Complication Of Percutaneous Coronary Intervention Research Articles

Study of Risk Factors and Applicability of Mehran Risk Score in Predicting Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention Patients – A Prospective Observational Cohort Study

Background: Contrast induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN and applicability of Mehran risk score (MRS) in Indian population. Methods: A total number of 432 patients were enrolled in the study. Patients of age ≥ 18 years with known CAD, ACS who underwent PCI were included. Patients were followed for development of CIN. Results: Mean eGFR of 88.4 + 30.65 ml/min/1.73 m2 and mean contrast volume usage of 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (p 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), contrast volume (0.155) were not associated with development of CIN whereas, smoking (0.021), hypotension (<0.001), heart failure (<0.001), anemia (0.001) and median eGFR (p < 0.001) were significantly associated with development of CIN. The incidence of CIN was 2.7 fold higher (OR : 2.68, 95% CI : 1.299-5.540, p = 0.008) in the intermediate group (MRS 6-10), 5.4 fold higher (OR : 5.403, 95% CI : 2.249-12.978, p <0.001) in the high risk group (MRS 11-15) and 51 fold higher (OR : 51.059, 95% CI : 18.195-143.278, p <0.001) in the very high risk groups (MRS > 16) when compared to the low risk group (MRS < 5) respectively. Conclusions: The incidence of CIN in the very high risk group (MRS > 16) was substantially higher in our study (77.8 %) as compared to same group in Mehran study (57.3 %).

A Nomogram for Predicting In-Stent Restenosis Risk in Patients Undergoing Percutaneous Coronary Intervention: A Population-Based Analysis.

ObjectiveIn-stent restenosis (ISR) is a fatal complication of percutaneous coronary intervention (PCI). An early predictive model with the medical history of patients, angiographic characteristics, inflammatory indicators and blood biochemical index is urgently needed to predict ISR events. We aim to establish a risk prediction model for ISR in CAD patients undergoing PCI.MethodsA total of 477 CAD patients who underwent PCI with DES (drug-eluting stents) between January 2017 and December 2020 were retrospectively enrolled. And the preoperative factors were compared between the non-ISR and ISR groups. The least absolute shrinkage and selection operator (LASSO) and multi-factor logistic regression were used for statistical analysis. The prediction model was evaluated using receiver operator characteristic (ROC) analysis, the Hosmer–Lemeshow 2 statistic, and the calibration curve.ResultsIn this study, 94 patients developed ISR after PCI. Univariate analysis showed that post-PCI ISR was associated with the underlying disease (COPD), higher Gensini score (GS score), higher LDL-C, higher neutrophil/lymphocyte ratio, and higher remnant cholesterol (RC). The multi-factor logistic regression analysis suggested that remnant cholesterol (odds ratio [OR] = 2.09, 95% confidence interval [CI] [1.40–3.11], P < 0.001), GS score (OR = 1.01, 95% CI [1.00, 1.02], P = 0.002), medical history of COPD (OR = 4.56, 95% CI [1.98, 10.40], P < 0.001), and monocyte (OR = 1.30, 95% CI [1.04, 1.70], P < 0.001) were independent risk factors for ISR. A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P = 0.609), discrimination (area under ROC curve was 0.847), and clinical usefulness by decision curve analysis.ConclusionPatients with certain preoperative characteristics, such as a history of COPD, higher GS scores, higher levels of RC, and monocytes, who undergo PCI may have a higher risk of developing ISR. The predictive nomogram, based on the above predictors, can be used to help identify patients who are at a higher risk of ISR early on, with a view to provide post-PCI health management for patients.

Coronary artery perforation after bioresorbable scaffold implantation treated with a new generation covered stent\u2014OCT insights

