Percutaneous Coronary Intervention For Coronary Artery Disease Research Articles

Prognosis after switching to electronic cigarettes following percutaneous coronary intervention: a Korean nationwide study.

Despite the increasing popularity of electronic cigarettes (E-cigarettes), the prognostic impact of switching to E-cigarettes in smokers with coronary artery disease who have undergone percutaneous coronary intervention (PCI) remains unclear. Using a nationwide cohort from the Korean National Health Insurance database, 17 973 adults (≥20 years) identified as smokers (based on a health screening examination within 3 years before PCI) who underwent health screening within 3 years after PCI were enrolled to determine changes in smoking habits. Patients were classified as continued combustible cigarette users, successful quitters, or switchers to E-cigarettes. The group switching to E-cigarettes was further divided into dual users (using both combustible and E-cigarettes) and those exclusively using E-cigarettes. Primary outcomes included major adverse cardiac events (MACEs), a composite of all-cause death, spontaneous myocardial infarction, and repeat revascularization. Among the total population, 8951 patients (49.8%) continued using combustible cigarettes, 1694 (9.4%) were switched to E-cigarettes, and 7328 (40.7%) successfully quit smoking after PCI. During a median follow-up of 2.4 years, the cumulative incidence of MACE was lower among E-cigarette switchers (10%) or quitters (13.4%) than among continued combustible cigarette users (17%). When continued combustible cigarette users were used as the reference, the multivariable-adjusted hazard ratios with 95% confidence intervals for MACE were 0.82 (0.69-0.98) for switchers to E-cigarettes and 0.87 (0.79-0.96) for successful quitters. Compared with dual users, entirely switching to E-cigarettes was associated with a significantly lower MACE risk (hazard ratio 0.71; 95% confidence interval 0.51-0.99). Among smokers who underwent PCI for coronary artery disease, switching to E-cigarette use (particularly complete transition) or quitting smoking was associated with reduced MACE risk than with continued combustible cigarette use. ClinicalTrials.gov NCT06338761.

Pattern of Coronary Angiography in Young Adults versus Older Adults Presented by Coronary Artery Disease in Correlation to Their Risk Factors with 1-year Follow-up of Their Clinical Outcome

Abstract Background: Coronary artery disease (CAD) is a leading cause of mortality worldwide, with varying patterns and risk factors across different age groups. While CAD is common in older adults, data on young adults are limited, with traditional risk factors and familial history playing a significant role in early disease development. The purpose of this study was to compare the coronary angiographic patterns in young adults (<40 years) and older adults (≥40 years) presented with CAD, assess the correlation with risk factors, and monitor clinical outcomes after 1 year. Patients and Methods: This retrospective cohort study was conducted at the National Heart Institute, including 2204 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention for CAD from January 2019 to January 2020. Patients were divided into two groups based on age: group A (<40 years) and Group B (≥40 years). Angiographic findings, risk factors, and clinical outcomes were assessed and compared. Results: Group B had significantly higher rates of hypertension (63.6% vs. 22.2%, P < 0.001), diabetes (53.5% vs. 24.1%, P < 0.001), and female gender (29% vs. 11.1%, P < 0.001) compared to Group A. Group A showed higher smoking rates (70.4% vs. 46.5%, P < 0.001) and positive family history (42.6% vs. 4.4%, P < 0.001). Angiographic findings revealed higher rates of single-vessel affection, coronary ectasia, aneurysm, and slow flow phenomenon in Group A, whereas Group B demonstrated more bifurcation lesions, chronic total occlusion, and calcification. Conclusions: This study highlights the need for age-specific approaches in managing CAD, with younger patients showing early disease onset and older patients exhibiting more complex disease. Tailored cardiovascular care is essential, focusing on lifestyle modifications in younger adults and managing metabolic conditions in older adults.

