Candidates For Percutaneous Coronary Intervention Research Articles

Association between preoperative right heart catheterization parameters and outcomes in patients undergoing isolated coronary artery bypass grafting.

Right ventricular catheterization may capture information that can help define prognosis before coronary artery bypass grafting (CABG). In this study, we evaluate the association between preoperative right heart catheterization parameters and outcomes of patients undergoing isolated CABG. All patients undergoing isolated CABG at our institution from 2013 to 2021 who also underwent preoperative right heart catheterization <14 days prior to isolated CABG were retrospectively queried. A total of 2343 patients underwent isolated CABG of whom 78 patients [20 (25.6%) female] were included in the final analysis. On multivariable regression, central venous pressure was significantly associated with operative mortality (odds ratio 1.14, 95% confidence interval 1.02-1.27, P = 0.024). Preoperative cardiac index was significantly inversely associated with intensive care unit length of stay (odds ratio 0.72, 95% confidence interval 0.62-0.84, P < 0.001) and duration of inotropic support (odds ratio 0.76, 95% confidence interval 0.63-0.92, P < 0.01). Assessment of preoperative cardiac function by right heart catheterization should be considered in high-risk patient populations, particularly those who have significant left ventricular dysfunction on preoperative echocardiography that would make them candidate for percutaneous coronary intervention, left ventricular assist device or heart transplantation. Further, right heart catheterization can help to guide preoperative optimization and intra-/postoperative decision-making.

Single-Cell RNA Sequencing Reveals an Immune Landscape of CD4+ T Cells in Coronary Culprit Plaques With Acute Coronary Syndrome in Humans-Brief Report.

Acute coronary syndrome (ACS) involves plaque-related thrombosis, causing primary ischemic cardiomyopathy or lethal arrhythmia. We previously demonstrated a unique immune landscape of myeloid cells in the culprit plaques causing ACS by using single-cell RNA sequencing. Here, we aimed to characterize T cells in a single-cell level, assess clonal expansion of T cells, and find a therapeutic target to prevent ACS. We obtained the culprit lesion plaques from 4 patients with chronic coronary syndrome (chronic coronary syndrome plaques) and the culprit lesion plaques from 3 patients with ACS (ACS plaques) who were candidates for percutaneous coronary intervention with directional coronary atherectomy. Live CD45+ immune cells were sorted from each pooled plaque samples and applied to the 10× platform for single-cell RNA sequencing analysis. We also extracted RNA from other 3 ACS plaque samples and conducted unbiased TCR (T-cell receptor) repertoire analysis. CD4+ T cells were divided into 5 distinct clusters: effector, naive, cytotoxic, CCR7+ (C-C chemokine receptor type 7) central memory, and FOXP3 (forkhead box P3)+ regulatory CD4+ T cells. The proportion of central memory CD4+ T cells was higher in the ACS plaques. Correspondingly, dendritic cells also tended to express more HLAs (human leukocyte antigens) and costimulatory molecules in the ACS plaques. The velocity analysis suggested the differentiation flow from central memory CD4+ T cells into effector CD4+ T cells and that from naive CD4+ T cells into central memory CD4+ T cells in the ACS plaques, which were not observed in the chronic coronary syndrome plaques. The bulk repertoire analysis revealed clonal expansion of TCRs in each patient with ACS and suggested that several peptides in the ACS plaques work as antigens and induced clonal expansion of CD4+ T cells. For the first time, we revealed single cell-level characteristics of CD4+ T cells in patients with ACS. CD4+ T cells could be therapeutic targets of ACS. URL: https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000046521; Unique identifier: UMIN000040747.

Evaluation of long-term outcomes of percutaneous coronary intervention in patients with moderate to severe calcified coronary artery lesions.

