Prevalence Of Coronary Artery Disease Research Articles

Calcium Scoring Improves Clinical Management in Patients With Low Clinical Likelihood of Coronary Artery Disease

BackgroundCoronary artery calcium scoring (CACS) improves management of chest pain patients. However, it is unknown whether the benefit of CACS is dependent on the clinical likelihood (CL). ObjectivesThis study aims to investigate for which patients CACS has the greatest benefit when added to a CL model. MethodsBased on data from a clinical database, the CL of obstructive coronary artery disease (CAD) was calculated for 39,837 patients referred for cardiac imaging due to symptoms suggestive of obstructive CAD. Patients were categorized according to the risk factor–weighted (RF-CL) model (very low, ≤5%; low, >5 to ≤15%; moderate >15 to ≤50%; high, >50%). CL was then recalculated incorporating the CACS result (CACS-CL). Reclassification rates and the number needed to test with CACS to reclassify patients were calculated and validated in 3 independent cohorts (n = 9,635). ResultsIn total, 15,358 (39%) patients were down- or upclassified after including CACS. Reclassification rates were 8%, 75%, 53%, and 30% in the very low, low, moderate, and high RF-CL categories, respectively. Reclassification to very low CACS-CL occurred in 48% of reclassified patients. The number needed to test to reclassify 1 patient from low RF-CL to very low CACS-CL was 2.1 with consistency across age, sex, and cohorts. CACS-CL correlated better to obstructive CAD prevalence than RF-CL. ConclusionsAdded to an RF-CL model for obstructive CAD, CACS identifies more patients unlikely to benefit from further testing. The number needed to test with CACS to reclassify patients depends on the pretest RF-CL and is lowest in patients with low (>5% to ≤15%) likelihood of CAD.

Coronary artery disease in older adults with congenital heart defects: risk factors and pharmacotherapy.

With advancing age, adults with congenital heart disease (ACHD) are at a higher risk of developing atherosclerotic coronary artery disease (CAD). We aimed to determine the prevalence of CAD, its risk factors, and use of guideline‑directed pharmacotherapy among older patients with ACHD. Patients and methods: We studied all ACHD patients aged 60 years or older hospitalized in our department between the years 2013 and 2020. CAD was defined as a history of acute coronary syndrome or coronary revascularization, or more than 50% diameter stenosis on coronary angiography. Data regarding the underlying heart defect, prevalence of cardiovascular risk factors, and drug prescriptions were collected. A total of 198 patients with known coronary artery status (mean [SD] age, 66.2 [5.3] years; 43.3% men) were included in the analysis. Of them, 54 (27.3%) had CAD. The individuals with CAD were more often men, and they were more likely to have a mild heart defect, dyslipidemia, and a history of hypertension and tobacco use. Multivariable analysis showed that male sex (P = 0.001), dyslipidemia (P = 0.003), and hypertension (P = 0.04) were positive independent predictors of CAD, whereas overweight / obesity was identified as a negative independent predictor (P = 0.04). The proportion of CAD patients on antiplatelet and / or anticoagulant drugs was 92.6%. β‑Blockers were prescribed to 87% of the patients, and a lipid‑lowering agent to 96% of the study population. CAD is common in older patients with ACHD. Our results underline the importance of identification and treatment of modifiable CAD risk factors in individuals with ACHD. The obesity paradox might also play a role in this population. The rate of guideline‑recommended pharmacotherapy implementation seems to be satisfactory.

Femoral Neck Osteoporosis Is Associated with a Higher Odds of Coronary Artery Disease in Indian Postmenopausal Women: A Cross-sectional Study from a Teaching Hospital in Southern India.

