Long-term Clinical Outcomes In Patients Research Articles

Long-term clinical outcomes in patients between the age of 50-70 years receiving biological versus mechanical aortic valve prostheses.

The last two decades have seen an incremental use of biological over mechanical prostheses. However, while short-term clinical outcomes are largely equivalent, there is still controversy about long-term outcomes. All patients between the ages of 50-70 years undergoing elective/urgent isolated aortic valve replacement at our institute between 1996 to 2023 were included. Trends, early and long term outcomes were investigated. A total of 1708 (61% male) patients with a median age of 63.60 (IQR : 58.28,67.0) years were included of which 1191 (69.7%) received a biological prosthesis.After inverse propensity score weighting, there were no short-term differences when comparing patients receiving biological and mechanical valves. However, patients who received mechanical prostheses had better long-term survival (p < 0.001). Sub-group analysis revealed that patients with biological size 19 mm prosthesis had the worse long-term survival. Patients with a size 21 mm mechanical prosthesis had better survival compared to both size 19 mm (HR: 0.25, 95% CI: 0.17,0.37, p < 0.001), 21 mm (HR: 0.33, 95% CI: 0.23,0.48, p < 0.001) and 23 mm (HR: 0.40, 95% CI: 0.27,0.60, p = <0.001) biological prosthesis.Additionally, patients with severe patient-prosthesis mismatch exhibited the lowest survival rate compared to those with moderate or no (HR 1.56, 95% CI 1.21, 2.00, p < 0.001). Patients aged between 50-70 years with a mechanical aortic prosthesis had better long-term survival compared to those with a biological prosthesis. Our study underscores the need for a critical re-evaluation of prosthesis selection strategies in this age group.

Favorable impact of FFRCT on myocardial revascularization outcomes: results from an observational real-world registry

Abstract Background Based on excellent clinical outcomes data, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by ESC guidelines for diagnosing obstructive coronary artery disease (OCAD) (1). The impact of FFRCT use on cardiovascular outcomes after revascularization is not well known. Purpose To assess the impact of FFRCT use on the post-procedural myocardial injury and long-term clinical outcomes of patients with OCAD undergoing myocardial revascularization. Methods Patients with suspected OCAD on CCTA (at least one stenosis of &amp;gt;50% in any vessel) were included from a 2013-2021 tertiary hospital registry. Propensity score adjusted Cox- regression and logistic regression analysis, respectively were used to assess the impact of FFRCT on the outcomes of patients with OCAD undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Post-revascularization myocardial injury (PMI) was defined as cardiac troponin (hs -cTnT) &amp;gt; 5 times the 99th percentile URL for PCI and hs- cTnT &amp;gt; 10 times the 99th percentile URL for CABG. Major adverse cardiovascular events (MACE) were defined as a composite endpoint of all – cause mortality, hospitalization for acute myocardial infarction, stroke, hospitalization for heart failure and repeated revascularization. Results Among 7541 patients, 1601 had suspected CCTA - derived OCAD. 559 patients were revascularized: 386(69.05%) by PCI, 166(29.7%) by CABG. FFRCT was performed in 252(45.1%) patients. During a follow-up of 4.4±2.2 years, 137(24.5%) patients experienced MACE. Survival analysis indicated significant differences in MACE and all-cause mortality–rates between FFRCT use and no FFRCT use (log- rank p = 0.033 and 0.004). A non–significant trend towards reduced MACE risk by using FFRCT (HR 0.736, 95% CI 0.513-1.055, P=0.095) and a significant reduction in all-cause mortality (HR 0.476, 95% CI 0.230–0.985, P=0.046) were observed. In the CABG group, FFRCT was associated with lower PMI incidence (5.3% vs. 15.6%, p=0.044). Multivariable analysis revealed no significant association between FFRCT use and PMI. Conclusion Using an observational design, this study demonstrates for the first time that FFRCT is able to reduce post- myocardial revascularization MACE. Contrary to previous studies on invasive FFR, this observed FFRCT - related MACE reduction was mainly driven by the reduction in all-cause mortality. No clear reduction of PMI was observed suggesting that the potential adjunctive value of FFRCT was not simply related to some technical improvements in the planning of PCI or CABG procedures. Even if derived from a large real-world registry, these promising observations will need to be confirmed by randomized studies. Survival analysis Forest Plot - multivariables analysis

Long-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head.