Coronary artery calcification reduces elasticity and can cause hemodynamic disturbances, increasing the risk of cardiovascular complications. Furthermore, coronary calcifications make cardiovascular interventions difficult. The present study aimed to study the cardiovascular outcomes of the coronary intervention of calcified lesions in the Iranian population. The present cross-sectional study evaluated patients with moderate to severe calcified coronary artery lesions on angiography who were candidates for percutaneous coronary intervention (PCI). Demographic, echocardiographic, and angiographic data of the patients were recorded. In addition, clinical outcomes, including mortality, myocardial infarction, stroke, and stent thrombosis, were also measured 1 year after the procedure. A total of 125 participants (65% male and 35% female) with a median age of 69 (13.0) years old were enrolled. The most common calcification degree was 270° (43.5%), followed by 360° (35.5%) and 180° (21.0%). Most patients had thrombolysis in myocardial infarction (TIMI) score of 3 (47.6%). A more than 10% residual coronary minimum lumen diameter was seen in 25.8% of patients. Puncture site hemorrhage and contrast-induced nephropathy were observed in 2 (1.6%) and 1 (0.8%) patients, respectively. Following 1 year after PCI, no cases of mortality, cerebrovascular accident, myocardial infarction, and stent thrombosis were reported. Furthermore, we observed one case of heart failure (0.8%) and target lesion revascularization (0.8%). In addition, we revealed a significant relationship between calcification degree and TIMI (p < 0.001) and body mass index (p = 0.049). Percutaneous management of calcified lesions with noncompliant balloon and one or two guidewires was associated with a good success rate and few complications.

Mysterious right ventricular function detection in isolated left anterior descending disease by speckle tracking imaging

Background and aim Early detection of impaired right ventricle (RV) would give significant data for management strategy and prognosis in patients with history of cardiac disease. Echocardiography machine is still the first and most widely used cardiac imaging modality in diagnosing heart disease and assessing systolic and diastolic function with high accuracy. The study aimed to assess mysterious RV function in significant isolated left anterior descending (LAD) disease by imaging with speckle tracking, strain, and strain rate. Patients and methods The present study was a comparative prospective study included 100 participants, 50 patients with significant LAD disease who were candidates for Percutaneous coronary intervention (PCI) (group I), and 50 persons as a control group (group II). All participants were exposed to full medical history, clinical examination, ECG, conventional echo, tissue Doppler, speckle tracking imaging. Results Global longitudinal free wall strain was statistically lower in patient than control group (−19.21±4.11 in patient group vs. −23.73±1.53 in control group, P&lt;0.001), and RV peak systolic strain rate was reduced in patient group than control group (−1.47±0.55 vs. −1.87±0.42, P&lt;0.001). Conclusion In isolated significant LAD disease RV function should be assessed even after opening of LAD by PCI. New echo modality like strain and strain rate are useful echo methods to detect mysterious RV function in patients with significant LAD disease.

Intracoronary injection of nitroglycerine can prevent unnecessary percutaneous coronary intervention

BackgroundDespite the recommendation of the current guidelines, intracoronary administration of nitroglycerine during coronary angiography is often neglected. We investigated the effect of intra-coronary nitroglycerin on the relief of coronary artery stenosis in the candidates for percutaneous coronary intervention (PCI).MethodsWe included patients with angina pectoris or myocardial infarction who were candidates for PCI. In the coronary angiography, the culprit vessel involved was evaluated, and bolus nitroglycerin at a dose of 25–200 mcg was injected into the affected coronary artery. A significant change in the percentage of coronary artery stenosis was considered a positive response, and these patients were then compared with patients who did not have a substantial change in the percentage of stenosis at the same time. Univariate analysis and then multivariate logistic regression analysis was performed to determine the predictors of response to intracoronary nitroglycerin.ResultsAmong 360 patients, 27 (7.5%) responded to nitroglycerine, and 333 (92.5%) were non-responsive. The mean age of patients was 60.2 ± 11.6 years, ranging from 23 to 93 years, and 265 (73.6%) were men. The study groups were not significantly different in the baseline demographic characteristics. The presence of multivessel disease (Odds ratio (OR) = 16.26, 95% confidence interval (CI):2.07–127.6; P = 0.008) and stenosis in the left circumflex artery (OR = 3.62, 95% CI: 1.03–12.70; P = 0.044) were the independent predictors for nonresponse to nitroglycerine, leading to PCI.ConclusionIn some cases, especially those without multivessel diseases, intracoronary nitroglycerine administration can efficiently relieve coronary stenosis and prevent unnecessary PCI.

Estimation of the segmental left ventricular physical and mechanical parameters using echocardiographic imaging for stent candidate patients.

