Stable Coronary Disease Research Articles

Impact of Stent Length on Short Term Outcomes in Patients With Stable Coronary Disease Undergoing PCI

Impact of Stent Length on Short Term Outcomes in Patients With Stable Coronary Disease Undergoing PCI

Nowy paradygmat leczenia przeciwzakrzepowego chorób miażdżycowych. Stanowisko grupy ekspertów wsparte przez Sekcję Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego dotyczące miejsca riwaroksabanu w terapii stabilnej choroby wieńcowej lub objawowej choroby tętnic obwodowych

The need to improve the efficacy of anticoagulant therapy in secondary prevention is indicated by the fact that intensive antiplatelet therapy only partially reduces cardiovascular risk. The results of the COMPASS study provide evidence that additional blocking of coagulation cascade may significantly affect the further prevention of major cardiovascular events in a selected population of patients. The following document is the opinion of an expert group summarising the latest knowledge regarding anticoagulant therapy in stable coronary disease and peripheral artery disease.

Nowy paradygmat leczenia przeciwzakrzepowego chorób miażdżycowych. Stanowisko grupy ekspertów wsparte przez Sekcję Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego dotyczące miejsca riwaroksabanu w terapii stabilnej CAD

The need to improve the efficacy of anticoagulant therapy in secondary prevention is indicated by the fact that intensive antiplatelet therapy only partially reduces cardiovascular risk. The results of the COMPASS study provide evidence that additional blocking of coagulation cascade may significantly affect the further prevention of major cardiovascular events in a selected population of patients. The following document is the opinion of an expert group summarising the latest knowledge regarding anticoagulant therapy in stable coronary disease and peripheral artery disease.

Perkütan Koroner İşlem Yapılan Hastalarda Klopidogrel Direncinin Klinik Belirteçleri

AbstartObjective: Antiplatelet therapy is an indispensable part of current coronary artery disease and resistance to ADP inhibitors leads to adverse cardiovascular events in patients. In this study, it was aimed to detect clopidogrel resistance markers in patients undergoing percutaneous coronary intervention. METHODS: Eighty consecutive patients (38 clopidogrel resistance, 42 controls) who underwent percutan intervention procedure due to coronary artery disease and who had tested positive for clopidogrel resistance at the end of the first week were included in the study. In the VerifyNow test,> 208 platelet reactivity unit clopidogrel resistance and> 550 aspirin reaction unit were accepted as aspirin resistance. 28 patients were treated with ST elevation MI, 18 patients without ST elevation MI, and the other patients were treated for stable coronary disease. Demographic findings, CV and family background variables, body mass index, injection fraction, aspirin resistance and biochemical parameters were compared. Findings: The mean age of the patients was 59 ± 12 and 15 were female. Subjects with clopidogrel resistance were significantly lower in Hemoglobin values. Resistance was more frequent in hypertension, while female sex and smokers were more frequent. Logistic regression analysis showed that hemoglobin (odds ratio = 0.8; 95% safety interval (0.678-0.945), p = 0.008] significantly predicted clopidogrel resistance. Conclusion: Low hemoglobin level predicts clopidogrel resistance independently of other clinical variables

Mechanism and extent of myocardial injury associated with out-of-hospital cardiac arrest

AimWe investigated the mechanism and extent of myocardial injury associated with out-of-hospital cardiac arrest (OHCA). Methods159 consecutive patients undergoing immediate coronary angiography after OHCA were included and divided into groups with acute culprit lesion (A), stable obstructive coronary disease (B) and non-obstructive or absent coronary disease (C). Post-resuscitation electrocardiogram (ECG) and serial measurements of high sensitivity cardiac troponin I (cTnI) were compared. ResultsST-elevation myocardial infarction (STEMI) was documented in 65% in group A, 26% in group B, and 11% in group C (p < 0.001). cTnI, which was 0.88 ng/mL, 0.44 ng/mL and 0.19 ng/mL in groups A, B and C on admission (p < 0.001), increased to a maximum of 63.96 ng/mL, 10.00 ng/mL and 2.35 ng/mL, respectively (p < 0.001). Within the group A, cTnI was significantly larger in patients with acute occlusion than in patients with spontaneous reperfusion at initial angiography. Within groups B and C, peak cTnI correlated with duration of resuscitation, number of defibrillations and cumulative adrenaline (epinephrine) dose. If admission cTnI exceeded 0.46 ng/mL and STEMI was present in ECG, sensitivity for detection of acute culprit lesion was 88% and specificity 54%. ConclusionsSignificant myocardial injury associated with OHCA occurs in the presence of acute culprit lesion while extent of myocardial injury in stable or absent coronary disease is significantly smaller and correlates with the duration and intensity of cardiac resuscitation. Admission cTnI, although combined with post-resuscitation ECG, have insufficient accuracy to securely predict presence of acute culprit lesion.