Short stem total hip arthroplasty (THA) is an alternative to conventional stem, designed to facilitate minimal-invasive surgery, physiological loading and preserve bone stock. However, there is insufficient evidence of the long-term outcomes in patients with osteonecrosis of the femoral head (ONFH). This study aims to analyze the clinical and radiographic results with a minimum follow-up of 10 years. Furthermore, the survival rate of the short stem was calculated. There were 81 patients (101 hips) with the mean age of 45 years (range, 21 to 68) in this study. The Harris Hip Scores (HHS) and Forgotten Joint Scores (FJS) were recorded to evaluate the clinical results. The appearance of osteointegration and radiolucent line were reviewed. The mean follow-up period was 129.3 months (range, 120-154). At the latest follow-up, the mean HHS and FJS were 96.9 ± 5.7 (range, 69-100) and 95 ± 7 (range, 75-100) points respectively. The radiographic changes around the stem showed osteointegration mainly in the proximal part, zones 1 (94.1%), 2 (84.2%), 6 (99%) and 7 (92.1%). One stem underwent revision due to periprosthetic fracture, using conventional stem with plate and screws. Survivorship of the stem with the endpoint for any reason was 99.01% (95% confidence interval [CI], 93.18-99.86%) and for aseptic loosening was 100% at 10 years. Short stem showed promising long-term clinical outcomes in patients with ONFH. The radiographic results demonstrated physiological proximal load transfer.

Real-World Long-Term Effectiveness of Implantable Cardioverter-Defibrillators in Elderly Patients

Because it is unclear whether implantable cardioverter-defibrillators (ICDs) are equally effective in patients of all ages, we investigated the association of age with long-term clinical outcomes of patients who underwent ICD implantation. A total of 416 consecutive patients (mean age: 69 years) from 4 tertiary hospitals who underwent ICD implantation or were upgraded from an existing permanent pacemaker between January 2011 and November 2022 were enrolled and divided into 3 groups based on age: <65 years (n=158), 65-74 years (n=138), and ≥75 years (n=120). We compared the incidence of all-cause death and adverse cardiovascular events, including cardiac death, appropriate ICD therapy, and heart failure hospitalization. During a median follow-up period of 3.2 years (interquartile range: 1.1-5.6 years), 120 patients died. Older patients had a higher cumulative incidence of all-cause death and composite adverse cardiovascular events. The cumulative incidence of cardiac death and appropriate ICD therapies did not differ significantly; however, the incidence of hospitalization for heart failure increased with age. In multivariate analysis, age was independently associated with all-cause death but not composite adverse outcomes. Age had a significant effect on subsequent all-cause death, but not on adverse cardiovascular events in patients with ICDs, suggesting that age should not be the only indication considered for ICD implantation.

Effect of Low-dose Administration of Carperitide for Acute Heart Failure: the LASCAR-AHF trial.

The effects of low-dose carperitide on long-term clinical outcomes of patients with acute heart failure (AHF) have not yet been fully elucidated. This study aimed to evaluate the effects of low-dose intravenous carperitide on the long-term clinical outcomes of patients with AHF. In this multicentre, open-label, randomised controlled trial, 247 patients with AHF received low-dose carperitide intravenously with standard treatment or a matching standard treatment for 72 h from November 2014 to March 2021 across nine sites in Japan. The primary endpoint was a composite of all-cause death and heart failure hospitalisation within 2 years. The primary endpoint was observed in 36 of 122 patients (29.5%) and 35 of 125 patients (28.0%) in the carperitide group and standard treatment groups, respectively (hazard ratio 1.26; 95% confidence interval (CI) 0.78-2.06, P = 0.827). No significant differences were observed in the secondary endpoints, including cumulative urine volume at 72 h; change in the degree of dyspnoea over 72 h; and changes in brain natriuretic peptide, cystatin C, renin, aldosterone, and catecholamine levels at 72 h post randomisation between the groups. A greater decrease in the estimated glomerular filtration rate was observed in the carperitide group compared with the standard treatment group (inter-group difference -3.9 ml/min/1.73 m2; 95% CI -7.0 to -0.8). In patients with AHF, low-dose carperitide did not reduce long-term mortality or hospitalisation events when combined with standard treatment. Because patient enrolment was terminated prematurely, the study was underpowered and inconclusive.

