Citations 2
Asian Pacific Society of Cardiology Consensus Statements on the Use of Percutaneous Coronary Intervention on Stenosis of the Left Main Coronary Artery
Tan, Jack Wei Chieh , Tan, Huay Cheem , Lee, Michael , Seth, Ashok , Sin, Kenny YK, Firman, Doni , Yap, Jonathan , Sison, Eric Oliver D, Yahya, Achmad Fauzi , Chan, Kok Meng, Chan, Howard Ho Yan, Murasato, Yoshinobu , Malik, Fazila‐Tun‐Nesa , Nguyen, Michael C., Zhang, Bin , Kim, Hyo-Soo , Nguyen, Quang Ngoc , Ako, Junya , Bhindi, Ravinay, Zhang, Junjie , Tam, Frankie Chor-Cheung, Sengottuvelu, G., Ramaiah, Asri Ranga Bin Abdullah, Ali, Rosli Bin Mohd, Harding, S. , Wong, Aaron Sung Lung , Loh, Poay Huan , Hsieh, I-Chang , Kehasukcharoen, Wirash , Linh, Dinh Huynh, Henry, Timothy D. , Tan, Jack Wei Chieh , Lo, Sidney, Sin, Kenny Yoong Kong , Park, Duk‐Woo , Chan, Kok Meng John, Chan, Ho Yan Howard, Nguyen, Michael C, Lee, Kwan , Santoso, Teguh Iman , Wongpraparut, Nattawut , Ramaiah, Asri Ranga Abdullah, Yeo, Khung Keong , Stankovic, Goran R.
Journal of Asian Pacific Society of Cardiology | October 2, 2024 | Volume: 3 | Issue: No issue available | Pages: No page available
Stenosis of the left main coronary artery (LM stenosis) is associated with significant mortality and morbidity due to the large area of affected myocardium. Evidence on the use of percutaneous coronary intervention (PCI) for the treatment of LM stenosis is growing. However, the role of Western guidelines on patients in the Asian-Pacific region is unclear due to anatomical variations, substantial heterogeneity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of LM stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group developed consensus recommendations on the use of PCI in the management of LM stenosis in the Asia-Pacific region. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral’. The resulting 12 statements provide guidance for clinical practitioners in the region on the use of PCI in the treatment of patients with LM stenosis.
Survival loss linked to guideline-based indications for degenerative mitral regurgitation surgery
Vancraeynest, David , Gerber, Bernhard, Benfari, Giovanni , Essayagh, Benjamin , Tribouilloy, Christophe , Ruşinaru, Dan, Ewe, See Hooi , investigators, MIDA (Mitral Regurgitation International Database), Antoine, Clémence , Malouf, Joseph F., Michelena, Hector, Guerra, Federico, Russo, Antonio Dello, Chow, Josie , Fan, Yiting , Keh, Yann Shan , Hamid, Nadira , Pin, Ding Zee, Trojette, Faouzi, Touati, Gilles, Rémadi, Jean Paul , Poulain, H, Ditaranto, Raffaello , Caponetti, Giuseppe, Savini, Carlo , Melfi, Rosetta, Meester, Christophe de, Khoury, Gébrine El , Gerber, Bernhard , Pasquet, Agnès, Collart, Frédéric , Avierinos, Jean Francois, Rossi, Andrea , Essayagh, Benjamin , Tribouilloy, Christophe , Bursi, Francesca , Biagini, Elena , Enriquez-Sarano, Maurice , Benfari, Giovanni , Pouleur, Anne–Catherine , Meester, Christophe de , Pasquet, Agnès , Michelena, Héctor I. , Grigioni, Francesco , Barbieri, Andréa , Bursi, Francesca , Aviérinos, Jean-François , Guerra, Federico , Yeo, Khung Keong , Lee, Alex Pui‐Wai , Vanoverschelde, Jean‐Louis , Enriquez‐Sarano, Maurice , investigators, MIDA (Mitral Regurgitation International Database), Michelena, Hector, Nkomo, Vuyisile T. , Guerra, Federico, Barbarossa, Alessandro , Russo, Antonio Dello, Wong, Randolph H.L. , Wan, Song , Caponetti, Giuseppe Angelo, Pacini, Davide , Chello, Massimo , Nusca, Annunziata , Ussia, Gian Paolo , Meester, Christophe de, Pasquet, Agnès, Théron, Alexis , Avierinos, Jean-Fançois, Mantovani, Francesca , Modena, Maria Grazia , Boriani, Giuseppe , Onorati, Francesco , Ribichini, Flavio Luciano
European Heart Journal - Cardiovascular Imaging | July 11, 2024 | Volume: 25 | Issue: 12 | Pages: 1703-1711
Abstract Aims Operating on patients with severe degenerative mitral regurgitation (DMR) is based on ACC/AHA or ESC/EACTS guidelines. Doubts persist on best surgical indications and their potential association with postoperative survival loss. We sought to investigate whether guideline-based indications lead to late postoperative survival loss in DMR patients. Methods and results We analysed outcome of 2833 patients from the Mitral Regurgitation International Database registry undergoing surgical correction of DMR. Patients were stratified by surgical indications: Class I trigger (symptoms, left ventricular end-systolic diameter ≥ 40 mm, or left ventricular ejection fraction < 60%, n = 1677), isolated Class IIa trigger [atrial fibrillation (AF), pulmonary hypertension (PH), or left atrial diameter ≥ 55 mm, n = 568], or no trigger (n = 588). Postoperative survival was compared after matching for clinical differences. Restricted mean survival time (RMST) was analysed. During a median 8.5-year follow-up, 603 deaths occurred. Long-term postoperative survival was lower with Class I trigger than in Class IIa trigger and no trigger (71.4 ± 1.9, 84.3 ± 2.3, and 88.9 ± 1.9% at 10 years, P < 0.001). Having at least one Class I criterion led to excess mortality (P < 0.001), while several Class I criteria conferred additional death risk [hazard ratio (HR): 1.53, 95% confidence interval (CI): 1.42–1.66]. Isolated Class IIa triggers conferred an excess mortality risk vs. those without (HR: 1.46, 95% CI: 1.00–2.13, P = 0.05). Among these patients, isolated PH led to decreased postoperative survival vs. those without (83.7 ± 2.8% vs. 89.3 ± 1.6%, P = 0.011), with the same pattern observed for AF (81.8 ± 5.0% vs. 88.3 ± 1.5%, P = 0.023). According to RMST analysis, compare to those operated on without triggers, operating on Class I trigger patients led to 9.4-month survival loss (P < 0.001) and operating on isolated Class IIa trigger patients displayed 4.9-month survival loss (P = 0.001) after 10 years. Conclusion Waiting for the onset of Class I or isolated Class IIa triggers before operating on DMR patients is associated with postoperative survival loss. These data encourage an early surgical strategy.