500.02 Clinical Outcomes At 2 Years of The Absorb Bioresorbable Vascular Scaffold Versus The Xience Drug-eluting Metallic Stent In Patients Presenting With Acute Coronary Syndrome Versus Stable Coronary Disease - Aida Trial Sub-study.

Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention (PCI) might lead to better outcomes when compared to conventional treatment with metallic drug-eluting stents. ACS patients (STE-ACS

Rapid Aspirin Desensitization is Safe and Feasible in Patients With Stable and Unstable Coronary Artery Disease: A Single-Center Experience.

There are limited data on aspirin (ASA) desensitization for patients with coronary disease. We present our experience with a rapid nurse-led oral desensitization regimen in patients with aspirin sensitivity undergoing coronary angiography. This single-center retrospective observational study includes patients with a history of ASA sensitivity undergoing coronary angiography with intent to perform percutaneous coronary intervention (PCI). Between January 2012 and January 2017, 24 patients undergoing coronary angiography for stable coronary disease (7 cases) or acute coronary syndromes (non-ST-segment myocardial infarction [NSTEMI; 8 cases], STEMI [9 cases]) underwent aspirin desensitization having reported previous reactions to aspirin. At initial presentation, previous sensitivity reactions were reported as: mucocutaneous reactions in 17 patients (urticaria in 3 [13%], nonurticarial rash in 6 [25%], angio-oedema in 8 [33%]), respiratory sensitivity in 4 (17%), and systemic anaphylactoid reactions in 3 (13%). Seventeen (71%) patients underwent PCI. Desensitization was acutely successful in 22 (92%) patients and unsuccessful in 2 (8%) patients who both had a single short-lived episode of acute bronchospasm treated successfully with nebulized salbutamol. Fifteen successfully desensitized patients completed 12 months of aspirin; no patient had recurrent hypersensitivity reaction. Aspirin was stopped prior to 12 months in 7 patients (replaced by warfarin [1 case], no antiplatelet or single antiplatelet clinically indicated and clopidogrel chosen [4 cases], patient choice without evidence of recurrent hypersensitivity [1 case], and death due to cardiogenic shock following STEMI [1 case]). A rapid aspirin desensitization protocol is safe and effective across a broad spectrum of hypersensitivity reactions and clinical presentations.

Short-term stent coverage of second-generation zotarolimus-eluting durable polymer stents: Onyx one-month optical coherence tomography study.

IntroductionTo date the early strut coverage with the second-generation durable-polymer ONYX zotarolimus-eluting stent (O-ZES) is unknown.AimOptical coherence tomography (OCT) assessed the strut coverage of O-ZES at thirty-day follow-up.Material and methodsOCT was performed after implantation and at 1-month follow-up in 15 patients treated with O-ZES.ResultsMean patient age was 67 ±7 years (73% males). The clinical presentation consisted of acute coronary syndromes (n = 13) and stable coronary disease (n = 2). Four (26%) patients had diabetes. OCT analysis was performed at baseline and 1-month follow-up in all stents. 378 cross-sections with 3582 struts were assessed at baseline and 3661 at follow-up. At follow-up, 88% struts were covered by tissue with a median thickness 37.91 μm (IQR: 22.32–64.15). Median in-stent area obstruction by neointima was 2.64% (IQR: 1.70–4.84). From the total stent covered area, 92.3% showed complete strut coverage. Homogeneous tissue was observed in 74% of cases. There were no differences in minimal lumen area (5.07 ±1.08 mm2 vs. 4.81 ±0.94 mm2, p = 0.125) or minimal stent area (4.95 ±1.22 mm2 vs. 4.92 ±0.99 mm2) at baseline and at follow-up. There were no differences in the rate of strut malapposition (4.3% vs. 5.7%, p = 0.417). For all stents, malapposition volume was 47.9 mm3 at baseline and 51.7 mm3 at follow-up, giving the late acquired stent malapposition volume of 3.8 mm3.ConclusionsThe second-generation durable polymer O-ZES showed favorable vessel healing at 30-day OCT follow-up.

