Displaying publications 81 - 100 of 178 in total

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  1. A Flowmeter Technique to Exclude Internal Mammary Artery Anastomosis Error in an Arrested Heart
    Hashim SA, Amin MA, Nair A, Raja Mokhtar RA, Krishnasamy S, Cheng K
    Heart Lung Circ, 2018 May;27(5):e59-e63.
    PMID: 29246681 DOI: 10.1016/j.hlc.2017.11.011
    The revision of an internal mammary artery graft anastomosis because of a technical error can be time-consuming and complicated and may lead to complications. Here, we describe the technical details and our early experience of using a standard transit-time flowmeter to exclude technical errors and facilitate rapid decision making for anastomosis revision in an arrested heart during aortic cross-clamping in the absence of ultrasound guidance.
    Matched MeSH terms: Coronary Artery Disease/surgery*
  2. Triple Vessel Coronary Artery Disease and Retinal Nerve Fibre Layer Thickness
    Neoh YL, Neoh PF, Salleh A, Yusof ZB, Gurusamy B, Ahmad Tajudin LS
    Ann Acad Med Singap, 2018 06;47(6):226-229.
    PMID: 30019068
    Matched MeSH terms: Coronary Artery Disease*
  3. Machine learning-based coronary artery disease diagnosis: A comprehensive review
    Alizadehsani R, Abdar M, Roshanzamir M, Khosravi A, Kebria PM, Khozeimeh F, et al.
    Comput Biol Med, 2019 08;111:103346.
    PMID: 31288140 DOI: 10.1016/j.compbiomed.2019.103346
    Coronary artery disease (CAD) is the most common cardiovascular disease (CVD) and often leads to a heart attack. It annually causes millions of deaths and billions of dollars in financial losses worldwide. Angiography, which is invasive and risky, is the standard procedure for diagnosing CAD. Alternatively, machine learning (ML) techniques have been widely used in the literature as fast, affordable, and noninvasive approaches for CAD detection. The results that have been published on ML-based CAD diagnosis differ substantially in terms of the analyzed datasets, sample sizes, features, location of data collection, performance metrics, and applied ML techniques. Due to these fundamental differences, achievements in the literature cannot be generalized. This paper conducts a comprehensive and multifaceted review of all relevant studies that were published between 1992 and 2019 for ML-based CAD diagnosis. The impacts of various factors, such as dataset characteristics (geographical location, sample size, features, and the stenosis of each coronary artery) and applied ML techniques (feature selection, performance metrics, and method) are investigated in detail. Finally, the important challenges and shortcomings of ML-based CAD diagnosis are discussed.
    Matched MeSH terms: Coronary Artery Disease/diagnosis*
  4. Oxidative status and reduced glutathione levels in premature coronary artery disease and coronary artery disease
    Musthafa QA, Abdul Shukor MF, Ismail NAS, Mohd Ghazi A, Mohd Ali R, M Nor IF, et al.
    Free Radic Res, 2017 Oct;51(9-10):787-798.
    PMID: 28899235 DOI: 10.1080/10715762.2017.1379602
    Identifying patients at risk of developing premature coronary artery disease (PCAD) which occurs at age below 45 years old and constitutes approximately 7-10% of coronary artery disease (CAD) worldwide remains a problem. Oxidative stress has been proposed as a crucial step in the early development of PCAD. This study was conducted to determine the oxidative status of PCAD in comparison to CAD patients. PCAD (<45 years old) and CAD (>60 years old) patients were recruited with age-matched controls (n = 30, each group). DNA damage score, plasma malondialdehyde (MDA) and protein carbonyl content were measured for oxidative damage markers. Antioxidants such as erythrocyte glutathione (GSH), oxidised glutathione (GSSG), and glutathione peroxidase activity (GPx), superoxide dismutase (SOD) and catalase (CAT) were also determined. DNA damage score and protein carbonyl content were significantly higher in both PCAD and CAD when compared to age-matched controls while MDA level was increased only in PCAD (p
    Matched MeSH terms: Coronary Artery Disease/blood*
  5. Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification
    Ong TK, Chin SP, Liew CK, Chan WL, Seyfarth MT, Liew HB, et al.
    Am Heart J, 2006 Jun;151(6):1323.e1-6.
    PMID: 16781246
    The new 64-row multidetector computed tomography (CT)-assisted angiography can now detect coronary artery disease with shorter breath-hold time and at faster heart rates for symptomatic patients. We aim to determine if the 64-row scanner can also overcome limitations due to mild to moderate calcification.
    Matched MeSH terms: Coronary Artery Disease/radiography*
  6. Fulltext Role of Matrix Metalloproteinase-2 in the Development of Atherosclerosis among Patients with Coronary Artery Disease
    Samah N, Ugusman A, Hamid AA, Sulaiman N, Aminuddin A
    Mediators Inflamm, 2023;2023:9715114.
    PMID: 37457745 DOI: 10.1155/2023/9715114
    Coronary artery disease (CAD) is a caused by atherosclerotic plaque buildup in the coronary arteries that supply blood and oxygen to the heart. Matrix metalloproteinase (MMP) is a family of zinc-dependent endopeptidase that is involved in various stages of atherosclerosis as demonstrated in in vitro and in vivo studies. MMP-2 is associated with both stable and unstable atherosclerotic plaque formation. The current review aimed to identify the role of MMP-2 in atherosclerosis development among CAD patients. Literature search was conducted through four online databases and only studies that were published from 2018 until February 2023 were included. The risk of bias was assessed by using the Newcastle-Ottawa Scale. A total of 10,622 articles were initially identified, and only eight studies that fulfilled the selection criteria were included in this review. The results showed that MMP-2 levels and activity were higher in patients with unstable CAD than those with stable CAD and healthy subjects. There was a significant association between MMP-2 levels and cardiovascular disease with MMP-14 levels, which is a pro-MMP-2 activator. In addition, two single nucleotide polymorphisms of the MMP-2 gene (rs243865 and rs243866) were significantly associated with the development of atherosclerosis. In conclusion, MMP-2 plays a crucial role in the development of atherosclerosis among patients with CAD and could be a potential target for CAD therapy.
    Matched MeSH terms: Coronary Artery Disease*
  7. Fulltext Prediction of Low-Dose Aspirin-Induced Gastric Toxicity Using Nuclear Magnetic Resonance Spectroscopy-Based Pharmacometabolomics in Rats
    Sha'aban A, Zainal H, Khalil NA, Abd Aziz F, Ch'ng ES, Teh CH, et al.
    Molecules, 2022 Mar 25;27(7).
    PMID: 35408523 DOI: 10.3390/molecules27072126
    BACKGROUND: Low-dose aspirin (LDA) is the backbone for secondary prevention of coronary artery disease, although limited by gastric toxicity. This study aimed to identify novel metabolites that could predict LDA-induced gastric toxicity using pharmacometabolomics.