Left ventricular (LV) dysfunction can be assessed by quantifying LV structure. In this study, physical parameters were extracted, including the systolic strain, wall stress, and elastic modulus of LV to diagnose stent candidate patients from the control group. Based on angiography results, 88 patients with coronary artery disease (CAD) were divided into 64 patients candidates for PCI (percutaneous coronary intervention) and 24 patients in the control group. With the thick-walled ellipsoidal model, the passive wall stresses at end-systole and end-diastole were estimated. Regional circumferential strain and regional longitudinal strain were obtained by speckle tracking technique. The inferoseptal circumferential wall stress in end-systole was statistically significant for the PCI group compared to the control group (p= .026). Anterior and inferoseptal circumferential strain for the PCI group (-17.25 ± 4.22 and -18.21 ± 4.04%) compared to the control group (-21.71 ± 4.74 and 20.58 ± 3.04%) were statistically significant, respectively (p= .000 and p= .011). Anterior and inferoseptal circumferential elastic modulus were statistically significant (p= .000 and p= .005). The receiver operator characteristic (ROC) curve analysis revealed that anterior and inferoseptal circumferential elastic modulus had the highest area under the curve with 76.6% sensitivity, 83.3% specificity for anterior circumferential, 68.8% sensitivity, and 70.8% specificity for inferoseptal circumferential, for the diagnosis of stent candidate patients. Regional elastic modulus parameter is suggested as a noninvasive and quantitative method for measuring LV function. Strain and stress parameters using the STE method and geometrical model can be helpful for diagnostic stent candidate patients.

Percutaneous Mechanical Circulatory Support Devices Use in Cardiogenic Shock and High-Risk Percutaneous Intervention.

Statistical data has shown that patients now treated in cardiac catheterization laboratories are older with several comorbidities, including renal failure, diabetes, and heart failure [1]. In past patients who were not suitable candidates for percutaneous coronary intervention due to their numerous comorbidities now seems to be a suitable candidate due to tremendous advancements in the field of interventional cardiology like new stent design and availability of advance mechanical circulatory support devices, i.e., Impella performing PCI on these high-risk patients become a viable option. There are two areas of cardiology in which mechanical circulatory support devices keep evolving: one is high-risk (percutaneous coronary intervention) PCI, and the other is a cardiogenic shock that is refractory to initial pressor support. &#x0D; In this article, we review evidence base data regarding the use of mechanical circulatory support devices in high-risk percutaneous intervention and cardiogenic shock.

Machine learning-based long-term outcome prediction in patients undergoing percutaneous coronary intervention

Traditional prognostic risk assessment in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) is based on a limited selection of clinical and imaging findings. Machine learning (ML) can consider a higher number and complexity of variables and may be useful for characterising cardiovascular risk, predicting outcomes, and identifying biomarkers in large population studies. We prospectively enrolled 9,680 consecutive patients with coronary artery disease who underwent PCI at our institution between January 2013 and December 2013. Clinical features were selected and used to train 6 different ML models (support vector machine, decision tree, random forest, gradient boosting decision tree, neural network, and logistic regression) to predict cardiovascular outcomes, 10-fold cross-validation to evaluate the performance of models. During the 5-year follow-up, 467 (4.82%) patients died. Eighty-seven risk baseline measurements were used to train ML models. Compared with the other models, the random forest model (RF-PCI) exhibited the best performance on predicting all-cause mortality (area under the receiver operating characteristic curve: 0.71±0.04). Calibration plots demonstrated a slight overprediction for patients using the RF-PCI model (Hosmer-Lemeshow test: P>0.05). The top 15 features related to PCI candidates' long-term prognosis, among which 11 were laboratory measures. ML models improved the prediction of long-term all-cause mortality in patients with coronary artery disease before PCI. The performance of the RF model was better than that of the other models, providing a meaningful stratification.

Assessing the Risks of Bleeding vs Thrombotic Events in Patients at High Bleeding Risk After Coronary Stent Implantation

