Background The presence of polyvascular disease (defined as atherosclerosis involving ≥2 distinct... more Background The presence of polyvascular disease (defined as atherosclerosis involving ≥2 distinct vascular territories) is a strong, independent predictor of subsequent cardiovascular (CV) events in patients with type 2 diabetes (T2D). In the SUSTAIN 6 trial, the glucagon-like peptide-1 receptor agonist once-weekly (OW) subcutaneous semaglutide reduced major adverse cardiovascular events (MACE; a composite of death from CV causes, non-fatal myocardial infarction and non-fatal stroke) in patients with T2D at high CV risk. Purpose This analysis of SUSTAIN 6 assessed the effect of OW semaglutide on MACE in patients with T2D, stratified by the number of atherosclerotic vascular territories at baseline. Methods Patients in SUSTAIN 6 were randomised to receive 0.5 or 1.0 mg OW subcutaneous semaglutide or placebo. The median follow-up was 2.1 years. In this post hoc analysis, the SUSTAIN 6 population was stratified according to documented atherosclerosis: polyvascular disease (≥2 vascular ...
Background Despite early and currently effective epicardial coronary recanalization in patients w... more Background Despite early and currently effective epicardial coronary recanalization in patients with acute myocardial infarction (AMI), the mortality rate after mechanical complication (MC) remains high. Despite its impact on the prognosis of patients with AMI, up-to-date real life data regarding to epidemiology and management of patients with MC following AMI still scarce and most studies exclude patients with MC. Methods Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the epidemiology, predictors and outcomes of patients with MC following AMI in the US. Results We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582–12.855,p< 0.001) in patients with MC compared ...
Background Obesity is a major risk factor for cardiovascular disease, with differential impact ac... more Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity‐related cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age‐adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity‐related cardiovascular deaths demonstrated a 3‐fold increase in AAMRs from 1999 to 2020 (2.2‐6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individu...
Catheterization and Cardiovascular Interventions, Jul 18, 2023
BackgroundPercutaneous coronary intervention (PCI) for bifurcation lesions can be technically cha... more BackgroundPercutaneous coronary intervention (PCI) for bifurcation lesions can be technically challenging and is associated with higher risk. There is little data on sex‐based differences in strategy and outcomes in bifurcation PCI.AimsWe sought to assess whether differences exist between women and men in the treatment and outcomes of bifurcation PCI.MethodsWe collected data on 4006 patients undergoing bifurcation PCI, from the e‐ULTIMASTER study, a prospective, multicentre study enrolling patients from 2014 to 2018. We divided the bifurcation cohort according to sex, with 1‐year follow‐up of outcomes (target lesion failure [TLF], target vessel failure [TVF], and patient‐oriented composite endpoint [POCE]).FindingsWomen were older (69.2 ± 10.9 years vs. 64.4 ± 11.0 years), with a greater burden of cardiovascular comorbidities. For true and non‐true bifurcation lesions, women and men were equally likely to undergo a single stent approach (true: 63.2% vs. 63.6%, p = 0.79, non‐true: 95.4% vs. 94.3%, p = 0.32), with similar rates of final kissing balloon (FKB) (37.2% vs. 35.5%, p = 0.36) and proximal optimization (POT) (34.4% vs. 34.2%, p = 0.93) in cases where two stents were used. Lastly, after propensity score matching, there was no difference between women and men in the incidence of the composite endpoints of TLF (5.5% vs. 5.2%, RR 1.05 [95% CI 0.77−1.44], p = 0.75), TVF (6.2% vs. 6.3%, RR 0.99 [95% CI 0.74−1.32], p = 0.96), and POCE (9.9% vs. 9.5%, RR 1.05 [95% CI 0.83−1.31], p = 0.70).ConclusionIn this contemporary, real‐world study of bifurcation PCI, we report no difference in stent strategy between women and men, with similar outcomes at 1‐year.
Introduction Patients with chronic inflammatory diseases are at increased risk for coronary arter... more Introduction Patients with chronic inflammatory diseases are at increased risk for coronary artery disease. Aim We aimed to assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention. Methods A Retrospective cohort study of all adult (&amp;amp;amp;gt;18 years) patients who underwent PCI in a large [1000 bed] tertiary care centerfrom January 2002 to August 2020. Results A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247/12,951 [1.9%]; 70 with IBD and 173 with AIRD. The composite endpoint of mortality, ACS or CHF admission was more frequent in the inflammatory disease group (77.5% in AIRD group, 72.9% in the IBD group and 59.6% in the non-inflammatory group, p&amp;amp;amp;lt;0.001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. The increased risk for ACS was 61% for AIRD patients and 37% for IBD patients. Patients with inflammatory diseases were found to have a significant increased risk CHF admission, while both IBD and AIED patients had a non-significant increased risk for mortality. Conclusion Patients with AIRD and IBD are at higher risk for cardiovascular events also in long term follow up once diagnosed with CAD and treated with PCI. FUNDunding Acknowledgement Type of funding sources: None.
