Coronary Dissection Research Articles

Abstract 11111: In-Hospital Outcomes of Coronary Atherectomy in Teaching vs Non-Teaching Hospitals

INTRODUCTION: Studies have analyzed contemporary data on outcomes at teaching vs non-teaching hospitals with the results found to be dissimilar in certain procedures in the United States. Coronary Atherectomy (CA) is a minimally invasive procedure that involves the opening of obstruction from heavily calcified blocked coronaries to improve blood flow to the heart. This study is set out to examine the differences in health care outcomes between teaching and non-teaching hospitals in patients who underwent CA using a nationally representative sample. METHODS: We reviewed data from the National Inpatient Sample (NIS) of patients admitted between 2016-2019. Using ICD-10 procedural codes, we identified patients who underwent CA (Rotational or Orbital) within the study period. We further categorized our study population into 2 groups based on teaching vs non-teaching status. Multivariate analysis was done to investigate the in-hospital outcomes between both groups and adjust for confounders. RESULTS: A total of 171,740 CA procedures were performed within the study period. 75% (129,585) vs 25% (42,155) of these procedures were performed in teaching vs non-teaching hospitals respectively. The mean age of patients who underwent the procedure was 65 years, with a higher preponderance in males (71.4%). There was no significant difference in in-hospital mortality in both groups (AOR 1.06, 95% CI 0.93 -1.21, p=0.372). There was also no observed difference in the odds of coronary perforation or cardiac tamponade (AOR 1.26, 95% CI 0.89-1.28 p=0.19) and (AOR 1.23, 95% CI 0.82-1.87, p=0.31) respectively. However, the teaching hospital groups had an increased odds of Coronary dissection (AOR 1.34, 95% CI 1.05 - 1.71, p=0.017) and heart Block (AOR 1.22, 95% CI 1.11-1.34, p< 0.001). We also noticed an increased odds of septic shock (AOR 1.24, 95% CI 1.05-1.80, p= 0.018), AKI (AOR 1.12, 95% CI 1.07-1.22, p=0.005) and a higher hospitalization duration (Adjusted coefficient 0.43, 95% CI 0.30-0.56, p< 0.001) in the teaching hospital group . CONCLUSION: CA performed at teaching hospitals is found to be associated with an increased risk of cardiac (coronary dissection and heart block) and non-cardiac (septic shock and AKI) outcomes.

Diffi culties in diff erential diagnosis of the etiology of STEMI in the early postpartum period

Objective. A clinical case of a 38-year-old female patient with STEMI in the early postpartum period describes the complex issues of diff erential diagnosis with imaging methods application. Results. During the patient’s fi rst hospitalization with STEMI, additional intravascular imaging techniques such as intracoronary ultrasound and/or optical coherence tomography, could help to determine the nature and signifi cance of the coronary lesion. Due to the inability to perform IVUS and OCT, we performed a coronary angiography. According to the results, there were no obvious signs of coronary dissection. Using additional intravascular imaging techniques, we might have obtained diff erent results and would have chosen a diff erent tactic of treatment.Conclusion. The case described indicates the need for a comprehensive diagnosis of MI in women in the postpartum period.

Assessment of the Role of NonTraditional Risk Factors on Spontaneous Coronary Artery Dissections

Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have assumed increasing interest. Aim: To assess NT-RF in the Parma SCAD registry population. Methods: 62 patients with SCAD, enrolled between January 2013 through November 2021, were divided in two groups: NT-RF (n=51) and T-RF (n = 11). Clinical, echocardiographic and angiographic features were compared between the two study populations; finally, the occurrence of major adverse cardiovascular events was assessed at follow-up. Results: At least one NT-RF among sex related, sex prevalent and gender specific risk factors was present in 82% of patients, while TRF for atherosclerotic disease were less common with hypertension being the most prevalent (40.3%) and diabetes the most seldom (3.2%). Patients with NT-RF were significantly younger (p=0.027) and mostly female compared to those without NT-RF (p=0.004). Type 2 (second Yip/Saw classification) dissection was the prevailing phenotype (54.8%) with a higher prevalence in the NT-RF group (63%, p=0.035). Major Adverse Cardiovascular Events (MACEs) occurred in 17.7% in all patients at a median follow-up of 23 months. When comparing the incidence of cardiovascular events in the 2 study groups, we did not find any significant differences (p=0.4) between groups. Conclusion: SCAD occurs more often in younger women without the traditional RF. Risk estimation does not include these factors and tailored prediction models are lacking. Clinicians and researchers should establish targeted interventions for primary prevention, early diagnosis and secondary prevention in younger women.

Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis.

Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.

Rotational atherectomy: assessment of the effectiveness and safety

Abstract Background Rotational atherectomy (RA) enables percutaneous coronary intervention (PCI) for complex and calcified coronary lesions, despite limited data regarding long-term outcomes. Purpose We aimed to characterize success rate, safety, and long-term outcomes with this technique in a single-centre with over a decade of experience. Methods We retrospectively analysed all cases of RA performed in a single-centre between January 2009 and December 2020. Angiographic success was defined as the presence of less than 30% residual stenosis and grade 3 TIMI (thrombolysis in myocardial infarction) flow. Complications included coronary perforation or dissection, burr entrapment, wire fracture, slow flow/no-reflow, side branch occlusion, peri-procedural myocardial infarction (MI), or death. Long-term major adverse cardiovascular (CV) events (MACE) included CV and all-cause death, MI, and target vessel revascularization. Results Of the total of 14,527 PCI performed, 410 procedures (2.8%) included RA. Most patients were male (74.0%) with mean age of 72.3±9.3 years. There was high prevalence of hypertension (85.65%) and dyslipidaemia (74.2%) which increased significantly over time (p trend=0.008 and p trend<0.001, respectively). One-third presented with acute coronary syndrome, most patients had multivessel disease (38.4% two-vessel, 32.7% three-vessel), and 12.2% had significant left main disease. Over time there was an increase in disease complexity, reflected by the proportion of type B2/C lesions (p trend =0.003) and median SYNTAX score (p trend =0.003). The utilization of transradial access increased over time (p trend =0.003) and maximum burr size was ≤1.50 mm in most cases (88.0%), with smaller sizes over time. Overall angiographic success rate was 96.6% without significant variation over time while complications (9.0%) showed a temporal decline (p trend=0.029) (Figure 1). Most frequent complications were coronary dissection (n=17) and burr entrapment (n=6). After a median follow-up of 40 (16–76) months, MACE occurred in 27.7% of patients, mainly due to CV death. At one year of follow-up, MACE, all-cause mortality and target vessel revascularization occurred in 12.1%, 6.4%, and 5.6%, respectively, without variation over time. Conclusions RA is an effective and safe technique, with a declining rate of peri-procedural complications along with technical developments. The rate of long-term events is concordant with the CV risk profile and coronary lesion complexity. Funding Acknowledgement Type of funding sources: None.

Spontaneous coronary artery dissection: current evidence from cardiac magnetic resonance and angiography screening

Abstract Purpose To assess the distribution and extent of myocardial infarction, as well as possible clinical significance of peripheral arteriopathy screening in a cohort of patients presented with spontaneous coronary dissection (SCAD) using cardiovascular magnetic resonance (CMR) for cardiac and vascular imaging. The adverse CMR features and predictors of infarction in subgroup analysis were also investigated. Methods This is an observational, single centre study of 144 consecutive, angiographically confirmed SCAD survivors >18 years old, based on collected data from Jan 2008-Nov 2020. All scans were performed on a 1.5-Tesla scanner. Cardiac structural and functional indices, myocardial infarct size and distribution were evaluated. In addition, vascular imaging was performed in all patients for thoracic aorta screening as part of the routine protocol, and in 75 patients peripheral arteriopathy screening from Circle of Willis to the iliac arteries was performed using 2D multi-slice and cine imaging, as well as 3D imaging methods. Results In the total population, 64% had infarction. Infarct size (%) was predictive of reduced left ventricular ejection fraction (LVEF) (p<0.001) and increased diastolic volumes (p<0.001 for both). Logistic regression showed SCAD in right coronary artery (Odds Ratio (OR): 5.2, p=0.034) predicted the presence of infarction. In the group who also underwent peripheral vascular screening, the overall prevalence of extra-coronary arteriopathy was 27% with fibromuscular dysplasia accounting for one-fourth of the cases (Figure 1). Of note, most positive vascular screening patients (73.3%) exhibited infarction (OR: 7.0, p=0.041), distributed in more than one territory (OR: 4.0, p=0.015) (Figure 2), while infarct size was negatively correlated with LVEF (p<0.001). Right ventricular ejection fraction was significantly reduced in positive screening patients (58.8±7.4 vs. 63.0±8.0, p=0.045). Further subgroup analysis showed pregnancy associated SCAD patients had significantly larger sized infarcts (25.1±6.1 vs. 6.2±0.7%, p<0.001) with reduced LVEF (51.0 vs 63.6±7.6, p<0.001). In logistic regression, this condition also predicted large infarcts >10% (OR: 9.8, p=0.009) in anterior walls (p<0.001). Conclusions Patients with SCAD require careful assessment of myocardial structure, function and characterization of infarction which may reflect the underlying pathophysiology. Extra coronary vascular screening, although not established in clinical practice, seems a rational strategy to potentially identify a subgroup with more severe infarction and likely to have vascular pathology. Funding Acknowledgement Type of funding sources: None.