BackgroundCoronary artery perforation is a rare but potentially lethal complication of percutaneous coronary intervention (PCI) with an associated mortality of 7–17%. We report the case of coronary artery perforation complicating Absorb bioresorbable vascular scaffold (BVS) implantation and the associated technical challenges with managing this life-threatening complication.Case reportA 46-year-old male was referred to our institution and underwent PCI with an Absorb bioabsorbable vascular scaffold (BVS) to a proximal LAD long segment bifurcation lesion. Following pre-dilation and deployment of the 3.5 × 28 mm Absorb BVS, high pressure post-dilation of the distal scaffold was complicated by a large, Ellis type III coronary perforation with no flow to the distal LAD beyond the rupture, and associated with a large pericardial effusion confirmed on bedside transthoracic echocardiogram (TTE). The insult was temporised with prolonged balloon inflation within the Absorb BVS immediately proximal to the site of perforation, permitting urgent insertion of a pericardial drain. After deflation of the balloon, a 3.0 × 21 mm BeGraft covered stent was deployed across the perforation, restoring normal LAD flow and abolishing the perforation. Cardio-pulmonary resuscitation was not required and the patient remained conscious throughout the procedure. TTE demonstrated normal left ventricular function and the patient was discharged 3 days later. Repeat angiography at 3 months showed patent stents with TIMI III flow, and optical coherence tomography (OCT) showed good expansion and apposition of the proximal Absorb BVS and BeGraft. The patient has remained well 4 years after PCI with no major cardiovascular events.ConclusionThe utility of bioresorbable scaffold technology remains controversial although meticulous implantation techniques are associated with improved clinical outcomes. Adoption of the Pre-dilatation, Sizing and Post-dilatation (‘PSP’) method of BVS implantation with routine aggressive vessel preparation and scaffold optimization however may contribute to a higher risk of vessel perforation. The case emphasises the importance of accurate sizing of the vessel with intracoronary imaging and demonstrates the value of newer generation covered stents with single-layer design and slimmer crossing profile producing improved deliverability and procedural success.

Risk factors for acute renal injury caused by contrast media after percutaneous coronary intervention and coronary angiography: A protocol for systematic review and meta-analysis.

Background:Contrast-induced acute kidney injury (CI-AKI) caused by contrast medium is one of the common complications of percutaneous coronary intervention (PCI)/coronary angiography (CAG). Early identification of the risk factors of CI-AKI in patients with PCI/CAG and help clinical staff to prevent and intervene as soon as possible is very important to improve the clinical outcome of patients. Although domestic and foreign scholars have studied and summarized the risk factors of CI-AKI in PCI/CAG, the conclusions are not the same. Therefore, in this study, meta-analysis was used to summarize the risk factors of CI-AKI in patients with PCI/CAG, and to explore the characteristics of high-risk groups of CI-AKI, to provide reference for early identification and prevention of clinical doctors and nurses.Methods:We will search related literature of PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Eligible studies will be screened based on inclusion criteria, and data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager version 5.3 software will be used for data analysis. Each process is independently conducted by 2 researchers, and if there is any objection, it will be submitted to the third researcher for resolution.Results:We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.Conclusions:The results of this analysis can be used to generate a risk prediction model and provide an intervention strategy for the occurrence of CI-AKI in PCI/CAG.

Optical coherence tomography versus angiography to guide percutaneous intervention: a real-world single center propensity-matched analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Optical coherence tomography (OCT) with its superior resolution has several benefits over coronary angiography (CA) to guide percutaneous coronary intervention (PCI). Despite the benefits of OCT in comparison with angiography, it is not widely used in developing countries like India data is limited in India specifically in all comer population to meet unmet need. Objective Here we aim to determine the clinical efficacy and safety outcomes of OCT versus CA alone in guiding PCI in all-comer patients. Methods This was a retrospective study which included 434 all comer patients which were propensity matched. These patients underwent PCI at our center between December 2018 and June 2020. The primary endpoint was MACE, a composite of cardiovascular death, repeat revascularization, stent thrombosis, recurrent ischemia and target vessel myocardial infarction (TV-MI) at 6 months. Secondary endpoint was target lesion failure (TLF), composite of stent thrombosis and in-stent restenosis. Safety endpoints were post-PCI s. creatinine and hospital stay and other outcome includes post PCI rise in CK-MB. Results A total of 217 patients were included in each group: the OCT group and conventional angiography guided PCI (angio group) after propensity matching. Compared to angio group, patients presenting with unstable angina, NSTEMI were significantly higher in the OCT group (55.7% vs 43.3%, p = 0.0095; 17.5% vs 10%, p = 0.02, respectively) while patients with STEMI were significantly low in the OCT (23.5% vs 41.5%, p = 0.00005). Number of balloons, maximum balloon size and left main interventions and contrast volume were more in OCT group than angio group (4.21 ± 1.67 vs 3.86 ± 1.76, P= 0.0034; 3.77 ± 0.63 mm vs 3.51 ± 0.52 mm,P &amp;lt; 0.0001; 24.52% vs 13.36 %,P = 0.003 and 202.53 ± 73.15 ml vs 161.91 ± 69.23 ml, P&amp;lt; 0.0001 respectively). The incidence of MACE at 6 months was numerically lower in the OCT group vs angio group but the difference was not statistically significant (15 [6.9%] vs 21 [9.7%]; p = 0.2964). No cases of TV-MI, TLF (stent thrombosis or in-stent restenosis) is observed in both the groups. Post procedure rise in CKMB was more in Angio group in comparison to OCT group (6.16 ± 31.28 ng/ml vs 39.5 ± 108.71 ng/ml, p &amp;lt; 0.001). Optimal stent expansion (&amp;gt;80%) was seen in 71.5% patients in post OCT-guided PCI. In OCT guided PCI group, OCT identified stent underexpansion in 28.5%, stent malapposition in 3.7%, stent edge dissection in 4.1%, and tissue prolapse in 10% of the patients. Conclusion In this large retrospective study, OCT guided PCI is feasible and OCT-guided PCI has tendency to improve clinical outcomes at six months follow up compared to conventional angiography guided PCI in all comer patients. Abstract Figure. central illustration Abstract Figure. Identification of PCI complications