Blood pressure and mortality after percutaneous coronary intervention: a population-based cohort study

Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. However, studies on blood pressure control targets in these patients remain insufficient. To assess the relationship between baseline blood pressure and all-cause mortality in CAD patients who underwent PCI. A population-based retrospective cohort study based on the national claims database of the Korean National Health Insurance System, which represents the entire Korean population. A total 38,330 patients with a history of PCI for CAD between 2005 and 2008 were recruited and followed up for all-cause mortality until December 31, 2017. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and they were classified into eight SBP and DBP groups each. The hazard ratios (HRs) for all-cause mortality were measured for each group. The pattern of SBP and DBP in this population followed a J-curve relationship for all-cause mortality, with the nadir point at 119 and 74 mmHg, respectively. In subjects aged > 60 years, high SBP (≥ 160 mmHg) and high DBP (≥ 90 mmHg) were significantly related to death. Moreover, in subjects aged > 60 years, low DBP (< 70 mmHg) was significantly related to mortality. There is a J-curve relationship between baseline blood pressure and all-cause mortality in patients who underwent PCI, and intensive lowering of blood pressure may be beneficial for these patients. However, the elderly population needs more attention as excessive BP lowering, particularly DBP, could instead increase the risk of death.

Gender Differences in Healthy Lifestyle Adherence Following Percutaneous Coronary Intervention for Coronary Artery Disease

Coronary artery disease (CAD) is the leading cause of mortality in Australian women. We identified gender differences in healthy lifestyle adherence in patients treated with percutaneous coronary intervention (PCI) for CAD. Consecutive patients were prospectively recruited from three Australian institutions (2016-2017). The primary endpoint at 1 year follow-up was healthy lifestyle adherence defined as 3/3 of: a heart-healthy diet, being physically active and not smoking. Secondary endpoints included cardiac rehabilitation attendance, medication use and lipid levels. From 729 participants (n=192, 26.3% women) 56% were adherent to all three lifestyle measures with no gender difference overall. Compared to men, women were less likely to smoke (7.7% versus 12.2%, p<0.001) to be physically active (61.5% versus 78.2%; p<0.0001), attend cardiac rehabilitation (58.2% versus 66.4%; p<0.045), and take statin therapy (85.4% versus 94.7%; p<0.0001). Female gender independently predicted physical inactivity (OR 2.41, 95% CI 1.57-3.68, p<0.001). Important gender differences exist in patients treated with PCI for CAD, namely, significant lower physical activity, cardiac rehabilitation attendance and statin use in women. These all represent key targets for gender-specific secondary prevention interventions.

Drug-Eluting Stents Versus Bare-Metal Stents in Large Coronary Artery Revascularization: Systematic Review and Meta-Analysis

ObjectivesWe aim to determine if drug eluting stents (DES) are better than bare-metal stents (BMS) in large coronary artery (diameter ≥ 3 mm) percutaneous coronary intervention (PCI). BackgroundDES have become the standard of care for PCI in coronary artery disease (CAD). However, the superiority of DES over BMS in large vessel CAD is not clear and previous studies have shown conflicting results. MethodsRandomized controlled trials (RCTs) comparing outcomes of PCI with BMS and DES for large vessel CAD were identified from the year 2000 to August 2019. The outcomes were studied individually and included all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis. Aggregated odds ratio and 95% CI were calculated using a random-effects model. ResultsEight RCTs were included (4 with data for first-generation DES, 3 with data for second-generation DES, and 1 with data for both first- and second-generation DES). Compared to BMS, second generation DES had a significantly lower rate of all-cause mortality (2.4% vs. 3.9%, OR 0.74, 95% CI 0.56–0.98, P 0.04), TLR (3.5% vs. 8.6% OR 0.38 95% CI 0.28–0.53, P < 0.001), and MI (2.1% vs. 2.9% OR 0.73 95% CI 0.53–1.0, P 0.05). The difference in all-cause mortality was not seen with first-generation DES. ConclusionNewer DES are associated with a lower mortality, TLR, and MI and thus should be preferred over BMS for large coronary artery PCI.