Patients who are candidates for percutaneous coronary intervention (PCI) and are at high bleeding risk constitute a therapeutic challenge because they often also face an increased risk of thrombotic complications. To develop and validate models to predict the risks of major bleeding (Bleeding Academic Research Consortium [BARC] types 3 to 5 bleeding) and myocardial infarction (MI) and/or stent thrombosis (ST) for individual patients at high bleeding risk and provide assistance in defining procedural strategy and antithrombotic regimens. This prognostic study used individual patient data from 6 studies conducted from July 1, 2009, to September 5, 2017, for 6641 patients at more than 200 centers in Europe, the US, and Asia who underwent PCI and were identified as being at high bleeding risk using the Academic Research Consortium criteria. In 1 year of follow-up (excluding periprocedural events), individual patient risks of MI and/or ST and major bleeding were evaluated using 33 baseline variables. To validate these models, a subgroup of 1458 patients at high bleeding risk from the ONYX ONE trial were analyzed. Statistical analysis was performed from February 1, 2019, to April 30, 2020. All patients underwent PCI with bare metal, drug-coated, or drug-eluting stent implants. Forward, stepwise multivariable proportional hazards models were used to identify highly significant predictors of MI and/or ST and BARC types 3 to 5 bleeding. A total of 6641 patients (4384 men [66.0%]; median age, 77.9 years [interquartile range, 70.0-82.6 years]) were included in this study. Over 365 days, nonperiprocedural MI and/or ST occurred in 350 patients (5.3%), and BARC types 3 to 5 bleeding occurred in 381 patients (5.7%). Eight independent baseline predictors of risk of MI and/or ST and 8 predictors for risk of BARC types 3 to 5 bleeding were identified. Four of these predictors were in both risk models. Both risk models showed moderate discrimination: C statistic = 0.69 for predicting MI and/or ST and 0.68 for predicting BARC types 3 to 5 bleeding. Applying these same models to the validation cohort gave a similar strength of discrimination (C statistic = 0.74 for both MI and/or ST and BARC types 3-5 bleeding). Patients with MI and/or ST had a mortality hazard ratio of 6.1 (95% CI, 4.8-7.7), and those with BARC types 3 to 5 bleeding had a mortality hazard ratio of 3.7 (95% CI, 2.9-4.8) compared with patients free of both events. Taking these data into account, the risk scores facilitate investigation of the individual patient trade-off between these 2 risks: 2931 patients (44.1%) at high bleeding risk in the 6 studies had a greater risk of MI and/or ST than of BARC 3 to 5 bleeding, 1555 patients (23.4%) had a greater risk of BARC 3 to 5 bleeding than of MI and/or ST, and 2155 (32.4%) had a comparable risk of both events. In a large cohort of patients at high bleeding risk undergoing PCI, 2 prognostic models have been developed to identify individual patients' risk of major coronary thrombotic and bleeding events. In future clinical practice, using an application on a smartphone to evaluate the trade-off between these 2 quantifiable risks for each patient may help clinicians choose the most appropriate revascularization strategy and tailor the duration and intensity of antithrombotic regimens.

One-Month Outcomes of Cases Receiving Ticagrelor after Percutaneous Coronary Intervention; a Case Series.

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist that can block ADP-induced platelet aggregation. This study aimed to describe one-month follow-up findings of cases undergoing ticagrelor therapy after percutaneous coronary intervention (PCI). This case series was performed on acute coronary syndrome (ACS) patients who were candidates for PCI and received aspirin plus ticagrelor after PCI. Patients were followed for one month and their outcomes were described. 156 cases with the mean age of 59.74 ± 9.24 years were studied (63% male). 45 (28.8%) cases complained of dyspnea (39 cases with mild and 6 cases with severe dyspnea). Bleeding occurred in 4 (2.5%) cases (intra-cranial hemorrhage (ICH) in one, hematuria in two, and skin hemorrhage in one case). There were no cases with bradycardia or thrombosis. One (0.6%) patient developed drug hypersensitivity reaction, which manifested as skin rash. The use of drug was stopped in 10 (6.4%) cases due to severe dyspnea (n= 6), ICH (n=1), skin rash (n=1), and concomitant left ventricular (LV) clot (n=2). The most important finding of one-month ticagrelor consumption were dyspnea, bleeding, and hypersensitivity reaction. No case of bradycardia and stent thrombosis was detected. In our study , iranian population has more susceptibility to dyspnea than PLATO result. The rate of drug discontinuation in this series of cases was 6.4 %.

