Complex Coronary Lesions Research Articles

Manual support during robotic-assisted percutaneous coronary intervention.

Robotic-assisted percutaneous coronary intervention (R-PCI) is an efficacious and safe treatment option for coronary artery disease. However, predictors of manual support during R-PCI are unknown, which we aimed to investigate in a multi-center study. We utilized patient-level data from R-PCIs carried out from 2020 to 2022 at four sites in Germany. Manual support was defined as the combination of partial manual assistance, where the procedure is ultimately completed using robotic techniques, and manual conversion. A two-step selection process based on akaike information criteria was used to identify the ideal multivariable model predicting manual support. In 210 patients (median age 69.0years; 25.7% female), a total of 231 coronary lesions were treated by R-PCI. Manual support was needed in 46 lesions (19.9%). Procedures requiring manual support were associated with significantly longer procedural times, greater total contrast fluid volumes, longer fluoroscopy times, and higher dose-area products. Amongst the predictors of manual support were lesions in the left anterior descending artery [OR: 1.09 (95%-CI: 0.99-1.20)], aorto-ostial lesions [OR: 1.35 (95%-CI: 1.11-1.64)], chronic total occlusions [OR: 1.78 (95%-CI: 1.38-2.31)], true bifurcations [OR: 1.37 (95%-CI: 1.17-1.59)], and severe calcification [OR: 1.13 (95%-CI: 1.00-1.27)]. Our findings reveal that nearly one out five of patients undergoing R-PCI required manual support, which was linked to longer procedure durations. Predictors of manual support reflected characteristics of more complex coronary lesions. These results highlight the limitations of current R-PCI platforms and underscore the need for technical advancements to address different clinical scenarios.

Impact of Side Branch Occlusion on Patient Outcomes After Bifurcation Percutaneous Coronary Intervention.

The outcomes and characteristics of patients with side branch occlusion (SBO) after bifurcation percutaneous coronary intervention (PCI) have received limited study. We compared the procedural characteristics and outcomes of patients with and without SBO among 933 provisional bifurcation PCIs performed in 803 patients at six centers between 2014 and 2024. The prevalence of SBO was 13% (n = 121). SBO patients had lower rates of hypertension, prior coronary artery bypass graft surgery (CABG), and prior PCI but higher angiographic complexity, with higher prevalence of left anterior descending artery stenoses, smaller side branch diameter and more severe side branch diameter stenoses. SBO patients were more likely to convert from provisional to two-stent strategies (24.8% vs 6.0%, p < 0.001), and to require plaque modification (39.7% vs 17.5%, p < 0.001) and side branch percutaneous transluminal coronary angioplasty (PTCA) (25.6% vs 12.9%, p < 0.001). SBO patients had lower technical (78.5% vs 96.2%, p < 0.001) and procedural (73.5% vs 92.2%, p < 0.001) success and similar in-hospital major adverse cardiovascular events (MACE), but higher dissection rates (7.1% vs 2.0%, p = 0.007). Patients with untreated SBO had similar in-hospital MACE with untreated SBO patients. During a median follow-up of 1,095 days patients with treated SBO (83.9%, n = 94) had lower follow-up MACE (hazard ratio [HR]: 0.29, 95% confidence intervals [CI]: 0.10, 0.84, p = 0.023) and mortality (HR: 0.22, CI: 0.065, 0.755, p = 0.016) compared with patients with untreated SBO. SBO occurs in 13% of provisional PCIs. SBO patients had more complex coronary lesions and worse follow-up clinical outcomes if the SBO was left untreated.