910 Uptake and Utilisation of Intravascular Imaging to Guide Percutaneous Coronary Intervention: Insights from the Victorian Cardiac Outcomes Registry

Percutaneous coronary intervention (PCI) remains an established therapeutic option for myocardial revascularisation. Use of intravascular imaging to guide PCI is known to improve clinical outcomes, with this benefit most pronounced when tackling complex lesion subsets. We therefore sought to ascertain the current uptake and use of intravascular imaging based on anonymised data from the Victorian Cardiac Outcomes Registry (VCOR). All consecutive patients undergoing PCI for coronary artery disease (CAD) were included (n=51,044) from January 2013 through December 2018. Intravascular imaging included intravascular ultrasound (IVUS) and optical coherence tomography (OCT) use. Patient/lesion characteristics were obtained and compared between angiographic- and imaging-PCI guided groups. Overall, 873 (1.7%) of patients had intravascular imaging to guide PCI during the study period, with IVUS used in 602 (1.2%), OCT in 246 (0.48%) and both in 25 (0.05%) cases. There was an increase in case rates of intravascular imaging year on year (p=0.001). Intravascular imaging was more commonly used in patients with diabetes (p=0.04) and those with stable CAD (p<0.001). Although angiographically-guided PCI remained the default modality used for treatment of all complex lesion subsets, rates of intravascular imaging use were higher for left-main stem intervention (14.7%), stent thrombosis (9.4%), in-stent restenosis (4.6%), treatment of chronic total occlusions (3.0%) and AHA Type B2/C lesions (1.9%). The uptake of intravascular imaging use during PCI remains limited in Victoria, even when considering more complex PCI procedures. These data should renew our focus on education, reimbursement and support for using intravascular imaging in Australia.

The Role of Xuefu Zhuyu Decoction in Prevention of Contrast‐Induced Nephropathy after Percutaneous Coronary Intervention

Objective This study aimed to investigate the effect of Xuefu Zhuyu decoction on preventing contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Methods A total of 256 patients undergoing selective PCI for coronary artery disease were consecutively enrolled and randomly divided into two groups: Group A (n = 126) and Group B (n = 130). Before and after PCI, all patients routinely received antiplatelet aggregation therapy, antilipidemic therapy, and hydration therapy. Besides routine therapy, patients in Group B received Xuefu Zhuyu decoction from 3 days before PCI to 3 days after PCI. Serum creatinine (Scr), estimated glomerular filtration rate (eGFR), superoxide dismutase (SOD), and malondialdehyde (MDA) were measured, respectively, at baseline (72 h before PCI) and at 24, 48, and 72 h after PCI. Results Compared with Group A, Group B presented a lower fluctuation of SCr and eGFR (P < 0.01). The incidence of CIN was less in Group B. According to the definition, CIN occurred in 5 patients (2.0%) in the intervention group and 5 (4.0%) in the control group (P=0.167). In terms of oxidative stress, Group B had a lower MDA (P < 0.05), but a higher SOD (P < 0.05). Conclusions Compared with the control group, Xuefu Zhuyu decoction intervention therapy increased the level of SOD and reduced MDA. The Xuefu Zhuyu decoction intervention group presented a higher level of eGFR at 24, 48, and 72 h after PCI in patients with coronary heart disease and a lower level of Scr. The results are propitious to prove that Xuefu Zhuyu decoction might play an antioxidative stress role in the prevention of CIN after PCI.

Incidence, retrieval methods, and outcomes of intravascular ultrasound catheter stuck within an implanted stent: Systematic literature review

