Revascularization For Coronary Artery Disease Research Articles

Minimally Invasive Coronary Artery Bypass Grafting in a Low-Risk Asian Cohort: A Propensity-Score Matched Study.

Minimally invasive coronary artery bypass grafting (MICS CABG) offers a new paradigm in coronary revascularization. This study aims to compare the outcomes of MICS CABG with those of conventional median sternotomy CABG (MS CABG) within a growing minimally invasive cardiac surgical program in Singapore. Propensity matching produced 111 patient pairs who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass surgery patients were matched to single- or double-graft MS CABG patients (Group 1). Multivessel MICS CABG patients were matched to MS CABG patients with equal number of grafts (Group 2). Overall, MICS CABG patients experienced shorter postoperative length of stay (P<0.071). In Group 2, procedural duration (P<0.001) was longer among MICS CABG patients, but it did not translate to adverse postoperative events. Postoperative outcomes, including 30-day mortality, reopening for bleeding, new onset atrial fibrillation as well as neurological, pulmonary, renal, and infectious complications were comparable between MICS and MS CABG groups. MICS CABG is a safe and effective approach for surgical revascularization of coronary artery disease and trends toward a reduction in hospital stay.

EARLY RESULTS OF MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING

Abstract Coronary artery bypass grafting (CABG) is the benchmark in elective revascularization for Coronary Artery Disease (CAD), particularly for complex or multivessel CAD, left main coronary involvement, diabetes, or impaired heart function. Traditional CABG, via median sternotomy using cardiopulmonary bypass (CPB), has limitations like CPB–related morbidity and sternal complications. Alternatives like Minimally Invasive Cardiac Surgery (MICS CABG) and Hybrid Revascularization (HR) aim to address these drawbacks. We present a series of 215 consecutive patients (mean age 67±9 years, 27.9% females, EuroSCORE II 1.5±1.3%) between 2017–2023 who underwent elective minimally invasive surgical revascularization. Among the cohort, 164 (76.3%) had Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) via anterolateral left mini–thoracotomy (ALMT) at the fifth intercostal space (IS), with 140 (85.4%) receiving a single left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery and 24 (14.6%) an additional distal anastomosis. Thirty–four (20.7%) had HR via percutaneous coronary intervention (PCI) on the right coronary artery (RCA). Of the total cohort, 35/215 patients (16.3%) underwent multivessel MICS CABG via ALMT, with mean 2.3±0.5 distal anastomoses using LITA, right ITA, radial artery, or saphenous vein. Heart manipulation was via a subxiphoid device. Four MICS CABG patients (11.4%) had HR. More than half of MICS CABG cases were performed with planned peripheral CPB, without cross–clamping the Aorta. Of the total cohort, 16/215 patients (7.4%) received MICS CABG in an endoscopic fashion, using 3D thoracoscopy for LITA and RITA harvesting via bilateral ports in the 2nd, 3rd, and 4th IS, employing peripheral CPB and aortic clamping by Chitwood clamp at the second IS, with cardioplegia delivery via a 4 cm right anterior MT. Distal anastomoses were performed via left anterior MT, with easy subxiphoid manipulation of the emptied heart. Transit time flowmetry was used in all cases. Conversion to sternotomy was needed in 3 cases, all were MIDCAB. Thirty–day mortality was 1.4%, median ventilation was 4 [2–5] hours, and Intensive Care Unit–stay was 1 [1–2] days. All patients received graft evaluation via computerized tomography before hospital discharge. Mean follow–up was 2.9±1.9 years (max 5 years), with no deaths and 4 (1.9%) requiring follow–up PCI. MICS CABG is a promising future technique for heart revascularization by dedicated teams.

