Prediction-Determining Outcomes and Their Predictors in Atrial Fibrillation Patients Receiving Multicomponent Antithrombotic Therapy in Real Clinical Practice

Aim Searching for clinical, angiographic, and biochemical predictors of cardiovascular complications (CVC) and hemorrhagic complications in patients with atrial fibrillation (AF) receiving a multicomponent antithrombotic therapy (MAT) for an elective percutaneous coronary intervention (PCI). Patients with ischemic heart disease (IHD) and AF who require MAT for PCI are at a high risk of thrombotic complications (stroke, systemic embolism, coronary events) and hemorrhage. This warrants searching for new risk factors determining prediction of the outcome.Materials and methods This study included 207 patients (146 males aged 70.1±8.3 years) with IHD and AF who received direct oral anticoagulants (DOAC) as a part of their MAT therapy. Median duration of the follow-up was 12 [8.0; 12.0] months. The efficacy endpoint was a sum of CVCs combining cardiovascular death, ischemic stroke, venous thromboembolic complications, acute coronary syndrome (ACS), and requirement for an unscheduled PCI. “Coronary events”, including ACS and requirement for an unscheduled PCI were analyzed separately. The safety endpoint was BARC type 2-5 bleeding. Upon admission, biomarkers (growth-differentiation factor 15 (GDF-15), D-dimer, thrombin-activated fibrinolysis inhibitor (TAFI), and plasminogen activator inhibitor-1 (PAI-1)) were measured for all patients. Searching for prognostically significant indexes was performed with the Cox proportional hazards regression.Results Incidence of all CVCs was 16.4 %. Independent predictors of CVC included the DOAC treatment at a reduced dose (odds ratio (OR) 2.5 at 95 % confidence interval (CI) 1.02-6.15; p=0.0454), GDF-15 >1191 pg /ml (OR 3.76 at 95 % CI, 1.26-11.18; p=0.0172), PAI-1 >13.2 U/ml (OR 2.67 at 95 % CI, 1.13-6,26; p=0.0245). Incidence of coronary complications was 9.2 %. Independent predictors of coronary complications included a SYNTAX index >26.5 (OR 4.5 at 95 % CI, 1.45-13.60; p=0.0090), PCI for chronic coronary occlusion (OR 3.21 at 95 % CI, 1.10-9.33; p=0.0326), a GDF-15 >1191 pg/ml (ОR 4.70 at 95 % CI, 1.32-16.81; p=0.0172). Incidence of BARC type 2-5 bleeding was 26.1 %. The only independent predictor for hemorrhage complications was the total PRECISE-DAPT score >30 (ОR 3.22; 95 % CI, 1.89-5.51; р<0.0001).Conclusion Three independent predictors of CVC were identified for patients with IHD and AF treated with MAT following an elective PCI: treatment with a reduced dose of DOAC, GDF-15 >1191 pg /ml, and PAI-1>13.2 U/ml. Independent predictors of coronary complications included a SYNTAX index >26.5, PCI for chronic coronary occlusion, and GDF-15 >1191 pg/ml. The factor associated with a risk of bleeding was the total PRECISE-DAPT score >30.

Chronic coronary artery occlusion: when does the benefit outweigh the risk?

Today, the treatment of patients with chronic coronary occlusion is one of the most difficult problems in interventional cardiology. This is due not only to the technical difficulties of endovascular recanalization, but also to the difficulty in selecting patients for whom revascularization will be beneficial. Due to the low evidence base and the conflicting results of large clinical trials, these patients are rarely referred for endovascular recanalization. The purpose of this article is to review the literature and systematize relevant knowledge on the management of patients with chronic coronary occlusion.

TRANSRADIAL ULTRA SUPPORT TECHNIQUE: A NOVEL METHOD ENHANCING GUIDE CATHETER SUPPORT IN THE INTERVENTIONAL TREATMENT OF CHRONIC TOTAL OCCLUSION IN CORONARY ARTERIES

Adequate guide support is crucial for percutaneous coronary interventions complicated by unfavorable coronary artery anatomy, pronounced calcification, or the presence of chronic total occlusion. A clinical case presents a novel technique for guide support during stenting chronic coronary occlusion via transradial approach originally proposed in the TransRadial Ultra Support Technique trial.

Abstract 165: Amp-activated Protein Kinase (ampk) α1 in Macrophages Promotes Collateral Remodeling and Arteriogenesis in Mice

Efficient arteriogenesis is vital for recovery after cardiovascular events (such as chronic coronary occlusion, myocardial infarction). Identifying the biological factors that affect arteriogenesis will help design new treatments for patients with chronic arterial stenosis and occlusions. Circulating monocytes and macrophages recruited within the surrounding tissue of collateral vessels following arterial occlusion have been reported to be essential to arteriogenesis in collateral arteries/arterioles because they promote the proliferation of vascular smooth muscle cells (VSMCs) and endothelial cells through secreted cytokines. Although a growing number of putative arteriogenic factors have been identified, the exact mechanisms that regulate collateral remodeling have remained largely unknown. Here we report that AMPK, an energy and redox sensor, is required for monocyte-mediated collateral remodeling. Collateral arteriogenesis was monitored in WT, global AMPKα1 knockout (KO), or macrophage-specific AMPKα1 KO mice with or without hind limb ligation. Compared to WT mice with ligation, global AMPKα1 KO mice displayed significant reduction in blood flow recovery and impaired remodeling of collateral arterioles. Similar impairments were observed in macrophage-specific AMPK α1 KO mice following hind limb ligation. Mechanistically, we found that AMPKα1 promotes the production of growth factors, such as transforming growth factor beta, by directly phosphorylating the inhibitor of nuclear factor kappa B (NF-κB) kinase alpha, resulting in an NF-κB-dependent production of growth factors. Collectively, our findings suggest a novel role for macrophage AMPKα1 in arteriogenesis and collateral remodeling and indicate that AMPKα1 activation might be a therapeutic target for treating occlusive vascular disorders.