BackgroundThere have been no reviews regarding intravascular ultrasound (IVUS) catheter entrapment during percutaneous coronary intervention (PCI). This study investigated the incidence, retrieval methods, and outcomes of IVUS catheter stuck within implanted stents. MethodsBetween January 2015 and July 2018, a total of 794 consecutive patients underwent PCI for coronary artery disease. Among them, 705 patients underwent stent implantation using IVUS. The patients with IVUS catheter entrapment in an implanted stent were investigated. ResultsTen patients (1.4%) suffered from an IVUS catheter stuck in an implanted stent. Among them, 7 patients had very tortuous lesions while 5 patients had severely calcified lesions. Seven patients (70%) underwent placement of the 3rd generation drug-eluting stent (DES), and the stent diameters were ≤2.5mm among 8 patients (80%). Retrieval methods were the buddy wire technique, the double guide catheter technique, covering the exit port of IVUS catheter with a balloon catheter, and covering with GuideLiner® catheter (Vascular Solutions Inc., Minneapolis, MN, USA). On multivariable analysis, the predictors of IVUS catheter entrapment were tortuous lesion [odds ratio (OR), 8.21; 95% confidence interval (CI), 2.19–30.7; p=0.002], 3rd generation DES (OR, 5.31; 95% CI, 1.08–26.1; p=0.021), and stent diameter ≤2.5mm (OR, 6.31; 95% CI, 1.29–30.8; p=0.010). Furthermore, we identified 6 cases of IVUS catheter entrapment through a systematic literature review. ConclusionsThe IVUS catheter was almost stuck in tortuous lesions and the 3rd generation DES with a small diameter. We could successfully retrieve it in all cases using various retrieval techniques.

Impact of serum 1,5-anhydro-d-glucitol level on the prediction of severe coronary artery calcification: an intravascular ultrasound study

BackgroundA low 1,5-anhydro-d-glucitol (AG) blood level is considered a clinical marker of postprandial hyperglycemia. Previous studies reported that 1,5-AG levels were associated with vascular endothelial dysfunction and coronary artery disease (CAD). However, the association between 1,5-AG levels and coronary artery plaque in patients with CAD is unclear.MethodsThis study included 161 patients who underwent percutaneous coronary intervention for CAD. The culprit plaque characteristics and the extent of coronary calcification, which was measured by the angle of its arc, were assessed by preintervention intravascular ultrasound (IVUS). Patients with chronic kidney disease or glycosylated hemoglobin ≥ 7.0 were excluded. Patients were divided into 2 groups according to serum 1,5-AG levels (< 14.0 μg/mL vs. ≥ 14 μg/mL).ResultsThe total atheroma volume and the presence of IVUS-attenuated plaque in the culprit lesions were similar between groups. Calcified plaques were frequently observed in the low 1,5-AG group (p = 0.06). Compared with the high 1,5-AG group, the low 1,5-AG group had significantly higher median maximum calcification (144° vs. 107°, p = 0.03) and more frequent calcified plaques with a maximum calcification angle of ≥ 180° (34.0% vs. 13.2%, p = 0.003). Multivariate logistic regression analysis showed that a low 1,5-AG level was a significant predictor of a greater calcification angle (> 180°) (OR 2.64, 95% CI 1.10–6.29, p = 0.03).ConclusionsLow 1,5-AG level, which indicated postprandial hyperglycemia, was associated with the severity of coronary artery calcification. Further studies are needed to clarify the effects of postprandial hyperglycemia on coronary artery calcification.

XLIMus drug eluting stent: A randomIzed controlled Trial to assess endothelialization. The XLIMIT trial

BackgroundThin strut 3rd generation drug eluting stents offer the potential advantage over the previous generation of better technical performance and reduced neointimal proliferation parameters, which are linked to mid and late term device failure. AimTo evaluate the performance of the Xlimus sirolimus-eluting stent (SES) against the Synergy everolimus-eluting stent (EES) in terms of device reendothelialization in patients undergoing PCI for coronary artery disease (CAD). MethodsXLIMIT is a multicenter randomized controlled trial targeting 180 patients requiring percutaneous coronary interventions (PCI). Patients will be treated with Xlimus SES or Synergy EES implantation and randomization will be performed in a 2:1 ratio. The primary endpoint will be the reendothelialization grade of the Xlimus stent in terms of strut coverage and neointimal hyperplasia volume as compared to Synergy. Secondary endpoints will be represented by clinical and procedural outcomes. The first patient was enrolled on February 2019. ConclusionsA clearer understanding of the endothelialization process of new generation DES could significantly impact the treatment with dual antiplatelet therapy in the future. Moreover, although not powered for clinical end-points, the XLIMIT trial will provide randomized data in a population with minimal exclusion criteria. Trial registrationClinicalTrials.gov Identifier: NCT03745053. Registered on November 19, 2018.