Non-invasive characterization of pancoronary inflammation by computed tomography angiography in patients with recent spontaneous coronary dissection

Abstract Background Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of myocardial infarction of unclear aethiology. Histopathological analyses have identified increased coronary inflammation in patients with SCAD [1]. Recently the peri-coronary adipose tissue attenuation (PCAT) derived from standard computed tomography angiography (CTA) has been established as a reproducible method for measuring vascular inflammation which enhances risk stratification in patients with coronary atherosclerosis [2]. Purpose To characterize the pancoronary and vessel-specific inflammation by means of CTA-derived PCAT in patients with recent SCAD compared with individuals without prior SCAD. Methods Patients with confirmed SCAD referred to a tertiary center between 2017 and 2021 who underwent CTA as a routine cardiac evaluation were included in this retrospective study. Subjects were matched 1:1 with individuals with no prior SCAD who underwent CTA within the same timespan, using the same scanner and imaging protocol, with coronary arteries free of obstructive disease and similar clinical characteristics (Table 1). PCAT was analyzed on end-diastolic CTA reconstructions with a semi-automated software using standard methodology (Figure 1A) [3]. Proximal 40 mm of all major coronary vessels >2 mm in diameter as well as the SCAD-related vessel were included. The primary outcome was pancoronary PCAT defined as mean PCAT in the right (RCA), left anterior descending (LAD) and circumflex (LCX) artery. Secondary outcome was vessel-specific PCAT defined as PCAT in RCA and averaged PCAT in LAD and LCX (PCAT LCA). Results The final cohort comprised 35 patients with recent SCAD (median 6.1 mo. [4.0–16.8] since SCAD, 94.3% female) and 35 patients in the non-SCAD group. Pancoronary PCAT was higher in patients with SCAD compared with non-SCAD group (−80.1 [IQR: −74.5, −84.6] vs. −83.4 HU [−78.7, −88.0], P=0.008) suggestive of increased coronary inflammation. Vessel-specific PCAT was higher for the RCA (−80.7 [−70.4, −86.9] vs. −85.3 [−80.4, −90.6] HU, P<0.001) and borderline higher for the LCA (−79.2 [−73.9, −83.2] vs. −83.4 [−78.0, −88.3] HU, P=0.056) in patients with SCAD compared with non-SCAD respectively (Figure 1B). In patients with SCAD, PCAT in previously dissected vessel was not significantly different from averaged PCAT in unaffected vessels (−78.4 [−73.7, −89.0] vs. −80.9 [−74.9, −83.3], P=0.77; Figure 1C). While PCAT numerically decreased with time since SCAD, the association was not statistically significant when patients were stratified into tertiles according to time from SCAD (Figure 1D). Conclusions Patients with recent SCAD have higher pericoronary adipose tissue attenuation compared with non-SCAD patients suggesting increased perivascular inflammatory activity. This association is not restricted to the dissected vessel, nor reflected in routine serum inflammatory analysis and persists over time. Funding Acknowledgement Type of funding sources: None.