    METHODS: Pre-dosed urine samples were collected from male Sprague-Dawley rats. The rats were treated with either LDA (10 mg/kg) or 1% methylcellulose (10 mL/kg) per oral for 28 days. The rats' stomachs were examined for gastric toxicity using a stereomicroscope. The urine samples were analyzed using a proton nuclear magnetic resonance spectroscopy. Metabolites were systematically identified by exploring established databases and multivariate analyses to determine the spectral pattern of metabolites related to LDA-induced gastric toxicity.

    RESULTS: Treatment with LDA resulted in gastric toxicity in 20/32 rats (62.5%). The orthogonal projections to latent structures discriminant analysis (OPLS-DA) model displayed a goodness-of-fit (R2Y) value of 0.947, suggesting near-perfect reproducibility and a goodness-of-prediction (Q2Y) of -0.185 with perfect sensitivity, specificity and accuracy (100%). Furthermore, the area under the receiver operating characteristic (AUROC) displayed was 1. The final OPLS-DA model had an R2Y value of 0.726 and Q2Y of 0.142 with sensitivity (100%), specificity (95.0%) and accuracy (96.9%). Citrate, hippurate, methylamine, trimethylamine N-oxide and alpha-keto-glutarate were identified as the possible metabolites implicated in the LDA-induced gastric toxicity.

    CONCLUSION: The study identified metabolic signatures that correlated with the development of a low-dose Aspirin-induced gastric toxicity in rats. This pharmacometabolomic approach could further be validated to predict LDA-induced gastric toxicity in patients with coronary artery disease.