A Retrospective Cohort Study of Decompressive Techniques for Cubital Tunnel Syndrome: In Situ Decompression Versus Ulnar Nerve Transposition.

Cubital tunnel syndrome (CuTS) is the second most common nerve entrapment syndrome of the upper extremity after carpal tunnel syndrome. In situ decompression (ISD) and ulnar nerve transposition (UNT) are the major surgery methods in practice for the treatment of CuTS. However, controversies exist over the efficacy and safety of these methods. The objective of the study was to compare the short- and long-term clinical outcomes in patients treated with ISD and UNT surgery. This was a retrospective study comprising 56 patients who underwent either ISD or UNT at Naresuan University Hospital between January 2013 and December 2022. Data on age, sex, hand involved, duration of the surgery, duration of the symptoms including the clinical outcomes such as elbow range of motion (ROM), quick disabilities of the arm, shoulder, and hand (QuickDASH), McGowan grade (MGG), Visual Analog Scale (VAS) for pain scores, motor and sensory conduction velocity (MCV1, MCV2, and SCV), and Tinel's sign were collected during the two-week, one-month, three-month, and six-month follow-ups post-surgery. Of the 56 patients in the study, 62.5% were female. The number of patients aged <60 years was higher in both groups. The mean age of patients in the ISD group was 49.07±6.13 years, while in the UNT group, it was 51.5±7.04 years. After one month, 53.57% and 32.14% of the patients recovered to MGG 1 in the ISD and UNT groups, respectively. The majority of the patients had MGG 1 six months after the surgery. The QuickDASH score and pain scores of the patients improved during all follow-ups, but no statistical significance was revealed when the two techniques were compared. The study found that both the ISD and UNT were efficient and safe in treating CuTS. Further study with the inclusion of parameters such as revision surgery and complications would be vital.

S7 The Association of Endoscopic Outcomes With Improvement in Long-Term Clinical Outcomes in Patients With Moderate to Severe Crohn’s Disease Treated With Risankizumab: Results from the Phase 3 FORTIFY Open-Label Extension Trial

S7 The Association of Endoscopic Outcomes With Improvement in Long-Term Clinical Outcomes in Patients With Moderate to Severe Crohn’s Disease Treated With Risankizumab: Results from the Phase 3 FORTIFY Open-Label Extension Trial

Sex differences in patients with atrial fibrillation and acute coronary syndrome or undergoing PCI: a real-world study

Background In patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI), female patients have a worse short-term prognosis than male patients has been consistently concluded in many studies. However, the impact of sex differences on long-term prognosis remains uncertain. Additionally, women are underrepresented in clinical trials exploring optimal antithrombotic strategies in patients with atrial fibrillation (AF) and ACS or PCI. To bridge this gap, this study aimed to investigate sex differences in clinical characteristics, treatment, and long-term clinical outcomes in patients with AF and ACS or PCI. Patients and methods This study included a total of 1237 patients with AF and ACS and 539 patients with AF and stable coronary artery disease (SCAD) who underwent PCI at the Fuwai Hospital of the Chinese Academy of Medical Sciences from January 2017 to December 2019. Patients were followed up until the end of 2021 to observe the occurrence of major adverse cardiovascular events (MACE). The relationship between sex and MACE was evaluated using Cox regression models and Kaplan–Meier’s survival curves. Results In patients with AF and ACS, multivariable COX regression analysis revealed that female patients were independently associated with a higher risk of MACE (HR = 1.45, 95% CI 1.11–1.89, p = .006). However, in AF patients with SCAD who underwent PCI, the analysis showed that female patients were not independently associated with MACE risk (HR = 1.12, 95% CI 0.62–2.03, p = .717). Conclusions In patients with AF and ACS, females have a significantly higher risk of long-term MACE compared to males. However, among patients with AF and SCAD who underwent PCI, there was no significant difference in long-term MACE risk between males and females.