Impact of Anatomical and Viability-Guided Completeness of Revascularization on Clinical Outcomes in Ischemic Cardiomyopathy

BackgroundComplete revascularization of coronary artery disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function. ObjectivesThis study sought to identify the impact of complete revascularization in patients with severe LV dysfunction. MethodsPatients enrolled in the REVIVED-BCIS2 (Revascularization for Ischemic Ventricular Dysfunction) trial were eligible if baseline/procedural angiograms and viability studies were available for analysis by independent core laboratories. Anatomical and viability-guided completeness of revascularization were measured by the coronary and myocardial revascularization indices (RIcoro and RImyo), respectively, where RIcoro = (change in British Cardiovascular Intervention Society Jeopardy score [BCIS-JS]) / (baseline BCIS-JS) and RImyo= (number of revascularized viable segments) / (number of viable segments supplied by diseased vessels). The percutaneous coronary intervention (PCI) group was classified as having complete or incomplete revascularization by median RIcoro and RImyo. The primary outcome was death or hospitalization for heart failure. ResultsOf 700 randomized patients, 670 were included. The baseline BCIS-JS and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were 8 (Q1-Q3: 6-10) and 22 (Q1-Q3: 15-29), respectively. In those patients assigned to PCI, median RIcoro and RImyo values were 67% and 85%, respectively. Compared with the group assigned to optimal medical therapy alone, there was no difference in the likelihood of the primary outcome in those patients receiving complete anatomical or viability-guided revascularization (HR: 0.90; 95% CI: 0.62-1.32; and HR: 0.95; 95% CI: 0.66-1.35, respectively). A sensitivity analysis by residual SYNTAX score showed no association with outcome. ConclusionsIn patients with severe LV dysfunction, neither complete anatomical nor viability-guided revascularization was associated with improved event-free survival compared with incomplete revascularization or treatment with medical therapy alone. (Revascularization for Ischemic Ventricular Dysfunction) [REVIVED-BCIS2]; NCT01920048)

C-41 | In-Hospital Outcomes of Revascularization for Coronary Artery Disease in Patients With Advanced Chronic Kidney Disease Versus End Stage Kidney Disease: National Inpatient Sample Database Analysis

C-41 | In-Hospital Outcomes of Revascularization for Coronary Artery Disease in Patients With Advanced Chronic Kidney Disease Versus End Stage Kidney Disease: National Inpatient Sample Database Analysis

Observational studies are needed to complete the body of evidence for left main coronary artery disease revascularization strategies.

Observational studies are needed to complete the body of evidence for left main coronary artery disease revascularization strategies.

Optimal management of coronary artery disease in patients undergoing TAVI: The heart team holds the power.

Key Points The presence and complexity of coronary artery disease (CAD) as well as angiography‐guided percutaneous coronary intervention regardless of completeness were not associated with worse outcomes compared to those without CAD undergoing transcatheter aortic valve implantation (TAVI). Revascularization of CAD in patients undergoing TAVI is safe, but should not be performed routinely. Revascularization should be guided by the heart team. Future randomized studies are needed to address whether revascularization in patients with CAD undergoing TAVI impacts clinical outcomes post‐TAVI and if so, does completeness or timing of revascularization play a role.

Trends and outcomes of concomitant aortic valve replacement and coronary artery bypass grafting in the UK and a survey of practices.

Concomitant revascularization of coronary artery disease at the same time as treatment for aortic valvopathy favourably impacts survival. However, combined surgery may be associated with increased adverse outcomes compared to aortic valve replacement (AVR) or coronary artery bypass grafting in isolation. We retrospectively analyzed all patients who underwent AVR with bypass grafting between February 1996 and March 2019 using data from the National Adult Cardiac Surgery Audit. We used a generalized mixed-effects model to assess the effect of the number and type of bypass grafts associated with surgical AVR on in-hospital mortality, postoperative stroke, and the need for renal dialysis. Furthermore, we conducted an international cross-sectional survey of cardiac surgeons to explore their views about concomitant AVR with coronary bypass grafting interventions. Fifty-one thousand two hundred and seventy-two patients were included in the study. Patients receiving 2 or more bypass grafts demonstrated more significant preoperative comorbidity and disease severity. Patients undergoing 2 and >2 grafts in addition to AVR had increased mortality as compared to patients undergoing AVR and only 1 graft [odds ratio (OR) 1.17, 95% confidence interval (CI) [1.05-1.30], P = 0.005 and OR 1.15, 95% CI [1.02-1.30], P = 0.024 respectively]. A single arterial conduit was associated with a reduction in mortality (OR 0.75, 95% CI [0.68-0.82], P < 0.001) and postoperative dialysis (OR 0.87, 95% CI [0.78-0.96], P = 0.006), but this association was lost with >1 arterial conduit. One hundred and three surgeons responded to our survey, with only a small majority believing that the number of bypass grafts can influence short- or long-term postoperative outcomes in these patients, and an almost equal split in responders supporting the use of staged or hybrid interventions for patients with concomitant pathology. The number of grafts performed during combined AVR and coronary artery bypass grafting is associated with increased morbidity and mortality. The use of an arterial graft was also associated with reduced mortality. Future studies are needed to assess the effect of incomplete revascularization and measure long-term outcomes. Based on our data, current published evidence, and the collective expert opinion we gathered, we endorse future work to investigate the short and long-term efficacy and safety of hybrid intervention for patients with concomitant advanced coronary and aortic valve disease.

