- Email: [email protected]
Comparison of Angiographic Outcomes after Drug-eluting Stents and Bare-metal Stents in Patients with Cardiac Allograft Vasculopathy: A Metanalysis
The 22nd Annual Scientific Meeting HFSA
S11
023 Comparison of Angiographic Outcomes after Drug-eluting Stents and Baremetal Stents in Patients with Cardiac Allograft Vasculopathy: A Metanalysis Sagar Ranka, Abhushan Poudyal, Udit Joshi, Vamsi Kodumuri, Neha Yadav; John H Stroger Hospital of Cook County, Chicago, IL
022 Device Measured Rapid Shallow Breathing Index Reflects Changing Respiratory Patterns but Minute Ventilation Reflects Changing Activity During Worsening Heart Failure in Ambulatory Patients Seth Rials1, Mehmet Aktas2, Alessandro Capucci3, Roy Gardner4, Michael Gold5, Giulio Molon6, Pramod Thakur7, Robert Sweeney7, Yi Zhang7, Qi An7, Viktoria Averina7, John Boehmer8; 1Ohio Health, Gahanna, OH; 2University of Rochester, Rochester, NY; 3Universita Politecnica delle Marche, Ancona, Italy; 4Golden Jubilee National Hospital, Clydebank, United Kingdom; 5Medical University of South Carolina, Charleston, SC; 6Sacro Cuore Hospital, Negrar, Italy; 7Boston Scientific, St. Paul, MN; 8Penn State Hershey Medical Center, Hershey, PA Background: Respiratory distress is common in heart failure (HF) and a primary driver for HF hospitalizations. Minute Ventilation (MV), a product of respiratory rate and tidal volume, is known to be elevated in HF patients due to ventilation/perfusion (V/Q) mismatch. However, it is not known if changes in MV accurately reflect emergence of rapid shallow breathing patterns in ambulatory patients preceding a HF event. Methods: The MultiSENSE trial enrolled 900 patients implanted with a COGNIS CRT-D and followed them up to 1 year. Device software was modified to permit collection of chronic diagnostic sensor data including impedance based respiration rate (RR) and tidal volume (TV), which was used to compute MV (= RR*TV) and Rapid Shallow Breathing Index (RSBI = RR/TV), and activity (XL). Daily averages were separately computed over entire 24 hours as well as during resting epochs. HF events (HFEs) were independently adjudicated and defined as HF admissions or unscheduled visits with intravenous HF treatment. Relative changes preceding HFEs were computed between a baseline 30 60 days prior to HFEs (BL) and 3-day preHFE (ST) as (ST-BL)/BLx100% and reported as mean +/- SEM. Significance was tested using Wilcoxon signed-rank test. Results: 900 patients followed for a year experienced 192 HFEs. Using 24-hour averages, significant changes were observed in RR, TV and RSBI indicating the emergence of rapid shallow breathing pattern leading up to HFE. MV average over 24 hours showed nonsignificant decrease coincident with decreased patient activity but showed no change when daily averaging was limited to resting epochs. In contrast, RR, TV and RSBI were significantly changed even at rest in directions consistent with the emergence of rapid shallow breathing pattern. Conclusion: Device measured rapid shallow breathing is significantly elevated in the three day epoch preceding HFEs, whereas minute ventilation is not, in both 24-hour as well as resting period daily averages. Automatic ambulatory longitudinal monitoring of changes in rapid shallow breathing patterns may enable better monitoring for emerging respiratory distress in HF patients.
Background: Coronary Allograft Vasculopathy (CAV) is a major determinant of long term survival after cardiac transplantation and remains one of the leading causes of death after the first year of orthotopic heart transplantation (OHT). Percutaneous revascularization is an option for amenable lesions with either drug-eluting stents (DES) or bare-metal stents (BMS). Choice of stent is dependent on patient and angiographic characteristics. Previous studies comparing the two stent subtypes have shown inconsistent results and thus we decided to do a meta-analysis to evaluate the net clinical effect. Methods: PubMed, Medline & EMBASE were queried for all English articles from 1993 to 2017. Inclusion criteria were patients with CAV undergoing percutaneous coronary intervention with either DES or BMS with follow up angiography at 1 year. Primary outcome was In-stent restenosis (ISR): defined as more than 50% stenosis of the stent diameter angiographically. Secondary outcome was mortality. Outcomes were analyzed in two groups: Patient-based analysis and Lesion-based analysis. Data were pooled with absolute event rate and metanalysis of the outcomes was performed using a weighted random effects model in RevMAN 5.0. Results: Seven studies including a total of 526 angiographic lesions (BMS 267; 50.7%) and 268 patients were analyzed. On lesion-based analysis, mean incidence of ISR in the BMS group vs the DES group was 31% vs 10.2% (RR 0.36; 95% CI 0.19 0.69; p=0.002). No difference in mortality was observed between the two groups (RR 0.86; 95% CI 0.16 0.46; p=0.86). Forest-plots for the outcomes are shown below. Conclusion: Our analysis suggests that when compared with BMS implantation, DES have a lower rate of in-stent restenosis but offer no reduction in mortality at 1 year.