Association of serum laboratory parameters with periprocedural myocardial infarction after a primary percutaneous coronary intervention.

Periprocedural myocardial infarction (PMI) is one of the mortality-related complications of percutaneous coronary intervention (PCI) and significantly affects short- and long-term adverse outcomes and immediate cardiovascular events. Our present study aimed to evaluate the association of preprocedural serum laboratory parameters and PMI in patients who received primary PCI and attempted to provide detailed data on the predictors of PCI-related PMI. A total of 1184 consecutive coronary artery disease (CAD) patients who received primary and elective PCI between July 2015 and June 2017 were included and divided into control group and PMI group. The data of serum laboratory parameters were collected from the electronic database of Meizhou People's Hospital. The results indicated that preprocedural fasting blood glucose were higher in PMI group compared with the control group (p < .001). Patients with prior hyperlipidemia were more likely to have experienced PCI-related PMI (p = .018) and the preprocedural level of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein B (Apo B), and LDL-C/high density lipoprotein cholesterol (HDL-C) were significantly enhanced in PMI group (p < .001). Multivariate regression analysis revealed that preprocedural fasting blood glucose > 6.11mmol/L (p < .001, OR = 1.949, 95% CI: 1.444-2.630) and LDL-C levels ≥130mg/dL (p = .005, OR = 1.941, 95% CI: 1.217-3.098) independently predicted PCI-related PMI. Our results indicated preprocedural fasting blood glucose >6.11mmol/L and LDL-C levels ≥130mg/dL may be useful predictors for PCI-related PMI. The study may provide a detailed data on the predictors of PCI-related PMI.

Incidence, Risk Factors, and Prognosis of Cholesterol Crystal Embolism Because of Percutaneous Coronary Intervention

Cholesterol crystal embolism (CCE) is a rare but serious complication of percutaneous coronary intervention (PCI). However, its incidence, risk factors, and prognosis in the contemporary era are not well known. We included 23,184 patients who underwent PCI in our institution between January 2000 and December 2019 in this study. The diagnosis of CCE was made histologically or by the combination of cutaneous signs and specific blood test results. In patients with CCE, we evaluated the incidence, risk factors, and prognosis. A total of 88 patients (0.38%) were diagnosed with CCE. The incidence of CCE seemed to decline through the investigated 20 years. Positive predictors of CCE were age ≥70 years (68% vs 59%, p=0.012), aortic aneurysm (23% vs 7.2% p <0.001), and a femoral approach (71% vs 45%, p <0.001), whereas a negative predictor of CCE was the use of an inner sheath (63% vs 77%, p <0.001). The rate of 1-year mortality and the requirement for chronic hemodialysis within 1 year after PCI in patients with CCE were 10% and 11%, respectively. The use of an inner sheath and a nonfemoral approach was associated with a lower incidence of CCE. In conclusion, because the prognosis of patients with CCE is still poor, preprocedural identification of high-risk patients and selection of low-risk procedures could be important for preventing CCE.