Red cell distribution width predicts new-onset atrial fibrillation in sepsis patients

Background Sepsis is a major cause of mortality in non-cardiac intensive care units, and ranks 10th among causes of death overall. Acute new onset atrial fibrillation is a common observation in critically ill patients admitted with sepsis, there is a direct relationship with disease severity. The red cell distribution width variations reflects a range of systemic diseases including heart failure, stable coronary disease, acute coronary syndrome and stroke. Objectives In this study, we aimed to investigate the relation between red cell distribution width (RDW) and atrial fibrillation (AF) in critically-ill patients with sepsis. Settings and Design We retrospectively examined 70 sepsis patients (35 sepsis patients with newly developed AF during intensive care unit (ICU) stay and 35 sepsis patients without AF matched with age and sex. We investigated the predictive potential for atrial fibrillation for RDW, Ejection fraction, central venous pressure (CVP), Heart rate and qSofa score. Results The mean age of AF group was 54.49 ± 10.07 vs. 56.26 ± 11.766 for Non-AF group. Baseline Ejection fraction, systolic blood pressure, heart rate and CVP showed no significant differences. RDW on admission was significantly different between groups; 18.94 ± 1.126 (AF group) vs. 14.76 ± 0.97 (Non AF Group). ROC curve analysis was done on AF group to determine cut-off values for RDW. Cut-off point was at 17.6 with 97 % sensitivity and 60.7 % specificity. Conclusions RDW levels were higher in sepsis patients with newly developed atrial fibrillation. An increased RDW level in the patient with sepsis may alert physician on developing or presence of atrial fibrillation.

Comparison of farmacodynamic properties of three different aspirin formualtions in patients with stable coronary disease

Background/Aim. The platelet aggregation, as a laboratory test for assessment of platelet function, is very efficient for optimal antiplatelet treatment and also to identify individuals who have suboptimal response to antiplatelet drugs, such as aspirin and clopidogrel. The aim of this study was to determine the level of inhibition of platelet aggregation using impedance aggregometry in the patients receiving different preparations of acetylsalicylic acid (ASA) in a dose of 100 mg per day. Methods. The examination included 215 patients (110 men and 105 women), treated with one of three different ASA preparations after acute myocardial infarction, as a single therapy or with clopidogrel. Among them, 89 patients were on Aspirin protect? (Bayer, Germany) ? Group 1 and 66 patients were on Cardiopirin? (GL Pharma GMBH, Austria) ? Group 2, while 60 patients were taking Andol? (Pliva, Croatia) ? Group 3. The groups were equal in the presence of factors that can influence platelet aggregation (age, gender, smoking, diabetes, taking other drugs). The platelet function was measured using the impedance aggregometer Multiplate (Multiplate Platelet Function Analyzer, Roche) in the blood samples with heparin for the platelet aggregation activated by the arachidonic acid (ASPI) and by thrombin (TRAP) tests [the area under the aggregation curve (AUC) was used to express the aggregation response over the measured time (AU*min)]. Results. Efficacy of ASA preparations showed statistically significant differences among the three investigated groups (?KW2 = 46.279; p &lt; 0.001), and it was also observed separately in the patients undergoing single therapy (?KW2 = 26.344; p &lt; 0.001) and dual therapy (?KW2 = 23.498; p &lt; 0.001). It was found that the patients who were taking Aspirin protect? obtained significantly better antiplatelet efficiency compared to the patients receiving Cardiopirin? (Z = 5.472; p &lt; 0.001) and Andol? (Z = 5.387; p = 0.022). There is reduced efficiency of all ASA preparations in smokers, while patients receiving Aspirin protect? were 10.5 times more likely to be responders. Conclusion. Different ASA preparations observed in this study showed different efficiency on the platelet function as measured by the method of impedance aggregometry.

