Reduction In Revascularization Research Articles

Heart health for South Asians: improved cardiovascular risk factors with a culturally tailored health education program

Background/AimThe Kaiser Permanente (KP) Northern California Heart Health for South Asians (HHSA) Program is a two-hour educational class that provides culturally relevant lifestyle and dietary recommendations to South Asian (SA) patients, in an effort to reduce their known disproportionate burden of cardiovascular (CV) disease. We evaluated the impact of the HHSA Program on CV risk factors and major adverse CV events (MACE).MethodsA retrospective cohort study identified 1517 participants of SA descent, ≥ 18 years old from 2006 to 2019. We evaluated the change in risk factors with program attendance (median follow up of 6.9 years) for systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), LDL, HDL, BMI, and HbA1c. We also performed a propensity matched analysis to evaluate differences in MACE including stroke, myocardial infarction (MI), coronary revascularization, and all-cause mortality.ResultsThere were significant improvements in DBP, TG, LDL-c, HDL-c, BMI, and HbA1c at one year follow up and sustained improvements in DBP (-1.01mmHg, p = 0.01), TG (-13.74 mg/dL, p = 0.0001), LDL-c (-8.43 mg/dL, p = < 0.0001), and HDL-c (3.16 mg/dL, p = < 0.0001) levels at the end of follow up. In the propensity matched analysis, there was a significant reduction in revascularization (OR 0.33, 95% CI 0.14–0.78, p = 0.011) and mortality (OR 0.41, 95% CI 0.22–0.79, p = 0.008), and a trend towards reduction in stroke.ConclusionsOur study demonstrates the efficacy of a culturally tailored SA health education program in improving CV risk factors and reducing MACE. The program highlights the importance and value of providing culturally tailored health education in primary CV disease prevention.

Abstract 11904: Heart Health for South Asians: Improved Cardiovascular Risk Factors and Outcomes With a Culturally Tailored Health Education Program

Introduction: The Kaiser Permanente (KP) Northern California Heart Health for South Asians (HHSA) Program is a two-hour educational class offered at KP Santa Clara, California. The class provides culturally relevant lifestyle and dietary recommendations to South Asian patients, in an effort to reduce the known disproportionate burden of cardiovascular (CV) disease in this population. We aimed to evaluate the impact of the HHSA Program on CV risk factors and major adverse CV events (MACE). Methods: A retrospective cohort study identified 1517 participants of South Asian descent, age ≥ 18 years old from 2006-2019. We evaluated the change in individual risk factors with program attendance (median follow up of 6.9 years) for the following variables: systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), LDL, HDL, BMI, and HbA1c. We also performed a propensity matched analysis to evaluate differences in MACE including stroke, myocardial infarction (MI), coronary revascularization, and all-cause mortality. Results: Differences in individual risk factors are outlined in figure 1A and show a significant improvement in SBP, DBP, TG, LDL, HDL and HbA1c at follow up. In the propensity matched analysis, there was a statistically significant reduction in revascularization (OR 0.33, 95% CI 0.14-0.78, p= 0.011) and mortality (OR 0.41, 95% CI 0.22-0.79, p= 0.008), a trend towards reduction in stroke (OR 0.22 , 95% CI 0.05-1.03, p= 0.054), and no statistically significant difference in the rate of MI (OR 0.93 , 95% CI 0.43-1.98, p= 0.85) (Figure 1B). Conclusions: Our study demonstrates the efficacy of a culturally tailored South Asian health education program in improving CV risk factors and reducing MACE. The program highlights the importance and value of providing culturally tailored, motivational health education in primary CV disease prevention.

Reduction of Revascularizations in Patients with Hypertriglyceridemia with Icosapent Ethyl: Insights from REDUCE-IT REVASC

Reduction of Revascularizations in Patients with Hypertriglyceridemia with Icosapent Ethyl: Insights from REDUCE-IT REVASC

Two-year outcomes after percutaneous coronary intervention with drug-eluting stents or bare-metal stents in elderly patients with coronary artery disease.

Report the results at 2 years of the patients included in the SENIOR trial. Patients above 75 years of age represent a fast-growing population in the cathlab. In the SENIOR trial, patients treated by percutaneous coronary intervention (PCI) with drug eluting stent (DES) and a short duration of P2Y12 inhibitor (1 and 6 months for stable and unstable coronary syndromes, respectively) compared with bare metal stents (BMS) was associated with a 29% reduction in the rate of all-cause mortality, myocardial infarction (MI), stroke, and ischaemia-driven target lesion revascularization (ID-TLR) at 1 year. The results at 2 years are reported here. We randomly assigned 1,200 patients (596[50%] to the DES group and 604[50%] to the BMS group). At 2 years, the composite endpoint of all-cause mortality, MI, stroke and ID-TLR had occurred in 116 (20%) patients in the DES group and 131 (22%) patients in the BMS group (RR 0.90 [95%CI 0.72-1.13], p = .37). IDTLR occurred in 14 (2%) patients in the DES group and 41 (7%) patients in the BMS group (RR 0.35 [95%CI 0.16-0.60], p = .0002). Major bleedings (BARC 3-5) occurred in 27(5%) patients in both groups (RR 1.00, [95%CI 0.58-1.75], p = .99). Stent thrombosis rates were low and similar between DES and BMS (0.8 vs 1.3%, (RR 0.52 [95%CI 0.01-1.95], p = .27). Among elderly PCI patients, a strategy combining a DES together with a short duration of DAPT is associated with a reduction in revascularization up to 2 years compared with BMS with very few late events and without any increased in bleeding complications or stent thrombosis.

