Cardiac Revascularization Research Articles

Comparison of outcomes between a single long stent and overlapping stents in long coronary artery lesion: a meta-analysis of the current literature

Abstract Background There is no consensus for the treatment of diffuse coronary artery lesions with a single long stent (SLS) or with overlapping of two or more stents (OLS). In this review, we aimed to compare the outcomes between these two approaches by performing a meta-analysis based on the literature. Methods We searched MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library for eligible studies. In total, 12 studies (n=6414) that included the outcomes in the follow-up period were included in this meta-analysis. Results Patients with OLS had higher risk of cardiac death and target lesion revascularization (TLR) than those with SLS (RR: 1.51, confidence interval: 1.03–2.21, p=0.03, I2=0% and RR: 1.64, confidence interval: 1.02–2.65, p=0.04, I2=38%, respectively). Fluoroscopy time was prolonged in OLS group compared to SLS group (SMD: 0.35, confidence interval: 0.25–0.46, p<0.01, I2=0%). Contrast volume usage was higher in the OLS group, but there was significant heterogeneity in pooled analysis (I2=95%). In subgroup analysis, there were no differences with respect to outcomes between the studies reported before and after the year 2015. Conclusion This was the first meta-analysis to indicate that cardiac death and TLR were higher and fluoroscopy time was longer in the OLS group than in the SLS group. Funding Acknowledgement Type of funding sources: None.

Everolimus-eluting bioresorabable scaffold system in the treatment of cardiac allograft vasculopathy: the cardiac allograft reparative therapy (CART) prospective multicentre pilot study

Abstract Background Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of PCI failure. The bioresorbable scaffolds (BRS) could represent a potential novel therapeutic tool for the treatment of coronary obstructions in CAV. Purpose To investigates the effects of BRS implantation in CAV patients in a Nationwide prospective study. Methods Multicentre, single-arm, prospective, open-label study that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS. The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the composite of cardiac death, myocardial infarction, and target lesion revascularisation at 12-and 36-month follow-up and the incidence of ISSR at 36 months. A paired analysis of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) at baseline and follow-up was also performed. Results Between 2015–2017 35 HTx patients were enrolled and treated on 44 coronary lesions with 51 BRS. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37).Angiographic lumen loss was 0.40±0.62mm at 12 months and 0.53±0.57mm at 36 months. Overall survival was 91.4% and 74.3%, and MACEs 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis a significant increase of the vessel external elastic membrane area in the treated segment of the BRS was described at the OCT, while some progression of CAV was detected proximally at the IVUS assessment. Conclusions BRS in CAV was feasible and safe, with an ISSR incidence similar to drug-eluting stents. For the first time, a positive remodeling was observed in HTx patients after PCI. Vessel enlargement and the lack of metallic stents may allow repeated PCI avoiding the vessel shrinkage caused by the addition of multiple metal layers, being CAV a complex clinical scenario with a high incidence of MACEs, mainly driven by PCI failure. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Partial funding by Abbott Vascular Italy

Morphological and clinical implications of the optical coherence tomography-derived lipid core burden index