    Matched MeSH terms: Coronary Artery Disease*
  8. Fulltext Return to flying after coronary artery disease: A case series among Malaysian pilots
    Mohammad Z, Ismail R, Mohamed Rus MR, Haron MH
    J Occup Health, 2021 Jan;63(1):e12241.
    PMID: 34155722 DOI: 10.1002/1348-9585.12241
    OBJECTIVES: Pilots with coronary artery disease (CAD) are at increased risk of myocardial infarction, stroke, and possibly death. Return to flying duties may be considered after a detailed risk assessment. The aim of this retrospective case series is to describe the return to flying duty process.

    METHODS: We conducted a retrospective case review of pilots diagnosed with CAD at the Institute of Aviation Medicine (IAM), Royal Malaysian Air Force (RMAF) in October 2020.

    RESULTS: Thirteen cases of CAD were included in the review. Ten pilots were diagnosed after developing acute coronary syndrome; the remaining three pilots were diagnosed during a routine medical examination via an exercise stress test. Twelve pilots required a revascularization procedure. A total of 11 pilots (84.6%) were recertified for flying duties, while another two were disqualified. The duration to recertification for these 11 pilots was between three months and one year.

    CONCLUSIONS: The risk assessment was initiated with initial risk-stratification using population-appropriate risk calculator combined with the 4 × 4 aeromedical risk matrix. The reassessment of return to flying after coronary artery disease must be carried out no sooner than six months after the event. Pilots must be hemodynamically stable with no evidence of significant inducible ischemic left and a minimum 50% of ventricular ejection fraction (LVEF). A follow-up is recommended at the initial six months after recertification and then annually with a routine noninvasive cardiac assessment.

