≥70%) stenoses or with ≥50% LMA stenosis. Results Absolute MBF and CFR were significantly reduced in patients with MVD as compared to those with 1VD [0.93 (IQR 0.76; 1.39) vs 1.94 (1.37; 2.21) ml/min/g, p=0.00012] and [1.4 (IQR 1.02; 1.85) vs 2.3 (1.8; 2.67), p=0.0004], respectively. The Syntax score correlated with global stress MBF (ρ=−0.64; p&amp;lt;0.0001) and CFR (ρ=−0.53; p=0.0003). ROC analysis showed higher sensitivity and specificity for stress MBF (85.2% and 81%), and CFR (88.9% and 80%) compared with semiquantitative MPS stress evaluation (69% and 69%). Multivariate regression analysis showed that only stress MBF [OR (95% CI) 0.59 (0.42–0.82); p&amp;lt;0.0003] was an independent predictor of MVD. Conclusion The use of absolute myocardial blood flow analysis with the CZT camera may identify high risk patients, such as those with multivessel disease. This approach could be used in clinical practice, increasing the accuracy in the evaluation of patients with known or suspected coronary artery disease. Funding Acknowledgement Type of funding source: None

The predictive value of arterial stiffness for multivessel disease after acute coronary syndrome

Acute coronary syndrome (ACS) is a primary cause of morbidity and mortality in the world. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. To assess the association between markers of arterial stiffness and multivessel disease after ACS. This prospective study was conducted from April 2017 to March 2018 in a single cardiac center. A total of 275 patients who were referred for first ACS were enrolled. Arterial stiffness was assessed by carotid to femoral pulse wave velocity (cfPWV), central pulse pressure (cPP) and augmentation index using SphygmoCor®XCEL. The mean age was 56.4 ± 10.6 years. Tobacco smoking and diabetes were present in 56.4% and 41.8% of patients, respectively. ST segment elevation myocardial infarction was predominant (54.5%) and 47.6% of patients had multivessel disease. This study showed that cfPWV (OR = 1.272; 95%IC [1.090;1.483]; P = 0.002) and cPP (OR = 1.071; 95%IC [1.024;1.121]; P = 0.003) were the two independent predictors of multivessel disease. The cfVOP threshold for predicting multivessel disease was 12.65 m/s (sensitivity of 48.1% and specificity of 76.4%). Arterial stiffness measured by cfPWV and cPP may reflect the extent of coronary artery disease after ACS.

Relation of arterial stiffness assessed by carotid to femoral pulse wave velocity to the extent of coronary artery disease

Coronary artery diseases (CAD) are among the leading causes of morbidity and mortality worldwid. Carotid to femoral pulse wave velocity (cfPWV) is well validated measure of arterial stiffness and a strong independent predictor of coronary events and cardiovascular mortality among several patient groups. We examined whether cfPWV was associated with the extent of CAD in patients admitted for first acute coronary syndrome (ACS). This prospective study enrolled 275 consecutive patients < 75 years old who underwent cfPWV measurement using SphygmoCor®XCEL devise and coronary angiogram for suspected ACS at a single cardiac center, between April 2017 and March 2018. When the extent of CAD was assessed by the number of diseased vessels (diameter of stenosis ≥ 70%), there was a significant association between the latter and cfVOP ( B = 0.081, 95% confidence interval (CI) [0.019; 0.142], P = 0.010) in linear regression analysis. The multivariate logistic regression shows that cfPWV was a independent predictor of multivessel disease (odds ratio = 1.272, 95% IC [1.090; 1.483], P = 0.002). The cut-off value of cfPWV at 12.65 m/s had a sensitivity of 48.1%, specificity of 76.4%, and area under receiver operating characteristic curve of 0.638 in predicting multivessel disease. Nevertheless, cfVOP was not associated with Gensini score. CfPWV was correlated with the extent of CAD assessed by the number of diseased vessels and was a independent predictor of multivessel disease. However, it did not correlate with Gensini score.