The Adherence to Guideline-Directed Therapy Post-Surgical Revascularisation in Coronary Artery Disease and Its Effect on Postoperative Outcomes

The Adherence to Guideline-Directed Therapy Post-Surgical Revascularisation in Coronary Artery Disease and Its Effect on Postoperative Outcomes

Long-term Outcomes for Drug-eluting Balloons versus Drug-eluting Stents in the Treatment of Small Vessel Coronary Artery Disease: A Systematic Review and Meta-analysis.

Background: This systematic review and meta-analysis compares long-term outcomes follow-up data comparing drug-eluting balloons (DEBs) and drug-eluting stents (DESs) in interventional treatment of small coronary artery disease (<3 mm). Methods: A systematic review was undertaken along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was 1-3-year performance of DEB versus DES in major adverse cardiac events. Secondary outcomes include all-cause mortality, MI, cardiac death, vessel thrombosis, major bleeding, target vessel revascularisation and target lesion revascularisation. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and random effects models. ORs are presented with a 95% CI. Results: Of 4,661 articles, four randomised control trials were included (1,414 patients). DEBs demonstrated reduced rates of non-fatal MI at 1 year (OR 0.44; 95% CI [0.2-0.94]), and BASKET-SMALL 2 reported a significant reduction in 2-year bleeding rates (OR 0.3; 95% CI [0.1-0.91]). There was no significant difference in all other outcomes. Conclusion: Long-term follow-up of DEB and DES use in small coronary arteries demonstrates DEBs be comparable with DESs in all outcomes at 1, 2 and 3 years of follow-up. A significant reduction was found in rates of non-fatal MI at 1 year in the DEB arm, and a reduction in major bleeding episodes at 2 years in the BASKET-SMALL 2 trial. These data highlight the potential long-term utility of novel DEBs in small coronary artery disease revascularisation.

In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease

In-hospital outcomes of endovascular abdominal aortic aneurysm repair after previous myocardial revascularization for coronary artery disease

Comparative Effectiveness of Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention for Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Clinical Trials.

Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are the options for revascularization in coronary artery disease (CAD). This meta-analysis aims to compare the efficacy of CABG and PCI for the management of patients with CAD. The meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, and EMBASE were searched for relevant articles. The reference list of included articles was also searched manually for additional publications. Primary endpoints were cardiovascular mortality and all-cause mortality. Secondary endpoints included myocardial infarction, stroke, and revascularization. In total, 12 randomized control trials (RCTs) were included in this meta-analysis encompassing 9,941 patients (4,954 treated with CABG and 4,987 with PCI). The analysis showed that PCI was associated with a higher risk of all-cause mortality (risk ratio (RR) = 1.26, 95% confidence interval (CI) = 1.10-1.45) and revascularization (RR = 2.42, 95% CI = 1.82-3.21). However, no significant differences were reported between two arms regarding cardiovascular mortality (RR = 1.15, 95% CI = 0.96-1.39), myocardial infarction (RR = 1.17, 95% CI = 0.82-1.67), and stroke (RR = 0.64, 95% CI = 0.35-1.16). CABG was associated with a significant reduction in all-cause mortality and revascularization compared to PCI. However, no significant difference was reported in the risk of cardiovascular mortality, myocardial infarction, and stroke between the two groups.

Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry

BackgroundLeft main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a “real-world” setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals).ResultsThis study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023).ConclusionsLM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.