Abstract Background Intracoronary optical coherence tomography (OCT) is a valuable tool for vulnerable plaque assessment and morphology-guided risk stratification. However the groundbreaking impact of OCT in clinical practice may be offset by its inherent limitation, the subjectivity in plaque interpretation. Recent studies reported a semi-automated method to assess fibrous cap thickness but data regarding an automated assessment of lipid component at OCT, such a lipid core burden index (LCBI), are lacking. Purpose The aim of this study was to assess the morphological characteristics and prognostic implications of an OCT-derived LCBI (OCT-LCBI). Methods In order to assess OCT-LCBI in 1003 patients with 1-year follow-up from the CLIMA multicenter registry (clinicaltrial.gov identifier NCT02883088) we used a novel previously validated software able to automate obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI4mm). A maxOCT-LCBI4mm cut-off of 400 was used, based on previous literature on this topic. Primary composite clinical endpoint included cardiac death, myocardial infarction and target vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed. Results Patients with a maxOCT-LCBI4mm ≥400 showed higher prevalence of fibrous cap thickness <75μm (FCT, odds ratio [OR] 1.43, 95% confidence interval [CI] 1.03–1.99; p=0.034), lipid pool arc >180°(OR 3.93, 95% CI 2.97–5.21; p<0.001), minimum lumen area <3.5 mm2 (OR 1.5, 1.16–1.94; p=0.002), macrophage infiltration (OR 2.38, 95% CI 1.81–3.13; p<0.001) and intra-plaque intimal vasculature (OR 1.34, 95% CI 1.05–1.72, p=0.021). A maxOCT-LCBI4mm ≥400 predicted the primary endpoint (adjusted hazard ratio [HR] 1.86, 95% CI 1.1–3.2; p=0.019) as well as the CLIMA endpoint (HR 2.56, 95% CI 1.24–5.29; p=0.011). Patients with high lipid content and thin FCT <75 μm were at higher risk for adverse events (HR 4.88, 95% CI 2.44–9.72; p<0.001) (Figure 1). Conclusions We applied for the first time in a large population with clinical follow-up a software able to automatically obtain a maxOCT-LCBI4mm. A high maxOCT-LCBI4mm was related to vulnerable plaque features and further clinical events. This study represents a step further towards a comprehensive automated assessment of the coronary plaque risk profile. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Supported by a grant from the Centro per la Lotta contro l'Infarto – Fondazione Onlus, Rome, Italy

The Clinical Effect of Dapagliflozin in Patients with Angiographically Confirmed Coronary Artery Disease and Concomitant Type 2 Diabetes Mellitus

Nowadays treatment of patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (DM) needs further study.
 The aim. Evaluation of the clinical effect and glycemic variability of dapagliflozin in patients with angiographically confirmed CAD and concomitant type 2 DM.
 Materials and methods. The study involved 47 patients with angiographically confirmed CAD. The patients underwent laboratory blood tests, electrocardiography, echocardiography, continuous glucose monitoring and percutaneous coronary intervention (PCI). Depending on the usage of dapagliflozin 10 mg, the patients were divided into 2 groups: group I (+SGLT2i, n = 24) and group II (–SGLT2i, n = 23). The average follow-up period was 16 months.
 Results. Distribution of the examined patients by age, anthropometric characteristics, duration of DM, functional state of the heart and kidneys, smoking, the presence of acute cardiovascular events and previous PCI showed no statistically significant difference. In patients of group I, on the background of taking SGLT2i, a decrease in body mass index and improved glycemic profile were revealed. Patients in group II were more likely to have complaints of angina (4 [17.3%] vs 1 [4.3%], p>0.05); repeated coronary angiography in this group was significantly more likely to reveal progression to atherosclerotic CAD (4 [17.3%], p<0.05) which required re-revascularization. No fatalities were detected during the follow-up.
 Conclusion. Dapagliflozin has improved glycemic and lipid profile of the blood and long-term prognosis after PCI. Adding this drug to the treatment reduces the clinical progression of CAD, the need for re-hospitalization and cardiac revascularization.

Effect of Stenting Strategy on the Outcome in Patients with Non-Left Main Bifurcation Lesions.

Previous studies have not compared outcomes between different percutaneous coronary intervention (PCI) strategies and lesion locations in non-left main (LM) bifurcation lesions. We enrolled 2044 patients from a multicenter registry with an LAD bifurcation lesion (n = 1551) or non-LAD bifurcation lesion (n = 493). The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). During a median follow-up period of 38 months, non-LAD bifurcation lesions treated with the two-stent strategy, compared with the one-stent strategy, were associated with more frequent TLF (20.7% vs. 6.3%, p < 0.01), TLR (16.7% vs. 4.7%, p < 0.01), and target vessel revascularization (TVR; 18.2% vs. 6.3%, p < 0.01). There was no significant difference in outcome among LAD bifurcation lesions treated with different PCI strategies. The two-stent strategy was associated with a higher risk of TLF (adjusted HR 4.34, CI 1.93–9.76, p < 0.01), TLR (adjusted HR 4.30, CI 1.64–11.27, p < 0.01), and TVR (adjusted HR 5.07, CI 1.69–9.74, p < 0.01) in the non-LAD bifurcation lesions. The planned one-stent strategy is preferable to the two-stent strategy for the treatment of non-LAD bifurcation lesions.