Clinical impact of direct rotational atherectomy in patients with complex coronary artery lesions

Owing to limited data on the optimal timing of rotational atherectomy (RA), we sought to evaluate the clinical impact of the early application of the RA strategy. Consecutive patients with severe coronary artery calcification were enrolled, who underwent percutaneous coronary intervention (PCI) using RA between January 2010 and October 2019 at 9 tertiary centers. Direct RA was defined as the early application of RA before the balloon was expanded to a size more than or equal to 2.0 mm. The primary endpoint was the composite outcome of technical failure or severe coronary dissection (type D, E, or F) during entire procedure. Of 581 lesions, 360 (62.0%) lesions underwent direct RA. The technical success rate was higher in the direct RA group than in the indirect RA group (97.5% vs. 93.7%, p = 0.021). The primary endpoint was more frequently observed in the indirect RA group than in the direct RA group (24.4% vs. 11.9%, p < 0.001). Multivariate logistic regression analysis revealed that the risk of the primary endpoint was higher in the indirect RA group than in the direct RA group (odds ratio 2.512, 95% CI 1.547–4.078, p < 0.001). Early application of RA may reduce the incidences of in-hospital adverse events and procedure-related complications.

Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity.

Recent trials have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) improves clinical outcome, as compared to angiography-guided PCI, in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall lesion complexity in each patient. The present study sought to investigate the impact of overall lesion complexity on the benefit of IVI-guided PCI. A total of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial (n=1,639) and the institutional registry of the Samsung Medical Center (n=2,972) were classified according to the number of complex lesion features found in each patient. The primary outcome was target vessel failure (TVF) at 3 years, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation. The cutoff value for the number of complex lesion features to predict TVF, determined using the maximally selected log-rank test, was 3. Patients with ≥3 complex lesion features had a higher risk of TVF than those with <3 complex lesion features (11.0% vs 7.2%, hazard ratio [HR] 1.59, 95% confidence interval [CI]: 1.28-1.96; p<0.001). IVI-guided PCI significantly reduced the risk of TVF compared with angiography-guided PCI in both groups (≥3 complex lesion features: 7.4% vs 14.4%, HR 0.49, 95% CI: 0.35-0.69; p<0.001; <3 complex lesion features: 5.7% vs 8.1%, HR 0.72, 95% CI: 0.53-0.98; p=0.039). The benefit of IVI-guided PCI tended to increase as the number of complex lesion features increased (absolute risk reduction for TVF: -0.012 vs -0.027 vs -0.055 vs -0.077, respectively, for 1 vs 2 vs 3 vs ≥4 complex lesion features; interaction p=0.048). In patients with complex coronary artery lesions, IVI-guided PCI showed a lower risk of TVF across all degrees of lesion complexity. The prognostic benefit of IVI-guided PCI tended to increase as patients had more complex lesion features. (RENOVATE-COMPLEX-PCI [ClinicalTrials.gov: NCT03381872]; Institutional cardiovascular catheterisation database of the Samsung Medical Center [ClinicalTrials.gov: NCT03870815]).

Simultaneous gastroepiploic artery to right coronary artery bypass and trans-catheter aortic valve implantation: case series.

Patients with coronary artery disease undergoing trans-catheter aortic valve implantation (TAVI) often receive TAVI alone. However, in cases of severe coronary lesions or anticipated difficulty in coronary access post-TAVI, percutaneous coronary intervention or coronary artery bypass grafting may be necessary. We performed simultaneous gastroepiploic artery to posterior descending artery bypass and TAVI in two patients with severe calcification of the right coronary artery ostium which is unsuitable for percutaneous intervention. The procedure was conducted through an upper median laparotomy, avoiding a full sternotomy. Patients were discharged on postoperative days 6 and 9, respectively. By combining minimally invasive techniques and avoiding median sternotomy, we achieved favorable outcomes without compromising the less invasive nature of TAVI. This approach demonstrates the potential for tailored, hybrid procedures in high-risk patients with concomitant aortic valve disease and complex coronary lesions.

Mini-crush or Nano-crush Stenting Technique for Complex Coronary Bifurcation Lesions: The Multicenter MINANO Registry.