The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion after Provisional Stenting of Coronary Bifurcation Lesions.

Layered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting. This is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying tissue. Overall, 207 patients with stable coronary disease were included. SB occlusion occurred in 26/207 (12.6%) bifurcation lesions. Operators decided not to perform additional treatment, and TIMI flow did not improve to ≥2 in cases with SB occlusion. The prevalence of OCT-detected layered pattern was more common in lesions with versus without SB occlusion (88.5% versus 33.7%, p < 0.0001); OCT-detected layered pattern was more often located on the same side of the SB (73.9% versus 21.3%, p < 0.0001) circumferentially compared to lesions without SB occlusion. Multivariable analysis showed that OCT-detected layered pattern was an independent predictor of SB occlusion (odds ratio 18.8, 95% confidence interval 5.1-68.8, p < 0.0001) along with true bifurcation lesion and wider angiographic bifurcation angle. The presence of an OCT-detected layered pattern near its ostium was a strong predictor of SB occlusion after provisional bifurcation stenting.

Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial.

Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (≥90, 89-60 and 59-30 mL/min/1.73 m2, respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com. Registration number: ISRCTN66068876). Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07-0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31-0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25-0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07-4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.

Anti-anginal drugs: Systematic review and clinical implications

BackgroundThe cornerstone of the treatment of patients affected by stable angina is based on drugs administration classified as first (beta-blockers, calcium channel blockers, short acting nitrates) or second line treatment (long-acting nitrates, ivabradine, nicorandil, ranolazine and trimetazidine). However, few data on comparison between different classes of drugs justify that one class of drugs is superior to another. MethodsWe performed a systematic review of the literature following PRISMA guidelines. Inclusion criteria: i) paper published in English; ii) diagnosis of stable coronary disease; iii) randomized clinical trial; iv) comparison of two anti-angina drugs; v) a sample size >100 patients; vi) a follow-up lasting at least 2 weeks; vii) paper published after 1999, when a meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina of Heidenreich et al. was published. Outcome: to establish whether the categorization in first and second line antianginal treatment is scientifically supported. ResultsEleven trials fulfilled inclusion criteria. The results show that there is a paucity of data comparing the efficacy of antianginal agents. The little data available show that there are not compounds superior to others in terms of improvement in exercise test duration, frequency of anginal attacks, need for sub-lingual nitroglycerin. ConclusionThe categorization of antianginal drug in first and second line is not confirmed.

High plasma FGF21 levels predicts major cardiovascular events in patients treated with atorvastatin (from the Treating to New Targets [TNT] Study)

BackgroundHigher plasma fibroblast growth factor 21 (FGF21) levels predict incident cardiovascular events in type 2 diabetes patients. However, whether FGF21 levels predict cardiovascular events in statin-treated patients in the general population is unknown. We investigated whether FGF21 levels predict major cardiovascular event (MCVE) in the Treating to New Targets (TNT) trial participants. MethodsAfter 8-week run-in on atorvastatin 10 mg/day, 10,001 patients with stable coronary disease in the TNT trial were randomized to 10 mg or 80 mg/day of atorvastatin for a median of 4.9 years. We analyzed data from 1996 patients with plasma FGF21 levels measured at randomization. Among them, 1835 patients had FGF21 measured one-year post-randomization. ResultsHigher ln-transformed FGF21 levels at randomization were associated with higher risk of incident MCVE (adjusted hazards ratio per SD increase = 1.18, P = 0.019). At 1-year post-randomization, FGF21 levels were lower in patients randomized to receive 80 mg versus 10 mg atorvastatin (186.9 versus 207.5 pg/mL respectively, P = 0.006). Higher ln-transformed FGF21 levels at 1-year post-randomization were also associated with higher subsequent risk of MCVEs (adjusted hazards ratio per SD increase = 1.24, P = 0.009). However, changes in FGF21 levels over 1-year were not related to subsequent MCVE risk. FGF21 levels had significant incremental value in net reclassification improvement in MCVE risk prediction. ConclusionsHigher plasma FGF21 levels are associated with higher CVD risk in statin-treated high-risk patients. Higher dose atorvastatin is associated with a reduction in FGF21 levels. FGF21 provides incremental value in CVD risk prediction in statin-treated patients.

