Association between Phenotypic Age and Mortality in Patients with Multivessel Coronary Artery Disease

Background. Chronological age (CA) is not a perfect proxy for the true biological aging status of the body. A new biological aging measure, phenotypic age (PhenoAge), has been shown to capture morbidity and mortality risk in the general US population and diverse subpopulations. This study was aimed at evaluating the association between PhenoAge and long-term outcome of patients with multivessel coronary artery disease (CAD). Methods. A total of 609 multivessel CAD patients who received PCI attempt and with follow-up were enrolled. The clinical outcome was all-cause mortality on follow-up. PhenoAge was calculated using an equation constructed from CA and 9 clinical biomarkers. Cox proportional hazards regression models and receiver operating characteristic (ROC) curves were performed to evaluate the association between PhenoAge and mortality. Results. Overall, patients with more diseases had older PhenoAge and phenotypic age acceleration (PhenoAgeAccel). After a median follow-up of 33.5 months, those with positive PhenoAgeAccel had a significantly higher incidence of all-cause mortality ( P = 0.001 ). After adjusting for CA, Cox proportional hazards models showed that both PhenoAge and PhenoAgeAccel were significantly associated with all-cause mortality. Even after further adjusting for confounding factors, each 10-year increase in PhenoAge was also associated with a 51% increased mortality risk. ROC curves revealed that PhenoAge, with an area under the curve of 0.705, significantly outperformed CA, the individual clinical chemistry measure, and other risk factors. When reexamining the ROC curves using various combinations of variables, we found that PhenoAge provides additional predictive power to all models. Conclusions. In conclusion, PhenoAge was strongly associated with all-cause mortality even after adjusting for CA. Our findings suggest that PhenoAge measure may be complementary in predicting mortality risk for patients with multivessel CAD.

Hybrid coronary revascularization in multivessel coronary artery disease: a systematic review

Aim: Hybrid coronary revascularization (HCR) for multivessel coronary artery disease (CAD) integrates coronary artery bypass grafting (CABG) and percutaneous intervention in a planned revascularization strategy. This systematic review summarizes the state of this art of this technique. Methods: Major databases searched until October 2021. Results: The available literature on HCR includes three randomized trials, ten meta-analysis and 27 retrospective studies. The greatest benefits are observed in patients with low-to-intermediate risk and less complex coronary anatomy; highly complex disease and the presence of risk factors favored conventional CABG in terms of adverse events and survival. Conclusion: HCR is an interesting approach for multivessel CAD but should not be considered a ‘one-size-fits-all’ procedure. Further studies will specify the subset of patients likely to benefit most from this hybrid approach.

One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease

Background: Data on one-stop hybrid coronary revascularization (HCR) are limited. This study aimed to compare the early and midterm outcomes of one-stop HCR with off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease.Methods: From April 2018 to May 2021, 752 patients with multivessel coronary artery disease who underwent isolated one-stop HCR or OPCAB were retrospectively included in this analysis. After exclusion and propensity score matching, 151 patients who underwent HCR were matched with 151 patients who underwent OPCAB. The primary endpoints were midterm major adverse cardiovascular and cerebrovascular events (MACCE) after the procedure. The secondary endpoints were in-hospital complications and outcomes.Results: The preprocedural characteristics were well balanced between the two groups after matching. The HCR group was associated with a lower rate of perioperative transfusion (23.8 vs. 53.0%, p < 0.001) and new-onset atrial fibrillation (AF) (5.3 vs. 15.2%, p = 0.004), shorter time of mechanical ventilation (h) [15 (16, 17) vs. 17 (16, 20), p < 0.001], and shorter length of stay (LOS) in the hospital (days) [19 (16, 24) vs. 22 (18, 27), p = 0.001]. Cumulated MACCE rates were similar between the two groups (15.9 vs. 14.0%, p = 0.59) during a median follow-up of 20 months.Conclusions: One-stop HCR is safe and efficacious with less invasiveness and faster postoperative recovery in selected patients with multivessel coronary artery disease. Randomized controlled trials with larger sample sizes and long-term follow-up are warranted to confirm these findings.

