Coronary artery disease最新文献

Background: Noninvasive cardiac testing with coronary computed tomography angiography (CCTA) and single-photon emission computed tomography (SPECT) are becoming alternatives to invasive angiography for the evaluation of obstructive coronary artery disease. We aimed to evaluate whether a novel artificial intelligence (AI)-assisted CCTA program is comparable to SPECT imaging for ischemic testing.

Methods: CCTA images were analyzed using an artificial intelligence convolutional neural network machine-learning-based model, atherosclerosis imaging-quantitative computed tomography (AI-QCT)ISCHEMIA. A total of 183 patients (75 females and 108 males, with an average age of 60.8 years ± 12.3 years) were selected. All patients underwent AI-QCTISCHEMIA-augmented CCTA, with 60 undergoing concurrent SPECT and 16 having invasive coronary angiograms. Eight studies were excluded from analysis due to incomplete data or coronary anomalies.

Results: A total of 175 patients (95%) had CCTA performed, deemed acceptable for AI-QCTISCHEMIA interpretation. Compared to invasive angiography, AI-QCTISCHEMIA-driven CCTA showed a sensitivity of 75% and specificity of 70% for predicting coronary ischemia, versus 70% and 53%, respectively for SPECT. The negative predictive value was high for female patients when using AI-QCTISCHEMIA compared to SPECT (91% vs. 68%, P = 0.042). Area under the receiver operating characteristic curves were similar between both modalities (0.81 for AI-CCTA, 0.75 for SPECT, P = 0.526). When comparing both modalities, the correlation coefficient was r = 0.71 (P < 0.04).

Conclusion: AI-powered CCTA is a viable alternative to SPECT for detecting myocardial ischemia in patients with low- to intermediate-risk coronary artery disease, with significant positive and negative correlation in results. For patients who underwent confirmatory invasive angiography, the results of AI-CCTA and SPECT imaging were comparable. Future research focusing on prospective studies involving larger and more diverse patient populations is warranted to further investigate the benefits offered by AI-driven CCTA.

Background: Limited data is available regarding in-hospital outcomes of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with Impella with and without a prior history of coronary artery bypass grafting (CABG).

Methods: We performed a retrospective study from the Nationwide Inpatient Sample from year 2016 to 2020. We identified patients who underwent Impella and percutaneous coronary intervention on the same day and excluded those with cardiogenic shock. Subsequently, we stratified them into those with and without prior CABG.

Results: During the study period, 18 925 patients underwent HR-PCI. Among these, 2043 (10.8%) patients had prior CABG. Patients without prior CABG had a higher percentage of acute coronary syndrome at presentation (62.7 vs 56.1%, P = 0.008). The proportion of females was significantly higher in those without prior CABG (32.4 vs 21.7%, P < 0.001). On multivariate analysis, there was no statistically significant difference in the in-hospital mortality (5.8% in CABG vs 8.5% in non-CABG, P = 0.52). Patients without prior CABG had higher rates of acute kidney injury, major bleeding, and blood transfusions. There were no significant differences in rates of cardiac arrest, ventricular arrhythmias, acute stroke, coronary dissections, and coronary perforations. Those without prior CABG had a longer duration of hospitalization (6.8 vs 9.3 days, P < 0.001) and higher hospital charges ($292 267 vs $322 206, P < 0.035).

Conclusion: Our study highlights that a history of previous CABG does not increase the risk of in-hospital mortality in patients undergoing Impella-assisted HR-PCI but is associated with reduced rates of complications.

Background: Mortality after percutaneous coronary intervention (PCI) remains a problem. Clinical databases such as the American College of Cardiology National Cardiovascular Data CathPCI Registry do not contain enough information to determine the specific cause of death after PCI, and thus are not able to identify opportunities for improvement (OFIs) that might have prevented the death of specific patients. We reviewed cases of death after coronary intervention to identify specific OFIs.

Methods: The University of New Mexico electronic medical record system was used to identify PCI patients who died before discharge from 1 January 2019 to 30 June 2021. Electronic medical records for each patient were reviewed by two physicians to identify presentation before PCI, procedural success of PCI, complications of PCI, contribution of PCI complications to death, and causes of death after PCI.

