Major Adverse Cardiac Or Cerebrovascular Events Research Articles

Unprotected left main stenting with a second-generation drug-eluting stent: one-year outcomes of the LEMAX Pilot study

We sought to assess the efficacy and safety of everolimus-eluting stents for unprotected left main disease. A total of 173 consecutive patients with de novo significant unprotected left main stenosis received an everolimus-eluting stent in four French centres. Among them, 140 (81 %) had involvement of the distal portion of left main, and 129/140 (92%) were treated with provisional side branch T-stenting, with a side branch stenting rate of 20%. Angiographic success was achieved in all cases. At 12 months, the cumulative rate of major adverse cardiac or cerebrovascular events (MACCE) was 26/173 (15%) including death from any cause (N=5, 2.9%), stroke (N=4, 2.3%), Q-wave myocardial infarction (MI) (N=2, 1.2%), non-Q-wave MI (N=6, 3.5%) and any repeat revascularisation (N=16, 9.3%). At one year, the rate of target-lesion revascularisation (TLR) was 5/173 (2.9%), target-vessel revascularisation was 12/173 (7 %) and the rate of definite or probable left main stent thrombosis 1/173 (0.6 %). Unprotected left main stenting using everolimus-eluting stents and a strategy of provisional side branch T-stenting for distal lesions, is safe and effective in the midterm, with a relatively low rate of events and reintervention at one year.

An integer based risk score for predicting 30-day major adverse cardiac or cerebrovascular events after percutaneous coronary intervention with drug-eluting stents: results from a?large prospective multicentre registry, the STENT Group

Previous risk models predicting in-hospital major adverse cardiac or cerebrovascular events (MACCE) after percutaneous coronary interventions (PCI) may underestimate actual short-term post-procedure complications due to the trend toward early discharge of patients. Using a subset (N=10,679) from the STENT Group registry, a logistic regression model was developed to predict 30-day MACCE which includes death, myocardial infarction, target vessel revascularisation and stroke. An integer-based risk score was created from the model and validated in another subset (N=3,099). In the study subset, there was significant difference between in-hospital and 30-day MACCE N=443 (2.0%) vs. 131 (4.2), p<0.01, respectively. A final risk model included nine variables; absence of pre-procedural statin (odds ratio=1.3, 95% confidence interval=1.0-1.5), haemoglobin level (0.9/1 gm increase, 0.8-0.9), cardiogenic shock (4.4, 3.1-6.3), acute congestive heart failure (1.6, 1.2-2.3), left main disease (2.2, 1.3-3.7), left anterior descending artery lesion (1.3, 1.0-1.5), ostial lesion (1.6, 1.2-2.1), coronary thrombosis (2.0, 1.4-2.9) and ACC/AHA type C lesion (1.3, 1.1-1.6). The c-statistics of the final model were 0.653 and 0.692 in the study and validation subset, respectively. In this large real world registry of DES, in-hospital MACCE did not represent short-term post-procedure prognosis. The risk model consisting of nine variables predicted 30-day MACCE with modest discriminatory value.

019 Interest of the SYNTAX Score to predict cardiovascular outcomes after stenting of unprotected left main coronary artery stenosis: 2 Years Follow-up of the ALMA registry

The SYNTAX (SX) score, an interesting tool to characterize the severity of the coronary artery disease was designed to predict cardiovascular outcomes in patients with three-vessel or unprotected left main coronary artery (ULMCA) disease in the SYNTAX study. However, the prognostic value of SX score in patients undergoing percutaneous coronary intervention (PCI) of ULMCA stenosis needs to be validated in the “real world”. The aim of our study was to evaluate the clinical outcome of all the patients undergoing PCI for ULMCA stenosis according to the SX score in a monocentric registry. Forty-five patients with de novo ULMCA stenosis (mean age 72 ± 10 years; 76% of male) underwent PCI with bare metal stent (BMS) or drug eluting stent (DES) from January 2006 to December 2008 and were included in the ALMA ( A ngioplasty of L eft M ain at l A riboisière hospital) registry. Twenty nine percent of patients were diabetics, mean ejection fraction (EF) was 54 ± 10%. EuroSCORE value was 5.4 ± 3.2 and SX score was 22 ± 8. Ostial ULMCA stenosis was involved in 27% and distal ULMCA lesion in 62% of cases. Distal ULMCA stenoses were treated by provisional T stenting in most of the cases, with one stent implantation in 48% of patients and with two stents in 44%. Clinical follow-up was achieved in all patients (25 ± 10 months). In-hospital MACCE occurred in 6.7% of patients (2 death and 1 myocardial infarction). The rate of major adverse cardiac or cerebrovascular events (MACCE) was 35.6%. Cardiac mortality in the registry was 8.8% at two years. Target lesion revascularisation occurred in 15.6% of patients (7.1% in the DES group vs. 19.4% in the BMS group; p = 0.31). None of the patients showing restenosis died. SX score was correlated to MACCE and cardiovascular death. A higher SX score (≥33) compared to the lower group (SX score between 0 to 32) is significantly associated with MACCE (83,3% vs. 28,1%; p < 0.01) and cardiac mortality (33.3% vs. 7.7%; p = 0.04). The SX score is a useful tool to predict MACCE and cardiac mortality in patients undergoing percutaneous revascularization of the left main coronary artery.

Treatment of Obstructive Sleep Apnea Is Associated With Decreased Cardiac Death After Percutaneous Coronary Intervention

Our purpose was to compare outcomes of patients treated for obstructive sleep apnea (OSA) versus patients with untreated OSA, all of whom had undergone percutaneous coronary intervention (PCI). Obstructive sleep apnea has been associated with increases in fatal and nonfatal cardiovascular events. It is not known whether treatment of OSA in patients who have had PCI results in a better outcome. In a retrospective cohort study, a group of patients with OSA diagnosed with polysomnography between 1992 and 2004 (apnea-hypopnea index > or =15) who subsequently underwent a PCI (n = 371) were stratified according to whether they were treated for OSA (n = 175) or not (n = 196). Main outcome measures were cardiac death, general mortality, major adverse cardiac events (MACE) (severe angina, myocardial infarction, PCI, coronary artery bypass grafting, or death), and major adverse cardiac or cerebrovascular events (MACCE). Patients treated for OSA had a statistically significant decreased number of cardiac deaths on follow-up when compared with untreated OSA patients (3% [95% confidence interval (CI) 0% to 6%] vs. 10% [95% CI 5% to 14%] after 5 years, p = 0.027), as well as a trend toward decreased all-cause mortality (p = 0.058). There was no difference in the number of MACE or MACCE between the 2 groups (p = 0.91 and 0.96, respectively). Treatment of OSA is associated with a reduction in the number of cardiac deaths, but not in MACE or MACCE, after PCI. Screening for and treating OSA in patients with coronary artery disease who may undergo PCI may result in decreased cardiac death.