Awareness Level and Practices of Heart Healthy Diet of Patients Undergoing Coronary Artery Bypass Grafting

Change in dietary habits with reduction in specific type of foods with heavy calories may help in prevention of many types of primary and secondary Cardiovascular Diseases (CVD). Coronary artery disease (CAD) is the most common cause of death all over the world and mostly treated by Coronary Artery Bypass Grafting (CABG). The recommended diet according to the guidelines, is high in fruits, vegetables and whole grains and is low in high fats and processed foods. The factors involved in consumption of low-quality diet mainly are lack of public awareness about the role of dietary style in development of CVD, lack of food due to low socioeconomic conditions, cultural and traditional differences of food preparation and availability of poor-quality food in markets Objectives: To assess the level of awareness amongst the patients of coronary artery bypass grafting in its worst form. Methods: The study was performed on 91 patients of CAD, admitted for CABG in tertiary care hospital. A questionnaire-based survey was conducted for a period of eight months. All patients admitted for revascularization for CAD were included. Details of patients co morbidities were collected and their socioeconomic status was confirmed from the medical record. They were scored on their general education, knowledge about heart healthy diet according to American Heart Association (AHA) dietary guidelines and their dietary practices were scored healthy or non-healthy based on their answers. Results: Among the patients, approximately, 75.82% were males, 96.7% had age above 49 years, half of the patients had some sort of awareness regarding heart healthy diet, 37% were following healthy diet, 50% were partially following and 4.4% were not following at all. Conclusion: The awareness of participants regarding heart healthy diet was over all poor and also their dietary practices were even worse and not in accordance to the medical recommendations. There is a need to increase awareness in heart patients regarding healthy diet choices so that their risk of disease progression can be reduced

A Cross-sectional Study to Assess the Patient's Confidence Regarding Secondary Lifestyle Modification and Knowledge of Heart Attack Symptoms Following Percutaneous Revascularization in Selected Hospitals of Navi Mumbai, India

Background of the Study: Cardiovascular Disease (CVD) is affecting millions of people in both developed and developing countries. Although the rate of death attributable to the disease has declined in developed countries in the past several decades, it is still the leading cause of death and extorts a heavy social and economic toll globally. In low-middle income countries, the prevalence of CVD has increased dramatically. By 2020, the disease is forecasted to be the major cause of morbidity and mortality in most developing nations. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100000 populations in India is higher than the global average of 235 per 100000 populations.&#x0D; CAD was estimated to account for around 15%–20% and 6%–9% of all deaths in India and the US. In addition to mortality, CAD is also responsible for morbidity and loss of quality of life&#x0D; Materials and Methods: Qualitative cross-sectional study design with a descriptive research approach was adopted for the present study. The study was conducted in D. Y. Patil Hospital and Terna Multi-Speciality Hospital and Research Centre, Nerul, Navi Mumbai with a sample size of 75. A Non-probability purposive sampling technique was used. In this study samples were patients who underwent Percutaneous revascularization for coronary artery disease. Data was collected using an Interview technique. The data was tabulated and analysed in terms of objectives of the study, using descriptive and inferential statistics.&#x0D; Results: The study results show that the majority of the respondents belonged to the age group 46 - 65 years with a frequency of 27 (36%) and were married 57 (76%). Representation of male respondents was 44 (59%) and the rest of the respondents belonged to female gender. They were educated up to high school and employed (service staff); their monthly income was &lt;30,000. They were currently diagnosed as STEMI 22 (29.33%), NSTEMI 17 (22.66%) and CAD/IHD 36 (48%). All the respondents had undergone PCI for CAD. Majority of them presented with the selected risk factor variables mentioned in the data collection tool. The respondents had knowledge about the classical symptoms of heart attack. However, they were unable to identify the other associative symptoms of heart attack. 97.33% of the respondents verbalized the correct response that is sudden pain and heaviness on the chest (n=73) which reciprocates to and sudden pain at the back of chest bone with pain moving towards the left or both arms (n=18) which reciprocates to 24%. However, few respondents have identified that heart attack is a sudden weakness of the upper arm and lower limb on one side of the body (n=26) which reciprocates to 35% and this option remains incorrect. Although from this (n=8) which reciprocates to 10% of the respondents have also managed to verbalize the right response which suggests that they may not have complete knowledge about heart attack symptoms. There was a significant difference between the number of people who were confident and those who were not confident, also there was a significant difference between confidence to some extent and versus confident (that is P&lt;0.05) about the items on the lifestyle modifying factors. The results indicate that fewer patients were confident about the lifestyle modifying factors. Also, the respondents showed positive correlation (&lt; +1.0) and negative correlation (&lt;-1.0) with risk factor variables.&#x0D; The study findings revealed that, patient did not verbalize complete knowledge and confidence regarding secondary lifestyle modification through the statistical analysis. There is a significant difference between the number of people who were confident versus those who were not confident and there was a significant difference between confidence to some extent versus confidence about the items on the lifestyle modifying factors. Also, there is a significant difference between risk factors and all the lifestyle modifying variables.&#x0D; Conclusion: There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve awareness in terms of health education in the population which will eventually increase their level of confidence.