Results: During the study period, 48 of 894 PCI patients died before discharge. Presentation was ST elevation myocardial infarction in 23 (48%) and out of hospital cardiac arrest in 17 (35%). PCI success rate was 90%. Causes of death were most frequently cardiac (80%), septic shock (4%), mixed cardiogenic and septic shock (4%), COVID (8%), and anoxic brain injury (4%).

Conclusion: All post-PCI deaths in this series occurred in acutely unstable patients, with cardiac comorbidities and myocardial infarction or cardiac arrest prior to catheterization. PCI reduced culprit stenosis to ≤50% in 96% of cases with an overall procedural success rate of 90% and only one major complication. No deaths were clearly related to operator error.

Introduction: Given radial artery conduits are increasingly utilized for coronary artery bypass grafting (CABG), avoiding transradial access (TRA) for invasive coronary angiography (ICA) may benefit patients who ultimately undergo CABG. We sought to predict the likelihood of severe multivessel disease (MVD) before ICA to guide this decision.

Methods: This was a single-center study of 1485 patients with stable symptoms who underwent ICA. A model to predict severe MVD was developed. Relative importance analyses were performed to identify clinical characteristics most associated with the presence or absence of severe MVD.

Results: When predicting severe MVD, the model had a sensitivity of 70.3% and specificity of 71.8% (area under the curve = 0.7105). With a prevalence of 12.5% in our cohort, the model had a strong negative predictive value of 94.4%. Relative importance analyses showed factors most associated with the presence of severe MVD were a history of abnormal noninvasive tests, typical chest pain, aspirin use, insulin-dependent diabetes, increasing age, and a family history of coronary artery disease. Conversely, the absence of severe MVD was most associated with female sex, undergoing ICA as workup for either noncardiac or valve surgery, lung disease, atypical chest pain, and increased BMI.

Conclusion: Clinical information available before ICA can risk stratify the likelihood of severe MVD and therefore aid in identifying patients that may need CABG and could stand to benefit from TRA avoidance. The potential benefits of maximizing radial artery conduit availability by avoiding TRA must be balanced against the risks of alternative access on an individual patient basis.

Objective: To assess the impact of perceived stress levels in patients undergoing percutaneous coronary intervention (PCI) on the occurrence of major adverse cardiovascular events (MACEs) within a 6-month follow-up period postprocedure.

Methods: A cohort of 339 hospitalized patients with coronary heart disease undergoing initial PCI was prospectively enrolled in the Department of Cardiology at two branches of Zhongda Hospital Affiliated to Southeast University between January 2022 and July 2022. Baseline data including demographic and clinical characteristics, along with the Chinese Perceived Stress Scale (CPSS), were collected. The occurrence of MACE was evaluated at 3 and 6 months post-PCI. Kaplan-Meier survival analysis and Cox regression models were engaged to analyze the relationship between perceived stress and MACE within 6 months after PCI.

Results: MACE occurred in 16.22% (55/339) of patients during the 6 following months. High CPSS at baseline was significantly associated with an increasing risk of short-term MACE occurrence (HR: 6.48, 95% confidence interval: 2.98-14.11, P < 0.05).

Conclusion: High perceived stress during the baseline period after PCI was significantly correlated with increased incidence of MACE within 6 months postprocedure. The perceived stress level could help to identify patients undergoing PCI at heightened risk of short-term MACE.

Background: Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population.

Methods: Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019. The presenting ECG was reviewed for pathological Q waves and patients were divided into groups with and without Q waves. The confirmatory multivariate analyses concerning the presence of Q wave, occurrence of heart failure, time to heart failure at 1 year, and the mortality status were performed with generalized structural equation model.

Results: A total of 1385 patients were included. Patients with pathological Q waves were more likely to suffer from anterior myocardial infarction (55.6 vs. 43.6%) and classified as Killip class >2 (13.5 vs. 8.0%). Among them, fewer reported ST segment resolution >50% (66.5 vs. 79.7%). They reported significantly lower LVEF (45.5 vs. 51.1%), longer symptom onset to ECG (168 vs. 111 min), and longer symptom-onset-to-balloon time (228 vs. 176 min). In addition, patients with Q waves were likely to stay longer in hospital (6.4 vs. 6.1 days) and faced a higher risk of heart failure (5.2 vs. 2.5%) in a year.

Conclusion: We highlight the important morbidity associated with Q waves at presentation and found not only that heart failure occurrence was higher in the Q wave group, but there was also an acceleration of and shorter onset to heart failure.