This multicenter study aimed to retrospectively evaluate the mid-term clinical outcomes of mini-crush (MCT) and nano-crush (NCT) techniques in patients with complex bifurcation lesions (CBLs). The study comprised 431 patients [male: 318 (73.8%), mean age: 60.96 ± 10.34 years] who underwent bifurcation PCI between January 2018 and December 2023 were included in the study from six tertiary centers. The primary endpoint was defined as the major cardiovascular events (MACE), which include cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (TLR). This is the first study to compare the clinical outcomes of MCT and NCT in patients with CBL. The initial revascularization strategy was MCT in 302 (70%) cases and NCT in 129 (30%) patients. SYNTAX scores [24.33±6.54 vs 24.43±5.45, p=0.707] were comparable in both groups. The incidence of MACE (18.6 vs. 10.9%, p=0.031), TVMI (11.6 vs 5.6%, p=0.030), and clinically driven TLR (14 vs. 6%, p=0.006) were significantly higher in the NCT group compared to the MCT group. Being in the MCT group (HR: 0.549, p=0.035), high SYNTAX score (HR: 1.105, p<0.001), non-fatal intra-procedural complications (HR: 3.269, p<0.001), proximal side-branch optimization (HR: 0.451, p=0.013), diabetes mellitus (HR: 2.263, p=0.009), and chronic kidney disease (HR: 1.948, p=0.024) were found to be independent predictors of MACE. This non-randomized study suggests that MCT was associated with better mid-term MACE, TVMI, and clinically driven TLR rates compared with NCT in patients with CBLs.

Predictive value of the HEART score for coronary lesions based on the SYNTAX score in patients with non-ST-elevation acute coronary syndrome

Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a prevalent condition in emergency settings, with lesion severity influencing treatment pathways. The SYNTAX score is determined by coronary angiography, which accurately assesses lesion complexity but is an invasive procedure. In contrast, the HEART score &amp;ndash; based on history, electrocardiogram, age, risk factors, and troponin &amp;ndash; offers a non-invasive, rapid assessment tool. This study evaluated the effectiveness of the HEART score in predicting the severity of coronary lesions, as represented by the SYNTAX score, in patients with NSTE-ACS. This cross-sectional study included 120 patients with NSTE-ACS admitted to Trung Vuong Hospital between December 2023 and September 2024. Patients were assessed for the HEART score and coronary angiography within 48 h of admission. The SYNTAX scores categorized patients into low- (0 &amp;ndash; 22), moderate- (23 &amp;ndash; 32), or high-risk groups (&amp;ge;33). Spearman&amp;rsquo;s correlation was used to assess the HEART&amp;ndash;SYNTAX relationship, with receiver operating characteristic (ROC) analysis identifying the optimal HEART score cutoff for predicting SYNTAX &amp;ge;23. The mean age of the cohort was 63.9 years, of which 66.7% were men. Common risk factors included hypertension (80.8%), hyperlipidemia (73.3%), and diabetes (25.8%). A significant positive correlation (&amp;rho; = 0.819, P &lt; 0.001) was observed between the HEART and SYNTAX scores, with higher HEART scores reflecting greater lesion complexity than SYNTAX scores. ROC analysis yielded an area under the curve of 0.912 (95% CI: 0.862 &amp;ndash; 0.963), with a HEART score cutoff of 5 showing 90.6% sensitivity and 83.9% specificity for predicting moderate-to-high SYNTAX scores (&amp;ge;23). The HEART score is an effective, non-invasive predictor of coronary lesion complexity in patients with NSTE-ACS, significantly correlating with the SYNTAX scores. A HEART score of &amp;ge;5 accurately identifies patients at risk for severe coronary disease, supporting its use in rapid, non-invasive risk stratification and facilitating timely intervention in emergency settings.

