1.
Safety and efficacy of coronary intravascular lithotripsy for calcified coronary arteries- a systematic review and meta-analysis.
Sattar, Y, Ullah, W, Mir, T, Biswas, S, Titus, A, Darmoch, F, Pacha, HM, Mohamed, MO, Kwok, CS, Fischman, DL, et al
Expert review of cardiovascular therapy. 2021;(1):89-98
Abstract
Objectives: Intravascular lithotripsy (IVL) clinical efficacy and safety in the treatment of calcified coronary artery disease (CAC) is not well known. We sought to assess IVL safety and efficacy in CAC. Methods: A comprehensive online databases search were performed to identify intravascular lithotripsy studies in patients with coronary artery disease. The primary outcome was IVL related change in the mean pre and post-procedural diameter of the coronary artery. Results: A total of 4 studies with 282 patients were included. The mean pre-IVL coronary diameter for all patients was 1.01 mm, while the mean post-IVL coronary diameter was 2.70 mm. The mean pre-post IVL diameter difference of coronary arteries on the pooled analysis was significantly lower by 4.08 mm (95% CI -4.94 to -3.30, p ≤ 0.00001). The Overall increase in the post-IVL lumen diameter was significantly higher than the pre-IVL diameter with a mean difference of -4.16 (95% CI -5.08 to -3.24, p = 0.000001). However, compared to pre-IVL, there was a significant reduction in the overall mean difference of luminal calcium angle after IVL of the stented coronary arteries (0.09, 95% CI 0.002-0.16, p = 0.01). Conclusion: Intravascular lithotripsy can offer a significant improvement in the vessel lumen to facilitate coronary stent delivery and deployments in severely calcified coronary arteries.
2.
Coronary artery calcium score and risk of cardiovascular events without established coronary artery disease: a systemic review and meta-analysis.
Abuzaid, A, Saad, M, Addoumieh, A, Ha, LD, Elbadawi, A, Mahmoud, AN, Elgendy, A, Abdelaziz, HK, Barakat, AF, Mentias, A, et al
Coronary artery disease. 2021;(4):317-328
Abstract
BACKGROUND Coronary artery calcium (CAC) is an indicator of atherosclerosis, and the CAC score is a useful noninvasive assessment of coronary artery disease. OBJECTIVE To compare the risk of cardiovascular outcomes in patients with CAC > 0 versus CAC = 0 in asymptomatic and symptomatic population in patients without an established diagnosis of coronary artery disease. METHODS A systematic search of electronic databases was conducted until January 2018 for any cohort study reporting cardiovascular events in patients with CAC > 0 compared with absence of CAC. RESULTS Forty-five studies were included with 192 080 asymptomatic 32 477 symptomatic patients. At mean follow-up of 11 years, CAC > 0 was associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic arm [pooled risk ratio (RR) 4.05, 95% confidence interval (CI) 2.91-5.63, P < 0.00001, I2 = 80%] and symptomatic arm (pooled RR 6.06, 95% CI 4.23-8.68, P < 0.00001, I2 = 69%). CAC > 0 was also associated with increased risk of all-cause mortality in symptomatic population (pooled RR 7.94, 95% CI 2.61-24.17, P < 0.00001, I2 = 85%) and in asymptomatic population CAC > 0 was associated with higher all-cause mortality (pooled RR 3.23, 95% CI 2.12-4.93, P < 0.00001, I2 = 94%). In symptomatic population, revascularization in CAC > 0 was higher (pooled RR 15, 95% CI 6.66-33.80, P < 0.00001, I2 = 72) compared with CAC = 0. Additionally, CAC > 0 was associated with more revascularization in asymptomatic population (pooled RR 5.34, 95% CI 2.06-13.85, P = 0.0006, I2 = 93). In subgroup analysis of asymptomatic population by gender, CAC > 0 was associated with higher MACE (RR 6.39, 95% CI 3.39-12.84, P < 0.00001). CONCLUSION Absence of CAC is associated with low risk of cardiovascular events compared with any CAC > 0 in both asymptomatic and symptomatic population without coronary artery disease.
3.
Predictive value of coronary artery calcium score in cardiovascular disease.
Liu, S, Zheng, X, Xu, J, Wang, X, Zhang, Y, Lv, B, Zheng, L, Sun, K
Frontiers in bioscience (Elite edition). 2020;(1):113-125
Abstract
We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03-0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101-300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1-100 (HR=0.03, 95% CI 0.01-0.06, Z=1.66, P=0.096), and further increased with CACS of 101-300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.
4.
Is abdominal vascular calcification score valuable in predicting the occurrence of colorectal anastomotic leakage? A meta-analysis.
Tong, L, Xie, D, Song, X, Wu, X, Wen, S, Liu, A
International journal of colorectal disease. 2020;(4):641-653
Abstract
OBJECTIVE Anastomotic leakage (AL) is a catastrophic surgical complication affecting the prognosis of patients after colorectal surgery. We aimed to determine the value of the arterial calcification (AC) score in predicting AL. METHODS Medline and Embase were searched through November 2019. The odds ratio (OR) and 95% confidence interval (CI) were used to estimate the association between AC and AL after colorectal surgery. The fixed-effects model or random-effects model was adopted for data pooling. Subgroup analyses were conducted to assess the effect of different aortoiliac trajectories. RESULTS Four studies involving 496 patients were included. The calcium volume and calcium score measurements of different trajectories revealed a significant difference with regard to the left and right common iliac arteries, the superior mesenteric artery, and the left common iliac artery. Calcification of the internal iliac artery significantly increased the risk of AL compared with no AL (OR = 1.005; 95% CI 1.002-1.009; P = 0.005), as did calcification of the left internal iliac artery (OR = 1.009; 95% CI 1.002-1.016; P = 0.011), but not of the common iliac artery (OR = 1.001; 95% CI 1.000-1.001; P = 0.317) or common and internal iliac artery (OR = 1.000; 95% CI 1.000-1.000; P = 1.000). CONCLUSIONS AC is associated with increased risk of AL following colorectal surgery. TRIAL REGISTRATION CRD42019141236.