Gender Differences in Adherence to Healthy Lifestyle Following Percutaneous Coronary Intervention for Coronary Artery Disease

Background: Exercise, a heart-healthy diet and smoking cessation reduce mortality in coronary artery disease (CAD) patients. However, gender differences in adherence rates to recommendations for healthy lifestyle aren’t well known. Aims: To ascertain gender differences in healthy lifestyle adherence at 12-month follow-up after percutaneous coronary intervention (PCI) for CAD. Methods: Patients who underwent PCI at three hospitals were prospectively followed throughout hospital admission, at 30 days and 12 months. The primary endpoint was adherence to a healthy lifestyle defined as 3/3 of heart-healthy diet, physically active and no current smoking. Secondary endpoints included each aspect of this primary endpoint, change from baseline cholesterol levels and cardiac rehabilitation attendance. Results: 729 people (26% female) were recruited. Women were older, with more diabetes and lower baseline TC and LDL. Adherence to healthy lifestyle at 12 months post-PCI was 56.6% with no significant difference between genders (51.3% vs 58.5%, p = 0.084). Women were more sedentary compared to men (38.7% vs 21.8%, p = <0.001). Men smoked more (13.8% vs 7.7%, p = 0.029), with no significant difference in healthy eating habits (82.4% vs 85.7%, p = 0.309). Women had a smaller reduction in mean LDL (0.60 vs 0.89, p = 0.23) and TG (0.34 vs 0.44, p = 0.46). Less women attended cardiac rehabilitation (58.2% vs 66.4%, p = 0.045). Conclusions: At 12 months following PCI for CAD, 56.6% of patients adhered to healthy lifestyles with no significant difference between genders. Women were significantly more likely to be sedentary, not attend cardiac rehabilitation and smoke less. Women had smaller reductions in LDL and TG levels.

Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis

BackgroundThe purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking.MethodsSixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training.ResultsSignificant differences were observed in the change in %body fat (TW: −2.7%, AW: −2.8%, CON: −0.4%), total cholesterol level (TW: −23.6 mg/dL, AW: −27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: −6.3 bpm, AW: −6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO2 peak (TW: 2.3 mL/kg·min−1, AW: 2.0 mL/kg·min−1, CON: −2.5 mL/kg·min−1) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups.ConclusionAW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden)

To determine gender differences and predictors of all-cause mortality (30 days and 1 year) after percutaneous coronary intervention (PCI) in patients with stable angina pectoris and acute coronary syndrome (non-ST-elevation myocardial infarction/unstable angina pectoris and ST-elevation myocardial infarction) in the British Cardiovascular Intervention Society (BCIS) and Swedish Coronary Angiography and Angioplasty Registry (SCAAR) data sets, an analysis of prospectively collected data from 2007 to 2011 was performed. In total, 458,261 patients (BCIS: n= 368,492 [25.9% women]; Sweden: n= 89,769 [27.2% women]) who underwent PCI were included in this analysis. Using multiple regression analysis, in the BCIS registry, female gender was an independent predictor of all-cause mortality at 30 days (odds ratio [OR] 1.15, 95% CI 1.10 to 1.22, p <0.0001) and at 1 year (OR 1.08, 95% CI 1.04 to 1.12, p<0.0001) after PCI for all patients. Likewise, in the SCAAR registry, female gender was an independent predictor of all-cause mortality at 30 days (OR 1.15, 95% CI 1.05 to 1.26, p= 0.002) and 1 year (OR 1.09, 95% CI 1.03 to 1.17, p= 0.006) after PCI for all patients. In both data sets, there was no statistically significant interaction between age and gender for all-cause mortality at 30 days (BCIS, p= 0.59; SCAAR, p= 0.40) and at 1 year (BCIS, p= 0.11; SCAAR, p= 0.83). In conclusion, despite advances in care, women compared with men continue to experience higher all-cause mortality after PCI for coronary artery disease. The patient's age at the time of PCI remains a strong predictive factor of mortality in this population. Strategies and further research are warranted to better address the management of coronary artery disease in women with possibly earlier diagnosis and more tailored treatments.