Purpose: Epidemiological studies have shown an association between coronary artery disease (CAD) and osteoporosis. We studied the prevalence of CAD among postmenopausal women with osteoporosis. Factors that were significantly associated with CAD were also assessed. Methods: This was a cross-sectional study conducted over a period of 2 years. Consecutive postmenopausal women aged ≥50 years were recruited. The details of an underlying CAD were obtained. Bone biochemical parameters, bone mineral density and body composition were assessed. Results: A total of 370 postmenopausal women with mean (standard deviation [SD]) ages of 61.6 (6.2) and 60.1 (6.0) years and a body mass index of 25.3 (14.1) kg/m2 were recruited. Among them, 110 of 370 patients (29.7%) had an underlying CAD and 222 of 370 (60%) had osteoporosis at either the femoral neck or lumbar spine (LS). The odds of CAD among those with osteoporosis were 3.5 (95% confidence interval [CI]: 2.1-5.9). An LS T-score of ≤-2.2 had a sensitivity of 80% and a specificity of 45% in predicting CAD (area under the curve, AUC: 0.736; 95% CI: 0.677-0.795; p<0.001). A femoral neck T-score of ≤-1.9 had a sensitivity of 80% and a specificity of 60% in predicting CAD (AUC: 0.748; 95% CI: 0.696-0.800; p<0.001). On a logistic regression analysis after adjusting for various clinical parameters, femoral neck osteoporosis had the highest odds of CAD. Conclusion: The prevalence of CAD was higher among postmenopausal women with osteoporosis. Femoral neck osteoporosis conferred the highest odds of CAD after adjustment for other clinical factors.

The prevalence of coronary artery disease in patients presenting with ‘non-anginal chest pain’

The prevalence of coronary artery disease in patients presenting with ‘non-anginal chest pain’

FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population.

Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p=.024) and higher FIB-4 index (1.46±.6 vs. .91±.46, p<.001) were independently associated with AVS. Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.

Autopsy Pathology of Heart and Coronary Vessels in Sudden Death: A Cross-sectional Study from Southern India

Introduction: Cardiac diseases emerge as the primary culprits behind sudden and unexplained deaths. Morphological evaluation through autopsy is invaluable in establishing the prevalence of cardiac lesions and coronary atherosclerosis within the general population. It provides healthcare researchers with valuable insights to develop preventive measures and early detection strategies crucial for improving survival rates. Aim: To estimate the prevalence of cardiac lesions in postmortem specimens of the heart from autopsies of sudden and unexplained deaths. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Government Medical College (a public sector hospital), Cochin, Kerala, India, from January to December 2021 on 140 specimens of the heart. Medicolegal autopsies were performed in the Department of Forensic Medicine, with specimens forwarded to the Pathology Department for histopathological examination. Hearts dissected by the modified Virchow’s method were examined for gross pathology in the cardiac wall, chambers, valves, coronaries and aorta. Microscopy findings were documented and the grading of coronary atherosclerosis was done using the Modified American Heart Association (AHA) criteria. Proportions were analysed from the compiled data using a Chi-square test. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0 software. Results: In the study encompassing 140 adult autopsies, the mean age of the study population was 45.98 with a Standard Deviation (SD) of 15.82 years and the male to female ratio was 3.5:1. The prevalence of cardiac lesions was as follows: coronary artery atherosclerosis (80.70%), Ischaemic Heart Disease (IHD) (44.28%), cardiac hypertrophy and hypertension (10%), pericarditis (6.42%) and myocarditis (3.50%). The male- to-female ratio for coronary atherosclerosis was 4.4:1, with triple vessel disease observed in 42.90% of cases. Atherosclerosis severity grades included early non atheromatous lesions (19.3%), Pathological Intimal Thickening (PIT) (23.6%), and advanced atherosclerotic lesions (37.80%). Among cases associated with Coronavirus Disease 2019 (COVID-19)-related deaths (10.7%), changes noted included myocarditis, microhaemorrhages, oedema, capillary dilatation, fibrin deposition and inflammatory infiltrates. Conclusion: The present study revealed a high prevalence of coronary atherosclerosis affecting all three vessels, particularly among the younger population. This underscores the significance of screening for cardiovascular risk factors and implementing preventive measures from an early age.

Altered Gut Microbiota as a Potential Risk Factor for Coronary Artery Disease in Diabetes: A Two-Sample Bi-Directional Mendelian Randomization Study.

