Progress in the retrograde approach for chronic total coronary artery occlusion

After the introduction of the retrograde approach in percutaneous coronary intervention for chronic total occlusion (CTO), different kinds of strategies and techniques have been developed in order to achieve final success. However, it has not been fully demonstrated whether these strategies and techniques can really improve the final result. We observed one case, for which the initial attempt of the retrograde approach for a CTO lesion was unsuccessful despite the successful approach of a retrograde guidewire to the lesion, and with the second retrograde approach 3 years later being eventually successful by using various kinds of strategies and techniques. This case clearly demonstrates how the final success through the retrograde approach can be achieved by using a combination of the improved strategies and techniques for CTO lesions. © 2008 Wiley‐Liss, Inc.     

Improvement in door-to-balloon times in management of acute ST-segment elevation myocardial infarction STEMI through the initiation of 'Code AMI'

Background: ST‐segment elevation myocardial infarction (STEMI) mandates rapid percutaneous coronary intervention (PCI) for optimal outcomes. The aim of this study was to assess our hospital practice for managing acute STEMI, identify processes associated with time delays, instrument changes to our acute STEMI management protocol and assess their effectiveness for improving our door‐to‐balloon time. Methods: We aimed to achieve this through the establishment of a quality improvement programme involving the cardiology and emergency departments. We analysed consecutive patients presenting with STEMI (April to September 2005 (group A) and the corresponding period in 2006 (group B), and compared patients presenting ‘in hours’ (0700 hours to 1800 hours (Monday to Friday)) versus ‘out of hours’ (all other times including public holidays). Results: In group A, 38 patients presented with a STEMI. Assessing time‐to‐treatment analysis, the median door to balloon time for primary PCI was significantly greater for ‘out of hours’ than ‘in hours’ (120 vs 67 min). The greatest time delay to PCI was from the PCI decision time to catheter laboratory arrival. Local changes were implemented to improve ‘out of hours’ times, including initiation of ‘Code AMI’. There were 59 patients in group B. We found that our changes led to a 29% improvement in ‘out of hours’ door‐to‐balloon time (median time 82 min, P = 0.005) with 69% being managed ≤90 min (P = 0.049) (group B). Conclusion: We have shown that ongoing review through a quality improvement programme improves door‐to‐balloon times, which is integral in the optimal management of patients with acute STEMI treated with primary PCI.     

Cardiac catheterization through ipsilateral radial and ulnar artery access during the same procedure

We evaluated the safety and feasibility of ipsilateral radial and ulnar artery cannulation during the same catheterization procedure. Crossover from radial to femoral was done in 122 patients. Both ipsilateral radial and ulnar catheterization were performed in 16 patients without any complications, which was further supported by Doppler ultrasonography.     

Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary Intervention

Objectives

The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.

优质护理在急性冠状动脉综合征急诊PCI救治中的影响分析

目的：探讨急性冠状动脉综合征（acute coronary syndrome,ACS）患者行急诊PCI救治时行优质护理的临床价值。方法选取急性冠状动脉综合征患者100例,随机均分为2组（n=50）。对照组行常规护理,观察组在常规护理基础上给予优质护理,比较治疗效果。结果2组患者的治疗效果差异较大,差异有统计学意义（P＜0.05）。结论急性冠状动脉综合征患者行急诊PCI救治时行优质护理具有较高的临床应用价值,可以在临床中进行大力推广并普及使用。     

Percutaneous Coronary Intervention for Chronic Total Occlusion—The Michigan Experience: Insights From the BMC2 Registry