Data-Driven Gross Patient Motion Detection and Compensation: Implications for Coronary 18F-NaF PET Imaging.

Patient motion degrades image quality, affecting the quantitative assessment of PET images. This problem affects studies of coronary lesions in which microcalcification processes are targeted. Coronary PET imaging protocols require scans of up to 30 min, introducing the risk of gross patient motion (GPM) during the acquisition. Here, we investigate the feasibility of an automated data-driven method for the detection of GPM during PET acquisition. Methods: Twenty-eight patients with stable coronary disease underwent a 30-min PET acquisition 1 h after the injection of 18F-sodium fluoride (18F-NaF) at 248 ± 10 MBq (mean ± SD) and then a coronary CT angiography scan. An automated data-driven GPM detection technique tracking the center of mass of the count rates for every 200 ms in the PET list-mode data was devised and evaluated. Two patient motion patterns were considered: sudden repositioning (motion of >0.5 mm within 3 s) and general repositioning (motion of >0.3 mm over 15 s or more). After the reconstruction of diastolic images, individual GPM frames with focal coronary uptake were coregistered in 3 dimensions, creating a GPM-compensated (GPMC) image series. Lesion motion was reported for all lesions with focal uptake. Relative differences in SUVmax and target-to-background ratio (TBR) between GPMC and non-GPMC (standard electrocardiogram-gated data) diastolic PET images were compared in 3 separate groups defined by the maximum motion observed in the lesion (<5, 5-10, and >10 mm). Results: A total of 35 18F-NaF-avid lesions were identified in 28 patients. An average of 3.5 ± 1.5 GPM frames were considered for each patient, resulting in an average frame duration of 7 ± 4 (range, 3-21) min. The mean per-patient motion was: 7 ± 3 mm (maximum, 13.7 mm). GPM correction increased SUVmax and TBR in all lesions with greater than 5 mm of motion. In lesions with 5-10 mm of motion (n = 15), SUVmax and TBR increased by 4.6% ± 5.6% (P = 0.02) and 5.8% ± 6.4% (P < 0.002), respectively. In lesions with greater than 10 mm of motion (n = 15), the SUVmax and TBR increased by 5.0% ± 5.3% (P = 0.009) and 11.5% ± 10.1% (P = 0.001), respectively. GPM correction led to the diagnostic reclassification of 3 patients (11%). Conclusion: GPM during coronary 18F-NaF PET imaging is common and may affect quantitative accuracy. Automated retrospective compensation of this motion is feasible and should be considered for coronary PET imaging.

TWARMI pilot trial: The value and optimal criteria of microvolt T-wave alternans in the diagnosis of reversible myocardial ischemia in patients without structural cardiac disease.

Microvolt T-wave alternans (MTWA) testing is a beat-to-beat fluctuation in the amplitude of T wave. We investigated whether: (a) MTWA can be new non-invasive tool for detection of reversible ischemia in patients with suspected CAD without structural heart disease, (b) MTWA can detect ischemia earlier and with greater test accuracy compared with exercise ECG ST-segment testing, and (c) threshold value of MTWA and heart rate at which the alternans is estimated can be different compared to standard values. A total of 101 patients with suspected stable coronary disease, but without structural heart disease, were included. Echocardiography, exercise ECG test, MTWA with classical and modified threshold alternans values, and coronary angiography were performed. About 33.3% patients had a false-positive result on exercise ECG test. The sensitivity of exercise ECG ST-segment test in the detection of coronary artery disease was 97.8%, and the specificity was 42.5% (DOR 33.89). In a group of angiographically positive patients, standard MTWA accurately identified 60% of patients, while 40% had a false-negative result. About 91.8% patients with negative angiography result were accurately identified with 8.2% false positives. The sensitivity of MTWA was 59.61% and specificity 91.83%. Best ratio of sensitivity and specificity (86.53% and 95.91%, DOR 151.06) had modified criteria for positive MTWA (MTWA >1.5µV at heart rate 115-125/min). This study showed that MTWA can be the new non-invasive tool for the detection of reversible ischemia in patients with suspected CAD without structural heart disease. Also, MTWA can detect ischemia earlier and with greater accuracy compared with exercise ECG testing.