Mycotic coronary aneurysm: A rare complication of percutaneous coronary intervention

Coronary artery aneurysms are extremely rare, major causative factors associated with this condition are atherosclerosis, trauma, connective tissue disorders, vasculitis, idiopathic, mycotic, and congenital. We present a case of a 49-year-old male who underwent primary angioplasty for acute ST-elevation myocardial infarction and presented with chest pain, fresh ST elevation, and fever after 10 days of the index procedure. The patient was suspected to have subacute stent thrombosis along with some infective pathology. However, work up did not reveal any systemic localization, and blood cultures were negative. Coronary angiogram showed aneurysm of the left anterior descending artery (LAD) with Grade 3 thrombus in the proximal part of stent with thrombolysis in myocardial infarction (TIMI) II antegrade flow. A two-dimensional echo revealed mild left ventricular dysfunction with moderate pericardial effusion. Cardiac positron emission tomography scan confirmed the suspicion of a stent-related mycotic aneurysm. Therefore, the patient was managed with intravenous antibiotics, antiplatelets, and low-molecular-weight heparin, followed by newer oral anticoagulants.

Clinical impact of noncontrast percutaneous coronary intervention in patients with acute coronary syndrome.

Contrast-induced acute kidney injury (CI-AKI) is one of the common serious complications of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to assess the significance of noncontrast strategy in the setting of ACS. CI-AKI was defined as an increase in serum creatinine of ?0.5 mg/dL or ?1.25 times from the baseline. One-year worsening renal function (WRF) was defined as an increase of ?0.3mg/dL in serum creatinine from the baseline after PCI. Of 250 ACS patients, 81 were treated with noncontrast PCI. The average doses of contrast medium in the noncontrast and conventional groups were 17 (9?22) ml and 150 (120?200) ml, respectively. CI-AKI was observed in 4 patients (5%) in the noncontrast group and 29 patients (17%) in the conventional group. Noncontrast PCI was associated with a lower incidence of CI-AKI (adjusted odds ratio, 0.26;95% confidence interval [CI], 0.08?0.82). The bootstrap method and inverse probability weighting led to similar results. CI-AKI was associated with a higher incidence of 1-year WRF (adjusted hazard ratio, 2.30;95% CI, 1.12?4.69), while noncontrast PCI was not. Noncontrast PCI was associated with the lower incidence of CI-AKI in ACS patients. J. Med. Invest. 69 : 57-64, February, 2022.

Risk factor profile, incidence, and relevance of Mehran risk score to predict contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Background: Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population. Materials and Methods: A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN. Results: The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (&lt;0.001), heart failure (&lt;0.001), anemia (0.001), and median eGFR (P &lt; 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P= 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P &lt; 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P&lt; 0.001) in the very high-risk groups (MRS &gt;16) when compared to the low-risk group (MRS &lt; 5). Dialysis was required only in 2 (3.1%) patients (P &lt; 0.022). Conclusions: The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS &gt;16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).

Patient Radiation Dose for Percutaneous Coronary Intervention by Treatment Area: Dosimetry Using DRLs 2020

Skin injury in patients due to radiation exposure has been a complication in percutaneous coronary intervention (PCI) for a long time. To the best of our knowledge, there have been no reports comparing radiation dose by treatment area with diagnostic reference levels (DRLs) 2020, although the radiation dose varies by treatment area in PCI. In this study, the treatment areas were classified into four segments (i.e., AHA #1-3, AHA #4, AHA #5-10, and AHA #11-15), and each segment was compared with DRLs 2020. This retrospective study included 984 consecutive patients with single-vessel disease and non-chronic total occlusion. PCI was performed on a single device. The median radiation dose was 1640.8 mGy, and the radiation dose for AHA #4 was 2732.0 mGy, which was significantly higher than the other treatment areas (p<0.001). In AHA #4, the radiation dose increased due to the heavy use of the left cranial view, and the patient background contributed to the increased lesion complexity. Therefore, it was challenging to evaluate AHA #4 and the other treatment areas with a uniform DRL value. Establishing a subdivided index for each treatment area is crucial if DRLs are used as a reference during procedures and as a guide for dose optimization.