Improving Outcomes With IVUS Guidance During Percutaneous Coronary Interventions

This review highlights the evidence surrounding the adjunctive diagnostic and therapeutic benefits of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI). Meta-analyses of randomized trials demonstrate that IVUS has a major impact on PCI-related outcomes with drug-eluting stents by reducing cardiovascular mortality and repeat revascularization. Its application in calcific coronary artery disease has helped identify the benefits and safety of coronary atherectomy, along with playing an important role for primarily guiding PCI while significantly reducing contrast volume in individuals with renal dysfunction. IVUS applications have been extended to the realms of CTO intervention, aneurysmal coronary disease, and iatrogenic/spontaneous coronary artery dissection. IVUS is also a proven cost-effective strategy. Nevertheless, despite these benefits, the global uptake of IVUS-guided PCI remains low. IVUS plays a pivotal role during PCI, particularly complex calcific and long lesions. IVUS-guided PCI is safe, cost-effective, and associates with substantial reductions in MACE. However, the worldwide uptake of IVUS-guided PCI remains considerably low. Further efforts are required to promote this evidence-based PCI strategy among the global interventional cardiology community to further improve the outcomes of our PCI candidates.

UTILIZATION OF HEMODYNAMIC SUPPORT DEVICES IN HIGH-RISK PCI: EXPERIENCE FROM A HIGH VOLUME CENTER

High-risk candidates for percutaneous coronary intervention (PCI) include patients with severe multi-vessel coronary artery disease (CAD), unprotected left main (LM) coronary artery stenosis, or last remaining patent conduit with a stenosis, especially in patients with a left ventricular ejection

Short-term outcome after percutaneous coronary intervention in patients with impaired left ventricular systolic function by conventional, tissue Doppler, and speckle-tracking echocardiographic study

Background Myocardial revascularization with chronic left ventricular (LV) dysfunction improved LV functional and survival. Echocardiographic (echo) remains the test for assessing cardiac function in clinical practice. Tissue Doppler imaging (TDI) and speckle-tracking echocardiography (STE) are new techniques in assessing LV functions. Aim To assess the short-term outcome of LV functions after percutaneous coronary intervention (PCI) in impaired LV systolic function using conventional, tissue Doppler, and STE. Patients and methods This study included 100 patients presented with ischemic cardiac chest pain, ejection fraction (EF) less than 55%, significant coronary occlusion (>70%) in a recent angiography, and were candidates for PCI. Echo study was done before and 3 months after PCI including conventional echo and TDI of both LV functions. Moreover, two-dimensional-STE: automated function imaging is used to reflect the systolic LV function by assessment of the LV global longitudinal strain (GLS). Results Three months after PCI, there was a significant increase in LV systolic function: EF (by M-mode and modified Simpson’s methods), FS (by M-mode), and mean Sm (by TDI), GLS (by STE). Moreover, LV diastolic function significantly increased: E wave velocity and E/A ratio, with no change in A wave velocity (by PW Doppler) and E’ velocity and E/E’ ratio (by TDI). EF measured by both M-mode and with modified Simpson’s methods was significantly correlated with average Sm (by TDI) and GLS (by STE) both before and after PCI. Moreover, Sm and GLS were positively correlated both before and after PCI. There was no statistically significant correlation between E/A ratio and average E’ both before and after PCI. E/A ratio was not correlated with E/E’ ratio before PCI but significantly correlated after PCI. Average E’ and E/E’ ratio were significantly correlated before PCI but not after PCI. Conclusion Significant improvement in the global LV systolic and diastolic functions occurs after PCI in patients with baseline impaired LV systolic function owing to coronary artery disease as assessed using conventional echo, TDI, and STE.

Assessment of Strain and Strain Rate in Patients with Coronary Artery Disease Before and After Percutaneous Intervention on Left Anterior Descending Coronary Artery

Introduction: Strain (S) and Strain Rate (SR) as echocardiography parameters are important in assessing changes in myocardial tissue and global and regional evaluation of systolic and diastolic functions and in detection of myocardial disorders as they change in early stages of myocardial ischemia. Therefore, the aim of this study was to compare changes of S and SR indices in systolic phase in patients with a significant stenosis of left anterior descending (LAD) before and after percutaneous coronary intervention (PCI).Methods: 48 patients candidate for PCI with significant lesion in LAD were enrolled in this study. Echocardiographic images taken one day before and a week after PCI. Echocardiographic scope of the LAD was defined as mid, basal, anteroseptal and mid-septal and apical segments then, S and SR parameters in all segments measured separately during systolic phase before and after PCI and compared together.Results: there was a significant increase after PCI only in two segments and SR values showed significant increase after PCI in four segments. In the analysis of sum of mean parameters, a significant increase was observed in SR values (10.12 to 11.30; P = 0.001), but not in S values (149.54 to 143.36; P = 0.1)Conclusions: The remedial effect of PCI on deformation values was observed in the first week. In early reperfusion period, S/SR indices have potential to be used as determinants of favorable response to revascularization therapy.