Self-reported health and adverse outcomes among women living with symptoms of angina or unspecific chest pain but no diagnosis of obstructive coronary artery disease-findings from the DenHeart study.

The objectives were to describe differences in self-reported health at discharge between women diagnosed with angina or unspecific chest pain and investigate the association between self-reported health and adverse outcomes within 3 years. Data from a national cohort study were used, including data from the DenHeart survey combined with 3 years of register-based follow-up. The population included two groups of women with symptoms of angina but no diagnosis of obstructive coronary artery disease at discharge (women with angina and women with unspecific chest pain). Self-reported health measured with validated instruments was combined with register-based follow-up on adverse outcomes (a composite of unplanned cardiac readmissions, revascularization, or all-cause mortality). Associations between self-reported health and time to first adverse outcomes were investigated with Cox proportional hazard models, reported as hazards ratios with 95% confidence intervals. In total, 1770 women completed the questionnaire (49%). Women with angina (n = 931) reported significantly worse self-reported health on several outcomes compared to women with unspecific chest pain (n = 839). Within the 3 years follow-up, women with angina were more often readmitted (29 vs. 23%, P = 0.011) and more underwent revascularization (10 vs. 1%, P < 0.001), whereas mortality rates were similar (4 vs. 4%, P = 0.750). Self-reported health (physical and mental) was associated with adverse outcomes between both groups (on most instruments). Women with angina reported significantly worse self-reported health on most instruments compared to women with unspecific chest pain. Adverse outcomes varied between groups, with women diagnosed with angina experiencing more events. ClinicalTrials.gov (NCT01926145).

Association between High Lipid Burden of Target Lesion and Slow TIMI Flow in Coronary Interventions.

Decreased thrombolysis in myocardial infarction (TIMI) flow is associated with poor clinical outcomes. However, its predictors are not fully known. A combination of near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) could be used to detect lesions at high risk of slow TIMI flow. This study evaluated 636 consecutive patients undergoing target-lesion NIRS-IVUS imaging prior to percutaneous coronary intervention (PCI). The maximal lipid core burden index over 4-mm segments (maxLCBI4mm) per target vessel was calculated. The primary endpoint was the association between maxLCBI4mm and post-interventional TIMI flow. A high lipid core burden index (LCBI) cut-off point was determined using receiver-operating characteristic analysis. Decreased TIMI flow (TIMI less than 3) occurred in 90 patients and normal TIMI flow in 546 patients. The decreased TIMI flow group showed significantly higher incidence of cardiovascular events (5.6% vs. 1.5%, log-rank p = 0.010) in three months of composite events including cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization. In multivariable analysis, a high LCBI (≥354) was independently associated with slow TIMI flow (OR, 2.59 (95% CI, 1.33–5.04), p = 0.005). High LCBI measured using NIRS-IVUS imaging was an independent predictor of decreased post-PCI TIMI flow. Performing PCI for high-LCBI lesions may necessitate adjunctive measures to prevent suboptimal post-PCI reperfusion.

331.6: Impact of Left Ventricular Ejection Fraction and Previous Cardiac Revascularization on Patient and Graft Survival in Kidney Transplant Receipts