PO540 Depression, Social Support, Quality of Life, and Medication Adherence In Patients With Stable Coronary Disease

PO540 Depression, Social Support, Quality of Life, and Medication Adherence In Patients With Stable Coronary Disease

Durée du traitement antiagrégant plaquettaire chez le sujet âgé stenté

Ischemic heart disease is a leading cause of death in Europe. At the same time, older patients are at high risk for coronary heart disease and represent an increasing proportion of patients in the catheterization laboratory in the context of an ageing population. The elderly patients are also at higher bleeding risk, and were poorly represented in major randomized trials. Duration of dual antiplatelet therapy (DAPT), after percutaneous coronary intervention (PCI) should be modulated in a personalized way taking into account hemorrhagic and ischemic risk factors, using risk scores based on the latest recommendations of the European Society of Cardiology. Even if the optimal duration of DAPT after PCI is 6 months in case of stable coronary disease and 12 months in case of an acute coronary syndrome, it can be drastically reduced, up to one month in case of high hemorrhagic risk, or can be prolonged for more than 12 months in case of high ischemic risk. The use of latest generation drug eluting stents associated with a short duration of DAPT has thus demonstrated its safety compared to these durations. In case of triple therapy treatment, associating DAPT and anticoagulation therapy, DAPT is recommended to be as short as possible, potentially reduced to 1 month. Finally, the concomitant prescription of proton pump inhibitor is essential to prevent gastrointestinal bleedings. This literature review will discuss the hemorrhagic risk stratification and choice of DAPT in elderly patients.

Changes in the quality of life of patients with stable ischemic heart disease and preserved left ventricular ejection fraction after coronary artery bypass grafting or stenting at 6-month follow-up

The aim — to compare the changes of the values of quality of life (QoL) in patients with stable coronary artery disease and preserved left ventricular (LV) ejection fraction (EF) within 6 months after revascularization interventions (coronary artery bypass grafting — CABG, or percutaneous coronary intervention — PCI) and to identify the factors that may affect QoL changes. Materials and methods. A single­center prospective study included data from a clinical, instrumental and laboratory examination of 115 patients (91 (79.1 %) men and 24 (20.9 %) women aged 32 to 92 years (mean age — 63 ± 10) with CAD and preserved LV systolic function (LVEF ≥ 45 %) consecutively selected for CABG (n = 71) or coronary stenting (n = 44). QoL was assessed by MLHFQ, SAQ and SF­36 questionnaires before and 6 months after myocardial revascularization. Also, changes in the distance of 6­minute walking test, Doppler echocardiographic indices of the LV diastolic function and the level of the brain natriuretic peptide (BNP) were analyzed. Results and discussion. After 6 months of follow­up in the study groups, the levels of QoL according to MLHFQ, SF­36 and SAQ scores significantly improved, compared to the baseline data (p < 0.001). In both groups there was a decrease of the functional class of angina by the Canadian classification (p < 0.001). There were no significant differences in the manifestation of stable angina pectoris in the compared groups after 6 months (p = 0.237). Improvement of QoL was associated with decrease of the BNP level from baseline 108.8 (50.1 — 185.4) to 32.3 (12.6 — 57.8) pg/ml in the stenting group (p = 0.002) and from 115.4 (62.0 — 150.6) to 52.4 (20.4 — 95.9) pg/ml in the CABG group (p < 0.001). The distance of the 6­minute walk test in the stenting group increased from 223 (148 — 328) m to 550 (400 — 600) m; in the CABG group this distance was, respectively, 260 (195 — 300) and 550 (415 — 600) m. Conclusions. Thus, in patients with stable ischemic coronary disease and preserved LV systolic function after coronary artery stenting or CABG, a significant improvement of QoL values was observed, compared to the baseline data. Favorable changes in QoL may be due to a decrease of angina pectoris, improvement of the Doppler echocardiographic parameters of LV diastolic function and functional status of the patients. The above­mentioned changes were associated with decrease of the BNP level.

TCT-96 Predicting angina-limited exercise capacity using coronary physiology

Coronary physiology is recommended to guide percutaneous coronary intervention (PCI) in stable coronary disease. PCI in such settings aims to relieve angina and improve exercise capacity. The aim of this study was to determine the relationship between instantaneous wave-free ratio (iFR), fractional