Background The presence of polyvascular disease (defined as atherosclerosis involving ≥2 distinct... more Background The presence of polyvascular disease (defined as atherosclerosis involving ≥2 distinct vascular territories) is a strong, independent predictor of subsequent cardiovascular (CV) events in patients with type 2 diabetes (T2D). In the SUSTAIN 6 trial, the glucagon-like peptide-1 receptor agonist once-weekly (OW) subcutaneous semaglutide reduced major adverse cardiovascular events (MACE; a composite of death from CV causes, non-fatal myocardial infarction and non-fatal stroke) in patients with T2D at high CV risk. Purpose This analysis of SUSTAIN 6 assessed the effect of OW semaglutide on MACE in patients with T2D, stratified by the number of atherosclerotic vascular territories at baseline. Methods Patients in SUSTAIN 6 were randomised to receive 0.5 or 1.0 mg OW subcutaneous semaglutide or placebo. The median follow-up was 2.1 years. In this post hoc analysis, the SUSTAIN 6 population was stratified according to documented atherosclerosis: polyvascular disease (≥2 vascular ...
Background Despite early and currently effective epicardial coronary recanalization in patients w... more Background Despite early and currently effective epicardial coronary recanalization in patients with acute myocardial infarction (AMI), the mortality rate after mechanical complication (MC) remains high. Despite its impact on the prognosis of patients with AMI, up-to-date real life data regarding to epidemiology and management of patients with MC following AMI still scarce and most studies exclude patients with MC. Methods Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the epidemiology, predictors and outcomes of patients with MC following AMI in the US. Results We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582–12.855,p< 0.001) in patients with MC compared ...
Background Obesity is a major risk factor for cardiovascular disease, with differential impact ac... more Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity‐related cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age‐adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity‐related cardiovascular deaths demonstrated a 3‐fold increase in AAMRs from 1999 to 2020 (2.2‐6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individu...
Catheterization and Cardiovascular Interventions, Jul 18, 2023
BackgroundPercutaneous coronary intervention (PCI) for bifurcation lesions can be technically cha... more BackgroundPercutaneous coronary intervention (PCI) for bifurcation lesions can be technically challenging and is associated with higher risk. There is little data on sex‐based differences in strategy and outcomes in bifurcation PCI.AimsWe sought to assess whether differences exist between women and men in the treatment and outcomes of bifurcation PCI.MethodsWe collected data on 4006 patients undergoing bifurcation PCI, from the e‐ULTIMASTER study, a prospective, multicentre study enrolling patients from 2014 to 2018. We divided the bifurcation cohort according to sex, with 1‐year follow‐up of outcomes (target lesion failure [TLF], target vessel failure [TVF], and patient‐oriented composite endpoint [POCE]).FindingsWomen were older (69.2 ± 10.9 years vs. 64.4 ± 11.0 years), with a greater burden of cardiovascular comorbidities. For true and non‐true bifurcation lesions, women and men were equally likely to undergo a single stent approach (true: 63.2% vs. 63.6%, p = 0.79, non‐true: 95.4% vs. 94.3%, p = 0.32), with similar rates of final kissing balloon (FKB) (37.2% vs. 35.5%, p = 0.36) and proximal optimization (POT) (34.4% vs. 34.2%, p = 0.93) in cases where two stents were used. Lastly, after propensity score matching, there was no difference between women and men in the incidence of the composite endpoints of TLF (5.5% vs. 5.2%, RR 1.05 [95% CI 0.77−1.44], p = 0.75), TVF (6.2% vs. 6.3%, RR 0.99 [95% CI 0.74−1.32], p = 0.96), and POCE (9.9% vs. 9.5%, RR 1.05 [95% CI 0.83−1.31], p = 0.70).ConclusionIn this contemporary, real‐world study of bifurcation PCI, we report no difference in stent strategy between women and men, with similar outcomes at 1‐year.
Introduction Patients with chronic inflammatory diseases are at increased risk for coronary arter... more Introduction Patients with chronic inflammatory diseases are at increased risk for coronary artery disease. Aim We aimed to assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention. Methods A Retrospective cohort study of all adult (&amp;amp;amp;gt;18 years) patients who underwent PCI in a large [1000 bed] tertiary care centerfrom January 2002 to August 2020. Results A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247/12,951 [1.9%]; 70 with IBD and 173 with AIRD. The composite endpoint of mortality, ACS or CHF admission was more frequent in the inflammatory disease group (77.5% in AIRD group, 72.9% in the IBD group and 59.6% in the non-inflammatory group, p&amp;amp;amp;lt;0.001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. The increased risk for ACS was 61% for AIRD patients and 37% for IBD patients. Patients with inflammatory diseases were found to have a significant increased risk CHF admission, while both IBD and AIED patients had a non-significant increased risk for mortality. Conclusion Patients with AIRD and IBD are at higher risk for cardiovascular events also in long term follow up once diagnosed with CAD and treated with PCI. FUNDunding Acknowledgement Type of funding sources: None.
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