A Novel Modified Mini-Crush Technique for Complex Coronary Bifurcation Lesions: Controlled Balloon-Crush

A Novel Modified Mini-Crush Technique for Complex Coronary Bifurcation Lesions: Controlled Balloon-Crush

SST2 levels and 3D speckle tracking as predictors of CAD severity in chronic coronary syndrome.

Previous studies on the relation of sST2 with atherosclerotic disease mostly focused on the predictive value of sST2 for heart failure. However, there is no definite conclusion about the correlation between sST2 level and a complex coronary lesion morphology detected with coronary angiography (CAG). The purpose of this work was to know sST2 level and 3D speckle-tracking echocardiography as predictor of coronary artery disease (CAD) severity in chronic coronary syndrome (CCS) individuals using Gensini score. This prospective cohort work was performed on 90 participants aging from 18 to 80years old, both sexes, with stable angina pectoris. Participants had been categorized into three groups: Group I (n = 30): control group scheduled by normal coronary angiography and group II (n = 60): case group which subdivided according to Gensini score into two equal subgroups: IIa: simple lesion (Gensini score < 20) and group IIb: complex lesion (Gensini score of ≥ 20). Plasma sST2 levels were measured in all participants using ELISA technique. GLS, GAS, GCS and ST2 can significantly predict severity of CAD in CCS, respectively (P < 0.001 and AUC (95% CI) = 0.949(0.881-0.984), 0.980(0.925 to 0.998), 0.908(0.828 to 0.959) and 0.702(0.597 to 0.794)) at cutoff ≥ - 10, - 21, - 12 and ≥ 10 with 96.67% (82.8% to 99.9%), 96.67% (82.8 to 99.9), 86.67% (69.3 to 96.2) and 63.33% (43.9 to 80.1) sensitivity (95% CI), 76.67% (64.0% to 86.6%), 85.0% (73.4 to 92.9), 73.33% (60.3 to 83.9) and 65.0% (51.6 to 76.9) specificity (95% CI), 67.44%, 76.32%, 61.90% and 47.50% PPV and 97.87%, 98.08%, 91.67% and 78.00%, NPV with accuracy of 83.33%, 88.89%, 77.78% and 64.44%. sST2 level, GLS, GAS and GCS can significantly predict severity of CAD in CCS.

Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator Experience on Outcomes.

Percutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center. This study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure. Retrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved. PCI center volume was categorized based on annual number of interventions: low (< 200), intermediate (200-499), and high (≥ 500). Operator experience was assessed by years of practice (low [< 5] and high [≥ 5]) and the number of PCI cases performed annually (low [< 75] and high [≥ 75]). The evaluated PCI outcomes were: PCI failure; procedural complications; PCI-related in-hospital mortality; 1 year post-intervention all-cause mortality. A total of 19,701 patients who underwent PCI were included in the analysis, of whom 17,432 had follow-up data available after 1 year. Of these, 58.1% presented with either ST-elevation or non-ST elevation myocardial infarction/unstable angina, while 41.9% had stable CAD. Nearly half of the patients had triple-vessel or left-main disease, and 8.7% presented with cardiogenic shock. The percent with PCI failure, procedural complications, PCI-related in-hospital death, and 1-year all-cause mortality were 4.9%, 5.1%, 2.7%, and 11.8%, respectively. Despite patients in higher-risk profiles being treated at high-volume PCI centers and by experienced operators, there were no significant differences in PCI failure, PCI-related in-hospital mortality nor 1-year all-cause mortality compared to those treated at low or intermediate volume PCI centers. However, high-volume PCI centers had procedural complications more frequently (4.7%) than did intermediate (3.9%) and low-volume (2.5%) centers (p < 0.001). After adjusting for confounding factors, no significant associations were found between PCI center volume and PCI outcome. Similarly, no significant relationship was found between operator experience and procedural complications, nor 1-year all-cause mortality. Nevertheless, operators with more years of practice were associated with lower PCI-related in-hospital mortality (odds ratio [95% CI] of 0.75 (0.57, 0.98); p < 0.038). Additionally, operators conducting a higher number of PCIs annually tended to have less PCI failures (odds ratio [95% CI] of 0.76 (0.57, 1.01); p = 0.062). A center's PCI volume did not significantly impact PCI outcome. In contrast, operator experience did impact outcomes. This result highlights areas for improvement and can help reform strategies for national PCI systems at both center and operator levels.