The Association Between Recurrence of Atrial Fibrillation and Revascularization in Patients With Coronary Artery Disease After Catheter Ablation.

Aim: The connection between revascularization for coronary artery disease (CAD) and the incidence of recurrent events of atrial fibrillation (AF) after ablation is unclear. This study aimed to explore the relationship between coronary revascularization and AF recurrence in patients who underwent radiofrequency catheter ablation (RFCA).Methods: Four hundred and nineteen patients who underwent performed coronary angiography at the same time as RFCA were enrolled in this study. Obstructive CAD was defined as at least one coronary artery vessel stenosis of ≥75% and percutaneous coronary intervention (PCI) was recommended. Non-obstructive CAD was defined as coronary artery vessel stenosis of <75%. The endpoint was freedom from recurrence from AF after RFCA during the 24-month follow-up.Results: In total, 102, 95, and 212 patients were undergone coronary angiography and diagnosed as having obstructive CAD, Non-obstructive CAD, and Non-CAD, respectively. During the 24-month follow-up period, patients without obstructive CAD were significantly more likely to achieve freedom from AF than patients with obstructive CAD (hazard ratio [HR]: 1.72; 95% confidence interval [CI]: 1.23–2.41; P = 0.001). The recurrence rate of AF was significantly lower in patients who underwent PCI than in those who did not (HR: 0.45; 95% CI: 0.25–0.80; P = 0.007). The multivariate regression analysis showed that the other predictors of AF recurrence for obstructive CAD were multivessel stenosis (HR: 1.92; 95% CI: 1.04–3.54; P = 0.036) and left atrial diameter (HR: 2.56; 95% CI: 1.31–5.00; P = 0.006).Conclusions: This study suggests that obstructive CAD is associated with a higher rate of AF recurrence. Additionally, For patients with CAD, coronary revascularization is related to a lower recurrence rate of AF after RFCA.

A\xa0neutralizing IL-11 antibody reduces vessel hyperplasia in a mouse carotid artery wire injury model

Vascular restenosis remains a major problem in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Neointimal hyperplasia, defined by post-procedure proliferation and migration of vascular smooth muscle cells (VSMCs) is a key underlying pathology. Here we investigated the role of Interleukin 11 (IL-11) in a mouse model of injury-related plaque development. Apoe−/− mice were fed a hyperlipidaemic diet and subjected to carotid wire injury of the right carotid. Mice were injected with an anti-IL11 antibody (X203), IgG control antibody or buffer. We performed ultrasound analysis to assess vessel wall thickness and blood velocity. Using histology and immunofluorescence approaches, we determined the effects of IL-11 inhibition on VSMC and macrophages phenotypes and fibrosis. Treatment of mice with carotid wire injury using X203 significantly reduced post-endothelial injury vessel wall thickness, and injury-related plaque, when compared to control. Immunofluorescence staining of the injury-related plaque showed that X203 treatment did not reduce macrophage numbers, but reduced the number of VSMCs and lowered matrix metalloproteinase 2 (MMP2) levels and collagen content in comparison to control. X203 treatment was associated with a significant increase in smooth muscle protein 22α (SM22α) positive cells in injury-related plaque compared to control, suggesting preservation of the contractile VSMC phenotype. Interestingly, X203 also reduced the collagen content of uninjured carotid arteries as compared to IgG, showing an additional effect on hyperlipidemia-induced arterial remodeling in the absence of mechanical injury. Therapeutic inhibition of IL-11 reduced vessel wall thickness, attenuated neointimal hyperplasia, and has favorable effects on vascular remodeling following wire-induced endothelial injury. This suggests IL-11 inhibition as a potential novel therapeutic approach to reduce arterial stenosis following revascularization in CAD and PAD patients.

Disparities in Screening and Treatment of Cardiovascular Diseases in Patients With Mental Disorders Across the World: Systematic Review and Meta-Analysis of 47 Observational Studies.