Abstract 10923: Indoxyl Sulfate Predicts the Presence of Polyvascular Disease in Patients With Coronary Artery Disease

Introduction: Progression of chronic kidney disease (CKD) is associated with extending multiple damaged vascular beds. Data to evaluate the relevance of accumulated uremic toxin for systemic atherosclerosis is limited. In the present study we assessed the clinical role of serum indoxyl sulfate (IS), a protein-bound uremic toxin for the presence of polyvascular disease (PVD) in patients with coronary artery disease (CAD). Methods and Results: We analyzed clinical data from 94 patients who underwent percutaneous coronary intervention for CAD and the prevalence of PVD, defined as 1-, 2- or 3-vessel disease was preoperatively screened. Serum IS levels were determined from blood sample by using high performance liquid chromatograph. Receiver operator characteristic (ROC) curve was used for discriminative ability between elevated IS levels and the presence of PVD. The prevalence of PVD among CAD patients was 38%. The median value of serum IS was 0.103 mg/dl and IS levels were negatively correlated with estimated glomerular filtration rate (e-GFR) (r=0.66 p &lt;0.001). IS levels in PVD patients were significantly higher than in patients who had only CAD (1.171 ± 4.38 mg/dl vs 0.147 ± 0.144 mg/dl, p &lt;0.001) and ROC analysis determined serum IS levels of 0.142 mg/dl as a cut-off value to predict the presence of PVD (sensitivity: 73.4 %, specificity: 79.6%, the area under curve: 0.778). Multivariate analysis found IS (odds ratio [OR]: 6.77, 95% confidence interval [CI] : 1.84-24.9, p=0.003), e-GFR &lt;60 ml/min/1.73m 2 (OR: 5.74, 95% CI : 1.47-22.4, p=0.01) and diabetes mellitus (OR: 4.80, 95% CI: 1.40-16.4, p=0.01) were independently associated with the presence of PVD. Conclusions: IS is an independent predictor of PVD in patients with CAD. This result may contribute to understanding the mechanism of accelerated atherosclerosis in CKD.

Abstract 12001: CHA2DS2-VASc Score Are More Predictive of Clinical Outcomes Compared With SYNTAX Score in Patients With Coronary Artery Disease

Purpose: To investigate the association among clinical outcomes, clinical variables (CHA2DS2-VASc score), and anatomical variables (SYNTAX score) in patients undergoing percutaneous coronary intervention (PCI) with coronary artery disease (CAD). Methods: A cohort of 1701 patients (69.7±10.7 years old, 77% male) who underwent PCI for CAD was analyzed from ICAS (Ibaraki Cardiovascular Assessment Study) multi-center registry between April 2007 to April 2010. We divided patients into 3 groups according to tertile of SYNTAX score; Low SYNTAX (0-8: n=567), Mid SYNTAX (9-15: n=567), and High SYNTAX (≧16: n=567). And we also divide into 3 subgroups on the basis of CHA2DS2-VASc score (low: 0-2, mid: 3-5, high: 6-8 point). Clinical outcomes were defined as major adverse cardiovascular event (MACE) which included all cause death, myocardial infarction, stroke, or hospitalization for worsening heart failure. Results: Mean follow up period was 440 days. Incidence of MACE was significantly increased according to increasing CHA2DS2-VASc score in high and low SYANTAX groups (figure). There was no relation between increasing SYNTAX score and MACE in each CHA2DS2-VASc subgroups. Receiver operating characteristics curve (ROC) showed area under the curve (AUC) was larger in CHA2DS2-VASc score than SYNTAX score for MACE (0.613 vs. 0.498). CHA2DS2-VASc score was an independent predictor of MACE after adjustment of multiple cofounders (per increase, OR: 1.30, 95% confidence interval: 1.17-1.43, p&lt;0.001), but not SYNTAX score (per increase, OR: 0.99, 95% confidence interval: 0.98-1.01, p=0.56). Conclusion: High CHA2DS2-VASc score provides worse clinical outcomes compared with SYNTAX score in patients with CAD in this registry.