Impact of complete revascularization on long-term clinical outcomes in patients with multi-vessel disease, including chronic total occlusion.

To compare the long-term prognostic effect of complete percutaneous coronary intervention (PCI) on cardiovascular events in chronic total occlusion (CTO) patients with the multi-vessel disease (MVD) compared with medical therapy (MT). We enrolled 441 patients with CTO and MVD who underwent PCI. The study population was divided into the CTO-PCI (n = 231) and the CTO-MT (n = 210) groups. Active PCI for non-CTO lesions was permitted in both groups. The primary endpoint was defined as the composite of all-cause death or myocardial infarction (MI). The primary endpoint occurred more frequently in the CTO-MT group (13.5%) than in the CTO-PCI group (4.7%; P = 0.002). However, the target vessel revascularization (TVR), as a secondary endpoint, occurred more in the CTO-PCI group (16.3% vs. 5.5%, P = 0.001). After propensity score matching (PSM) analysis, the primary endpoint was higher in the CTO-MT group (12.6%) than in the PCI group (2.3%): all-cause death (8.4% vs. 2.3%, P = 0.042) and MI (4.3% vs. 0.0%, P = 0.023). Moreover, TVR of the CTO lesions occurred more frequently in the CTO-PCI group (18.1% vs. 6.8%, P = 0.009). Significant improvement in the left ventricular ejection fraction (LVEF) was observed in both groups. According to the results of the subgroup analysis, CTO-PCI may be more effective in patients with diabetes, preserved LVEF (> 50%), and well-developed collateral vessels (> grade II). In this study, complete revascularization in CTO with MVD reduced the incidence of all-cause death, MI, and a composite of both over a 5year follow-up compared to medical treatment for CTO lesions.

Coronary vasospasm and cardiovascular outcomes in patients with isolated myocardial bridging: A retrospective study.

Mounting evidence suggests an associated between myocardial bridging (MB) and coronary vasospasm (CVS); however, no consensus has been established on whether CVS worsens clinical outcomes in patients with MB. Therefore, this retrospective study aimed to compare the long-term clinical outcomes in patients with MB based on CVS presence. This retrospective study enrolled 254 consecutive patients with MB undergoing provocative testing for coronary reactivity between January 1, 2009 and December 30, 2015, and stratified them into 2 groups: (a) group A (with CVS, n = 168); and (b) group B (without CVS, n = 86). The primary endpoints were major adverse cardiovascular events (MACEs), a composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, ischemia-driven revascularization, ischemia-driven coronary angiography, and ischemia-related hospitalization. Diverse Cox models were used to determine whether CVS independently influenced MACE. The mean age of study participants was 50.8 years, and 60.2% of them were male. The median follow-up period was 8.15 years. The rate of MACE was 35.1% and 26.7% in groups A and B, respectively. Group A had a significantly higher risk of MACE than group B (the reference group) in model 3 (hazard ratio [HR]:1.92; 95% confidence interval [CI]:1.12-3.29) and model 4 (adjusted HR: 1.94; 95% CI: 1.04-3.59). The presence of CVS adversely affects clinical outcomes in patients with MB. Further prospective clinical studies are required to confirm this association.

Baseline characteristics, management patterns and outcome in patients with pulmonary embolism and malignancy: Insights from a single-centre study

Background and aimAcute pulmonary embolism (PE) is one of the main causes of death in patients with active cancer. In this study, we evaluated the impact of malignancy on the treatment choices, and short- and long-term clinical outcomes in patients with acute PE. MethodsIn this study, 872 acute PE patients (age 61.6 ± 16.8 years, female 57.5 %) from different risk and treatment categories were retrospectively analyzed and divided into two groups according to the presence of active malignancy. ResultsActive malignancy was documented in 129 (14.8 %) out of the 872 patients. Ultrasound-assisted-thrombolysis (USAT), rheolytic-thrombectomy (RT), systemic-thrombolysis (ST) and anticoagulation-alone therapies were noted in 27.3 %, 6.4 %, 16.6 % and 49.7 % of overall PE patients. RT and anticoagulation therapies were more frequent in patients with malignancy whereas ST and USAT were more frequently used in the other group. Regardless of the presence of malignancy and the treatment modality chosen, significant improvements were achieved in all treatment targets (p < 0.001 for all). Bleeding rates were similar in both groups, while in-hospital and long-term mortality was higher in the malignancy cohort. Active malignancy was found to be an independent predictor for composite of 60-day mortality and PE-related rehospitalization (adjusted OR: 2.43; 95 % CI: 1.32–4.47, p = 0.04) and long-term mortality (adjusted HR: 2.25, 95 % CI: 1.29–3.91, p = 0.004). ConclusionConcomitant malignancy adversely affects both short- and long-term outcomes in patients with acute PE. Although these patients are more vulnerable, it is possible to achieve satisfactory treatment success with acceptable bleeding rates with the inclusion of catheter-based methods as treatment option.