This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality. The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed. Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results. People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.

Early Cardiovascular Toxicity with Treatment of Follicular Lymphoma Is Associated with Shorter Overall Survival

Introduction: The clinical course of follicular lymphoma (FL) is characterized by recurrent relapses and progressively shorter remissions, with many patients surviving beyond one decade from initial diagnosis. During this time, patients will receive several courses of therapy, which can be complicated by significant toxicities, particularly in elderly patients with multiple comorbidities. While the incidence and outcomes of cardiovascular toxicities observed in subjects with aggressive lymphomas treated with anthracycline based chemotherapy are well known, there is limited information regarding the incidence of cardiovascular events (CVE) in FL patients, many of whom have historically received similar antineoplastic regimens. We conducted a retrospective study to observe the incidence of CVE in FL patients from the time of diagnosis and their effect on patient outcomes.Patients and Methods: We accessed the Hematologic Malignancies Database of University Hospitals Seidman Cancer Center to identify patients diagnosed with FL between 2002 and 2014. We collected patient data including baseline demographics and risk factors, disease characteristics, treatments prescribed and outcomes, including response, relapse, and incidence of CVE. Multivariate logistic regression modeling was performed to identify risk factors associated with incidence of CVE. Cumulative incidence (with death as competing risk) was used to estimate the incidence of CVE. The Kaplan-Meier method was used to assess overall survival (OS) and progression-free survival (PFS). Two-tailed log-rank test compared OS and PFS curves. All analyses were performed using IBM SPSS Statistics 2015.Results: Two hundred and twenty-seven FL patients were included for analysis. Median age at diagnosis was 60 years, with 161 patients presenting with advanced stage FL (71%). Approximately two thirds of patients had intermediate or high-risk disease by FLIPI at diagnosis (n= 147, 65%). Decreased ejection fraction at diagnosis was identified in 5 patients (2.2%). Baseline characteristics and initial therapy choice are summarized in Table 1. A total of 143 patients (63%) received chemo-immunotherapy as part of their initial therapy, which included an anthracycline in 99 subjects (44%).After a median follow up of 66 months, 52 patients (23%) have died. Forty-two patients (18.5%) presented with CVE, with 2 and 5 - year cumulative incidence of 6.4 % (95% CI, 3.9-10.6%) and 13.5% (95% CI, 9.5-19.2%) respectively. Twenty- three patients (10%) developed congestive heart failure while 9 (4%) had an acute coronary syndrome or required coronary artery disease revascularization. Multivariate analysis (Table 2) identified age > 60 years, male gender, prior history of coronary artery disease and anthracycline treatment were independent risk factors for CVE.Patients who were prescribed systemic or local therapy after initial diagnosis of FL had a higher cumulative incidence of CVE than patients who were observed initially (5-year cumulative incidence 15.8% vs 9.6 %, respectively) (p=0.043). In addition, subjects who received anthracycline-based therapy at any point in the treatment course presented a higher cumulative incidence of CVE than those never treated with anthracyclines (5-year cumulative incidence 19.1% vs 8.2%, respectively) (p=0.019). The 5-year OS of patients who developed a CVE within 2 years of diagnosis was 56% (95% CI, 27.3-85.6%) versus 85% (95% CI, 80.1-90.3%) in patients who did not develop an early CVE (p=0.048) (Figure 1)Conclusion: Cardiovascular events in patients diagnosed with FL have a significant effect on their OS. Patients who require treatment are at increased risk of developing cardiovascular events, particularly those treated with anthracycline-based chemo-immunotherapy. Continued investigation is necessary to determine whether novel therapies have the same effect in cardiovascular risk. Interventions to identify, monitor and ameliorate cardiovascular risk factors in patients with FL should be investigated to improve survival. [Display omitted] DisclosuresMalek:Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Membership on an entity's Board of Directors or advisory committees; Celgene: Speakers Bureau. Cooper:Novartis: Research Funding. de Lima:Celgene Corporation: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees. Caimi:Abbvie: Equity Ownership; Incyte: Equity Ownership; Celgene: Speakers Bureau; Seattle Genetics: Equity Ownership.

Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis.

Background: Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21–2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06–2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21–12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR.

The Latest Evidence on Revascularization of Coronary Artery Disease

The Latest Evidence on Revascularization of Coronary Artery Disease