Practical use of dual-lumen catheter-facilitated reverse wire technique for nonhighly angulated side branch

Dual-lumen catheter (DLC)-facilitated reverse wire technique is considered a method of last resort for inserting a guidewire into a markedly angulated side branch. Moreover, this technique can be practically applied to other types of anatomical variations around the bifurcation. Case 1 was that of a 53-year-old man with a tight stenosis of the proximal left anterior descending artery at the diagonal bifurcation with angiographically apparent coronary dissection. We successfully achieved guidewire insertion into the targeted branch using the DLC-facilitated reverse wire technique. Case 2 involved a 78-year-old man with total occlusion of the mid-portion of the right coronary artery. The guidewire reentry point in the atrioventricular branch was slightly distant from the true distal end of the occlusion. We successfully used the DLC-facilitated reverse wire technique to pass a second guidewire to the posterodescending artery. Case 3 was that of an 80-year-old man whose coronary artery had an aneurysm with severe stenoses at both entry and exit of the aneurysm. We adopted the DLC-facilitated reverse wire technique and easily advanced the guidewire by matching the guidewire advancing path with the direction of the sequential conduit constituted by the coronary aneurysm and stenosis. The timing of decision-making to try the DLC-facilitated reverse wire technique is important. The lesion for which reverse wiring is suitable is usually difficult to be treated with conventional guidewire crossing. We have to promptly judge the validity of applying this technique based on the angiographic findings of targeted lesions and take immediate action to implement this procedure to reduce the procedural time and irradiation dose.

Seasonal Variation in Day-by-Day Home Blood Pressure Variability and Effect on Cardiovascular Disease Incidence.

Although day-by-day home blood pressure (BP) variability (BPV) has been associated with cardiovascular disease (CVD) risk, it remains unclear whether this association differs from season to season. The present study aimed to assess seasonal variation in day-by-day home BP variability and its association with CVD risk. We analyzed the data from a nationwide, prospective observational study, the J-HOP study (Japan Morning Surge-Home Blood Pressure), in which 14 consecutive days of home BP monitoring were conducted. The values of SD (SDsystolic BP [SBP]), coefficient of variationSBP, and average real variabilitySBP of home SBP were used as indices of day-by-day home BPV. Among 4231 participants (mean age, 64.9±10.9 years, 46.7% male, 91.5% hypertensives), all 3 day-by-day home BPV indices were lower in summer than winter after adjusting for confounding factors. In winter, SDSBP, coefficient of variationSBP, and average real variabilitySBP were significantly associated with increased risk of CVD events (coronary artery disease, stroke, heart failure, and aortic dissection; adjusted hazard ratio [95%CI] per 1-SD of SDSBP, 1.26 [1.02-1.54]; coefficient of variationSBP, 1.24 [1.02-1.52]; average real variabilitySBP, 1.44 [1.17-1.77]). These relationships were also observed in the analysis of quartiles of BPV parameters (adjusted hazard ratio [95%CI] compared to the first quartile, fourth quartile of SDSBP 2.26 [1.06-4.85]; coefficient of variationSBP 2.96 [1.43-6.15]; average real variabilitySBP 2.73 [1.25-5.93]). In other seasons, however, there were no significant associations between day-by-day home BPV and CVD event risk. Our findings indicate that day-by-day home BPV measured in winter is more strongly associated with future CVD incidence than that measured in other seasons.

Współwystępowanie zapalenia pęcherzyka żółciowego i zawału serca bez istotnych zwężeń w tętnicach wieńcowych u 65-letniej chorej

Myocardial infarction with nonobstructive coronary arteries (MINOCA), is increasingly recognized as an important and separate cause of myocardial infarction among patients with the acute coronary syndrome (ACS). The dominant pathophysiological mechanisms of MINOCA include coronary pathologies (epicardial spasm, coronary microcirculation disorder, spontaneous coronary dissection, coronary thrombosis/embolism) with the absence of disease with significant angiographic artery stenosis. This study presents a clinical course of myocardial infarction (MI) without significant stenosis in the coronary arteries and cholecystitis, in 65 years old woman, with some risk factors of atherosclerosis (smoking, obesity, atherogenic dyslipidemia, high levels of C-reactive protein, old age and physical inactivity). In the first days, myocardial infarction was complicated by an atrioventricular block. Coronarography revealed no significant stenosis confirming the occurrence of MINOCA.

