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Clinical features of potential after-effects of percutaneous coronary intervention in the treatment of silent myocardial ischemia

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Abstract

Clinical predictors for later adverse cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) for silent myocardial ischemia remain undetermined. We investigated clinical features leading to later adverse cardiovascular events in patients who underwent PCI for silent myocardial ischemia. Of a total of 294 consecutive patients with a diagnosis of silent myocardial ischemia who successfully underwent contemporary PCI in our institute between January 2013 and December 2014, an initial event of any of all-cause death, hospitalized heart failure, acute coronary syndromes, and target vessel revascularization were identified as later adverse cardiovascular events and evaluated an association of them with baseline clinical characteristics. Silent myocardial ischemia was defined by an assessment of either electrocardiogram, myocardial perfusion imaging, coronary angiogram, or coronary fractional flow reserve. During a median follow-up of 565 days (interquartile range 361–816), later adverse cardiovascular events were identified in 38 patients (13%) consisting of 6 deaths, 5 hospitalized heart failures, 2 acute coronary syndromes, and 25 target vessel revascularizations. A presence of chronic kidney disease and/or insulin-treated diabetes mellitus, but not other clinical features, was strongly associated with later adverse cardiovascular events (hazard ratio 8.22; 95% confidential interval 2.95–29.25, P < 0.0001). Those events were increased in accordance with advanced stages of chronic kidney disease (P = 0.0003). A presence of chronic kidney disease and/or insulin-treated diabetes mellitus may lead the potential after-effects of PCI in the treatment of silent myocardial ischemia.

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Acknowledgements

We are sincerely grateful to Toshiaki Masuda for his profound contributions in managing the data in the present study, and are appreciative of all of the staff of Sakakibara Heart Team.

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi, Fuchu, Tokyo, 183-0003, Japan

    Shinichiro Doi, Makoto Suzuki, Takehiro Funamizu, Itaru Takamisawa & Mitsuaki Isobe

  2. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Shinichiro Doi, Takehiro Funamizu & Hiroyuki Daida

  3. Department of Cardiology, Kawasaki Saiwai Hospital, 31-27 Omiya, Saiwai, Kawasaki, Kanagawa, 212-0014, Japan

    Tetsuya Tobaru

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  1. Shinichiro Doi
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  2. Makoto Suzuki
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Correspondence to Makoto Suzuki.

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Doi, S., Suzuki, M., Funamizu, T. et al. Clinical features of potential after-effects of percutaneous coronary intervention in the treatment of silent myocardial ischemia. Heart Vessels 34, 1917–1924 (2019). https://doi.org/10.1007/s00380-019-01444-8

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