The current body of research points to a notable correlation between an imbalance in gut microbiota and the development of type 2 diabetes mellitus (T2D) as well as its consequential ailment, coronary artery disease (CAD). The complexities underlying the association, especially in the context of diabetic coronary artery disease (DCAD), are not yet fully understood, and the causal links require further clarification. In this study, a bidirectional Mendelian randomization (MR) methodology was utilized to explore the causal relationships between gut microbiota, T2D, and CAD. By analyzing data from the DIAGRAM, GERA, UKB, FHS, and mibioGen cohorts and examining GWAS databases, we sought to uncover genetic variants linked to T2D, CAD, and variations in gut microbiota and metabolites, aiming to shed light on the potential mechanisms connecting gut microbiota with DCAD. Our investigation uncovered a marked causal link between the presence of Oxalobacter formigenes and an increased incidence of both T2D and CAD. Specifically, a ten-unit genetic predisposition towards T2D was found to be associated with a 6.1% higher probability of an increase in the Oxalobacteraceae family's presence (β = 0.061, 95% CI = 0.002-0.119). In a parallel finding, an augmented presence of Oxalobacter was related to an 8.2% heightened genetic likelihood of CAD (β = 0.082, 95% CI = 0.026-0.137). This evidence indicates a critical pathway by which T2D can potentially raise the risk of CAD via alterations in gut microbiota. Additionally, our analyses reveal a connection between CAD risk and Methanobacteria, thus providing fresh perspectives on the roles of TMAO and carnitine in the etiology of CAD. The data also suggest a direct causal relationship between increased levels of certain metabolites - proline, lysophosphatidylcholine, asparagine, and salicylurate - and the prevalence of both T2D and CAD. Sensitivity assessments reinforce the notion that changes in Oxalobacter formigenes could pose a risk for DCAD. There is also evidence to suggest that DCAD may, in turn, affect the gut microbiota's makeup. Notably, a surge in serum TMAO levels in individuals with CAD, coinciding with a reduced presence of methanogens, has been identified as a potentially significant factor for future examination.

Impact of Magnesium on In-Hospital Ami Outcomes in Bangladesh.

Background: Coronary artery disease (CAD) is a major cause of death globally. Bangladesh has a high prevalence of CAD, especially in urban areas. Acute myocardial infarction (AMI) is a serious condition that occurs when there’s a blockage in the coronary arteries. Electrolyte imbalances, such as magnesium deficiency, can worsen AMI. Objectives: To evaluate the association between serums magnesium level on in-hospital acute myocardial infarction outcomes. Study Design and Methods: This prospective study recruited 110 patients diagnosed with AMI in Dhaka, Bangladesh. Researchers measured serum magnesium levels, monitored patients, and recorded clinical outcomes. Results: The study found that patients with lower magnesium levels were more likely to experience complications such as arrhythmias, cardiogenic shock, and left ventricular dysfunction. Conclusion: The study highlights the importance of monitoring magnesium levels in AMI patients. However, more research is needed to determine the optimal magnesium level and its impact on patient outcomes.

Assessment of Lipid Profile Status in Diabetes Mellitus in Iraqi Patients

Introduction: Diabetes mellitus (DM) greatly burdens health and economic status worldwide. One of the major sequels of DM is its effect on coronary artery disease (CAD) prevalence. DM-associated dyslipidemia is considered one of the hazardous comorbidities as it directly accelerates atherosclerosis, hypertension, and CAD. Aim of the study: This study aimed to assess the lipid profile status among T2DM patients from Iraq. Subjects and methods: The current study randomly selected 100 diabetic patients of equal sex distribution. All included patients were subjected to anthropometric measurements, blood glucose, and lipid profile assessments. Results: Among the studied patients, 76 patients were found to have dyslipidemia, while 23 did not show any disturbance in their lipid profiles. Diabetic patients with dyslipidemia had significantly higher BMI compared to the non-dyslipidemia group. There were statistically significant higher levels of PPBS, TG, TC, and LDL cholesterol in patients with diabetic dyslipidemia compared to the other group. Moreover, there were statistically significantly lower HDL cholesterol levels in patients with diabetic dyslipidemia compared to the non-dyslipidemia group. Conclusion: DM is directly related to increased serum triacylglycerols, total serum cholesterol, LDL cholesterol, and a decrease in HDL cholesterol.