Effect of Li's catheter in the cardiac resynchronization therapy implantation

Objective: To evaluate the effect of Li's catheter in cardiac resynchronization therapy (CRT) implantation. Methods: This study was a retrospective cohort study. Patients with indications for CRT implantation who visited the Department of Cardiology, Peking University People's Hospital from January 1, 2016 to January 1, 2022 were enrolled. Patients were divided into Li's catheter group (CRT implantation with Li's catheter) and control group (CRT implantation with the traditional method). The general clinical data of the patients were obtained through the electronic medical record system. Li's catheter is a new type of coronary sinus angiography balloon catheter independently developed by Dr. Li Xuebin (patent number: 201320413174.1). The primary outcome was the success rate of CRT device implantation, and the secondary outcomes included efficacy and safety parameters. Efficacy indicators included operation time, coronary sinus angiography time, left ventricular lead implantation time, X-ray exposure time, left ventricular lead threshold, and diaphragm stimulation. Safety outcomes included incidence of coronary sinus dissection, cardiac tamponade, and pericardial effusion. Results: A total of 170 patients were enrolled in this study, including 90 in Li's catheter group and 80 in control group. Age, male proportion of patients, proportion of patients with ischemic cardiomyopathy, hypertension, diabetes mellitus, chronic renal insufficiency, New York Heart Association (NYHA) functional classification, left ventricular ejection fraction, left ventricular end-diastolic diameter, proportion of left bundle branch block, and preoperative QRS wave width were similar between the two groups (all P>0.05). In Li's catheter group, 34 cases (37.8%) implanted with CRT defibrillators, and 28 cases (35.0%) implanted with CRT defibrillators in control group, the difference was not statistically significant (P=0.710). The success rate of CRT device implantation in Li's catheter group was 100% (90/90), which was significantly higher than that in control group (93.8%, 75/80, P=0.023).The operation time was 57.0 (52.0, 62.3) minutes, the time to complete coronary sinus angiography was 8.0 (6.0, 9.0) minutes, and the time of left ventricular electrode implantation was 8.0 (7.0, 9.0) minutes in Li's catheter group, and was 91.3 (86.3, 97.0), 18.0 (16.0, 20.0), 25.0 (22.0, 27.7) minutes respectively in control group, all significantly shorter in Li's catheter group (all P<0.05). The exposure time of X-ray was 15.0 (14.0, 17.0) minutes in Li's catheter group, which was also significantly shorter than that in control group (32.5 (29.0, 36.0) minutes, P<0.001). There was no coronary sinus dissection and cardiac tamponade in Li's catheter group, and 1 patient (1.1%) had diaphragmatic stimulation in Li's catheter group. In control group, 6 patients (6.7%) had coronary sinus dissection, and 1 patient (1.1%) developed pericardial effusion, and 3 patients (3.3%) had diaphragmatic stimulation. The incidence of coronary sinus dissection in Li's catheter group was significantly lower than that in control group (P=0.011). The postoperative left ventricular thresholds in Li's catheter group and control group were similar (1.80 (1.60, 2.38) V/0.5 ms vs. 1.80 (1.60, 2.40) V/0.5 ms, P=0.120). Conclusions: Use of Li's catheter is associated with higher success rate of CRT implantation, short time of coronary sinus angiography and left ventricular electrode implantation, reduction of intraoperative X-ray exposure, and lower incidence of coronary vein dissection in this patient cohort.

Spontaneous coronary artery dissection: update on treatment and strategies to improve the diagnostic and therapeutic pathway

Spontaneous coronary dissection is an infrequent cause of acute coronary syndrome, which has been understood only recently in terms of pathophysiology, presentation, diagnosis and treatment. In particular, new evidence has emerged on its treatment in the interventional and medical fields, especially on the management of antiplatelet therapy, which is presented in this review; moreover, the local experience of the registry of spontaneous coronary dissections DISCO and its role in improving the management of these patients are reported.