ObjectivesThe aim of this study was to describe the performance and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Michigan.BackgroundCTO PCI has been associated with reduction in angina, but previous registry analyses showed a higher rate of major adverse cardiac events with this procedure.MethodsTo study uptake and outcomes of CTO PCI in Michigan, patients enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry (2010 to 2017) were evaluated. CTO PCI was defined as intervention in a 100% occluded coronary artery ≥3 months old.ResultsAmong 210,172 patients enrolled in the registry, 7,389 CTO PCIs (3.5%) were attempted, with 4,614 (58.3%) achieving post-procedural TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. The proportion of PCIs performed on CTOs increased over the study period (from 2.67% in 2010 to 4.48% in 2017). Thirty of 47 hospitals performed >50 CTO interventions in 2017. Pre-procedural angina class ≤2 was present in one-quarter, and functional assessment for ischemia was performed in 46.6% of patients. Major complications occurred in 245 patients (3.3%) and included death (1.4%), post-procedural stroke (0.4%), cardiac tamponade (0.5%), and urgent coronary artery bypass graft surgery (1.3%). Procedural success improved modestly from 44.5% in 2010 to 54.9% in 2017 (p for trend < 0.001). Rates of in-hospital mortality (p for trend = 0.247) and major adverse cardiac event (p for trend = 0.859) for CTO PCI remained unchanged over the study period.ConclusionsThe rate of CTO PCI in Michigan increased over the study period. Although the success rate of CTO PCI has increased modestly in contemporary practice, it remained far below the >80% reported by select high-volume CTO operators. The rate of periprocedural major adverse cardiac events or death remained unchanged over time. These data suggest room for improvement in the selection and functional assessment of CTO lesions before subjecting patients to the increased procedural risk associated with CTO PCI.     

Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers

ObjectivesThe aim of this study was to explore characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs).BackgroundLittle is known about patients who underwent ASC PCI before Medicare reimbursement was instituted in 2020.MethodsUsing commercial insurance claims from MarketScan, adults who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease from 2007 to 2016 were studied. Propensity score analysis was used to measure the association between treatment setting and the primary composite outcome of 30-day myocardial infarction, bleeding complications, and hospital admission.ResultsThe unmatched sample consisted of 95,492 HOPD and 849 ASC PCIs. Patients who underwent ASC PCI were more likely to be younger than 65 years, to live in the southern United States, and to have managed or consumer-driven health insurance. ASC PCI was also associated with decreased fractional flow reserve utilization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.20 to 0.48; p < 0.001). In unmatched, multivariate analysis, ASC PCI was associated with increased odds of the primary outcome (OR: 1.25; 95% CI: 1.01 to 1.56; p = 0.039) and bleeding complications (OR: 1.80; 95% CI: 1.11 to 2.90; p = 0.016). In propensity-matched analysis, ASC PCI was not associated with the primary outcome (OR: 1.23; 95% CI: 0.94 to 1.60; p = 0.124) but was significantly associated with increased bleeding complications (OR: 2.49; 95% CI: 1.25 to 4.95; p = 0.009).ConclusionsCommercially insured patients undergoing ASC PCI were less likely to undergo fractional flow reserve testing and had higher odds of bleeding complications than HOPD-treated patients. Further study is warranted as Medicare ASC PCI volume increases.     

Occurrence, productivity and spatial distribution of key-premises in two dengue-endemic areas of Rio de Janeiro and their role in adult Aedes aegypti spatial infestation pattern

Objectives To evaluate: (1) the occurrence, maintenance, productivity, spatial distribution and premise condition index score of Adese aegypti‐infested houses and key‐premises in a suburban district (Tubiacanga) and a slum (Favela do Amorim) of Rio de Janeiro and (2) the role of these factors in adult Ae. aegypti female spatial distribution. Methods and Results A total of 2456 premises were inspected for immature and 1100 for adult collection. Key‐premises corresponded to 16.08% and 17.86% of infested houses in Tubiacanga, and 13.5% and 11.1% in Favela do Amorim, during the dry and wet seasons, respectively. Key‐premises held significantly more immature Ae. aegypti, pupae and larvae than infested houses in Favela do Amorim and Tubiacanga during the dry and wet seasons. In Favela do Amorim, key‐premises had a significantly higher PCI score than infested but non‐key houses. Conclusion The spatial distribution of key‐premises and adult Ae. aegypti females was often congruent, indicating that key‐premises influence the infestation pattern observed in the study areas.