Stable Coronary Artery Disease: Who Finally Benefits from Coronary Revascularization in the Modern Era? The ISCHEMIA and Interim ISCHEMIA-EXTEND Analysis

Bershtein, Leonid; Sumin, Alexey; Zbyshevskaya, Elizaveta; Gumerova, Victoria; Tsurtsumia, Darejan; Kochanov, Igor; Andreeva, Alina; Piltakian, Vartan; Sayganov, Sergey

doi:10.3390/life13071497

Cited by 4 publications

(1 citation statement)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While ICD has demonstrated a superiority in terms of lives saved [ 30 , 90 ], it is also important to assess whether revascularization, obtained either through PCI or CABG, is complete in order to achieve improved cardiac performances and outcome, similarly to reduction in fatal arrhythmias in the ischemic and post-ischemic settings. The role of revascularization yet remains controversial, mostly due to the selected approach based either on optimal medical therapy alone or in combination with routine angiography and revascularization [ 91 , 92 ].…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Revascularization and Left Ventricular Dysfunction for ICD Eligibility

Romano,

Spaccarotella,

Indolfi

et al. 2023

Life

View full text Add to dashboard Cite

Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter–defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation.

show abstract

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Revascularization and Left Ventricular Dysfunction for ICD Eligibility

Romano,

Spaccarotella,

Indolfi

et al. 2023

Life

View full text Add to dashboard Cite

show abstract

The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients

Kadoglou,

Papadopoulos,

Khattab

et al. 2024

Hellenic Journal of Cardiology

View full text Add to dashboard Cite

Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice

Sumin,

Starovoytova,

Shcheglova

et al. 2024

Acta biomedica scientifica

View full text Add to dashboard Cite

Background. Despite the high evidence level of the currently existing international recommendations on stable coronary heart disease (CHD) and chronic coronary syndrome, their implementation in domestic clinical practice is insufficient.The aim of the work. To analyze the choice of diagnostic tactics (non-invasive and invasive) in patients with suspected obstructive coronary heart disease in real clinical practice.Methods. The study included outpatients with suspected obstructive CHD, in whom the pre-test probability (PTP) of obstructive CHD was determined; if PTP = 5–15 %, clinical probability was assessed based on CHD risk factors. Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (< 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization.Conclusion. In the cohort of outpatients with suspected coronary heart disease we examined during invasive coronary angiography, the frequency of obstructive lesion of the coronary arteries remains low. Non-invasive tests were performed in isolated cases, while PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization. To increase the frequency of detection of obstructive coronary heart disease, we should adhere to the diagnostic algorithms of the European Society of Cardiology and make wider use of non-invasive imaging tests.

show abstract

Stable Coronary Artery Disease: Who Finally Benefits from Coronary Revascularization in the Modern Era? The ISCHEMIA and Interim ISCHEMIA-EXTEND Analysis

Cited by 4 publications

References 35 publications

Revascularization and Left Ventricular Dysfunction for ICD Eligibility

Revascularization and Left Ventricular Dysfunction for ICD Eligibility

The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients

Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice

Contact Info

Product

Resources

About