Intravascular lithotripsy-assisted PCI for severely calcified coronary lesions: evaluating the impact on quality of life and outcomes.

Despite the increased uptake of intravascular lithotripsy (IVL) for treating severely calcified coronary lesions, there is limited patient-level data examining the effect of IVL on quality of life, symptomatology, and outcomes beyond 30days. We sought to assess demographics, procedural characteristics, outcomes, and impact of IVL on patient-reported angina after a minimum of 6months follow-up. A retrospective single-center study was conducted of patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Technical success and complications were assessed along with clinical outcomes, which included all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and MACE (composite of death, stroke, MI, and TLR). Canadian Cardiovascular Society (CCS) angina classification was assessed at virtual clinical follow-up. Forty-seven consecutive patients were included. At a mean follow-up of 306 ± 74days, the mean CCS angina score was reduced by 53% post-IVL-assisted PCI (2.9 vs 1.4, p < 0.001). Technical and procedural success were high (94% and 92%, respectively). One patient (2%) met the pre-specified criteria for in-hospital MACE and 4 (9%) met pre-specified MACE at follow-up, including 2 deaths and 2 TLR. Procedural complications included coronary dissection (11%) and coronary perforation (6%) and were managed either conservatively or with PCI. Coronary IVL is a safe and effective adjunctive therapy for treating heavily calcified coronary lesions. This cohort shows high procedural success and a significant reduction in CCS angina at follow-up.

Initial Experience With a Novel Sheathless Guiding Catheter (Hyperion SheathLess) for Transradial Coronary Intervention.

The Hyperion SheathLess guiding catheter (Asahi Intecc) is a novel guiding system for transradial percutaneous coronary intervention (PCI). Compared with the previous model (SheathLess Eaucath; Asahi Intecc), improvements achieved with the Hyperion SheathLess catheter are a more flexible tip and a smaller outer diameter of the catheter while maintaining the diameter of the inner lumen. The aim of this study was to report our initial experience with this guiding catheter. A total of 127 consecutive patients undergoing transradial PCI using a 6-Fr Hyperion SheathLess guiding catheter (n = 78) or a 7-Fr catheter (n = 49) were analyzed. Procedural success was 99.2%, with 1 patient (0.8%) requiring conversion to femoral access. No patients were noted to have coronary ostial dissection. Doppler ultrasound examination of the radial artery at 30-day follow-up was available in 111 of 127 patients, with 3 patients (2.7%; all 3 patients in the 7-Fr catheter group) found to have radial artery occlusion. Radial spasm occurred in 3 patients (2.4%; all 3 patients in the 7-Fr catheter group). Forearm hematoma occurred in 10 patients (7.9% total; 4 grade-1 patients [3.2%], 5 grade-2 patients [3.9%], and 1 grade-3 patient [0.8%]). The use of the Hyperion SheathLess guiding catheter for transradial PCI was feasible and associated with a low rate of procedure-related complications, including coronary ostial dissection. This sheathless guiding catheter could be a valuable option to further decrease the risk of procedure-related complications.

The Association of Serum Uric Acid/Albumin Ratio with No-Reflow in Patients with ST Elevation Myocardial Infarction.

The goal of this investigation was to explore the relationship between serum uric acid/albumin ratio (UAR) and no-reflow (NR) in ST elevation myocardial infarction (STEMI) patients (n = 838) who underwent primary percutaneous coronary intervention (pPCI). Angiographic NR was defined as thrombolysis in myocardial infarction (TIMI) flows 0, 1, and 2 in the absence of coronary spasm or dissection. NR developed in 91 (10.9%) STEMI patients. Patients with NR had higher UAR and according to multivariable logistic regression models, a high UAR was an independent risk factor for NR. The area under the curve (AUC) value of the UAR was .760 (95%CI: .720-.801) in a receiver-operating characteristics curve (ROC) assessment. Notably, the UAR AUC value was greater than that of its components: albumin (AUC: .642) and serum uric acid (AUC: .637) (P < .05 for both comparisons). The optimum UAR value in detecting NR in STEMI patients was >1.21 with a sensitivity of 82% and a specificity of 67%. This was the first study to report that the UAR was independently associated with NR in STEMI patients who underwent pPCI.