Successful percutaneous coronary intervention in a patient with combined deficiency of FV and FVIII due to novel compound heterozygous mutations in LMAN1

Percutaneous coronary intervention (PCI) in patients with congenital coagulation factor deficiencies presents a unique challenge. They are not only at increased risk of perioperative bleeding but can also suffer thrombosis of the stent as preventive anticoagulation and antiplatelet therapy is difficult. Several cases of successful PCI have been described in patients with haemophilia A and B, but there are no reports in patients with combined coagulation factor deficiencies. We used PCI to treat the coronary artery disease in a patient with the combined deficiency of factor V and factor VIII (F5F8D) and analysed the molecular basis of the disorder for this patient. A 68-year-old patient was admitted for urgent PCI with bare metal stent placement after the diagnosis of the F5F8D. Peripheral blood DNA was extracted for the sequence analysis of LMAN1 and MCFD2 genes. Mutations in LMAN1 was confirmed by molecular cloning of the PCR product and resequencing of the resulting clones. The patient underwent successful PCI with good long-term outcome. Our patient tolerated anticoagulation therapy well, with unfractionated heparin, and double antiplatelet therapy while he was initially supported with fresh frozen plasma and recombinant FVIII. Molecular analysis revealed that the patient carries unusual compound heterozygous frameshift mutations on the same microsatellite repeat region in exon 8 of LMAN1, one of which is a novel mutation (c.912delA). Our results suggest that patients with F5F8D can safely undergo PCI for coronary artery disease, with the treatment individualized to the specific patient.

Abstract 18926: Serum Resistin is not Associated with the Response to Lipid-Lowering Therapy in Non-Diabetic Patients with Coronary Artery Disease

Background : Resistin is an adipokine that mediates insulin resistance in obese mice. In human, however, circulating resistin levels are not associated with obesity or insulin resistance. Although the function of human resistin is enigmatic, it has recently been reported that human resistin plays a role in hepatocyte low-density lipoprotein (LDL) receptor suppression. Objectives : Aim of this study was to determine if serum levels of resistin are associated with the response to lipid-lowering therapy and the prognosis in coronary artery disease (CAD). Methods : One hundred and eighty two patients without diabetes who underwent percutaneous coronary intervention for CAD participated in this study. We measured pre-procedural serum resistin levels. After procedures, we treated the patients with atorvastatin 20mg and evaluated response to the statin therapy at 6-month follow-up. We also performed 6-month follow-up coronary angiography (CAG) in all patients and quantitative coronary angiographic analysis was conducted. Results : After adjusting age, sex, BMI, hypertension and smoking, serum levels of resistin had positive correlation with total cholesterol (Pearson’s partial correlation coefficient (r)=0.170, p =0.015) and LDL (r=0.159, p =0.023) at baseline. However, there was no correlation between baseline serum levels of resistin and the decrement of LDL after statin therapy (r= 0.07, p =0.36). Although, serum resistin (odds ratio 1.714, 95%CI 1.266-2.319) and hypertension (odds ratio 4.617, 95%CI 1.535-13.887) were independent predictors of coronary artery disease in multivariate logistic regression analysis, we found no relationship between baseline serum levels of resistin and decrement in minimal lumen diameter of target vessel at follow-up CAG (r=0.003, p =0.96). Conclusions : Higher baseline serum resistin levels and the positive correlation between serum resistin and baseline LDL in CAD patients suggest that resistin may affect coronary atherosclerosis via lipid metabolism pathway. However, serum resistin is not associated with the response to lipid-lowering therapy and the prognosis in CAD. The different mechanism of restenosis after DES implantation might explain the irrelevance of resistin level and restenosis.