    Matched MeSH terms: Coronary Artery Disease/diagnosis*
  9. Fulltext Pulse wave velocity as a marker of severity of coronary artery disease
    Alarhabi AY, Mohamed MS, Ibrahim S, Hun TM, Musa KI, Yusof Z
    J Clin Hypertens (Greenwich), 2009 Jan;11(1):17-21.
    PMID: 19125854 DOI: 10.1111/j.1751-7176.2008.00061.x
    To determine whether pulse wave velocity (PWV) as a measure of arterial stiffness is a marker of coronary artery diseases (CAD), the authors did a cross-sectional study in 92 patients undergoing coronary angiography for suspected CAD. Arterial stiffness was assessed through recording PWV from the left carotid-right femoral arteries using an automated machine. The mean PWV was higher in patients with CAD than in those without CAD (11.13+/-0.91 vs 8.14+/-1.25 m/sec; P
    Matched MeSH terms: Coronary Artery Disease/diagnosis*
  10. Subclinical coronary artery disease in Asian rheumatoid arthritis patients who were in remission: a pilot study
    Ma NH, Teh CL, Rapaee A, Lau KB, Fong AY, Hi S, et al.
    Int J Rheum Dis, 2010 Aug;13(3):223-9.
    PMID: 20704618 DOI: 10.1111/j.1756-185X.2010.01533.x
    INTRODUCTION: Rheumatoid arthritis (RA) patients who have active disease with longer disease duration have been reported to have increased risk of cardiovascular events compared to the normal population.
    OBJECTIVE: The primary aim of our study is to ascertain the prevalence of significant asymptomatic coronary artery disease (CAD) in Asian RA patients who are in remission using multi-detector computed tomography (MDCT). The secondary aims of our study are the usage of pulse wave velocity and the biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-senstivity C-reactive protein (hs-CRP) to detect subclinical atherosclerosis in RA patients.
    METHODS: We performed a comparative cross-sectional study of 47 RA patients who were in remission with a control group of non-RA patients with a history of atypical chest pain in Sarawak General Hospital from November 2008 to February 2009. All patients underwent 64-slice MDCT, assessment of arterial stiffness using the SphygmoCor test and blood analysis for NT-proBNP and hsCRP.
    RESULTS: There were 94 patients in our study with a mean age of 50 +/- 8.8 years. The RA and control patients in each group were matched in terms of traditional CV risk factors. Our RA patients had a median disease duration of 3 years (IQR 5.5). MDCT showed evidence of CAD in nine (19.1%) RA patients and three (6.4%) control patients (P = 0.06). There was no significant association between pulse wave velocity (PWV) and presence of CAD in our RA group. There was no significant correlation between PWV with levels of proBNP or hsCRP in our RA patients.
    CONCLUSIONS: In our current pilot study with the limitation of small sample size, RA was not associated with an increased risk of CAD in our RA patients who were in remission. Larger studies of CAD in Asian RA patients are needed to confirm our current finding.
    Study site: Sarawak General Hospital, Kuching, Sarawak, Malaysia
    Matched MeSH terms: Coronary Artery Disease/blood; Coronary Artery Disease/ethnology*; Coronary Artery Disease/radiography; Coronary Artery Disease/ultrasonography
  11. Radiation dose in coronary CT angiography associated with prospective ECG-triggering technique: comparisons with different CT generations
    Sabarudin A, Sun Z, Ng KH
    Radiat Prot Dosimetry, 2013;154(3):301-7.
    PMID: 22972797 DOI: 10.1093/rpd/ncs243
    A retrospective analysis was performed in patients undergoing prospective ECG-triggered coronary computed tomography (CT) angiography (CCTA) with the single-source 64-slice CT (SSCT), dual-source 64-slice CT (DSCT), dual-source 128-slice CT and 320-slice CT with the aim of comparing the radiation dose associated with different CT generations. A total of 164 patients undergoing prospective ECG-triggered CCTA with different types of CT scanners were studied with the mean effective doses estimated at 6.8 ± 3.2, 4.2 ± 1.9, 4.1±0.6 and 3.8 ± 1.4 mSv corresponding to the 128-slice DSCT, 64-slice DSCT, 64-slice SSCT and 320-slice CT scanners. In this study a positive relationship was found between the effective dose and the body mass index (BMI). A low radiation dose is achieved in prospective ECG-triggered CCTA, regardless of the CT scanner generation. BMI is identified as the major factor that has a direct impact on the effective dose associated with prospective ECG-triggered CCTA.
    Matched MeSH terms: Coronary Artery Disease/epidemiology*; Coronary Artery Disease/radiography*
  12. Mitochondrial disorder, diabetes mellitus, and findings in three muscles, including the heart
    Bhattacharjee M, Venugopal B, Wong KT, Goto YI, Bhattacharjee MB
    Ultrastruct Pathol, 2006 Nov-Dec;30(6):481-7.
    PMID: 17183762
    The authors describe the case of a 50-year-old man with chronic progressive external ophthalmoplegia (CPEO), diabetes mellitus (DM), and coronary artery disease. The patient had no cardiac conduction abnormalities. During coronary artery bypass surgery, his heart and two skeletal muscles were biopsied. All three muscles showed ragged red fibers. The heart muscle showed significant glycogen accumulation. Analysis of mitochondrial DNA (mtDNA) showed a 5019-base-pair deletion, with no duplications. There were morphologically abnormal mitochondria in all 3 muscles, with clinically apparent difference in preservation of function. The combination of diabetes mellitus and mtDNA deletion is fortuitous, as they can be causally linked. The cardiac pathology allows speculation about the possible adaptive processes that may occur in the heart in DM. There are few reported cases with CPEO and excess glycogen in the heart. Most show deposition of fat and poorer clinical outcomes as compared to those with glycogen deposition. This observation may lend support to the hypothesis that in the myocardium, adaptive responses are mediated via changes in glucose handling, whereas alterations in fat metabolism likely represent maladaptation.
    Matched MeSH terms: Coronary Artery Disease/complications*; Coronary Artery Disease/surgery
  13. Fulltext Polymer-free drug-coated coronary stents in patients at high bleeding risk
    Urban P, Meredith IT, Abizaid A, Pocock SJ, Carrié D, Naber C, et al.
    N Engl J Med, 2015 Nov 19;373(21):2038-47.
    PMID: 26466021 DOI: 10.1056/NEJMoa1503943
    BACKGROUND: Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month.
    METHODS: In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization.
    RESULTS: We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001).
    CONCLUSIONS: Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).
    Matched MeSH terms: Coronary Artery Disease/drug therapy; Coronary Artery Disease/therapy*
  14. Fulltext Trial of everolimus-eluting stents or bypass surgery for coronary disease
    Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY, et al.
    N Engl J Med, 2015 Mar 26;372(13):1204-12.
    PMID: 25774645 DOI: 10.1056/NEJMoa1415447
    BACKGROUND: Most trials comparing percutaneous coronary intervention (PCI) with coronary-artery bypass grafting (CABG) have not made use of second-generation drug-eluting stents.
    METHODS: We conducted a randomized noninferiority trial at 27 centers in East Asia. We planned to randomly assign 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary end point was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years after randomization. Event rates during longer-term follow-up were also compared between groups.
    RESULTS: After the enrollment of 880 patients (438 patients randomly assigned to the PCI group and 442 randomly assigned to the CABG group), the study was terminated early owing to slow enrollment. At 2 years, the primary end point had occurred in 11.0% of the patients in the PCI group and in 7.9% of those in the CABG group (absolute risk difference, 3.1 percentage points; 95% confidence interval [CI], -0.8 to 6.9; P=0.32 for noninferiority). At longer-term follow-up (median, 4.6 years), the primary end point had occurred in 15.3% of the patients in the PCI group and in 10.6% of those in the CABG group (hazard ratio, 1.47; 95% CI, 1.01 to 2.13; P=0.04). No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke. However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG.
    CONCLUSIONS: Among patients with multivessel coronary artery disease, the rate of major adverse cardiovascular events was higher among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. (Funded by CardioVascular Research Foundation and others; BEST ClinicalTrials.gov number, NCT00997828.).
    Matched MeSH terms: Coronary Artery Disease/surgery; Coronary Artery Disease/therapy*
  15. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials
    Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, et al.
    Catheter Cardiovasc Interv, 2018 02 15;91(3):387-395.
    PMID: 28471086 DOI: 10.1002/ccd.27109
    OBJECTIVES: to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon.