Fragmented QRS Complex as a Predictor of Multivessel Disease in Acute Coronary Syndrome

Background: The incidence of multivessel disease in acute coronary syndrome (ACS) is expected to be identified as early as possible in order to perform optimal management. The presence of multivessel disease can lead to ischemia or myocardial infarction. Fragmented QRS complex (fQRS) is a new electrocardiography (ECG) parameter that has been proven to be caused by ischemia or myocardial infarction.Methods: A cross-sectional study. Patients with ACS that admitted at Dr. Wahidin Sudirohusodo Makassar since December 2014 - March 2015 who are eligible were enrolled in this study.Presence of fQRS evaluated on first 12-lead ECG at hospital admission. Presence of multivessel disease based on coronary angiography. Data were analyzed by logistic regression. Data was significant if the p-value&lt;0.05.Results: There are 63 subjects (56 men and 7 women) included in this study. Older age, history of ACS before, presence of dyslipidemia, and presence of fQRS were significantly more often in group with multivessel disease. After analyzed with logistic regression, the fQRS was the only significant predictor of multivessel disease with p value 0.003 and odds ratio 13.28.Conclusion: Presence of fQRS in the first 12-lead ECG when admitted to the hospital was an independent predictor of multivessel disease in patients with ACS.

Prevalence and Significance of Carotid Plaques in Patients With Coronary Atherosclerosis

Background and ObjectivesCarotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis.Subjects and MethodsThe study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7±10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm.ResultsCarotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4±8.9 years vs. 57.2±10.7 years, p<0.0001), had a thicker CIMT (0.89±0.20 mm vs. 0.77±0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1±60.7 mg/dL vs. 121.6±47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multi-vessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (≥65 years), hypertension, and increased CIMT (≥1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis.ConclusionCarotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.

Predictors of multivessel disease in cases of acute chest pain

Background: Patients with unstable angina not showing ischemia at the exercise treadmill test after medical stabilization usually have a low-risk coronary anatomy. However, some of them have multivessel disease, and it is not known what characteristics are associated with the extension of the coronary artery disease in this subset of patients. Objective: To determine clinical and exertional characteristics associated with multivessel disease in patients with unstable angina and a negative exercise test. Methods: 312 hospitalised patients with unstable angina and a negative exercise test who had undergone cardiac catheterization were reviewed. The relationship between coronariographic findings (presence of multivessel disease) and clinical characteristics, exercise parameters and left ventricular function was studied. Results: Multivessel disease was present in 97 patients (31%). The following variables were associated with the presence of multivessel disease: age more than 65 years old, previous myocardial infarction, previous admissions because of unstable angina, peripheral artery disease, presence of more than two coronary risk factors, left ventricular dysfunction, functional capacity less than 6 METS, duration of exercise less than 8 min and less than 85% of the maximum heart rate. Multivariate analysis showed, as independent predictors of multivessel disease: previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease. Conclusions: In patients with medically stabilized unstable angina and a negative exercise test, previous myocardial infarction, previous admissions because of unstable angina, presence of more than two coronary risk factors and peripheral artery disease, but not exercise parameters, are independent predictors of multivessel disease.

Signos predictores de enfermedad coronaria multivaso en la ecocardiografía con dobutamina

To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers. A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6). Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.

Identification of multivessel coronary artery disease by exercise echocardiography

Objectives. This study examined the ability of exercise echocardiography to identify multivessel coronary artery disease and ascertain its incremental value when combined with clinical and exercise test variables.Background. Although exercise echocardiography has been shown to be accurate for the detection of coronary artery disease, little is known about its utility for identifying multivessel involvement, and its incremental value when combined with clinical and exercise test variables has not been studied.Methods. One hundred fifty consecutive patients were selected on the basis of having had an exercise echocardiographic and a coronary angiographic study within 6 months without any revascularization procedure. Significant coronary artery disease (≥50% diameter stenosis in any major coronary artery) was present in 117 patients, and multivessel (two- or three-vessel) disease was present in 90 patients. The exercise echocardiographic studies were reviewed by an experienced observer unaware of the results of the coronary angiogram.Results. The overall sensitivity and specificity of exercise echocardiography for the identification of multivessel disease were 73% and 70%, respectively. A stepwise logistic regression analysis identified the number of abnormal regions on the postexercise images as the strongest independent predictor of multivessel disease; also significant were a history of myocardial infarction and ST segment depression of at least 2 mm on the peak exercise electrocardiogram.Conclusions. Exercise echocardiography adds independent and incremental information to clinical and exercise test variables for identifying multivessel coronary artery disease.