Management and prognosis of catheter induced aortocoronary dissection: A multicentric observational study

Catheter-induced aortocoronary dissection(CIACD) is a rare but potentially devastating complication of percutaneous coronary interventions(PCI). We aimed to assess the incidence, management modalities and in-hospital outcomes of CIACD. This was a retrospective multicentric observational cohort from the national PCI registry. Dissections were defined using the NHLBI classification. The primary endpoint was the occurrence of in-hospital Major Adverse Cardiovascular Events(MACE): a composite clinical criterion including in-hospital cardiac death(CD), heart failure and post-procedural myocardial infarction(MI). Between 2011 and 2020,75556 PCI were performed. We identified 68 patients(0.09%) with CIACD. The mean age was 60 ± 11 yrs and the sex ratio was 1,7. The radial approach was predominant(58,8%). Judkins left and Judkins right catheters caused CIACD in respectively 33,8% and 35,3% of the population. 6 patients had previously normal coronary arteries. CIACD was located at the left main coronary artery in 55,9%. The majority of CIACD was Type C(39,7%). Associated aortic dissection (AAD) was observed in 6 patients (8,8%). Management modalities consisted mainly of immediate stenting of the dissection(75%), however, 16 operators (23,7%) preferred initial medical treatment. Dissections disappeared in 15 patients. 30% of PCI were performed by fellows. 10 patients (14,7%) presented in-hospital MACE. In hospital CD and post-procedural MI occurred in 4,4% and 7,4% of the population. Multivariate analysis showed that left dominance angiogram HR = 12[1,03-142] P= 0,013, AAD HR = 41[1,13-1555] P = 0,047 and procedure complications HR = 13[1,43-130] P = 0,023 were predictive of In-hospital MACE. The management of CIACD is still challenging. Our study was one of the largest series showing that stenting is the main treatment of CIACD; however selective patients who have been treated medically had a good clinical and angiographic evolution.

External Multicenter Validation of the Mehran Risk Score for Contrast Induced Acute Kidney Injury

Contrast induced acute kidney injury (CIAKI) is a known complication of percutaneous coronary intervention (PCI). Mehran Risk Score (MR score) has been previously shown to predict CIAKI, renal replacement therapy (RRT), and one-year mortality in patients undergoing PCI. The purpose of our study was to externally validate the MR score.

736 Hazy spots: through the eye of optical coherence tomography

Abstract Aims Acute stent thrombosis after coronary artery stent placement is a rare but serious complication in percutaneous coronary intervention (PCI). Stenting culprit lesions in acute coronary syndrome (ACS) has higher risk of acute stent thrombosis than stable coronary artery disease, and many local and systemic factors may contribute to increase this risk. Tissue protrusion (TP), and in particular, plaque prolapse after PCI can play a role in acute stent thrombosis, and intra-vessel imaging is the principal instrument to identify such underlying lumen alteration after stent implantation, and guide intervention. Methods and results We report the case of a 54-year-old man with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, obesity and no other relevant comorbidities in remote history, who underwent a coronary angiography for an unstable angina. A long, calcific sub-occlusion of the left anterior descending artery (LAD), which involved LAD-first diagonal branch (D1) bifurcation (Medina 1.1.1) and LAD-D2 bifurcation (Medina 1.1.0) was found. After deployment of two overlapping drug-eluting stents (DES), (ULTIMASTER TANSEI 3.0 × 38 mm and 3.0 × 21 mm) and struts apposition optimization with sequence of proximal optimization technique (POT) on D1 and D2, and a kissing balloon technique (KS) on LAD-D2 bifurcation, a ‘hazy’ in-stent image was detected right after the LAD-D2 bifurcation, suggesting an acute in-stent thrombosis, in absence of flow alteration (TIMI 3), symptoms or ECG modifications. Multiple thrombus-aspiration were made and resulted in abundant thrombus removal and improvement in the angiographic image, with persistent valid flow on every three vessels (TIMI 3). After 5 days of triple anticoagulant therapy with ticagrelor, cardioaspirin and UFH infusion, he underwent a new coronary angiography control. A similar ‘hazy’ image was detected right after LAD-D2 bifurcation within the LAD. An optical coherence tomography (OCT) pullback was made to assess the nature of the angiographic finding. OCT showed good struts apposition in almost every cross-sectional images, but an evident TP was detected right on the angiographic hazy spot. OCT allowed to evaluate the lipid-richness of the stented plaque and the nature of the TP, which was mixed with evident both white and red thrombus apposition (minimum luminal area measured 4.5 mm2). OCT guided a new PCI, with a stent-in-stent implantation on LAD. TP was absent on the post-PCI OCT run. Conclusions In this report, we showed the usefulness of OCT in revealing a potential high risk thrombogenic source. OCT not only characterized something that angiography alone couldn’t, but suggested the etiology of the amount of thrombus removed by the vessel during the first PCI. Indeed, despite an optimized cycle of anticoagulant therapy, OCT still revealed several mixed thrombus apposition on the TP, and this suggested its role in the acute stent thrombosis. OCT guided the choice to appose a new stent-in-stent to solve a potential thrombogenic source.