    METHODS: The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR).

    RESULTS: After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups.

    CONCLUSION: In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.

    Matched MeSH terms: Coronary Artery Disease/mortality; Coronary Artery Disease/surgery*
  16. Levodopa-induced myocardial infarction in a patient with Parkinson's disease and severe coronary artery disease
    Ng CF, Tiau PW, Tan HJ, Norlinah MI
    J R Coll Physicians Edinb, 2019 Mar;49(1):37-39.
    PMID: 30838990 DOI: 10.4997/JRCPE.2019.108
    Levodopa is the most effective medical treatment for Parkinson's disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.
    Matched MeSH terms: Coronary Artery Disease/complications*; Coronary Artery Disease/diagnosis
  17. Fulltext Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group
    Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, et al.
    JACC Cardiovasc Interv, 2020 06 22;13(12):1391-1402.
    PMID: 32473887 DOI: 10.1016/j.jcin.2020.02.043
    Although drug-eluting stents are still the default interventional treatment of coronary artery disease, drug-coated balloons (DCBs) represent a novel alternative therapeutic strategy in certain anatomic conditions. The effect of DCBs is based on the fast and homogenous transfer of antiproliferative drugs into the vessel wall during single balloon inflation by means of a lipophilic matrix without the use of permanent implants. Although their use is established for in-stent restenosis of both bare-metal and drug-eluting stents, recent randomized clinical data demonstrate a good efficacy and safety profile in de novo small-vessel disease and high bleeding risk. In addition, there are other emerging indications (e.g., bifurcation lesions, large-vessel disease, diabetes mellitus, acute coronary syndromes). Because the interaction among the different delivery balloon designs, doses, formulations, and release kinetics of the drugs used is important, there seems to be no "class effect" of DCBs. On the basis of the amount of recently published data, the International DCB Consensus Group provides this update of previous recommendations summarizing the historical background, technical considerations such as choice of device and implantation technique, possible indications, and future perspectives.
    Matched MeSH terms: Coronary Artery Disease/mortality; Coronary Artery Disease/therapy*
  18. Comparison of One-Year Outcomes in Patients >75 Versus ≤75 Years With Coronary Artery Disease Treated With COMBO Stents (From The MASCOT Registry)
    Chandrasekhar J, Sartori S, Aquino MB, Baber U, Hájek P, Atzev B, et al.
    Am J Cardiol, 2020 07 15;127:1-8.
    PMID: 32418717 DOI: 10.1016/j.amjcard.2020.04.014
    Older patients who undergo coronary interventions are at greater risk of ischemic events and less likely to tolerate prolonged dual antiplatelet therapy (DAPT) due to bleeding risk. The COMBO biodegradable polymer sirolimus-eluting stent promotes rapid endothelialization through endothelial progenitor cell capture technology which may be advantageous in elderly patients. We compared 1-year clinical outcomes and DAPT cessation events in patients >75 versus ≤75 years from the MASCOT registry. MASCOT was a prospective, multicenter cohort study of all-comers undergoing attempted COMBO stenting. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, myocardial infarction (MI) not clearly attributed to a nontarget vessel or clinically driven target lesion revascularization. Bleeding was adjudicated using the Bleeding Academic Research Consortium criteria. Adjusted outcomes were analyzed using Cox regression methods. The study included 18% (n = 479) patients >75 years and 72% (n = 2,135) patients ≤75 years. One-year TLF occurred in 4.6% patients >75 years versus 3.1% patients ≤75years of age, p = 0.10; adj hazard ratio 1.36, 95% confidence intervals 0.77 to 2.38, p = 0.29. There were no significant differences in cardiac death (1.7% vs 1.3%, p = 0.55), MI (2.1% vs 1.2%, p = 0.14), target lesion revascularization (1.7% vs 1.4%, p = 0.60) and definite stent thrombosis (0.8% vs 0.4%, p = 0.19). Major Bleeding Academic Research Consortium 3,5 bleeding (3.1% vs 1.5%, p = 0.01) and DAPT cessation rates (32.4% vs 23.0%, p <0.001) were significantly higher in elderly patients. In conclusion, elderly patients >75 years treated with COMBO stents had similar TLF but significantly greater incidence of bleeding than younger patients and DAPT cessation in one-third of patients over 1 year.
    Matched MeSH terms: Coronary Artery Disease/diagnosis; Coronary Artery Disease/surgery*
  19. Fulltext Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study
    Lee KY, Ong TK, Low EV, Liow SY, Anchah L, Hamzah S, et al.
    BMJ Open, 2017 05 28;7(5):e014307.
    PMID: 28552843 DOI: 10.1136/bmjopen-2016-014307
    OBJECTIVES: Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability.