Left circumflex coronary artery is protected against no-reflow phenomenon following percutaneous coronary intervention for coronary artery disease

Despite the positive impact of percutaneous coronary intervention (PCI) on reducing mortality, a small percentage of patients experience poor myocardial reperfusion following PCI. However, factors associated with no-reflow remain unclear. We investigated clinical factors associated with no-reflow following PCI for coronary artery disease (CAD). We retrospectively analyzed 1622 consecutive CAD patients who underwent PCI over a 5-year period at our institution. Patients were divided into two groups according to the presence (n = 31) or absence (n = 1591) of no-reflow, defined as Thrombolysis in Myocardial Infarction flow grade <3 after PCI. No significant differences in patient characteristics or PCI strategy were seen between the no-reflow and normal flow groups. The incidence of no-reflow was significantly lower in the left circumflex artery (LCx) than in the left anterior descending artery (LAD) (P = 0.0015), with no differences in characteristics or PCI strategy between these two target vessels. Multivariate analysis revealed that involvement of the LCx was an independent protective factor against no-reflow (odds ratio 0.14, 95 % confidence interval 0.02-0.98, P = 0.044). In conclusion, LCx as the target vessel was protective against no-reflow compared with LAD following PCI for CAD. Our results suggest that embolic protection devices may be unnecessary in CAD patients with involvement of LCx.

Association of health insurance status with presentation and outcomes of coronary artery disease among nonelderly adults undergoing percutaneous coronary intervention

The aim of this study was to determine if insurance status is associated with adverse outcomes in patients with coronary artery disease. A cohort of 13,456 patients who underwent percutaneous coronary intervention (PCI) between January 1, 2004, and December 31, 2007, at 4 New York State teaching hospitals was retrospectively studied. The primary outcome of interest was in-hospital mortality from any cause. Of the 13,456 patients studied, 11,927 (88.6%) were insured by private carriers, 1,036 (7.7%) patients were covered by Medicaid, and 493 (3.7%) were uninsured. Uninsured and Medicaid patients tended to be younger and more often nonwhite and Hispanic. They had a higher prevalence of congestive heart failure and worse left ventricular function. Compared with privately insured patients, uninsured and Medicaid patients had increased all-cause mortality (1.2% and 0.9%, respectively, vs 0.3%; P < .001). For all patients, lack of insurance (OR 3.02, 95% CI 1.10-8.28) and Medicaid (OR 4.39, 95% CI 1.93-9.99) were independently associated with mortality. Lack of insurance (OR 5.02, 95% CI 1.58-15.93) and Medicaid (OR 4.55, 95% CI 1.19-17.45) were also independently associated with increased mortality in patients undergoing emergent PCI. Lack of insurance and Medicaid insurance are both independently associated with an increased risk of in-hospital mortality after PCI for coronary artery disease.

Percutaneous coronary intervention in asians- are there differences in clinical outcome?

BackgroundEthnic differences in clinical outcome after percutaneous coronary intervention (PCI) have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD).MethodsA prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE) of myocardial infarction (MI), repeat revascularization and all-cause death at six months.Results7889 patients underwent PCI; 7544 (96%) patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11). There were 5130 (68%) Chinese, 1056 (14%) Malays and 1001 (13.3%) Indian patients. The remaining 357 (4.7%) patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1%) patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p < 0.001). This was contributed by increased rates of MI (Indians 1.9% vs. Chinese 0.9% vs. Malays 1.3%; OR 4.49 95%CI 1.91-10.56 p = 0.001), repeat revascularization (Indians 6.5% vs. Chinese 4.1% vs. Malays 5.1%; OR 1.64 95%CI 1.22-2.21 p = 0.0012) and death (Indians 11.4% vs. Chinese 7.6% vs. Malays 9.9%; OR 1.65 95%CI 1.23-2.20 p = 0.001) amongst Indian patients.ConclusionThese data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.