Periodontitis in Patients Undergoing Coronary Angiography: A Cross-Sectional Study.

Background Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with coronary artery disease (CAD) being the primary contributor. Periodontitis, a common non-communicable disease, has been associated with an increased risk of CVD. Previous studies have suggested a link between the severity of periodontitis and the degree of coronary artery obstruction. Objective This study aims to investigate the correlation between the severity of periodontitis and coronary artery stenosis, as measured by the SYNTAX score I (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery), and to examine the association between severe periodontitis and other coronary pathologies, such as diffuse coronary disease and coronary thrombosis. Materials and methods An observational cross-sectional study was conducted at the Second Cardiology Clinic, University Multiprofile Hospital for Active Treatment "St. Marina", Varna, Bulgaria, from December 2021 to January 2024. A total of 199 patients aged 45-64 years, indicated for coronary angiography, were included. Periodontal assessment included measuring probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP), and plaque index (PI). Subgingival plaque samples were analyzed for periodontal pathogens. Coronary angiography was performed, and the SYNTAX score I was calculated to assess the severity of coronary artery stenosis. Statistical analyses, including chi-square tests and Spearman's correlation, were conducted to evaluate the associations. Results Among the 199 participants, 74.9% had severe periodontitis (stage III and IV). A weak but statistically significant correlation was found between mean CAL, periodontitis stage, and the SYNTAX score I (p < 0.01 and p < 0.05, respectively), indicating that more severe forms of periodontitis were associated with greater coronary artery stenosis. No correlation was observed between the presence of periodontal pathogens or the total microbial count and the SYNTAX score I. Additionally, no association was found between severe periodontitis and other coronary conditions, such as diffuse coronary disease and thrombosis. Conclusion This study provides new insights into the relationship between periodontal infection and coronary artery disease. Our findings suggest that severe periodontitis is significantly associated with a higher frequency and more complex coronary lesions, as indicated by the SYNTAX score I. However, no link was observed between specific periodontal pathogens and coronary stenosis. These results underscore the importance of early diagnosis and management of periodontal infections in patients with CAD, highlighting the potential benefits of an integrated approach to managing cardiovascular and periodontal health. Further studiesare needed to explore these associations in more depth.

Impact of Robotic Percutaneous Coronary Intervention (R-PCI) With and Without CCTA-Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry.

Several studies have confirmed the safety and efficacy of robotic assisted coronary interventions for simple and complex coronary lesions. However, in the real-world clinical setting the currently available evidence is still inconclusive with regard to clinical outcomes. In terms of financial sustainability, the emerging use of pre-PCI Coronary Computed Tomography Angiography (CCTA) may potentially impact the overall patient journey and related costs. However, the role of CCTA guidance in elective robotic-assisted revascularizations and its potential impact on hospital economics has never been investigated. Therefore, we aimed to assess the clinical impact of R-PCI according to procedural complexity and its potential financial sustainability when integrated with CCTA guidance. Major adverse cardiovascular events (MACE) at the latest clinical follow-up available have been prospectively evaluated in a single center cohort of 111 patients undergoing elective R-PCI (CorPath, Corindus GRX Robotic Drive, Boston, MA). The study population was subsequently divided into two groups according to either the median Syntax Score (SS = 14) as a surrogate of procedural complexity or the adoption of CCTA-guidance. Additionally, both periprocedural and in-hospital outcomes have been investigated in the overall cohort and in the subgroups. Overall, MACE occurred in 5.4% of the patients at a median follow-up of 309 days. Procedural complexity was associated with significantly longer procedural time and radiation exposure (SS ≥ 14: 94.5 ± 32.1 vs. 78.7 ± 25.5 min, p = 0.011, and 32.7 ± 30.9 vs. 22.5 ± 19.8 mSv, p = 0.010, respectively), but not with increased in-hospital and long-term clinical outcomes. Additionally, patients undergoing CCTA-guided R-PCI had a significantly higher rate of same-day-discharge (SDD-64.6% vs. 44.2% respectively, p = 0.034) than those without CCTA support. R-PCI appears safe and effective regardless the procedural complexity. Moreover, the integration of robotics and CCTA-guidance appears to have beneficial impact on hospital economics by optimizing resource utilization and improving patient selection for percutaneous revascularization.