Prevalence of coronary artery disease in chronic obstructive pulmonary disease patients- a retrospective observational study

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation that results in progressive and irreversible air flow obstruction usually caused by an inflammatory response of the lungs to noxious particles and gases. There are periods of acute episodes of worsening and exacerbation. COPD was predicted to be the third leading cause of death worldwide by 2020, is a major cause of disability adjusted life years (DALY). Patients with COPD are often complicated by coronary artery disease (CAD), both of which are public health problems. There are probably a lot of mechanisms involved in the co-existence of these comorbidities like ageing, sedentary life style, systemic inflammation, atherosis and arterial stiffness. The confirmation of this comorbidity in COPD is very important as it can have implications in the management of the disease. Methods: This observational study was done in a tertiary care hospital in Central Kerala. It was a retrospective observational study. 100 patients were included in the study. Results: Out of 100 COPD patients that were included in the study, 27% of them had CAD as a comorbidity which implies that all patients with COPD should be screened for CAD as well. Conclusions: All COPD patients should be screened for a coexisting CAD.

Retraction: Prevalence of coronary artery disease and its risk factors in Majmaah City, Kingdom of Saudi Arabia.

[This retracts the article DOI: 10.3389/fcvm.2022.943611.].

Association between bone mineral density and coronary plaque burden in patients with coronary artery disease: a cross-sectional study using quantitative computed tomography.

To evaluate the association between osteoporosis and coronary calcification and coronary plaque burden in patients with atherosclerosis and coronary artery disease (CAD). This study included 290 men and 177 postmenopausal women with angiography-confirmed atherosclerosis or CAD who underwent chest multidetector row computed tomography covering L1-L2 between September 2020 and October 2021. Quantitative computed tomography was used to measure the lumbar vertebra's bone mineral density (BMD). The coronary artery calcium score (CACS) and total coronary plaque burden were quantified using the Agatston and modified Gensini scores, respectively. Associations between BMD and CACS and modified Gensini scores were assessed using multivariate regression analysis. Lasso regression was used in model selection. In men, BMD was inversely associated with CACS [ β = -0.24; 95% confidence interval (CI), -0.35 to -0.13; P < 0.001) and coronary artery calcification (CAC) presence [odds ratio (OR) = 0.71; 95% CI, 0.52-0.96; P = 0.03) in the unadjusted model. After adjusting for age, modified Gensini score, prior percutaneous coronary intervention and hypertension, BMD was inversely associated with CACS ( β = -0.11; 95% CI, -0.22 to -0.01; P = 0.04). In postmenopausal women, BMD was inversely associated with CACS ( β = -0.24; 95% CI, -0.39 to 0.10; P < 0.001) and CAC presence (OR = 0.66; 95% CI, 0.47-0.92; P = 0.01) in the unadjusted model but no other models ( P > 0.05). In both sexes, BMD did not correlate with the modified Gensini score or CAD prevalence (all P > 0.05). In patients with coronary atherosclerosis and CAD, BMD of the lumbar vertebra correlated inversely with CACS in men but not postmenopausal women. Additionally, BMD did not correlate with the modified Gensini score in both sexes.

Coronary artery disease and other cardiovascular disorders among the physicians.

