Effects of Body Mass Index on Clinical Outcomes in Female Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

Faggioni, Michela; Baber, Usman; Afshar, Arash; Giustino, Gennaro; Sartori, Samantha; Sorrentino, Sabato; Steg, Philippe Gabríel; Windecker, Stephan; Leon, Martin B.; Stone, Gregg W.; Wijns, William; Serruys, Patrick W.; Valgimigli, Marco; Camenzind, Edoardo; Weisz, Giora; Smits, Pieter C.; Kandzari, David E.; Galatius, Søren; Birgelen, Clemens von; Jeger, Raban; Mikhail, Ghada; Itchhaporia, Dipti; Mehta, Laxmi S.; Ortega, Rebecca; Kim, Hyo Soo; Kastrati, Adnan; Chieffo, Alaide; Dangas, George; Morice, Marie‐Claude; Mehran, Roxana

doi:10.1016/j.jcin.2017.06.060

Cited by 31 publications

(26 citation statements)

References 29 publications

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“…First, currently, radial is the access of choice for the majority of the percutaneous coronary procedures, and thus the younger generation of interventional cardiologists are less experienced in managing femoral cannulation and its related complications [5,6]. Second, an increasing number of TFAs are used for high-risk patients undergoing complex PCvI and for the implantation of left ventricular devices; percutaneous aortic valve and endoprosthesis implantation require transfemoral access for bigger devices [14,[20][21][22]. Therefore, the magnitude of UGC benefits may potentially be greater in patients undergoing such high-risk interventions.…”

Section: Discussionmentioning

confidence: 99%

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Sorrentino

Nguyen

Salerno

et al. 2020

JCM

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Background: It is unclear whether or not ultrasound-guided cannulation (UGC) of the femoral artery is superior to the standard approach (SA) in reducing vascular complications and improving access success. Objective: We sought to compare procedural and clinical outcomes of femoral UGC versus SA in patients undergoing percutaneous cardiovascular intervention (PCvI). Methods: We searched EMBASE, MEDLINE, Scopus and web sources for randomized trials comparing UGC versus SA. We estimated risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) for categorical and continuous variables, respectively. Primary efficacy endpoint was the success rate at the first attempt, while secondary efficacy endpoints were access time and number of attempts. Primary safety endpoints were the rates of vascular complications, while secondary endpoints were major bleeding, as well as access site hematoma, venepuncture, pseudoaneurysms and retroperitoneal hematoma. This meta-analysis has been registered on Centre for Open Science (OSF) (osf.io/fy82e). Results: Seven trials were included, randomizing 3180 patients to UGC (n = 1564) or SA (n = 1616). Efficacy between UGC and SA was the main metric assessed in most of the trials, in which one third of the enrolled patients underwent interventional procedures. The success rate of the first attempt was significantly higher with UGC compared to SA, (82.0% vs. 58.7%; RR: 1.36; 95% CI: 1.17 to 1.57; p < 0.0001; I2 = 88%). Time to access and number of attempts were significantly reduced with UGC compared to SA (SMD: −0.19; 95% CI: −0.28 to −0.10; p < 0.0001; I2 = 22%) and (SMD: −0.40; 95% CI: −0.58 to −0.21; p < 0.0001; I2 = 82%), respectively. Compared with SA, use of UGC was associated with a significant reduction in vascular complications (1.3% vs. 3.0%; RR: 0.48; CI 95%: 0.25 to 0.91; p = 0.02; I2 = 0%) and access-site hematoma (1.2% vs. 3.3%; RR: 0.41; CI 95%: 0.20 to 0.83; p = 0.01; I2 = 27%), but there were non-significant differences in major bleeding (0.7% vs. 1.4%; RR: 0.57; CI 95%: 0.24 to 1.32; p = 0.19; I2 = 0%). Rates of venepuncture were lower with UGC (3.6% vs. 12.1%; RR: 0.32; CI 95%: 0.20 to 0.52; p < 0.00001; I2 = 55%). Conclusion: This study, which included all available data to date, demonstrated that, compared to a standard approach, ultrasound-guided cannulation of the femoral artery is associated with lower access-related complications and higher efficacy rates. These results could be of great clinical relevance especially in the femoral cannulation of high risk patients.

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Section: Discussionmentioning

confidence: 99%

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Sorrentino

Nguyen

Salerno

et al. 2020

JCM

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“…Several studies have demonstrated an obesity paradox in patients with existing CAD after percutaneous coronary intervention (PCI) or coronary artery bypass grafting. These data are summarized in Table .…”

Section: Studies Showing An Obesity Paradox In Obese Compared With Nwmentioning

confidence: 99%

“…The 1‐year post‐PCI incidence of MACE and death was lower in overweight and obese than the underweight and NW patients (HR 0.71 [ P = .005] and 0.78 [ P = .056], respectively). Faggioni and colleagues examined the effects of obesity on cardiovascular mortality, all‐cause mortality, and MACE in 11 557 women aged 63 to 70 years with CAD. The patients were classified according to BMI as underweight (BMI < 18.5), NW (BMI 18.5–24.9), overweight (BMI 25–29.9), obese (BMI 30–34.9), or morbidly obese (BMI ≥ 35).…”

Section: Studies Showing An Obesity Paradox In Obese Compared With Nwmentioning

confidence: 99%

Obesity is bad regardless of the obesity paradox for hypertension and heart disease