Comparison of Access Site Complications in Primary Percutaneous Coronary Intervention (PCI) Using the Radial Versus the Femoral Approach for Complex Lesions: A Prospective Study.

Percutaneous coronary intervention (PCI) is a widely used therapeutic approach for complex coronary artery disease, especially in patients with ST-elevation myocardial infarction (STEMI). The choice of vascular access site, typically radial or femoral, can significantly impact patient outcomes due to varying complication rates associated with each approach. This study aimed to compare access site complications between radial and femoral approaches in primary PCI for complex coronary lesions, providing insights into the safety and efficacy of these approaches. A prospective cohort study was conducted from January 1, 2023, to December 31, 2023, at a tertiary care cardiovascular center. A total of 350 adult patients presenting with STEMI and requiring emergency PCI for complex coronary lesions were included and randomized equally to either radial (n = 175) or femoral (n = 175) access groups. Primary outcomes included access site complications, such as hematomas, pseudoaneurysms, arteriovenous fistulas, and major bleeding events. Secondary outcomes included procedural success, access site crossover, and hospital stay duration. Data were analyzed using chi-square tests, Student's t-tests, and multivariate logistic regression. The incidence of access site complications was significantly lower in the radial group (11.4%) compared to the femoral group (22.9%) (p = 0.007). Major bleeding events were also notably reduced in the radial group (2.3% vs. 8.6%, p = 0.01). There was a significantly shorter median hospital stay for the radial group (three days vs. five days, p < 0.001), while procedural success rates were comparable between groups (97.1% vs. 94.3%, p = 0.31). The radial approach for primary PCI in complex lesions is associated with fewer access site complications and shorter hospital stays compared to the femoral approach, supporting its use as the preferred access site.

Intravascular imaging-guided percutaneous coronary intervention according to lesion complexity

Abstract Background Recent trials have shown intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) has prognostic benefit compared with angiograph-guided PCI in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall complexity of target lesions in each patient. Objectives To investigate an impact of the number of complex lesion features on the benefit of IVI-guided PCI. Methods A total of 4,611 patients with complex coronary artery lesions from the RENOVATE-COMPLEX-PCI trial (n=1,639) and the institutional registry of a medical center (n=2,972) were classified according to the number of complex lesion features found in each patient. The primary outcome was a target vessel failure (TVF) at 3 years, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. Results The best cut-off number of complex lesion features for the risk of TVF was 3 and patients with ≥3 complex lesion features had higher risk of TVF than those with &amp;lt;3 complex lesion features (11.0% vs. 7.2%; HR 1.59, 95% CI 1.28-1.96, P&amp;lt;0.001). IVI-guided PCI significantly reduced the risk of TVF compared to angiography-guided PCI in both groups (≥3 complex lesion features: 7.4% vs. 14.4%, HR 0.49; 95% CI 0.35-0.69, P&amp;lt;0.001; &amp;lt;3 complex lesion features: 5.7% vs. 8.1%; HR 0.72, 95% CI 0.53-0.98, P=0.039). The benefit of IVI-guided PCI tended to increase as the number of complex lesion features increased (absolute risk reduction for TVF: -0.012 vs. -0.027 vs. -0.055 vs. -0.077, respectively, for the number of complex lesion features 1 vs. 2 vs. 3 vs. ≥4, interaction P=0.048). Conclusion In patients with complex coronary artery lesions, IVI-guided PCI reduced the risk of TVF regardless of overall complexity of the target lesions in each patient. The prognostic benefit of IVI-guided PCI tended to increase as patients had more complex lesion features.Clinical Outcomes

Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk

Abstract Background Recent randomized controlled trials support intravascular imaging-guided PCI to improve patient prognosis, however, future risk of clinical events in patient with coronary artery disease is not solely determined by lesion characteristics or how these lesions are treated. Objectives Current study investigated whether the effects of intravascular imaging in complex percutaneous coronary invention (PCI) would differ according to atherothrombotic risks. Methods This study was post-hoc analysis of the RENOVATE-COMPLEX-PCI trial that compared intravascular imaging-guided PCI with angiography-guided PCI in patients with complex coronary artery lesions. Study population was stratified according to atherothrombotic risk assessed by Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) (a sum of age≥75 years, diabetes mellitus, hypertension, smoking, peripheral arterial disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction) into low-risk (TRS-2P&amp;lt;3) or high-risk (TRS-2P≥3) groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel related myocardial infarction, or clinically driven target vessel revascularization. Results Among the total patients, 1,247 were low-risk and 392 were high-risk. The risk of TVF was significantly higher in the high-risk group than the low-risk group (15.5% vs. 7.2%; hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.51–3.00; P&amp;lt;0.001). The benefits of intravascular imaging-guided PCI over angiography-guided PCI did not differ between the low-risk group (5.6% vs. 10.4%; HR, 0.56; 95% CI, 0.36–0.86) and the high-risk group (14.1% vs. 18.5%; HR, 0.71; 95% CI, 0.41–1.24) without significant interaction (interaction P=0.496). Conclusions Although patients with high atherothrombotic risk had significantly worse clinical outcome than those with low atherothrombotic risk, the prognostic impact of intravascular imaging-guided PCI compared with angiography-guided PCI was similarly observed in both low and high future atherothrombotic risk groups.Structured Graphical Abstract

Impact of Diabetes Mellitus on Bifurcation Percutaneous Coronary Intervention: Insights from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions Registry

The impact of diabetes mellitus (DM) on the outcomes of bifurcation percutaneous coronary intervention (PCI) has received limited study. We compared the procedural characteristics and outcomes of patients with and without DM in 1,302 bifurcation PCIs (1,147 patients) performed at 5 centers between 2013 and 2024. The prevalence of DM was 33.8% (n = 388). Patients with diabetes were younger and had more cardiovascular risk factors and greater angiographic complexity, including more main vessel calcification and more frequent stenoses in the left main, proximal left anterior descending, and right coronary artery. There was no difference in technical (95.5% vs 94.9%, p = 0.613) or procedural success (90.2% vs 91.3%, p = 0.540); provisional stenting was used less frequently in patients with diabetes (64.5% vs 71.1%, p = 0.015). Patients with diabetes had higher rates of repeat in-hospital PCI and acute kidney injury. Other in-hospital outcomes were similar after adjusting for confounders. During a median follow-up of 1,095 days, diabetes was independently associated with greater incidence of major adverse cardiovascular events (hazard ratio [HR] 2.04, 95% confidence intervals [CI] 1.52 to 2.72, p <0.001), myocardial infarction (HR 1.94, 95% CI 1.05 to 3.25, p = 0.033), death (HR 2.26, 95% CI 1.46 to 3.51, p <0.001), and target (HR 1.6, 95% CI 1.01 to 2.66, p = 0.045) and nontarget (HR 2.00, CI 1.06 to 3.78, p = 0.032) vessel revascularization. Patients with DM who underwent bifurcation PCI had greater risk of in-hospital repeat-PCI and major adverse cardiac events during follow-up than did those without diabetes.