Clinical Performance of a Paclitaxel Drug-Coated Balloon in Real-World Percutaneous Coronary Intervention Practice: The PEARL Registry.

Randomized controlled trials for in-stent restenosis (ISR) and de novo lesions in small-diameter vessels have shown promising results, but data on DCB use in real-world practice are still scarce. The aim of the PEARL (Paclitaxel-Eluting Angioplasty Balloon in the Real-World) registry was to evaluate the safety and efficacy of a paclitaxel DCB in real-world percutaneous coronary intervention (PCI) practice. Between 2014 and 2019, a total of 513 patients treated with the Protégé paclitaxel DCB (Wellinq) were prospectively included at 4 hospitals in the Netherlands. The primary endpoint was 2-year major adverse cardiac event (MACE), defined as cardiac death, target-vessel myocardial infarction, or target-lesion revascularization (TLR). DCB was used for ISR in 382 patients and for de novo lesions in 131 patients. Acute coronary syndrome was the reason for presentation in 58.9% of patients. At lesion level, 34.1% of lesions were classified as type B2 and 36.1% as type C. Predilation was performed in 62.2% and noncompliant DCB was used in 40.7% of lesions. DCB-related procedural complications were infrequent (3.3%, mostly coronary dissection [2.3%]). Bailout stenting was required in 3.1%. MACE during 2-year follow-up occurred in 17.1% of patients treated for ISR and 9.7% of patients treated for de novo lesions. The incidence of TLR was 11.7% of ISR patients and 2.9% of de novo patients. History of coronary artery bypass grafting and lesion length were predictors of MACE in patients treated for ISR. The use of Protégé paclitaxel DCB for PCI of ISR and de novo lesions is safe and effective during 2-year follow-up.

Epicardial Fat Necrosis After COVID-19 Infection: A Case Report

Epipericardial or epicardial fat necrosis (EFN) is a self-limited inflammatory process occurring in the mediastinal fat surrounding the heart. It is an uncommon cause of acute chest pain and mimics more critical clinical disorders such as acute coronary syndrome, aortic dissection, and pulmonary embolism. However, EFN is frequently overlooked and under-recognized in emergency departments (EDs) owing to the unfamiliarity of this condition among physicians and radiologists. Herein, we present the case of a previously healthy young male patient, with a recent history of mild COVID-19 infection (two weeks before presentation), who presented to the ED for acute chest pain. Paraclinical evaluation including computed tomography (CT) of the chest revealed fat stranding along with the left epicardial fat pad in favor of EFN.

P56 SPONTANEOUS CORONARY ARTERY DISSECTIONS: ANALYSIS OF NON TRADITIONAL RISK FACTORS

Abstract The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT–RF) have assumed increasing interest, but few data are available. NT–RF include three categories: Sex–related (SR–NT–FR), Sex–predominant (SP–NT–RF) and Gender–related (GR–NT–RF). (Table 1) Aim of the Study The objective of our analysis was to evaluate the incidence of NT–RF in Parma SCAD registry population. Material and methods We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021 Results Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT–RF, 51 patients (82%) had at least one of all, with at least one SR–RF (66%) or GR–RF (64,5%). Patients with NT–RF were younger at time of SCAD (mean age 53 vs 66; p = 0.027) and they were predominantly females (48 vs 7 pts, p = 0.004) (Table 2). No differences were found among NT–RF SCAD and nNT–RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST–segment elevation myocardial infarction (43 pts, 72.6%) vs ST–segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT–RF and nNT–RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow–up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT–RF group without statistical significance (NT–RF SCAD 19.6% – nNT–RF SCAD 9.1%; p = 0.4). (Table 3) Conclusion SCAD is an emerging cause of myocardial infarction in young and middle–aged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT–RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.