Abstract 4114293: Impact of stent length on long-term clinical outcomes in acute myocardial infarction patients treated with second-generation drug-eluting stents

Background: Stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, there are few data in acute myocardial infarction (AMI) patients treated with very long drug-eluting stents (DES). We conducted this study to evaluate the impact of stent length on the long-term clinical outcomes. Method: The study included a total of 9,021 AMI patients who underwent PCI with 2 nd generation DESs. The patients were categorized into 3 groups according to the stent length: group A (&lt;38mm, n=6821), group B (38 – 59mm, n=1735) and group C (≥60mm, n=465) and compared using the inverse probability of treatment-weighted (IPTW) method. The primary outcome was the incidence of major adverse cardiac events (MACEs) up to 3years. Results: After adjustment for baseline differences, stent length was still significantly associated with higher cumulative rates of MACE [Odd ration(OR) :1.15 for 38 -59mm group, 95% confidence interval (CI): 1.06-1.26, p= 0.001, OR 1.23 for ≧ 60mm group, 95% CI: 1.13 -1.34, p&lt; 0.001], especially, non-target vessel revascularization (TVR), not TVR, (table). In subgroup analysis, 3-year TVR according to stent length, Biolimus A9 stent was associated with TVR in patient with more than 38-59mm stent (OR 6.50, 95% CI: 2.60 to 16.26, p 〈 0.001). Conclusion: Even in the 2 nd generation DES era, stent length was associated with adverse long-term clinical outcomes in patients with AMI. Interestingly, long stent implantation did not affect target vessel failure but non-TVR.

Abstract 4122710: Impact of cigarette smoking on long-term clinical outcomes in patients with coronary chronic total occlusion lesions

Cigarette smoking is a significant risk factor for coronary artery disease (CAD). However, evidence regarding on the long-term clinical effects of smoking in the Asian population with chronic total coronary occlusion (CTO) is insufficient. This study aimed to assess the effects of smoking on 5-year (median follow-up period 4.2 ± 1.5 years, interquartile range 4.06-5.0 years) clinical outcomes in patients with CTO lesions who had undergone percutaneous coronary intervention (PCI) or medical treatment (MT). We enrolled 681 consecutive patients with CTO who had undergone diagnostic coronary angiography and subsequent PCI or MT. Patients were categorized into smokers (n = 304) and non-smokers (n = 377). The primary endpoint encompassed major adverse cardiovascular events (MACE), including a composite of all-cause death, myocardial infarction (MI), and revascularization over a 5-year period. Propensity score matching (PSM) analysis was used to adjust for potential baseline confounders. After PSM analysis, two propensity-matched groups (200 pairs, n = 400) were generated, and the baseline characteristics of both groups were balanced. The smokers exhibited a higher cardiovascular risk of MACE (29.5% vs. 18.5%, p = 0.010) and non-target vessel revascularization (17.5 vs. 10.5%, p = 0.044) than those of the non-smokers(Table 1). In a landmark analysis using Kaplan-Meier (KM) curvesat the 1-year, the smokers had significantly higher rate of MACE in early period (up to 1-year) (18.8% and 9.2%, p=0.008) compared with non-smokers(Figure 1). Cox hazard regression analysis by propensity score-adjustedwith , revealed that smoking was independently associated with an increased risk of MACE. The findings indicate that smoking is a strong cardiovascular risk factor in patients with CTO, regardless of treatment strategies (PCI or MT) (Figure 2). In addition, in a subgroup analysis, the risk of MACE was most prominently elevated in the group of smokers who underwent PCI.