To evaluate the prevalence of cardiovascular disorders (CVDs), specifically coronary artery disease (CAD), among Thai physicians, and the cardiac testing being used. The associated or risk factors of CAD were also studied. Data of Thai physicians who participated in the hospital's corporate social responsibility "Save Doctors' Heart" project conducted between February 14, 2022, and October 31, 2022, were collected: personal illness, family history of CAD, workplace, work hours, dietary habits, exercise, stress, body mass index, laboratory and cardiac testing. Of 1231 physicians, the median age was 48.0 ± 10.34 years, with 55.2% were female; 83.1% reported working <55 h per week, 29.7% exercised ≥3 days a week, and 28.0% were overweight or obese. Hypertension, diabetes mellitus, and dyslipidemia were found in 46.3%, 30.5%, and 75.8%, respectively. Abnormal findings were observed in 29.7% of chest X-rays, 17.7% of electrocardiograms, 33.0% of echocardiograms, 10.6% of exercise stress tests, and 3.8% of stress echocardiograms. Moderate/extensive coronary artery calcium (CAC) scores were present in 12.7%. The prevalence of CVDs or CAD were 51.7% and 11.2%, respectively. Independent risk factors for CAD included older age, male gender, history and/or new findings of DM, and moderate to extensive CAC scores. The prevalence of CVDs and CAD among Thai physicians is 51.7% and 11.2%, respectively. The independent risk for CAD was older age, male, having DM, and moderate to extensive CAC scores. The physicians who are at risk should be cautious, modify their lifestyle, and have appropriate screening/diagnostic testing for cardiac abnormality.

Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction

BackgroundType 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this population. ObjectivesThe purpose of this study was to evaluate sex-based disease differences in type 2 MI among patients evaluated with coronary computed tomography angiography and fractional flow reserve. MethodsIn a single-center, prospective study, patients with strictly adjudicated type 2 MI underwent coronary computed tomography angiography with fractional flow reserve. ResultsAmong 50 study participants enrolled, 50% were women. A similar mix of MI precipitants was present in both sexes. ST-segment depression was more common in women (64% vs 32%), while men were more likely to have T wave inversion (68% vs 36%). Women and men had comparable coronary artery calcium scores (median: 152 [Q1, Q3: 45, 762] vs 234 [Q1, Q3: 56, 422]). Prevalence of any CAD (84% vs 100%), obstructive CAD (24% vs 28%), and hemodynamically significant focal stenosis (20% vs 32%) were similar between sexes. Total plaque volume was similar between sexes, but women had significantly lower levels of low-attenuation plaque (median: 3 [Q1, Q3: 1, 7] vs 9 [Q1, Q3: 3, 14]). ConclusionsAmong patients with type 2 MI, prevalence of any CAD and obstructive CAD did not differ according to sex. Total plaque volume was similar between sexes, but women had a lower volume of low-attenuation plaque (DEFINing the PrEvalence and Characteristics of Coronary Artery Disease Among Patients With TYPE 2 Myocardial Infarction Using CT-FFR [DEFINE TYPE2MI]; NCT04864119)

Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review.

Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.

Very long versus overlapping drug eluting stents for the management of long coronary artery lesions

Background The prevalence of long diffuse coronary artery disease (CAD) is increasing nowadays due to increase prevalence of multiple risk factors and population ageing. We aimed in our study to show the differences clinically or angiographically (guided by IVUS) between the use of single long stent versus overlapping stents in very long coronary lesions (≥40 mm) in patients presented with chronic coronary syndromes. Methods 550 patients presenting with chronic coronary syndromes were included: 320 treated with a single long stent (≥40 mm) and 230 patients with two or more overlapping stents. Angiographic follow-up (guided by IVUS) 6 months after PCI was performed only in 50 patients. We assessed the procedural characteristics and the occurrence of major adverse cardiovascular events (MACE) after a median follow-up of 24 months. Results Total stent length was 56.16 ± 14.85 mm and mean diameter was 3.05 ± 0.36 mm. At the end of follow-up, MACE rate in the single long stent group was 4.1% vs. 7.8% in the overlapping stents group, with higher incidence in overlapping stents group but non-statistically significant (p value = 0.059). PCI using overlapping stents consumed more contrast volume (248 ± 85.36 vs 164.5 ± 70.43 ml, p < 0.001), and higher fluoroscopy time (23.65 ± 9.19 vs 19.72 ± 9.19 min, p < 0.001). Regarding IVUS subgroup follow-up, there was no significant difference between both groups regarding in-stent restenosis and MACE. Conclusions We can conclude that long or overlapping stents are both acceptable therapeutic choices for patients with long CAD. There was no difference between both strategies regarding angiographic follow-up guided by IVUS after 6 months.