Hybrid coronary revascularization versus percutaneous coronary intervention: A systematic review and meta-analysis.

Hybrid coronary revascularization (HCR) is an emerging approach for multivessel coronary artery disease (MVD) which combines the excellent long-term outcomes of surgery with the early recovery and reduced short-term complications of percutaneous coronary intervention (PCI). Here, we evaluated the effectiveness of HCR compared to PCI in patients with MVD. A systematic database search in PubMed/MEDLINE, Embase, Scopus, and CENTRAL/CCTR was conducted by June 2021. Random-effects meta-analysis was performed, comparing major adverse cardiac and cerebrovascular events (MACCE) at 30days and at latest follow-up between patients undergoing HCR versus PCI. A total of 27,041 patients (HCR: 939 patients, PCI: 26,102 patients) were included from seven studies published between 2013 and 2021. At latest follow-up, HCR was associated with lower rates of myocardial infarction (OR 0.40, 95% CI 0.20-0.80, p=0.010) and target vessel revascularization (OR 0.49, 95% CI 0.37-0.64, p<0.001), while the difference for MACCE did not reach statistical significance (OR 0.46, 95% CI 0.20-1.05, p=0.061). No differences were observed in terms of 30-day outcomes, nor rates of mortality or stroke at latest follow-up. HCR might be a valid alternative to multivessel PCI, demonstrating a lower incidence of MI and TVR. Center experience, well-coordinated heart team discussions, and good patient selection likely remain essential to ensure optimal outcomes. Future comparative studies are required to define the optimal target population.

C58. Management of Ellis Type V RV Branch Coronary Perforation Using Handmade Covered-stent: a case report

Abstract Coronary perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI) requiring urgent management including balloon inflation, thrombin, microcoils, fat embolization, autologous blood clots administration, heparin-reversing agent, covered-stent implantation, or surgery. We report a case of Ellis type V RV branch coronary artery perforation during PCI treated with a handmade covered-stent. A 69-year-old female presented with typical angina in three days. She was hemodynamically stable and no sign of congestion. Laboratory results showed leukocytosis, mild elevation of liver transaminase, elevated CK-MB level, mild hypoalbuminemia. ECG showed sinus rhythm with atrial bigeminy, late-onset inferoposterior and RV MI, and first-degree AV block. TTE revealed reduced LV systolic function (LVEF 45%), impaired LV relaxation, reduced RV function, marked LV hypokinetic in inferior, inferoseptal, apicoseptal, and inferolateral wall, and mild ischemic mitral regurgitation. DCA result showed 90 – 95% tubular stenosis in mid-LAD and total occlusion in proximal-RCA with grade V thrombus. She had an anomaly of RV branch angle that resembles the RCA so that the guidewire perforated the distal part of the RV branch artery. PCI was done using hydrophilic wire to distal RCA. Ellis type V perforation was found following multiple balloon inflation in RV branch. Perforation was managed with a handmade covered-stent using a Sirolimus-eluting stent with Tegaderm film. TIMI flow 3 was reached without thrombi or residual stenosis. In medical centers that have limited resources, handmade covered-stents can be used as an option after unsuccessful balloon inflation trial.