Abstract 4136632: Impact of Postoperative Atrial Fibrillation on Long-term Clinical Outcomes in Patients after Coronary Artery Bypass Grafting

Background: The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes has not been adequately evaluated yet. Methods: Among consecutive 14927 patients who underwent their first coronary revascularization in the CREDO-Kyoto PCI/CABG Registry Cohort-3 (2011-2013), the study population consisted of 1483 patients who underwent CABG after excluding those with prior AF. POAF was defined as newly documented AF during hospitalization for CABG. The primary outcome measure was all-cause death after discharge. The median clinical follow-up was 5.7 (interquartile range, 4.4-6.6) years. Results: POAF was observed in 337 patients (23%). Multivariable logistic regression analysis indicated that age &gt;=75 years (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.24-2.10; P&lt;0.001) and cardiopulmonary bypass (CPB) use (OR, 1.40; 95%CI, 1.09-1.79; P=0.01) were independent predictors of POAF. Of the 1400 patients discharged alive among the study population, the POAF group included more older patients, patients with prior stroke, and patients prescribed beta-blockers and oral anticoagulants than the non-POAF group. The cumulative 5-year incidence of all-cause death was 15.9% in the POAF group and 13.0% in the non-POAF group (Log-rank P=0.38). After adjusting for confounders, the adjusted risk for all-cause death was almost neutral (adjusted HR, 0.96; 95%CI, 0.70-1.31; P=0.81). The cumulative 5-year incidence of stroke was significantly higher in the POAF group than in the non-POAF group (8.0% versus 4.2%; Log-rank P=0.02), and the adjusted risk of stroke in the POAF group relative to the non-POAF group tended to be higher (adjusted HR: 1.58, 95%CI, 0.99-2.53; P=0.057). However, the cumulative 5-year incidence of major bleeding was significantly higher in the POAF group than in the non-POAF group (14.6% versus 10.7%; Log-rank P=0.01). Even after adjusting for confounders, the excess risk of major bleeding in the POAF group was significant (adjusted HR, 1.42; 95%CI, 1.01-2.00; P=0.041). Conclusions: Advanced age and CPB use were associated with POAF occurrence. POAF was not associated with long-term mortality after discharge. However, it tended to be associated with a higher risk for stroke and was associated with a significantly higher risk for major bleeding. Further study would be needed to clarify the appropriate management of POAF after CABG.

Long-term Clinical Outcomes of Patients With Medullary Thyroid Cancer: A Single Institution, Tertiary Referral Centre Experience

AimsMedullary thyroid cancer (MTC) is a rare form of thyroid cancer with a variable disease course. We aimed to conduct a real-world analysis of the clinical outcomes of patients with MTC, thereby providing further insight into the prognosis and management. Materials and methodsAll patients with MTC whose data were available on electronic patient records since its introduction in 1992 at our institution were collected retrospectively. Data collected include patient characteristics, staging, treatment modalities and survival outcomes. The data extraction cut-off was 31st December 2022. Progression-free survival (PFS) and overall survival (OS) were analysed using Kaplan–Maier curves and log-rank test. The significance threshold was set at p value <0.05. Results164 patients were included in this study. The median age at presentation was 44 years. Majority of patients (61%) presented with advanced disease; 41% were stage IVa, 4% IVb and 16% IVc. The 10-year OS was 92% for stage I-III disease, 77% for stage IVa/b and 38% for stage IVc. Germline rearranged during transfection (RET) mutations were detected in 21% of patients. 98% of patients received primary surgery and 24% received systemic treatment for recurrent/metastatic disease, with a high response rate seen with RET-specific inhibitors in those with RET-mutant MTC. Adjuvant radiotherapy improved locoregional control for those with locally advanced disease (p = 0.001) but failed to translate into OS benefit (p = 0.486). ConclusionSurvival outcomes observed in our cohort mirror those reported in the literature and highlight the need for improved therapy options, especially in those presenting with metastatic disease. Our data reaffirmed a lack of survival benefit with adjuvant radiotherapy for MTC with a high rate of systemic relapse and future research should focus on evolving mechanisms of resistance to novel tyrosine kinase inhibitors.