Inter- and Intraobserver Repeatability of Myocardial Flow Reserve Values Determined with SPECT Study Using a Discovery NM530c Camera and Corridor 4DM Software

Background: Myocardial blood flow (MBF) and flow reserve (MFR) examination, especially useful in the diagnosis of multivessel coronary artery disease (CAD), can be assessed with a cadmium-zinc-telluride (CZT) SPECT gamma camera, as an alternative to the expensive and less available PET. However, study processing is not free from subjective factors. Therefore, this paper aims to evaluate intra- and interobserver repeatability of MBF and MFR values obtained by the same operator and two independent operators. Methods: This study included 57 adult patients. MBF and MFR were assessed using a Discovery NM530c camera in a two-day, rest/dipyridamople protocol, using 99mTc-MIBI. Data were processed using Corridor4DM software, twice by one operator and once by another operator. Results: The repeatability of the assessed values was quite good in the whole myocardium, LAD and LCX vascular territories, but was poor in the RCA territory. Conclusions: The poor repeatability of MBF and MFR in RCA vascular territory can be explained by poor automatic orientation of the heart axis during post-processing and a so-called “cardiac creep” phenomenon. Better automatic heart orientation and introduction of automatic motion correction is likely to drastically improve this repeatability. In the present state of the software, PET is better for patients requiring assessment of MFR in the RCA territory.

The Influence of Risk Factors on Perioperative Results of Multivessel Coronary Artery Bypass Grafting Through the Left Anterior Minitoracotomy

Multivessel coronary artery bypass grafting (CABG) through the left anterior minitoracotomy using the technique of total coronary revascularization via left anterior thoracotomy (TCRAT) is routinely performed in our institution since July 2017. This technique is used in all patients regardless of the number of anastomoses, quality and location of coronary targets, body mass index, age, comorbidities and predicted postoperative risk. The aim. To present the results of 349 consecutive patients with isolated multivessel coronary artery disease who underwent minimally invasive CABG. To compare perioperative outcomes of minimally invasive CABG in patients with existent risk factors for CABG and to identify possible contraindications to the use of this CABG technique. Materials and methods. From July 2017 to January 2020, 357 consecutive patients were underwent multivessel CABG at our institution. Eight (2.3%) patients in whom CABG was performed through the median sternotomy were excluded from the study. The remaining 349 (97.7%) patients underwent complete myocardial revascularization through the left anterior minitracotomy using TCRAT technique (peripheral cannulation for cardiopulmonary bypass (CPB), cold blood cardioplegia). All the patients were divided into groups according to the presence of risk factors (obesity, old age, diabetes, risk of postoperative mortality greater than 2.0 calculated by EuroSCORE II scale) to analyze the impact of these factors on intraoperative and postoperative parameters. Results. Intra- and postoperative parameters in patients of all groups were within safe limits. There was no statistically significant difference between the patients older and younger than 70. Diabetic and obese patients had a longer total operation time (on average by 5%, p = 0.003 and 7%, p = 0.019, respectively), CPB time (on average by 8%, p = 0.002 and 11%, p = 0.0001, respectively) and intensive care unit stay (on average by 15%, p = 0.004 and 17%, p = 0.013, respectively) compared to the patients without these conditions. The patients with EuroSCORE II risk more than 2.0 were had longer main phase of the operation (on average by 12 minutes, i.e. 8%, p = 0.013), they required longer ventilation time (by 27%, p = 0.036), longer stay in the intensive care unit (by 23%, p = 0.0004), had a longer hospital stay (by 15%, p < 0.0001), they were more likely to have acute kidney damage that required hemodialysis, and mortality was observed only in this group of patients. However, even in this group of severe patients, the incidence of complications and mortality did not exceed the predicted rates. Conclusions. The technique of minimally invasive CABG through the left anterior thoracotomy allow the possibility to avoid median sternotomy in 97.7% of patients with multivessel coronary artery disease. The technique of minimally invasive multivessel CABG through the left anterior thoracotomy is universal and does not require patient selection, because it can be used effectively and safely regardless of obesity, diabetes or old age. This technique can be performed in patients with any EuroSCORE II rate without the mortality rate increase.

Prevention of ischaemic events in subjects with polydistrict vascular disease

The incidence of new cardiovascular events in patients with chronic coronary syndrome remains high, particularly in the presence of concomitant high thrombotic risk factors (diabetes mellitus, renal failure, multivessel coronary artery disease, multiple district atherosclerosis, recurrent events, heart failure). The risk of such recurrent events can be reduced by implementing various strategies, which include careful individual stratification of ischaemic and haemorrhagic risk and the choice of the most appropriate antithrombotic therapy for the individual patient, also by combining aspirin with a second antiplatelet agent/a low-dose anticoagulant, in order to achieve the maximum net clinical benefit.