P391 A ‘FAKE’ PERIPARTUM CARDIOMYOPATHY: THE KEY ROLE OF CARDIAC MRI

Abstract K.M. Woman, 47 years old; Moroccan–born, she doesn’t speak Italian. History limited by the language barrier Medical histroy: caesarean section two months prior to admission (pluriparae with 6 births) In home therapy with estrogen–progestin pill Access to the emergency room for thoraco–abdominal pain of not exactly onset with dyspnoea (Killip II) EKG: sinus tachycardia, poor progression of the R wave in the precordial leads with mild ST–elevation in the same leads TTS echocardiographic: slightly dilated left ventricle, hypo / akinesia of the apex in its entirity with LVEF 38%; mild mitral regurgitation. Normal size and fuction of RV, PAPS slightly elevated; no pericardial effusion. Coronarography: mild non–critical atheroma of the main vessels. Occlusion of a small branch of division of OM Ventriculography (suspected Tako–Tsubo): reduced contractile function of the LV in relation to akinesia of the apex in its entirety Chest CT without contrast: diffuse areas of parenchymal nodular thickening &amp;gt;&amp;gt; lower lobes, thickening of interlobular and intralobular septa, mild pericardial effusion Blood sampling: elevated cardiac troponin hs in the absence of a typical curve for ACS; high inflammation markers Admission to cardiology with diagnosis of acute heart failure in PPCM (vs myocarditis.) Pneumonia. Slow and progressive improvement of the hemodynamic status and of the septic status with diuretic and antibiotic therapy. Prolactin antagonist (cabergoline) therapy and therapy for heart failure was started. During the hospital stay the patient was asymptomatic, not more angor, no arrhythmias on the EKG monitor, hemodynamic stability. Upon completion of the diagnosis, cardiac MRI was performed which modifies the diagnosis: dilated eccentric remodeling of the left ventricle with moderate reduction of global systolic function; akinesia of the lateral segments on the mid–basal, septal and lower apical planes and of the apex which corresponds to LGE ischemic–type enhancement for MI– outcomes. No evident endoventricular thrombi. Faded reactive signs of the pericardium with a slight fluid share Acute heart failure in hypokinetic heart disease with ischemic etiopathogenesis due to undated anterior silent MI (likely due to spontaneous coronary dissection)

P57 SPONTANEOUS DISSECTION OF THE DISTAL MARGINAL BRANCH IN A YOUNG WOMAN IN THE PERIPARTUM WITH NO FLOW LIMITATION AT THE PRESENTATION EVOLVED INTO SEVERE DISSECTION OF THE ANTERIOR CIRCUMFLEX AND DESCENDING ARTERY COMPLICATED BY CARDIOGENIC SHOCK

Abstract We describe the case of a 39–year–old woman with a history of recent natural birth, who came to our observation for an episode of oppressive chest pain while breastfeeding her baby at night. At the entrance, the electrocardiographic and echocardiographic findings and myocardiocitonecrosis enzymes were normal; after three hours the second enzymatic determination was clearly increased, so the patient was admitted to our ICU with a diagnosis of SCA / NSTEMI. She was therefore subjected to coronary angiography with a small hematoma in the distal tract of the marginal branch without flow limitation; it was therefore decided, in accordance with the AHA and ESC guidelines, for a conservative medical therapy. On the third day of hospitalization, the patient presented recurrence of chest pain with electrocardiographic evidence of ST segment elevation in the anterolateral site. A new angiographic evaluation was therefore performed urgently, showing a complete retrograde dissection from the marginal branch to the circumflex branch and to the anterior descending branch with TIMI 0–1 flow. During the procedure the patient underwent a prolonged hypotensive episode associated with frequent polymorphic ventricular ectopic beats, with rapid evolution towards a picture of overt cardiogenic shock. Therefore we proceeded quickly to perform PTCA with placement of medicated stents on all branches involved in the dissection, with rapid improvement of the haemodynamic picture. Spontaneous coronary dissections represent for a hemodynamist a condition of great technical difficulty where the margins of error are very high. Thanks to the technological evolution of materials, an experienced hemodynamist is able, more and more easily, to be successful in the revascularization procedure and to resolve extremely serious clinical pictures. This case report describes a spontaneous coronary dissection that most often occurs in young women in good health and without risk factors for coronary heart disease, particularly in the peripartum period. The presentation was similar to an acute coronary syndrome. According to AHA and ESC guidelines, therapy was conservative if dissection / hematoma is not a flow restriction with coronary angiography after a few days to demonstrate vessel restoration.