Background: Single center studies have implicated baseline left ventricular ejection fraction (LVEF) and baseline coronary artery disease as strongly associated with post-kidney transplant graft and patient survival, including in limited multivariate models. However, the United States’ Scientific Registry of Transplant Recipients (SRTR) does not directly include any cardiac variables as part of its risk adjustment model, raising the question of whether the current SRTR model fairly risk adjusts potential recipients. Methods: This study used the novel prospective United States National Surgical Quality Improvement Program (NSQIP) Transplant database to assess the impact of LVEF and pre-transplant revascularization on post-transplant outcomes in deceased donor renal transplantation (DDRT). Recipients from 2017-2019 were identified and stratified by LVEF into <50 and 50+ categories. A separate analysis stratified patients into if they had received pre-transplant revascularization, defined as either coronary bypass surgery or percutaneous intervention. Post-transplant outcomes were assessed. Results: A total of 2377 DDRT recipients were included from 29 centers. Mean follow up was 200 days. Only 4.8% had LVEF<50 at transplant, while 13.3% had undergone cardiac revascularization prior to transplant. There were several baseline differences between patients who did and did not have previous revascularization. Previous revascularization was associated with increased risk of requiring cardiac CPR (1.3 vs 0.1%, p=0.002), organ space surgical site infection (3.8 vs 1.1%, p=-0.001), delayed graft function (39.2 vs 28.3%, p<0.001), requiring dialysis at last follow up (5.7 vs 3.9%, p<0.001), myocardial infarction (4.4 vs 0.8%, p<0.001), pneumonia (3.2 vs 1.1%, p=0.011), recatherization (14.2 vs 8.2%, p=0.002), sepsis (4.1 vs 1.7%, p=0.018), septic shock (1.3 vs 0.3%, p=0.036), UTI (10.1 vs 6.1%, p=0.023), and longer ICU stay (0.86 vs 0.47 days, p=0.004). In univariate analysis, previous revascularization was associated with increased hazard of death (HR 2.4, p=0.02) but not graft loss (HR 1.3, p=0.52). In a multivariate model including previous revascularization and existing SRTR variables (age, diabetes, peripheral vascular disease, albumin, KDRI) as predictors, previous revascularization was related to a higher hazard of death (HR 1.43) however this was not a statistically significant finding (p=0.42). Conclusions: We conclude that in the DDRT in patients with previous cardiac revascularization is much more common (13.3%) than in those with LVEF<50 (4.8%). We also demonstrate that previous cardiac revascularization is a powerful predictor of both patient survival and several post-transplant complications. However, we also show that existing variables (e.g. diabetes, PVD, age) in the SRTR risk stratification model largely capture the impact of previous cardiac revascularization on patient survival at least in the early follow up period.

Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents: BIOFLOW V Final 5-Year Outcomes.

Randomized trials have demonstrated the superiority of ultrathin strut drug-eluting stents compared with alternative stent designs. Whether these differences persist over late-term follow-up is uncertain. This study sought to compare late-term (5-year) clinical outcomes among patients treated with ultrathin strut (60 µm) bioresorbable polymer sirolimus-eluting stents (BP SES) and thin strut (81 µm) durable polymer everolimus-eluting stents (DP EES). BIOFLOW V (Biotronik Prospective Randomized Multicenter Study to Assess the Safety and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in the Treatment of Subjects with Up to Three De Novo or Restenotic Coronary Artery Lesions V) was an international, 2:1 randomized trial comparing percutaneous coronary intervention with ultrathin strut BP SES versus thin strut DP EES regarding the primary endpoint of 12-month target lesion failure (TLF). Prespecified outcomes through 5 years were assessed. Among 1,334 patients randomized to treatment with BP SES (n = 884) or DP EES (n = 450), the 5-year rates of TLF were 12.3% for BP SES and 15.3% for DP EES (P = 0.108). Revascularization with BP SES was associated with a significantly lower target vessel-related myocardial infarction (6.6% vs 10.3%, P = 0.015) and late/very late definite/probable stent thrombosis (0.3% vs 1.6%, P = 0.021). Ischemia-driven target lesion revascularization was numerically but not significantly lower with BP SES (5.9% vs 7.7%, P = 0.202). Cardiac death rates were 2.6% versus 1.9% (P=0.495) for BP SES and DP EES, respectively. In a large, randomized trial, TLF and the individual outcomes of cardiac death and target lesion revascularization at 5 years were similar among patients treated with BP SES versus DP EES. Both target vessel-related myocardial infarction and late/very late definite/probable stent thrombosis were significantly lower with BP SES. These results confirm the durability of safety and the effectiveness of percutaneous coronary intervention with ultrathin BP SES.