    DESIGN: This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates.

    SETTING: Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions.

    PARTICIPANTS: The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost.

    RESULTS: The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost.

    CONCLUSIONS: Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for the purpose of economic evaluations.

    REGISTRATION: Malaysian MOH Medical Research and Ethics Committee (ID: NMRR-13-1403-18234 IIR).

    Study site: 5 hospitals (unnamed) of which 1 is a university teaching hospital
    Matched MeSH terms: Coronary Artery Disease/economics*; Coronary Artery Disease/therapy*
  20. 1H NMR based pharmacometabolomics analysis of urine identifies metabolic phenotype of clopidogrel high on treatment platelets reactivity in coronary artery disease patients
    Amin AM, Sheau Chin L, Teh CH, Mostafa H, Mohamed Noor DA, Sk Abdul Kader MA, et al.
    J Pharm Biomed Anal, 2017 Nov 30;146:135-146.
    PMID: 28873361 DOI: 10.1016/j.jpba.2017.08.018
    Clopidogrel high on treatment platelets reactivity (HTPR) has burdened achieving optimum therapeutic outcome. Although there are known genetic and non-genetic factors associated with clopidogrel HTPR, which explain in part clopidogrel HTPR, yet, great portion remains unknown, often hindering personalizing antiplatelet therapy. Nuclear magnetic resonance (1H NMR) pharmacometabolomics analysis is useful technique to phenotype drug response. We investigated using 1H NMR analysis to phenotype clopidogrel HTPR in urine. Urine samples were collected from 71 coronary artery disease (CAD) patients who were planned for interventional angiographic procedure prior to taking 600mg clopidogrel loading dose (LD) and 6h post LD. Patients' platelets function testing was assessed with the VerifyNow® P2Y12 assay at 6h after LD. Urine samples were analysed using 1H NMR. Multivariate statistical analysis was used to identify metabolites associated with clopidogrel HTPR. In pre-dose samples, 16 metabolites were associated with clopidogrel HTPR. However, 18 metabolites were associated with clopidogrel HTPR in post-dose samples. The pathway analysis of the identified biomarkers reflected that multifactorial conditions are associated with clopidogrel HTPR. It also revealed the implicated role of gut microbiota in clopidogrel HTPR. Pharmacometabolomics not only discovered novel biomarkers of clopidogrel HTPR but also revealed implicated pathways and conditions.
    Matched MeSH terms: Coronary Artery Disease/drug therapy*; Coronary Artery Disease/urine*
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