Drug-eluting compared to bare metal stents in patients with end-stage renal disease on dialysis: a meta-analysis.

To systematically review literature comparing bare metal stent (BMS) to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on dialysis. ESRD patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stent-related complications including major adverse cardiovascular events. Because dialysis usually qualifies ineligibility for randomized clinical trials, an evidenced-based stent choice for these patients is scarce. PUBMED, CINHAL, COCHRANE, EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES outcome in ESRD patients on dialysis. Twenty studies including 64 232 patients were considered. The use of DES was significantly associated with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.76-0.89], death from a cardiovascular cause (OR 0.80, 95% CI 0.76-0.84) and target lesion revascularization/target vessel revascularization (OR 0.73, 95% CI 0.53-1.00). No significant difference was found in stent thrombosis (OR 1.08, 95% CI 0.50-2.33) and myocardial infarction incidence (OR 0.91, 95% CI 0.69-1.20). Our meta-analysis shows a significant reduction in all-cause and cardiovascular mortality with the use of DES over BMS in dialyzed patients. Despite the lack of randomized studies, systematic use of DES in these high-risk patients should thus reasonably be considered as a first option in percutaneous coronary intervention candidates.

Association between CYP2C19*2/*3 Polymorphisms and Coronary Heart Disease.

This study sought to explore the relationship between cytochrome P450 2C19 (CYP2C19) *2/*3 polymorphisms and the development of coronary heart disease (CHD), and to evaluate the influence of the single nucleotide polymorphisms (SNPs) on the occurrence of adverse clinical events in CHD patients. A total of 231 consecutive patients candidate for percutaneous coronary intervention genotyped for CYP2C19*2 (681G>A) and *3 (636G>A) polymorphisms were enrolled. The adverse clinical events were recorded during a follow-up period of 14 months. The incidence of CHD, according to coronary angiography, was significantly higher (P=0.025) in CYP2C19*2 carriers group. Stepwise binary logistic regression analysis revealed that among factors that potentially influenced the presence of CHD (age>60 years, gender, BMI, etc.), CYP2C19*2 carriers (OR 1.94, 95% CI: 1.08-3.50, P=0.028) and male gender (OR 2.74, 95% CI: 1.58-4.76, P=0.001) were independent predictors, which were associated with the presence of CHD. The follow-up results showed that the incidence of adverse cardiovascular events within 14 months of discharge was significantly higher in the CYP2C19*2 carriers than in the non-carriers (21.6% vs. 6.3%, P=0.019). The results of the multivariate Cox proportional hazards model showed that CYP2C19*2 loss-of-function was the only independent factor which predicted the coronary events during the follow-up period of 14 months (OR=3.65, 95% CI 1.09-12.25, P=0.036). The adverse impact of CYP2C19*2 polymorphisms was found not only in the risk of the presence of CHD, but also in the adverse cardiovascular events in CHD patients during the follow-up period of 14 months. However the same influence was not found in CYP2C19*3 mutation in Chinese Han population.

A Randomized Trial to Assess Regional Left Ventricular Function After Stent Implantation in Chronic Total Occlusion: The REVASC Trial

ObjectivesThe aim of this study was to investigate whether percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) improves left ventricular function. BackgroundThe benefit of PCI in CTOs is still controversial. MethodsPatients with CTOs who were candidates for PCI were eligible for the study and were randomized to PCI or no PCI of CTO. Relevant coexisting non-CTO lesions were treated as indicated. Patients underwent cardiac magnetic resonance imaging at baseline and at 6 months. The primary endpoint was the change in segmental wall thickening (SWT) in the CTO territory. Secondary endpoints were improvement of regional wall motion and changes in left ventricular volumes and ejection fraction. Furthermore, major adverse coronary events after 12 months were assessed. ResultsThe CTO PCI group comprised 101 patients and the no CTO PCI group 104 patients. The change in SWT did not differ between the CTO PCI (4.1% [interquartile range: 14.6 to 19.3]) and no CTO PCI (6.0% [interquartile range: 8.6 to 6.0]) groups (p = 0.57). Similar results were obtained for other indexes of regional and global left ventricular function. Subgroup analysis revealed that only in patients without major non-CTO lesions (basal SYNTAX [Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery] score ≤13) CTO PCI was associated with larger improvement in SWT than no CTO PCI (p for interaction = 0.002). Driven by repeat intervention, major adverse coronary event rates at 12 months were significantly lower in the CTO PCI group (16.3% vs. 5.9%; p = 0.02). ConclusionsNo benefit was seen for CTO PCI in terms of the primary endpoint, SWT, or other indexes of left ventricular function. CTO PCI resulted in clinical benefit over no CTO PCI, as evidenced by reduced major adverse coronary event rates at 12 months.