Comparative Clinical Performance of Two Types of Drug-Eluting Stents with Abluminal Biodegradable Polymer Coating: Five-Year Results of the DESTINY Randomized Trial

Introduction and Objectives: The Stents Coated with the Biodegradable Polymer on Their Abluminal Faces and Elution of Sirolimus versus Biolimus Elution for the Treatment of de Novo Coronary Lesions - DESTINY Trial is a non-inferiority randomized study that compared the InspironTM sirolimus-eluting stent (SES) with the control BiomatrixTM Flex biolimus-eluting stent (BES). Previous reports in the first year showed similar outcomes for both stents, in clinical, angiographic, optical coherence tomography, and intravascular ultrasound assessments. The present analysis aims to compare the clinical performance of these two biodegradable polymer drug-eluting stents five years after the index procedure. Methods: A total of 170 patients (194 lesions) were randomized in a 2:1 ratio for treatment with SES or BES, respectively. The primary endpoint for the present study was the five-year rate of combined major adverse cardiac events, defined as cardiac death, myocardial infarction, or target lesion revascularization. Results: At five years, the primary endpoint occurred in 12.5% and 17.9% of the SES and BES groups, respectively (p=0.4). There was no definite or probable stent thrombosis among patients treated with the novel SES stent during the five years of follow-up, and no stent thrombosis after the first year in the BES group. Conclusions: The novel InspironTM stent had similar good clinical performance in long-term follow-up when compared head-to-head with the control latest-generation BiomatrixTM Flex biolimus-eluting stent.

Long-term outcomes of percutaneous revascularization for internal mammary artery-left anterior descending artery bypass failure.

Despite the excellent long-term results of internal mammary artery (IMA)-left anterior descending (LAD) bypass, percutaneous revascularization of IMA is sometimes required for IMA-LAD bypass failure. However, its clinical outcomes have not been fully elucidated. The aim of this study was to investigate the long-term clinical outcomes, including target lesion revascularization (TLR) following contemporary percutaneous revascularization of failed IMA bypass graft. We examined data of 59 patients who had undergone percutaneous revascularization of IMA due to IMA-LAD bypass failure at nine hospitals. Patients with IMA graft used for Y-composite graft or sequential bypass graft were excluded. The incidence of TLR was primarily examined, whereas other clinical outcomes including cardiac death, myocardial infarction, and target vessel revascularization were also evaluated. Mean age of the enrolled patients was 67.4 ± 11.3years, and 74.6% were men. Forty patients (67.8%) had anastomotic lesions, and 17 (28.8%) underwent revascularization within three months after bypass surgery. Procedural success was achieved in 55 (93.2%) patients. Stent implantation was performed in 13 patients (22.0%). During a median follow-up of 1401days (interquartile range, 282-2521days), TLR was required in six patients (8.5% at 1, 3, and 5years). Patients who underwent percutaneous revascularization within 3months after surgery tended to have a higher incidence of TLR. Clinical outcomes of IMA revascularization for IMA-LAD bypass failure were acceptable.

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

AimsIn-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention. Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO.MethodsWe retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO.ResultsA total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between the PCB group and the DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64–2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05).ConclusionsPCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.

Effect of Post-Transplant Cardiac Angiographic Procedures on Post-Transplant Renal Function

Cardiac interventions often are performed before and after renal transplant for coronary artery disease. The aim of this study was to investigate whether post-transplant cardiac coronary procedures affect post-transplant renal function. We retrospectively included renal transplant recipients who underwent renal transplant procedures at Baskent University between April 28, 1997 and January 20, 2020. We analyzed the effect of cardiac catheterization in renal transplant recipients between 6 and 12 months post-transplant with post-transplant renal function assessed by glomerular filtration rate (GFR). We compared the effect of the type of coronary intervention on GFR change in group 1, whereby group 1 was divided into 2 subgroups (coronary artery bypass grafting [CABG] and stenting). Group 1 included patients who underwent cardiac intervention, whereas group 2 included those who had not undergone cardiac intervention. In all, 108 patients underwent coronary angiography; 45 (41.7%) had normal coronaries or minimal coronary artery disease (CAD); 37 (34.3%) underwent stent implantation; 26 (24.1%) underwent CABG. The mean post- transplantation GFR of all patients after cardiac catheterization was 84.26+25.91 (mL/min/1.73 m2). The final, after 12 months mean GFR of all patients was 69.55+27.05. The final GFR was significantly lower than the initial post-renal GFR value in patients who underwent cardiac intervention but not in non-intervened patients. Invasive cardiac revascularization procedures showed a negative effect on post-transplant renal function in renal transplant recipients. All renal transplant recipients who underwent cardiac intervention survived the intervention, and there was no mortality. The reason for this outcome was assumed to be because of the short follow-up period.