Clinical Impact of Sarcopenia Screening on Long-Term Mortality in Patients Undergoing Coronary Bypass Grafting.

Sarcopenia is an aging-related condition characterized by loss of skeletal muscle mass and is an indicator of subclinical atherosclerosis. The relationship between reduced muscle mass and long-term clinical outcomes in patients with advanced coronary artery disease who have undergone coronary artery bypass grafting (CABG) is not fully understood. This study is sought to evaluate the prognostic implications of sarcopenia screening in patients undergoing CABG. A total of 2810 patients who underwent CABG were analysed and classified according to presence of reduced muscle mass. The skeletal muscle index (SMI) was calculated as L3 muscle area (cm2)/height (m)2 on computed tomography. Reduced SMI was defined as SMI ≤ 45 cm2/m2 in male and ≤ 38 cm2/m2 in female. The primary outcome was all-cause mortality, and survival analysis was performed using the Kaplan-Meier method and compared with the log-rank test. The median follow-up was 8.7 years, and 924 patients (32.9%) had reduced SMI. Patients with reduced SMI were older (67.7 ± 8.8 vs. 62.2 ± 9.8 years; p < 0.001) and less frequently male (69.8% vs. 81.1%; p < 0.001). SMI was significantly associated with risk of death on a restricted cubic spline curve (HR = 1.04 per-1 decrease; 95% CI 1.03-1.05; p < 0.001). Patients with reduced SMI had a higher incidence of long-term mortality than those with preserved SMI (survival rate 41.4% vs. 62.8%; HRadj = 1.18, 95% CI 1.03-1.36, p = 0.020). Subgroup analysis showed that the prognostic implication of reduced SMI on long-term survival was more evident in male (HRadj = 2.01, 95% CI 1.72-2.35) than female (HRadj = 1.28, 95% CI 0.98-1.68) (interaction p = 0.006). Reduced muscle mass, defined by SMI on computed tomography, was associated with long-term mortality after CABG. These results provide contemporary data to allow the evaluation of physical frailty in patients with advanced coronary artery disease before surgery. Long-Term Outcomes and Prognostic Factors in Patients Undergoing CABG or PCI: NCT03870815.

The Predictive Value of the CatLet Scoring System for Long-Term Prognosis After Percutaneous Coronary Intervention in Patients With Chronic Coronary Syndrome.

Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system is a newly developed vascular scoring for assessing the degree of coronary artery stenosis and coronary artery variability. Preliminary studies have demonstrated its superiority over the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score in predicting outcome in patients with acute myocardial infarction (AMI). This study aimed to assess the predictive value of the CatLet score in long-term prognosis after PCI for chronic coronary syndrome (CCS). A total of 201 patients, who were diagnosed with chronic coronary syndrome, undergoing coronary DES implantation and calculable Catlet score at the Second Affiliated Hospital of Wannan Medical College in China were consecutively enrolled from January 2020 to June 2021. The primary endpoint was major adverse cardiac events (MACEs), defined as a composite of myocardial infarction, recurrent angina, cardiac death, heart failure and ischemia-driven revascularization, were stratified according to CatLet score tertiles: 0 ≤ CatLet_low ≤ 23(n = 66), CatLet_mid 24-43(n = 68), and CatLet_top ≥ 44(n = 67), respectively. The CatLet score predicted long-term prognosis with a median follow-up of 3.0 years. Of 201 patients analyzed, the rates of MACEs and cardiac death were 25.37% and 3.98%, respectively. The Kaplan-Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the CatLet score, with p-value < 0.05 on the trend test. For MACE and cardiac death, the area under the curve (AUC) of the CatLet score was 0.744 (95% confidence interval [CI]: 0.668-0.820) and 0.804 (95% CI: 0.672-0.936), respectively; Alone or after adjusting for risk factors, the multivariable-adjusted hazard ratio (95% CI)/unit higher score was 9.41 (3.18-27.85) for MACEs and 1.85 (1.20-2.84) for cardiac death, respectively. The CatLet score is an independent predictor of long-term clinical outcomes in patients with chronic coronary syndrome after percutaneous coronary intervention.