The EUROpean and Chinese cardiac and renal Remote Ischemic Preconditioning Study (EURO-CRIPS CardioGroup I): A randomized controlled trial

BackgroundThe potential protective effects of remote ischemic preconditioning (RIPC) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) remain to be defined. Methods and resultsA double blind, randomized, placebo controlled multicenter study was performed. Patients younger than 85years old, with a renal clearance of 30–60ml/min/1.73m2, who were candidates for PCI for all clinical indications except for primary PCI, were allocated 1:1 to RIPC or to standard therapy. The primary endpoint was incidence of CIN. The secondary endpoint was incidence of peri-procedural myocardial infarction (PMI). From February 2013 to April 2014, 3108 patients who were scheduled for coronary angiography were screened for the study. 442 fulfilled the inclusion criteria and 223 received PCI. These patients were randomized to sham RIPC (n=107) or treatment group (n=116). The only pre-specified subgroup of diabetic patients included 85 (38%) cases. RIPC significantly reduced CIN incidence in the overall population (12.1% vs. 26.1%, p=0.01, with a NNT=9) and in non-diabetic patients (9.2% vs. 25.0%, p=0.02), but showed no benefit in diabetics (16.7% vs. 28.2%, p=0.21). A trend for lower PMI was seen in the intervention arm (creatine kinase - muscle brain >5 URL; 8.4% vs. 16.4%, p=0.07; troponin T >5 URL; 27% vs. 38%, p=0.21). ConclusionsRemote ischemic preconditioning significantly reduces the incidence of acute kidney injury in non-diabetic patients undergoing PCI. Larger sample size is presumably needed to assess the effect of RIPC for patients with diabetes mellitus.Clinical Trial number:NCT02195726https://www.clinicaltrial.gov/.

Should fraction flow reserve be considered an important decision-making tool to stratify patients with stable coronary artery disease for percutaneous coronary intervention?: A meta-analysis.

Background:Nowadays, fraction flow reserve (FFR) is being discussed in every percutaneous coronary intervention (PCI) capable hospitals. Owing to recent development in the medical field, FFR-guided PCI should be able to find a place in Interventional Cardiology. At present, the importance of FFR to stratify patients who require PCI has seldom systematically been investigated. In this analysis, we aimed to compare the major adverse cardiac events (MACEs) mainly in patients with stable coronary artery disease (CAD) to whom PCI was recommended and deferred respectively based on the FFR value.Methods:Electronic databases were searched for studies comparing FFR-recommended versus FFR-deferred coronary stenting. Long-term MACEs, mortality, and myocardial infarction (MI) were considered as the clinical endpoints in this analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and the analyses were carried out by the latest version of the RevMan software.Results:A total number of 1753 patients (670 patients were revascularized, whereas 1083 patients were deferred from revascularization based on the FFR value) were analyzed. Current results showed MACEs and MI were significantly higher in the FFR-recommended PCI group with OR 1.34 (95% CI: 1.05–1.72; P = .02) and OR 1.73 (95% CI: 1.19–2.51; P = .004, I2 = 0%), respectively. However, mortality was similarly manifested with OR 1.23 (95% CI: 0.92–1.63; P = .16, I2 = 0%).Conclusion:Significantly higher MACEs were observed in patients to whom PCI was recommended compared to those patients who were deferred from undergoing PCI based on the FFR values. Therefore, FFR might indeed be an important decision-making procedural tool, which should be used to stratify stable CAD patients with an advanced disease and who are qualified candidates for PCI. Further research should confirm this hypothesis.

Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency.

To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5-60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3- and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.