Safety and Clinical Performance of Biodegradable Polymer-Coated Ultra-Thin Everolimus-Eluting Stents in "Real-World" Patients: A Multicenter Registry (PERFORM-EVER).

Background:Tetrilimus (Sahajanand Medical Technologies Limited, Surat, India) is a biodegradable polymer-coated everolimus-eluting stent with cobalt–chromium stent platform and ultra-thin (60 µm) strut thickness. We aimed to report 1-year safety and clinical performance of Tetrilimus everolimus-eluting stent in patients with coronary artery disease in “real-world” clinical practice.Methods:The PERFORMance of biodegradable polymer-coated ultra-thin EVERolimus-eluting stents was an observational, multicenter, single-arm, and investigator-initiated retrospective registry. All “real-world” patients who had received Tetrilimus everolimus-eluting stent between July-2015 and October-2016 at four study centers were analyzed. The data were collected retrospectively either by extraction from existing databases in consecutive fashion where index and follow-up data existed or the follow-up was obtained by telephonic contact. Primary endpoint was 1-year incidence of target lesion failure, which was defined as a composite endpoint of cardiac death, myocardial infarction, and target lesion revascularization by percutaneous or surgical methods. The Academic Research Consortium-defined stent thrombosis was assessed as additional safety endpoint.Results:During the study period, 815 Tetrilimus everolimus-eluting stents (1.4 ± 0.5 stent/patient) were implanted to treat 735 coronary lesions (1.1 ± 0.3 stent/lesion) in 594 patients (mean age: 55.6 ± 12.1 years). The cumulative incidence of target lesion failure at 1-year follow-up was 3.7%, which included 9 (1.5%) cardiac deaths, 8 (1.4%) myocardial infarctions, and 5 (0.8%) target lesion revascularizations. There were 5 (0.8%) cases of probable stent thrombosis and 4 (0.7%) cases of possible stent thrombosis at 1-year follow-up. Conclusion:Low incidences of target lesion failure and stent thrombosis at 1-year follow-up indicates that biodegradable polymer-coated ultra-thin Tetrilimus everolimus-eluting stents may have encouraging safety and efficacy in unselected real-world patients with coronary artery disease, including those with high-risk characteristics and complex lesions.

Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative

BackgroundIntravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. MethodsProspective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. ResultsA total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. ConclusionsIn this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.

UTP Regulates the Cardioprotective Action of Transplanted Stem Cells Derived From Mouse Cardiac Adipose Tissue

Adipose tissue is a source of stem cells with a high potential of differentiation for cell-based regenerative therapies. We previously identified mouse P2Y2, an ATP and UTP nucleotide receptor, as a regulator of adipogenic and endothelial differentiation of cardiac adipose-derived stem cells (cADSC). We investigated here the potential involvement of P2Y2 receptor in the cardioprotective action of undifferentiated cADSC transplantation in mouse ischemic heart. Transplantation of cADSC was realized in the periphery of the infarcted zone of ischemic heart, 3 days after left anterior descending artery ligation. A strong reduction of collagen stained area was observed 14 days after cADSC injection, compared to PBS injection. Interestingly, loss of P2Y2 expression totally inhibits the ability of transplanted cADSC to reduce cardiac fibrosis. A detailed gene ontology enrichment analysis was realized by comparing RNA-sequencing data obtained for UTP-treated wild type cASDC and UTP-treated P2Y2-null cASDC. We identified UTP target genes linked to extracellular matrix organization such as matrix metalloproteinases and various collagen types, UTP target genes related to macrophage chemotaxis and differentiation into pro-fibrotic foam cells, and a significant number of UTP target genes linked to angiogenesis regulation. More particularly, we showed that UTP regulated the secretion of CCL5, CXCL5, and CCL12 chemokines and serum amyloid apolipoprotein 3, in the supernatants of UTP-treated cADSC. Interestingly, CCL5 is reported as a key factor in post-infarction heart failure and in the reparative and angiogenic action of transplanted ADSC on ischemic tissue. We investigated then if a UTP-pretreatment of cADSC amplifies their effect on cardiac revascularization in mouse ischemic heart. Transplantation of cADSC was able to increase peri-infarct capillary density, 14 days after their injection. This beneficial effect on cardiac revascularization was enhanced by a UTP-pretreatment of cADSC before their transplantation, and not observed using P2Y2-null cADSC. Our data support that the efficacy of transplanted cADSC can be regulated by the release of inflammatory mediators such as extracellular nucleotides in the ischemic site. The present study highlights the P2Y2 receptor as a regulator of cADSC cardioprotective action, and as a potential target for the therapeutic use of undifferentiated cADSC in post-ischemic cardiac ischemia.