The Challenge of Treating Complex Coronary Lesions: A Call for More Personalized Approaches in Angioplasty.

The Challenge of Treating Complex Coronary Lesions: A Call for More Personalized Approaches in Angioplasty.

Association between high plasma levels of legumain and cardiovascular events in patients undergoing coronary angiography.

Degradation of vascular extracellular matrix is important in atherosclerosis. Cysteine protease legumain is upregulated in atherosclerotic plaques. We recently reported that plasma legumain levels are high in patients with complex coronary lesions. This study investigated the association between legumain levels and cardiovascular events in 372 patients undergoing coronary angiography. Patients with acute coronary syndrome were excluded. Of the 372 patients, 225 had coronary artery disease (CAD). During a mean follow-up of 7.0 ± 4.3 years, cardiovascular events occured in 62 patients. Compared with 310 patients without events, 62 with events tended to have higher prevalence of complex lesions (15% vs. 10%). Notably, patients with events had higher legumain levels (median 5.51 vs. 4.90 ng/mL, P < 0.01) than those without events. A Kaplan-Meier analysis showed lower event-free survival in patients with legumain > 5.0 ng/mL than in those with ≤ 5.0 ng/mL (P < 0.01). In multivariate Cox regression analysis, legumain level was an independent predictor of cardiovascular events. The hazard ratio for legumain > 5.0 ng/mL for cardiovascular events was 2.18 (95%CI = 1.27-3.77, P < 0.01). Only among 225 patients with CAD, patients with events had higher legumain levels (5.49 vs. 4.73 ng/mL) than without events (P < 0.02). Legumain level was also a predictor of cardiovascular events in patients with CAD. Thus, high plasma legumain levels were associated with an increased risk of cardiovascular events in patients undergoing coronary angiography and those with stable CAD.

TCT-345 DYNAMX Bioadaptor Stent Implantation for the Treatment of Complex Coronary Lesions: Insights From the DYNAMITE Study

TCT-345 DYNAMX Bioadaptor Stent Implantation for the Treatment of Complex Coronary Lesions: Insights From the DYNAMITE Study

Correlation Between Complexity of Coronary Lesions and Delta High-sensitivity Troponin (hs-cTn) I Levels in Patients of Non-ST Elevation Myocardial Infarction

Non-ST Elevation Myocardial Infarction is a critical condition where early identification of myocardial injury is essential for risk stratification and treatment. High-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for detecting myocardial damage. Objectives: To assess the association between Syntax scores and initial significant delta hs-cTnI in patients who had been hospitalized with Non-ST Elevation Myocardial Infarction. Methods: Observational cohort study from January 2022 to December 2022 involving a total of one hundred and fifty patients admitted at Hayatabad Medical Complex Peshawar. hs-cTnI on admission and at 1, 2 hours and between (6h-12 h) post-admission daily was measured. Coronary lesion complexity was assessed with Syntax scores according to the results of coronary angiography. Statistical Analysis of data was performed using Pearson correlation to analyze the association between syntax scores delta hs-cTnI levels. Results: SYNTAX scores were correlated with Δhs-cTnI levels at all-time points, and the strongest correlation was found 6-12 hours post-admission (r=0.78). The syntax score had a mean value of 24.11 ± 14.74, and hs-cTnI levels increased over time to reflect the extent of myocardial injury. Conclusions: It was concluded that in Non-ST Elevation Myocardial Infarction patients, Syntax scores demonstrating more complex coronary lesions are related to higher delta hs-cTnI levels. This value highlights the use of hs-cTnI as a biomarker to evaluate the severity of myocardial injury and direct clinical decision-making in Non-ST Elevation Myocardial Infarction. Delta hs-cTnI measurements in diagnostic and risk stratification algorithms may lead to enhanced early identification of disease with improved outcomes.