A model to predict multivessel coronary artery disease from the exercise thallium-201 stress test

<h3>PURPOSE:</h3> The aim of this study was to (1) determine whether nonimaging variables add to the diagnostic information available from exercise thallium-201 images for the detection of multivessel coronary artery disease; and (2) to develop a model based on the exercise thallium-201 stress test to predict the presence of multivessel disease. <h3>PATIENTS AND METHODS:</h3> The study populations included 383 patients referred to the University of Virginia and 325 patients referred to the Massachusetts General Hospital for evaluation of chest pain. All patients underwent both cardiac catheterization and exercise thallium-201 stress testing between 1978 and 1981. <h3>RESULTS:</h3> In the University of Virginia cohort, at each level of thallium-201 abnormality (no defects, one defect, more than one defect), ST depression and patient age added significantly in the detection of multivessel disease. Logistic regression analysis using data from these patients identified three independent predictors of multivessel disease: initial thallium-201 defects, ST depression, and age. A model was developed to predict multivessel disease based on these variables. As might be expected, the risk of multivessel disease predicted by the model was similar to that actually observed in the University of Virginia population. More importantly, however, the model was accurate in predicting the occurrence of multivessel disease in the unrelated population studied at the Massachusetts General Hospital. <h3>CONCLUSION:</h3> It is, therefore, concluded that (1) nonimaging variables (age and exercise-induced ST depression) add independent information to thallium-201 imaging data in the detection of multivessel disease; and (2) a model has been developed based on the exercise thallium-201 stress test that can accurately predict the probability of multivessel disease in other populations.

A model to predict multivessel coronary artery disease from the exercise thallium-201 stress test

purpose: The aim of this study was to (1) determine whether nonimaging variables add to the diagnostic information available from exercise thallium-201 images for the detection of multivessel coronary artery disease; and (2) to develop a model based on the exercise thallium201 stress test to predict the presence of multivessel disease. patients and methods: The study populations included 383 patients referred to the University of Virginia and 325 patients referred to the Massachusetts General Hospital for evaluation of chest pain. All patients underwent both cardiac catheterization and exercise thallium-201 stress testing between 1978 and 1981. results: In the University of Virginia cohort, at each level of thallium-201 abnormality (no defects, one defect, more than one defect), ST depression and patient age added significantly in the detection of multivessel disease. Logistic regression analysis using data from these patients identified three independent predictors of multivessel disease: initial thallium-201 defects, ST depression, and age. A model was developed to predict multivessel disease based on these variables. As might be expected, the risk of multivessel disease predicted by the model was similar to that actually observed in the University of Virginia population. More importantly, however, the model was accurate in predicting the occurrence of multivessel disease in the unrelated population studied at the Massachusetts General Hospital. conclusion: It is, therefore, concluded that (1) nonimaging variables (age and exercise-induced ST depression) add independent information to thallium-201 imaging data in the detection of multivessel disease; and (2) a model has been developed based on the exercise thallium-201 stress test that can accurately predict the probability of multivessel disease in other populations.

Complementary role of thallium-201 scintigraphy to predischarge exercise electrocardiography for patients stratification after a first myocardial infarction.

The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged after a first acute myocardial infarction. Twelve electrocardiographic, clinical and scintigraphic variables were analysed. Angiography at one month revealed MVD (greater than 70% narrowing in vessels unrelated to infarction) in 26 patients (45%). ST segment depression of 1mm or greater, thallium defects in multiple vascular distributions (MVTL), and reversible thallium defects in a vascular distribution different from the infarct related vessel predicted patients at risk for MVD (predictive value respectively of 68%, 65% and 75%). The other variables were not significantly associated with the presence of MVD. Only ST segment depression and thallium defects in multiple vascular distributions emerged as independent predictors of MVD. Their combination yielded a 77% sensitivity and a 59% specificity for MVD. Combination of thallium imaging with the predischarge exercise ECG significantly improved the stratification provided by the exercise test alone (P less than 0.05). A positive thallium scan (MVTl defects) associated with a positive ECG (ST depression) carried a risk for MVD of 80% in the population studied. When both tests were negative, MVD was infrequent (risk 22%). Because improvement in the stratification of patients is not as clear as expected from studies performed at a later stage, it appears that exercise thallium scintigraphy at a submaximal level one or two weeks after infarction does not provide optimal information. Predischarge exercise thallium-201 scintigraphy, however, is superior to an exercise tolerance test alone in separating patients into those with high and low risk of MVD.