S11
023 Comparison of Angiographic Outcomes after Drug-eluting Stents and Baremetal Stents in Patients with Cardiac Allograft Vasculopathy: A Metanalysis Sagar Ranka, Abhushan Poudyal, Udit Joshi, Vamsi Kodumuri, Neha Yadav; John H Stroger Hospital of Cook County, Chicago, IL
022 Device Measured Rapid Shallow Breathing Index Reflects Changing Respiratory Patterns but Minute Ventilation Reflects Changing Activity During Worsening Heart Failure in Ambulatory Patients Seth Rials1, Mehmet Aktas2, Alessandro Capucci3, Roy Gardner4, Michael Gold5, Giulio Molon6, Pramod Thakur7, Robert Sweeney7, Yi Zhang7, Qi An7, Viktoria Averina7, John Boehmer8; 1Ohio Health, Gahanna, OH; 2University of Rochester, Rochester, NY; 3Universita Politecnica delle Marche, Ancona, Italy; 4Golden Jubilee National Hospital, Clydebank, United Kingdom; 5Medical University of South Carolina, Charleston, SC; 6Sacro Cuore Hospital, Negrar, Italy; 7Boston Scientific, St. Paul, MN; 8Penn State Hershey Medical Center, Hershey, PA Background: Respiratory distress is common in heart failure (HF) and a primary driver for HF hospitalizations. Minute Ventilation (MV), a product of respiratory rate and tidal volume, is known to be elevated in HF patients due to ventilation/perfusion (V/Q) mismatch. However, it is not known if changes in MV accurately reflect emergence of rapid shallow breathing patterns in ambulatory patients preceding a HF event. Methods: The MultiSENSE trial enrolled 900 patients implanted with a COGNIS CRT-D and followed them up to 1 year. Device software was modified to permit collection of chronic diagnostic sensor data including impedance based respiration rate (RR) and tidal volume (TV), which was used to compute MV (= RR*TV) and Rapid Shallow Breathing Index (RSBI = RR/TV), and activity (XL). Daily averages were separately computed over entire 24 hours as well as during resting epochs. HF events (HFEs) were independently adjudicated and defined as HF admissions or unscheduled visits with intravenous HF treatment. Relative changes preceding HFEs were computed between a baseline 30 60 days prior to HFEs (BL) and 3-day preHFE (ST) as (ST-BL)/BLx100% and reported as mean +/- SEM. Significance was tested using Wilcoxon signed-rank test. Results: 900 patients followed for a year experienced 192 HFEs. Using 24-hour averages, significant changes were observed in RR, TV and RSBI indicating the emergence of rapid shallow breathing pattern leading up to HFE. MV average over 24 hours showed nonsignificant decrease coincident with decreased patient activity but showed no change when daily averaging was limited to resting epochs. In contrast, RR, TV and RSBI were significantly changed even at rest in directions consistent with the emergence of rapid shallow breathing pattern. Conclusion: Device measured rapid shallow breathing is significantly elevated in the three day epoch preceding HFEs, whereas minute ventilation is not, in both 24-hour as well as resting period daily averages. Automatic ambulatory longitudinal monitoring of changes in rapid shallow breathing patterns may enable better monitoring for emerging respiratory distress in HF patients.
Background: Coronary Allograft Vasculopathy (CAV) is a major determinant of long term survival after cardiac transplantation and remains one of the leading causes of death after the first year of orthotopic heart transplantation (OHT). Percutaneous revascularization is an option for amenable lesions with either drug-eluting stents (DES) or bare-metal stents (BMS). Choice of stent is dependent on patient and angiographic characteristics. Previous studies comparing the two stent subtypes have shown inconsistent results and thus we decided to do a meta-analysis to evaluate the net clinical effect. Methods: PubMed, Medline & EMBASE were queried for all English articles from 1993 to 2017. Inclusion criteria were patients with CAV undergoing percutaneous coronary intervention with either DES or BMS with follow up angiography at 1 year. Primary outcome was In-stent restenosis (ISR): defined as more than 50% stenosis of the stent diameter angiographically. Secondary outcome was mortality. Outcomes were analyzed in two groups: Patient-based analysis and Lesion-based analysis. Data were pooled with absolute event rate and metanalysis of the outcomes was performed using a weighted random effects model in RevMAN 5.0. Results: Seven studies including a total of 526 angiographic lesions (BMS 267; 50.7%) and 268 patients were analyzed. On lesion-based analysis, mean incidence of ISR in the BMS group vs the DES group was 31% vs 10.2% (RR 0.36; 95% CI 0.19 0.69; p=0.002). No difference in mortality was observed between the two groups (RR 0.86; 95% CI 0.16 0.46; p=0.86). Forest-plots for the outcomes are shown below. Conclusion: Our analysis suggests that when compared with BMS implantation, DES have a lower rate of in-stent restenosis but offer no reduction in mortality at 1 year.