Chrysant

2018

J of Clinical Hypertension

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Obesity has risen significantly worldwide and has become a major health and societal problem. 1,2 Obesity does not imply good health since obesity is associated with several major cardiovascular risk factors, which include the metabolic syndrome, hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia, which lead to increased cardiovascular and all-cause mortality in obese people. 3,4 Despite these adverse cardiovascular effects of obesity, some studies indicate better cardiovascular outcomes in obese individuals with the so called "obesity paradox," 5-10 in contrast to other studies that show adverse cardiovascular outcomes of obesity. [11][12][13][14][15][16] The obesity paradox has been demonstrated in patients with preexisting coronary artery disease (CAD) 5-10 as well as in patients with heart failure (HF) 17,18 and hypertension [19][20][21][22][23] and is giving the wrong signal in obese people and in our efforts to stem the tide of obesity in the United States and elsewhere. 24,25 Since obesity begets CAD, hypertension, and HF, it is therefore better to prevent these complications by preventing obesity instead of inviting them and then trying to treat them. In this respect, a new large study in 3.5 million people has demonstrated that obesity even in metabolically healthy persons is associated with higher cardiovascular and all-cause mortality compared with nonobese healthy individuals. 15 This commentary is based on the findings of this study together with other recent study findings.

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“…Тем не менее, в течение последних двух десятилетий были опубликованы результаты ряда исследований, в которых показано, что у паци-ентов с избыточным весом или ожирением может регистрироваться более благоприятный прогноз, чем у лиц с нормальным весом. Данный парадокс был описан у пациентов с различными заболеваниями [3], в том числе острым коронарным синдромом [4], чрескожными коронарными вмешательствами (ЧКВ) [5] и/или при инфаркте миокарда с подъемом сегмен-том ST (ИМпST) [6,7]. Единого мнения о причинах "парадокса ожирения" нет.…”

Section: результатыunclassified

Clinical Specifics of Patients State After Revascularized Myocardial Infarction, Depending on the Baseline Obesity Status

2018

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Цель. Изучение исходных клинических особенностей пациентов, перенес-шими инфаркт миокарда с подъемом сегмента ST и первичное чрескожное коронарное вмешательство, с различным статусом ожирения. Материал и методы. В исследование было последовательно включено 105 мужчин перенесшими инфаркт миокарда с подъемом сегмента ST и первич-ное чрескожное коронарное вмешательство. У всех пациентов оценивалось общее ожирение (ООж) по индексу массы тела (ИМТ) и висцеральное эпикар-диальное ожирение (ЭО) по толщине эпикардиальной жировой ткани по дан-ным эхокардиографии. В зависимости от этих показателей было сформиро-вано 6 групп пациентов с различным сочетанием ООж и ЭО. Всем больным была проведена коронарография в остром периоде инфаркта миокарда, определялись уровни адипокинов, рецепторов к лептину, скорость клубочко-вой фильтрации и уровень альбумина в моче. Результаты. Выявлено, что исходные клинические показатели в группах изуча-емых пациентов значимо зависели от наличия ООж и ЭО и их различного соче-тания. В группах с ЭО по сравнению с группами без ЭО были выявлены более высокая встречаемость 2-3-х коронарного атеросклероза, жизнеопасных нару-шений ритма в остром периоде инфаркта миокарда, лептинорезистетности, альбуминурии. А при сравнении групп по наличию или отсутствию ООж четкой связи встречаемости тех же изучаемых показателей с ИМТ не выявлено. Наибо-лее часто мультифокальный атеросклероз, нарушения ритма, дисадипокине-мия, альбуминурия встречался в группе с сочетанием ООж и ЭО, что, возможно, связано с наибольшим объемом висцерального жира. Заключение. Наше исследование еще раз показало, что ожирение крайне разнородное состояние, и в зависимости от критериев, выбранных для срав-нения групп пациентов с ожирением, можно получить совершенно разные результаты распространенности сердечно-сосудистых рисков, проявлений, осложнений от классического представления о неблагоприятном влиянии ООж, до благоприятного с "парадоксом ожирения". А значит нет парадокса ожирения, а есть парадокс критериев оценки степени и вида ожирения. Aim. Evaluation of comparable clinical specifics of patients after ST elevation myocardial infarction (STEMI) and primary percutaneous intervention, with various grade of obesity. Material and methods. To the study, consequently 105 males included, post STEMI and primary percutaneous intervention (PCI). In all patients, general obesity (GO) was assessed by body mass index (BMI) and visceral epicardial obesity (EO) by the thickness of epicardial adipose tissue by echocardiography. According to the values, 6 groups of patients were formed with various combination of GO and EO. All patients underwent coronary arteriography in acute stage of MI, levels of adipokines, leptin receptors measured, as the glomerular filtration rate and urine albumin level.Results. It was found that the baseline clinical parameters in patients' groups significantly correlated with GO and EO and various combination. In EO comparing to non-EO groups there were high prevalence of 2-3-vessel coronary lesion, life threatening rhythm d...

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Effects of Body Mass Index on Clinical Outcomes in Female Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

Cited by 31 publications

References 29 publications

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Obesity is bad regardless of the obesity paradox for hypertension and heart disease

Clinical Specifics of Patients State After Revascularized Myocardial Infarction, Depending on the Baseline Obesity Status

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