Incremental Value of ABI and CAC Beyond Traditional Risk Markers in Long-term Prediction of Cardiovascular Disease Incidence in Participants with Diabetes: Multi-Ethnic Study of Atherosclerosis

IntroductionPrimary prevention of cardiovascular disease (CVD) emphasizes detection of subclinical atherosclerosis (SA). Diabetes Mellitus is a high-CVD risk condition with higher prevalence of systemic atherosclerosis. Ankle brachial index (ABI) and coronary artery calcium (CAC) are commonly used measures to detect SA. The primary objective of this study was to evaluate the improvement in CVD risk prediction beyond traditional risk factors after adding ABI and CAC within diabetic participants. MethodsMESA is an observational cohort of 6,814 participants free of clinical cardiovascular disease at baseline. Participants were included in this analysis if they had diabetes or impaired fasting glucose. Cox proportional hazard regression was used to assess the association between CAC score and ABI and outcomes (incident CVD and all-cause mortality). We compared the C-index between a model with traditional risk factors alone and models including ABI and/or CAC. Results1,719 participants were included in the analysis. Average age was 64 years, 55% male, 25% White, 13% Chinese, 34% Black, and 27% Hispanic. Higher CAC and lower ABI were associated with higher risk of CVD (Figure 1) and mortality among people with diabetes. Both ABI and CAC improved CVD discrimination over and above standard risk factors (C-index 0.689 for risk factors alone, 0.719 for CAC, 0.696 for ABI, and 0.721 for both). Similarly for mortality, discrimination was improved over risk factors alone (C-index 0.739) for CAC (0.746), ABI (0.747), and both (0.748). ConclusionThese two subclinical atherosclerosis measures may aid in clinical decision making among those with diabetes.

Stroke and Bleeding Risks of Endocardial Ablation for Ventricular Arrhythmias

BackgroundRisks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach. ObjectivesThis study sought to assess embolic and bleeding complications in relation to pre-periprocedure and post-periprocedure antithrombotic regimens. MethodsProspective assessment for complications was performed for 663 endocardial radiofrequency catheter ablation procedures in 616 consecutive patients (median age 64 years [Q1-Q3: 54-73 years], 70.3% men, 71.6% with cardiomyopathy, 44.5% with sustained ventricular tachycardia). ResultsThere were 2 strokes (0.3%; 95% CI: 0.0%-0.8%), 1 transient ischemic attack (0.15%), and 2 pulmonary emboli (0.3%). There were 39 bleeding complications (5.9%) including 11 pericardial effusions (1.7%), and 28 related to vascular access (4.2%). Consistent with the prevalence of coronary artery disease (47.5%), atrial fibrillation (30.0%), and prior stroke (10.6%), preprocedure, 464 patients (70.0%) were taking antithrombotic agents including 220 (33.2%) taking aspirin alone (ASA), and 163 (24.6%) taking warfarin or a direct acting oral anticoagulant (DOAC). Preprocedure non-ASA antiplatelet use (OR: 2.846; P = 0.011) and DOAC use (OR: 2.585; P = 0.032) were associated with risk of bleeding complications. Following ablation, 49.8% of patients were treated with ASA 325 mg/d and 30.3% received DOACs or warfarin. New DOAC or warfarin administration was initiated in only 6.6% of patients. Overall, 39.7% of patients continued the same preprocedure antithrombotic regimen. ConclusionsStroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d as a minimal postprocedure regimen with more potent regimens for selected patients.

The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature.

The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.

Characteristics of patients with intradialytic hypotension in North Kuala Lumpur and the prevalence of coronary artery disease among them

Characteristics of patients with intradialytic hypotension in North Kuala Lumpur and the prevalence of coronary artery disease among them