Long-term Clinical Outcomes in Patients with Waldenström Macroglobulinemia (WM) Who Received Zanubrutinib in the Phase 3 ASPEN Study: A Report from the Zanubrutinib Extension Study

Long-term Clinical Outcomes in Patients with Waldenström Macroglobulinemia (WM) Who Received Zanubrutinib in the Phase 3 ASPEN Study: A Report from the Zanubrutinib Extension Study

Impact of Triglyceride Levels on the Long-term Clinical Outcomes in Patients With Acute Myocardial Infarction.

Hypertriglyceridemia is a known cardiovascular risk factor. However, the relationship between serum triglyceride (TG) levels and the clinical outcomes in patients with acute myocardial infarction (AMI) is unclear. We conducted a single-center, retrospective observational study involving 538 consecutive patients with AMI who underwent emergent percutaneous coronary intervention within 12 hours of onset. Patients were categorized into three groups based on their serum TG levels at admission as follows: T1 group (TG <78 mg/dl, n=172), T2 group (78≤TG<141 mg/dl, n=177), and T3 group (141 mg/dl ≤TG, n=176). The primary endpoint was major adverse cardiovascular events (MACEs) defined as a composite of cardiovascular death, non-fatal MI, and non-fatal stroke. The median follow-up period was 2.4 (1.5-4.2) years. Patients in the T1 group were older, had a higher proportion of females, and had fewer cardiovascular risk factors. However, they also had a higher prevalence of multi-vessel coronary artery disease and severely calcified culprit lesions. The T1 group had a significantly higher rate of MACEs (20.4% in T1, 12.4% in T2 and 8.5% in T3, p<0.05 by Log-rank test, respectively). Multivariate analysis revealed that T1 was an independent predictor of MACEs (hazard ratio=2.19, 95% confidence interval=1.16-4.14, p<0.05). Although patients with AMI with low TG levels at admission had fewer coronary risk factors, they had more severe calcified culprit lesions and worse clinical outcomes.

Impact of real-world off-label dose of Apixaban on long-term clinical outcomes in patients with atrial fibrillation and chronic kidney disease

Abstract Background Apixaban represent one of the cornerstone treatments to prevent cardioembolic events in patients with nonvalvular atrial fibrillation (NVAF). However, the choices of Apixaban dose guided by the decision-making process of the physician, which considers specific according to kidney functions are inconsistent in the real-world practice. Objective The objective of the present study is to evaluate the effects of real-world Off-label dose of Apixaban on long-term clinical outcomes in NVAF patients with chronic kidney disease (CKD). Methods Our database of AF patients diagnosed with CKD from 2018 to 2023 was used to obtain laboratory, echocardiography, electrocardiogram (ECG), and clinical outcomes data. Inclusion criteria were all AF patients with CKD using Apixaban. And we compared bleeding, systemic thrombotic events including stroke/systemic embolism and death according to off-label real -world dose of Apixaban. Results Among 635 patients with AF and CKD (76.9±10.4 years), 335 (52.8%) patients took off-label underdosed Apixaban. Difference in the baseline characteristics was not observed among patients including CHA2DS2 VASc score and HASBLED score. During the median 18-month follow-up, a lower incidence of bleeding events (P=0.001) was observed in the off-label underdosed Apixaban group compared to those with standard dose or off-label overdosed Apixaban. However, there was no significant difference of systemic thrombotic events including stroke/systemic embolism and death according to off-label real-world dose of Apixaban (off-label underdose vs. standard dose, P=1.000; off-label overdose vs. standard dose, P=1.000; off-label underdose vs. off-label overdose, P=0.609). In multivariate analysis, HASBLED score was independent risk factors for bleeding events (OR 9.650; CI 1.998-46.622; P=0.005). Conclusions Compared with standard or off-label overdose of Apixaban, off-label underdose of Apixaban was associated with a lower risk of bleeding in patients with AF and CKD, with no difference in the risk of stroke/systemic embolism or death, supporting the apixaban dosing tailored to specific clinical features and drug pharmacokinetics of the Asian patients.