Prevention of No-flow With Distal Protection Device in Patients Underwent Percutaneous Coronary Intervention

Objectives To evaluate the feasibility and safety of distal protection device (PercuSurge) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. Methods From October 2004 to August 2007, 40 patients with high risk acute coronary syndrome who received primary coronary intervention were included in this study. Patients were divided into two groups according to whether PercuSurge was attempted during PCI. The basic clinical characteristics, angiographic results, and follow-up data before discharge were compared. Coronary arteries blood flow thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion (TMP) grade and the rate of no-reflow were performed in all cases after PCI. Results There was no significant difference between the two groups in basic clinical characteristics and angiography before PCI (P>0.05). All patients underwent PCI successfully in both groups. In the PercuSurge group, PCI with PercuSurge guardwire protection was performed successfully in 18 patients. There was significant difference between the two groups in TIMI 3 flows gained in target vessels after PCI. Better percentage of TMP grade 3 of target vessels was achieved in PercuSurge group. Less no-reflow were found in PercuSurge group. There were lower peak troponin I and serum MB isoenzyme of creatine kinase levels, higher left ventricular ejection fraction and smaller left ventricular end-diastolic dimension in the PercuSurge group after PCI at the date before discharge (P<0.05). There was no major adverse cardiac events in PercuSurge group, only one patient died in the control group. Conclusions This study demonstrates that using the PercuSurge Guardwire system during PCI in high risk acute coronary syndrome patients to prevent no-reflow is feasibility and safety.     

Procedural Success Rates and Mortality in Elderly Patients With Percutaneous Coronary Intervention for Cardiogenic Shock

ObjectivesThe aim of this study was to determine the impact of age on procedural and clinical outcomes in patients with cardiogenic shock (CS).BackgroundThe use of early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with acute myocardial infarction (AMI) complicated by CS.MethodsData from consecutive patients with AMI and CS treated with PCI enrolled into the prospective ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte) PCI registry were centrally collected and analyzed. Patients were divided into 4 groups according to their age (<65, 65 to 74, 75 to 84, and >85 years). Patients’ characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared among the 4 groups.ResultsBetween 2010 and 2015, a total of 2,323 consecutive patients with AMI and CS were treated by PCI in 51 hospitals. TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 patency after PCI decreased with increasing age from 84% to 78%, while in-hospital mortality increased from 32% to 56%. Bleeding rates were low (2.0% to 2.3%) and not different among age groups. In the multivariate analysis, higher age, TIMI flow grade <3 after PCI, 3-vessel disease, and left main PCI were independent predictors of mortality.ConclusionsPCI in patients with AMI and CS is associated with a high procedural success rate and a low bleeding rate, even in very elderly patients, while mortality increases with increasing age. Because mortality in elderly patients with CS without revascularization therapy is very high, it seems justified to perform PCI in selected patients to reduce mortality.     

Appropriateness and Outcomes of Percutaneous Coronary Intervention at Top-Ranked and Nonranked Hospitals in the United States

Objectives

This study sought to compare the appropriate use and outcomes of percutaneous coronary intervention (PCI) between top-ranked and nonranked hospitals.

Impact of Chronic Thrombocytopenia on In-Hospital Outcomes After Percutaneous Coronary Intervention

Objectives

This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI).

Coronary Angiography and Percutaneous Coronary Intervention After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations.     

Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Undergoing Percutaneous Coronary Intervention

BackgroundData on the impact of residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl are scarce.ObjectivesThe purpose of this study was to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl.MethodsAll patients undergoing PCI between January 2009 and December 2016 in a single tertiary center, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least 2 measurements ≥4 weeks apart) were retrospectively analyzed. High RIR was defined as hsCRP >2 mg/l. Patients were categorized as persistent low RIR (first low then low hsCRP), attenuated RIR (first high then low hsCRP), increased RIR (first low then high hsCRP), or persistent high RIR (first high then high hsCRP). Primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement.ResultsA total of 3,013 patients were included, with persistent low, attenuated, increased, and persistent high RIR in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively. Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years; p < 0.001). After adjustment, the presence of persistent high RIR remained strongly associated with MACCE (adjusted hazard ratio: 2.10; 95% confidence interval: 1.45 to 3.02; p < 0.001).ConclusionsAmong patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.     

Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With Percutaneous Coronary Intervention

Objectives

In 13,038 patients with non–ST-segment elevation acute coronary syndrome undergoing index percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndrome) and TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trials, the relationship between PCI-related myocardial infarction (MI) and 1-year mortality was assessed.

Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

Objectives

This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype–guided antiplatelet therapy after percutaneous coronary intervention (PCI).

Evaluation of Coronary Artery–Saphenous Vein Composite Grafts: The Aortic No-Touch Technique

We retrospectively compared the results of conventional coronary artery bypass grafting (CABG) performed on patients who showed no preoperative evidence of serious atherosclerosis of the ascending aorta with the results of the aortic no-touch technique (using coronary artery–saphenous vein composite grafts) on CABG patients who did show such evidence.From 2003 through 2012, 3,152 consecutive patients underwent isolated primary CABG at our hospital. We chose 360 for the current study. The study group (n=120) comprised patients who had undergone operation via the aortic no-touch technique. Propensity-score-matching (1:2) was used to select the control group of 240 patients who had undergone conventional CABG. Early and late survival rates, reintervention-free survival rates, and freedom from cardiac death were compared.Early and late mortality rates were similar in the study and control groups (P=0.19 vs P=0.29, respectively), as were cardiac-related death (2.5% vs 2.1%, respectively; P=0.53) and overall death (8.3% vs 7.9%, respectively; P=0.51). Overall survival rates were 91.7% vs 92.1% and freedom-from-cardiac-death rates were 97.4% vs 97.5% (P=0.71 vs P=0.78, respectively; mean follow-up period, 5.27 ± 2.51 yr). Reintervention-free survival rates were also similar (96.7% vs 98.8%, respectively; P=0.2).As a result of the similar rates of early and late survival, reintervention-free survival, and freedom from cardiac death, we conclude that the aortic no-touch technique with composite grafts might be a reasonable option in patients who have atherosclerotic ascending aorta that cannot be clamped.Key words: Aortic diseases/complications, aortic no-touch technique, calcinosis/complications, coronary artery bypass, graft occlusion, vascular, myocardial revascularization/methods, porcelain aorta, retrospective studies, saphenous vein/transplantation, saphenous vein composite grafts, treatment outcomePorcelain aorta or disseminated atherosclerotic involvement of the entire ascending aorta presents major surgical limitations during coronary artery bypass grafting (CABG). Chief among these is the need to avoid aortic cross-clamping, in order to circumvent neurologic and other sequelae.¹ One alternative to cross-clamping is to bypass the aorta with a composite of one or more saphenous vein (SV) and radial artery grafts anastomosed to the left internal mammary artery (LIMA), which previously has been anastomosed to the left anterior descending coronary artery. These grafts are also known as Y or T composite grafts.Although the safety and efficacy of arterial composite grafts for total arterial revascularization have been proved,^2,3 the safety and efficacy of venous composite grafts are still widely debated. Hwang and colleagues⁴ have reported that the SV composite graft can be used as an alternative to the arterial composite graft. However, Gaudino and associates⁵ have maintained that the patency of SV composite grafts is suboptimal.The objectives of our study were to compare SV-composite-graft results with conventional coronary-artery-graft results in particular regard to reintervention-free survival, freedom from cardiac death, and early and late mortality rates.