C58. Management of Ellis Type V RV Branch Coronary Perforation Using Handmade Covered-stent: a case report

Abstract Coronary perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI) requiring urgent management including balloon inflation, thrombin, microcoils, fat embolization, autologous blood clots administration, heparin-reversing agent, covered-stent implantation, or surgery. We report a case of Ellis type V RV branch coronary artery perforation during PCI treated with a handmade covered-stent. A 69-year-old female presented with typical angina in three days. She was hemodynamically stable and no sign of congestion. Laboratory results showed leukocytosis, mild elevation of liver transaminase, elevated CK-MB level, mild hypoalbuminemia. ECG showed sinus rhythm with atrial bigeminy, late-onset inferoposterior and RV MI, and first-degree AV block. TTE revealed reduced LV systolic function (LVEF 45%), impaired LV relaxation, reduced RV function, marked LV hypokinetic in inferior, inferoseptal, apicoseptal, and inferolateral wall, and mild ischemic mitral regurgitation. DCA result showed 90 – 95% tubular stenosis in mid-LAD and total occlusion in proximal-RCA with grade V thrombus. She had an anomaly of RV branch angle that resembles the RCA so that the guidewire perforated the distal part of the RV branch artery. PCI was done using hydrophilic wire to distal RCA. Ellis type V perforation was found following multiple balloon inflation in RV branch. Perforation was managed with a handmade covered-stent using a Sirolimus-eluting stent with Tegaderm film. TIMI flow 3 was reached without thrombi or residual stenosis. In medical centers that have limited resources, handmade covered-stents can be used as an option after unsuccessful balloon inflation trial.

Extremely Late Stent Thrombosis in a First Generation Drug- Eluting Stent 10 Years After Stent Deployment: A Case Report

Stent thrombosis is one of the gravest complications of percutaneous coronary intervention which usually manifest as ST-segment elevation myocardial infarction or sudden death. There are a very few case reports in the literature regarding extremely late stent thrombosis in a drug-eluting stent. Here we report a case of extremely late stent thrombosis in a first generation drug-eluting stent in a 54 year old gentleman. To the best of our knowledge, this is the first case report with the longest duration (10 years) after sirolimus eluting first-generation DES in Bangladesh. Bangladesh Heart Journal 2021; 36(2): 164-168

Stent-graft and double-guiding catheter technique to rescue iatrogenic coronary perforation.

IntroductionCoronary artery perforation (CAP) is an infrequent, yet life-threatening complication of percutaneous coronary interventions, posing a major risk of cardiac tamponade and mortality.MethodsWe report on effective management of Ellis type III CAP with use of double-guiding catheter technique and stent-graft implantation.ResultsProlonged balloon inflation via the first guiding catheter allows for temporary closure of the bleeding site. At the same time, stent-graft is inserted via the second guiding catheter to seal the perforation. After rapid deflation of the balloon, the stent is immediately advanced and expanded.ConclusionsThe procedure minimises the time between deflation of the balloon and implantation of the stent-graft, allowing for successful bleeding cessation.

Multi-Center, Prospective, Nation-Wide Coronary Angioplasty Registry in Thailand (Thai PCI Registry): Registry Design and Rationale

Background: Coronary artery disease (CAD) is one of the most common causes of death worldwide. Percutaneous coronary intervention (PCI) is currently the main revascularization modality for these patients. The practice of PCI, outcomes and resource utilization varies in many parts of the world. Therefore, it is important to have local information regarding the patient demographics, pattern of PCI practice, and outcomes. Objective: To report the study design, protocol and rationale of the Thai PCI registry. Materials and Methods: Thai PCI Registry is a prospective, multi-center study which is an initiative project of the Cardiac Intervention Association of Thailand (CIAT). The study consisted of phase I for cross-sectional data registry and phase II for follow up study. The project was started in November 2015. All catheterization laboratories in Thailand were invited to participate in this nationwide registry. The details regarding patient characteristics, procedural details, equipment, and outcomes of PCI were prospectively collected using well-constructed case record form. The protocol of the registry has been approved by the Central Research Ethics Committee (CREC). The project received a research grant from the Health System Research Institute, The Ministry of Public Health, in Thailand, March 2017. Results: There were 39 hospitals from all areas of the country participated in the registration. The hospital type and size were varied and well represented of the PCI centers in Thailand. The registry planned to enroll all consecutive PCI patients at each hospital for approximately one year with the estimated number of PCI at 22,000 procedures. Initially, all patients were followed up for at least 6 and 12 months. Conclusion: The present study provides rationale, protocol, definition and study design of Thai PCI registry. The results of the Thai PCI registry would yield the essential information regarding the current real-world practice as well as the results and complications of PCI. Keywords: Coronary angioplasty; Nationwide registry; Percutaneous coronary intervention; Thailand; Real-world