Search

Background High-dose aspirin has been reported to exacerbate coronary artery spasm in patients with vasospastic angina. We investigated clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis. Methods We included patients without significant coronary artery stenosis on coronary angiography (CAG) and with positive results on intracoronary ergonovine provocation test between January 2003 and December 2014. A total of 777 patients were divided into two groups according to prescription of low-dose aspirin at discharge: aspirin group (n = 321) and non-aspirin group (n = 456). The major adverse cardiovascular events (MACE), defined as composite outcomes of cardiac death, acute myocardial infarction, revascularization, or rehospitalization requiring CAG or medication change due to recurrent angina were compared. Results The aspirin group had significantly higher incidence of MACE (22.8% versus 12.1%; p = 0.04) and had higher tendency for rehospitalization (20.6% versus 11.2%; p = 0.08). All-cause mortality and cardiac death were similar between the two groups. After propensity score matching, the aspirin group had greater risk of MACE (hazard ratio [HR] 1.54; 95% confidence interval [CI], 1.04–2.28; p = 0.037) and rehospitalization requiring CAG (HR, 1.33; 95% CI, 1.13–4.20; p = 0.03), and a higher tendency for rehospitalization (HR, 1.40; 95% CI, 0.94–2.09; p = 0.12). Conclusion In vasospastic angina without significant coronary artery stenosis, patients taking low-dose aspirin are at higher risk of MACE, driven primarily by tendency toward rehospitalization. Low-dose aspirin might be used with caution in vasospastic angina patients without significant coronary artery stenosis. [ABSTRACT FROM AUTHOR]

Objectives To compare clinical outcomes of percutaneous coronary intervention (PCI) with those of optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. Background Limited data are available on the efficacy of OMT for the treatment of single-vessel CTO. Methods Between March 2003 and February 2012, we enrolled 2024 CTO patients in a retrospective, observational registry and analyzed 435 patients with CTO of a single coronary artery. We divided patients into an OMT group (n = 147) and PCI group (n = 288) according to the initial treatment strategy. One-to-many (1:N) propensity score matching with a non-fixed matching ratio was also performed. The primary outcome measured in this study was major adverse cardiac events (MACEs) including cardiac death, myocardial infarction, and repeated coronary revascularization. Results The median follow-up duration was 47.6 (interquartile range: 22.9 to 68.9) months. Major adverse cardiac events were noted for 16 patients (10.9%) in the OMT group compared to 41 patients (14.2%) in the PCI group (p = 0.38). After propensity-score matching, there were no significant differences between the OMT group and PCI group with respect to MACE frequency (10.1% vs. 16.9%, adjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 0.88–4.68, p = 0.10) or cardiac death (OMT vs. PCI: 5.1% vs. 4.8%, HR, 1.14; 95% CI, 0.30–4.42, p = 0.85). Subgroup analysis showed that the rate of MACEs was significantly lower in the OMT group compared to the PCI group among patients with an APPROACH score ≤ 18 and SYNTAX score ≤ 12. Conclusions As a treatment strategy in patients with single-vessel CTO, PCI did not reduce the risk of MACE or cardiac death. These results suggest that OMT may be a better initial strategy for patients as assessed by low APPROACH and SYNTAX scores. [ABSTRACT FROM AUTHOR]

Background Limited data exist regarding clinical outcomes of multiple chronic total occlusions (CTOs) according to therapeutic strategies, coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical treatment (MT). Methods From March 2003 to February 2012, a total of 2024 patients with at least one CTO were enrolled in retrospective, single-center registry. 393 patients with at least two CTOs were categorized based on the intention-to-treat principle. Propensity-score matching was performed. The primary outcome was major adverse cardiac and cerebral events (MACCE). Results Of 393 patients with multiple CTOs, 169 patients (43%) were referred for CABG, 130 (33%) for PCI, and 94 (24%) for MT. Median overall follow-up duration was 46.5 (interquartile range 22.7 to 74.6) months. After propensity-score matching analysis, CABG had lower rates of MACCE when compared with PCI (HR = 0.43, 0.21–0.85, P = 0.01) and MT (HR = 0.10, 0.04–0.27, P < 0.01). Rates of repeat revascularization was significantly lower in CABG, compared with PCI (HR = 0.05, 0.01–0.40, P < 0.01) and MT (HR = 0.01, 0.00–0.54, P = 0.02). CABG had similar rates of cardiac death compared with PCI group (HR = 0.97, 0.37–2.53, P = 0.95), but had significantly lower rates of cardiac death compared with MT (HR = 0.24, 0.08–0.75, P = 0.01). Conclusions For management of multiple CTOs, MT alone was associated with higher incidence of cardiac death and MACCE compared with CABG. PCI was associated with higher incidence of MACCE, as driven by higher repeat revascularization rate. These findings suggest that CABG might be associated with better clinical outcome and considered as the preferred treatment strategy in patients with multiple CTOs. [ABSTRACT FROM AUTHOR]

Abstract: Background: Debate continues over the importance of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI). We evaluated the prognostic significance of PMI in patients undergoing PCI for bifurcation lesions. Methods: Between January 2004 and June 2006, patients from 16 centers who received non-left main bifurcation lesion PCIs were enrolled. PMI was defined as a peak creatine kinase-myocardial band (CK-MB) ≥3 times the upper limit of normal after PCI. We compared long-term cardiac mortality between patients with and without PMI. Results: Among the 1188 patients, PMI occurred in 119 (10.0%). Left ventricular ejection fraction<50% (adjusted hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.13–3.82, p =0.018), multi-vessel coronary artery disease (adjusted HR: 2.28, 95% CI: 1.36–3.81, p =0.002), and PCI-related acute closure in a side branch (adjusted HR: 3.34, 95% CI: 1.23–9.02, p =0.018) were the significant risk factors for PMI. During the median follow-up of 22.7months, the unadjusted rate of long-term cardiac mortality was significantly higher in patients with PMI than in those without PMI (2.5% vs. 0.7%, p =0.026). After multivariable adjustment, the relationship between PMI and short-term (≤30day) cardiac mortality was significant (adjusted HR: 12.32, 95% CI: 1.07–141.37, p =0.044). However, PMI was not an independent prognostic factor of long-term cardiac mortality (adjusted HR: 2.59, 95% CI: 0.62–10.85, p =0.20). Conclusions: PMI occurs in patients with a higher prevalence of adverse cardiac risks and predicts short-term but not long-term cardiac mortality in patients undergoing bifurcation lesion PCI. [Copyright &y& Elsevier]