Abstract 407: Modulation of Delta-Like Ligand-4 Signaling Improves Myocardial Revascularization Following Coronary Ischemia

Delta-like ligand-4 (DLL4) is an arterial-specific Notch ligand and balanced signaling by DLL4 is required for functional neovascularization. We hypothesized that modest inhibition of DLL4 signaling improves myocardial revascularization following coronary ischemia. Myocardial infarction was induced by ligation of mid-left anterior descending (LAD) artery via rapid left thoracotomy in 6-8 week-old male mice with inducible endothelial-specific knockout or overexpression of DLL4. DLL4 silencing in homozygous mice on the day of or 5 days prior to LAD ligation resulted in significant reduction in revascularization. At four weeks, explanted hearts showed 1.8-fold fewer vessels in LAD territory, 3-fold greater myocardial hypoxia, 1.7-fold larger fibrotic scar and 17% increased perfusion defect in the left ventricle (LV) by scintigraphy. CT angiography confirmed fewer collateral vessels. Echocardiography showed increased LV dilation (37% higher end-diastolic volume) and 12% greater reduction in ejection fraction (EF) compared to baseline (all p&lt;0.001). Overexpression of DLL4 showed a similarly worse outcome. Conversely, partial DLL4 knockout in heterozygous animals resulted in improved outcomes in all parameters. For translational application, animals were systemically administered 1.5mg/kg or 3mg/kg DLL4-Fc intraperitoneally three times a week beginning the day of ligation. RT-PCR analysis of downstream molecules confirmed that systemic DLL4-Fc partially inhibits Notch signaling in endothelial cells in the ischemic LV. When LAD was ligated very proximally, DLL4-Fc improved survival. With mid-LAD ligation, DLL4-Fc induced a dose-dependent increase in number of CD 31-positive vessels and by CT angiography. There was a dose-dependent reduction in hypoxic myocardial area, scar burden, and scintigraphic perfusion defect. DLL4-Fc treated mice had lower end-diastolic LV volume and preserved or improved EF. In an ischemia-reperfusion model, DLL4-Fc increased the number of vessels in the ischemic zone. Our data suggests that balanced DLL4 signaling is crucially required for myocardial angiogenic recovery following coronary ischemia. Modulation of DLL4 signaling has translational therapeutic potential.

A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis

Studies demonstrate that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is associated with reduced revascularization and major adverse cardiac events (MACE) rates compared to bare metal stents (BMS) in native coronary vessels. Optimal PCI treatment of saphenous vein graft (SVG) lesions remains unclear despite SVG procedures representing up to 10% of PCI cases. We therefore performed a meta-analysis to compare outcomes between BMS and DES in SVG PCI. A search (2004-2009) of MEDLINE and conference proceedings for all relevant studies comparing mortality and MACE outcomes in DES versus BMS in SVG PCI and meta-analysis of the data was performed. Twenty studies were identified from 2005 to 2009 enrolling a total of 5,296 patients. Meta-analysis revealed a decrease in mortality associated with DES use, odds ratio (OR) 0.68; 95% confidence interval (CI) 0.53-0.88; P = 0.004. Similarly, MACE (OR 0.64; 95% CI 0.51-0.82; P < 0.001), total lesion revascularization (OR 0.60; 95% CI 0.43-0.83; P = 0.002), and total vessel revascularization (OR 0.57; 95% CI 0.41-0.80; P = 0.001) were significantly decreased in the patients in which DES were used compared to BMS. This reduction in mortality and MACE events associated with DES use appears to be limited to registry studies and not randomized controlled studies. Our meta-analysis suggests DES use to be safe in SVG PCI and associated with reduced mortality and MACE rates with reductions in revascularization also observed.

Paclitaxel-Eluting Versus Bare-Metal Stents in Acute ST Elevation Myocardial Infarction (STEMI)

Data comparing efficacy and safety of drug eluting stents (DES), particularly paclitaxel stent with bare metal stents (BMS) in the setting of acute ST elevation myocardial infarction (STEMI) is limited and inconclusive. The aim of our study is to compare the efficacy and safety of paclitaxel stent with bare metal stent in acute STEMI. A retrospective cohort study was performed on patients from our single community hospital who participated in the C-PORT trial from January 2003 to May 2005. One hundred forty-three patients treated exclusively with either BMS or paclitaxel DES were included (79 with paclitaxel DES and 64 with BMS) and were followed at 1, 3, and 6 months. The primary outcome was occurrence of major adverse cardiac events defined as cardiac death, STEMI or NSTEMI or the need for target vessel revascularization. Variables were compared using appropriate statistics and event free survival curves were estimated. Baseline clinical characteristics in BMS and paclitaxel DES groups were well matched. No statistical difference between BMS and DES groups in the rate of cardiac death (6% vs. 9%, P = 0.56), STEMI or NSEMI (1.6% vs. 1.3% respectively, P = 0.88) and composite end point (13% vs. 10%, P = 0.65) was observed while a significant reduction in target vessel revascularization was seen in DES group (6% vs. 0% respectively, P = 0.02) was noticed. In our patient group with acute STEMI, the use of paclitaxel DES did not show significant decrease in cumulative end points, cardiac mortality and recurrent STEMI or NSTEMI compared with BMS over a 6-month follow-up period. However, a significant reduction in revascularization of target vessel was seen.