P77 SIEMENS ARTIS VD11 ANGIOGRAPH‘S POTENTIAL WITH THE CLEARSTENT PROTOCOL IN PERFORMING PERCUTANEOUS CORONARY ANGIOPLASTY: FIRST EXPERIENCES

Abstract Objectives The use of the CLEARstent image functions allows you to highlight fine structures, for example the expansion of a stent. Composite images are created by averaging several frames of a scene and considering the alignment of the markers of a stent. If an ECG signal is available, the cardiac phase is also considered. Using the CLEARstent function allows you to create special reference images from any scene or natively acquired fluoroscopic scene. The goal of CLEARstent images is to optimize the procedural result of mechanical cardiac revascularization and to improve the outcomes of treated patients. Methods The use of the Siemens Artis VD11 angiograph requires specific technical and medical knowledge and skills regarding, at least, radiation protection, safety procedures and patient safety. The people who work with the system, who use it and who move it must have acquired this knowledge and skills in their working life The application training was provided to the medical–technical–nursing staff of the Hemodynamics Unit of the “San Luca” PO of Vallo della Lucania “by qualified Siemens personnel. The application training offered by Siemens is binding before any use of the system Results 701 coronary angiography procedures and 118 urgent revascularizations were performed at our Hemodynamics Unit in the period from 11/27–2020 to 12/21–2021, period of use of the aforementioned angiograph, 701 coronary angiography procedures and 118 revascularizations in an emergency pattern ( STEMI–NSTEMI at high risk). In all mechanical myocardial revascularization procedures, the opening and optimal positioning of the coronary stents were verified with the CLEARstent system. There was no periprocedural complication. Conclusions The CLEARstent system allows to highlight fine structures, for example hypo–expanded stents, creating special reference images from any negatively acquired fluoroscopic scene, consequently allowing optimal positioning and opening of a coronary stent. Therefore, it is inserted together with intracoronary imaging techniques (IVUS, OCT) as a further aid to guide percutaneous interventions in order to optimize the acute procedural outcome of PCI and to improve the clinical outcomes of treated patients.

E-25 | Ultra-thin Everolimus-eluting Stents in Atherosclerotic Lesions: Three Years Follow-up with Subgroup Analysis of Ultra-long Lesions

E-25 | Ultra-thin Everolimus-eluting Stents in Atherosclerotic Lesions: Three Years Follow-up with Subgroup Analysis of Ultra-long Lesions

A-25 | Racial Differences in Rates of Cardiac Catheterization and Revascularization in Patients with History of Cocaine Use Admitted with Acute Coronary Syndrome

A-25 | Racial Differences in Rates of Cardiac Catheterization and Revascularization in Patients with History of Cocaine Use Admitted with Acute Coronary Syndrome

The Role of the Association Between Serum C-Reactive Protein Levels and Coronary Plaque Macrophage Accumulation in Predicting Clinical Events - Results from the CLIMA Registry.

The present investigation aims to study the interaction between systemic and intra-plaque inflammation in predicting cardiac events. We investigated C-reactive protein (CRP) levels as well as plaque inflammation with optical coherence tomography (OCT)-detected macrophages in the CLIMA study. 689 patients had admission CRP serum values reported, and high CRP values were defined as ≥ 2mg/dl. The main study endpoint was a composite of cardiac death, myocardial infarction, and/or target vessel revascularization at 1-year follow-up. At multivariate Cox regression analysis, a large (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.2-4.3; p = 0.013) and superficial (HR 2.78, 95%CI 1.5-5.1; p = 0.001) macrophage arc was predicted of the main composite endpoint in patients with high CRP levels. Patients with large/superficial macrophage accumulation and low CRP levels were not at higher risk of adverse events. The presence of high CRP levels and large/superficial macrophage accumulation at OCT analysis identified patients at higher risk of clinical events.