Effect Of Percutaneous Coronary Intervention Research Articles

A study on effect of percutaneous coronary intervention on diastolic function in coronary artery disease

A study on effect of percutaneous coronary intervention on diastolic function in coronary artery disease

Left ventricular function recovery after revascularization: comparative effects of percutaneous coronary intervention and coronary artery bypass grafting.

In 2013, heart failure with recovered ejection fraction (HFrecEF) was introduced as a new heart failure phenotype. This review provides an overview of HFrecEF and the comparative effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on left ventricular ejection fraction (LVEF) recovery in patients with ischemic cardiomyopathy. There has been emerging data indicating that LV functional recovery is possible and HFrecEF is associated with improved survival and better quality of life. CABG may be associated with larger improvement in LVEF when compared with PCI. However, there is significant paucity of studies, which directly compare the impact of PCI and CABG on LVEF recovery in the setting of ischemic cardiomyopathy. LVEF recovery is emerging as an important outcome with demonstrated survival and quality-of-life benefits. Future randomized clinical trials comparing the impact of contemporary PCI and CABG on LVEF recovery are needed in patients with ischemic cardiomyopathy.

PERCUTANEOUS CORONARY INTERVENTION WITH BIORESORBABLE VASCULAR SCAFFOLD VERSUS MINIMALLY INVASIVE OFF-PUMP BYPASS SURGERY: 30-DAYS FOLLOW UP

Aim. To assess the comparative 30-day effectiveness of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffold (BVS) versus minimally invasive direct coronary artery bypass (MIDCAB) for left anterior descending coronary artery disease.Methods. 130 patients with significant (≥70%) LAD disease were recruited in the study. Patients were randomized either to PCI with BVS (n = 65) or MIDCAB (n = 65). The groups of patients were comparable in baseline demographic, clinical and angiographic parameters. The endpoints included adverse cardiovascular events (all-cause mortality, myocardial infarction, stroke, target vessel revascularization) and scaffold thrombosis and were measured on day 30 after the indexed intervention.Results. At 30-day follow-up, there were no significant differences in the incidence of the adverse cardiovascular events between the study groups (0% MIDCAB vs. 3.1% PCI, р = 0.151), myocardial infarction (0% vs. 3.1%, p = 0.151), target vessel revascularization (0% vs. 1.5%, p = 0.32) and scaffold (graft) thrombosis (0% vs. 1.5%, p = 0.32).Conclusion. PCI with BVS and MIDCAB in patients with stable coronary artery disease and isolated left anterior descending lesions demonstrated comparable outcomes at 30-days follow-up.

The influence of cancer on post-resuscitation treatments among out-of-hospital cardiac arrest patients

Quality of post-resuscitation care is a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). Surprisingly, about 10% of cancer patients of cardiac arrest survived to hospital discharge. Recent studies show effect of percutaneous coronary intervention (PCI) is similar between cancer patients and non-cancer patients. However the influence of pre-arrest cancer status on post-resuscitation treatments received following OHCA has not been previously studied. In this study, we hypothesize that OHCA patients with cancer receive lower post-resuscitation treatments compared with those without cancer.

TCT-27 Left ventricular function following higher-risk percutaneous coronary intervention performed with hemodynamic support

In contrast to coronary artery bypass grafting, there is a paucity of published data on the effect of percutaneous coronary intervention (PCI) among patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (LVSD). We assessed the change in left ventricular ejection

Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial

BackgroundThe optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. ObjectivesThis study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. MethodsCKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. ResultsCKD was present in 361 of 1,869 randomized patients (19.3%) in whom baseline estimated glomerular filtration rate was available. Patients with CKD had higher 3-year rates of the primary endpoint compared with those without CKD (20.8% vs. 13.5%; hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 1.22 to 2.09; p = 0.0005). ARF within 30 days occurred more commonly in patients with compared with those without CKD (5.0% vs. 0.8%; p < 0.0001), and was strongly associated with the 3-year risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95% CI: 2.73 to 7.73; p < 0.0001). ARF occurred less commonly after revascularization with PCI compared with CABG both in patients with CKD (2.3% vs. 7.7%; HR: 0.28; 95% CI: 0.09 to 0.87) and in those without CKD (0.3% vs. 1.3%; HR: 0.20; 95% CI: 0.04 to 0.90; pinteraction = 0.71). There were no significant differences in the rates of the primary composite endpoint after PCI and CABG in patients with CKD (23.4% vs. 18.1%; HR: 1.25; 95% CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%; HR: 0.97; 95% CI: 0.73 to 1.27; pinteraction = 0.38). ConclusionsPatients with CKD undergoing revascularization for LMCAD in the EXCEL trial had increased rates of ARF and reduced event-free survival. ARF occurred less frequently after PCI compared with CABG. There were no significant differences between PCI and CABG in terms of death, stroke, or MI at 3 years in patients with and without CKD. (EXCEL Clinical Trial [EXCEL]; NCT01205776)

Impact of Omega-3 Supplementation on High Sensitive C-Reactive Protein Level and 30-Day Major Adverse Cardiac Events After the Implementation of Coronary Stent in Patients with Chronic Kidney Disease: A Randomized Clinical Study.

Purpose: Studies have revealed that patients with chronic kidney disease (CKD) are more susceptible to adverse effects of percutaneous coronary intervention (PCI). In addition, the role of elevated high sensitive C-reactive protein (hs-CRP) in the prediction of adverse cardiac outcomes after coronary stent implantation has already been shown. Therefore, in this study, we aimed to evaluate the effect of omega-3 supplementation on hs-CRP and 30-day major adverse cardiac events (MACE) in patients with CKD undergoing elective PCI.Methods: In this randomized trial, 80 CKD patients who were candidates for elective PCI, were randomly assigned to two groups; the first group received a single dose of omega-3 (2500 mg, 12 h before PCI) as well as the standard drug regimen of PCI and the second group received placebo plus the standard therapy (325 mg loading dose of aspirin, 600 mg loading dose of clopidogrel, and weight-adjusted intravenous heparin). Hs-CRP levels were measured at baseline and 24 h after the intervention as a primary endpoint. The secondary endpoint was the incidence of MACE over a 30-day period after PCI.Results: Omega-3 did not significantly decrease post-PCI serum level of hs-CRP; however, the overall 30-day MACE was significantly lower in the omega-3 group compared to the control group (p=0.05).Conclusion: Our results revealed the positive effect of the omega-3 supplement on decreasing 30-day MACE; hence, omega-3 may be considered as an effective adjunctive therapy to the standard drug regimen used before PCI. The evaluation of the effect of omega-3 on long-term MACE is recommended for future studies.

Effect of percutaneous coronary intervention and medical therapy on quality of life and cognitive function in patients with coronary heart disease

To explore the effect and difference of percutaneous coronary intervention (PCI) and medical therapy on quality of life and cognitive function in patients with coronary heart disease (CHD), and to investigate the relationship between quality of life and cognitive function. Methods: A total of 320 patients with CHD, who underwent coronary angiography and PCI (PCI group, n=160), or underwent coronary angiography and medical therapy (drug therapy group, n=160), were selected. The quality of life was assessed by using the Health Survey Form SF-36 (SF-36) and the Seattle Angina Questionnaire (SAQ), and the cognitive function was assessed by using the Mini-Mental State Examination (MMSE). General data of patients were collected on the day of coronary angiography. Telephone follow-up was conducted in 1 month after treatment, and the outpatient review was carried out in 3 and 6 months after treatment. Results: A total of 309 valid questionnaires were collected. The scores of quality of life in the PCI group and the drug therapy group after treatment were both increased compared with those before treatment (both P<0.05). The SF-36 scores of four dimensions (role physical, bodily pain, vitality and mental health) in the PCI group were all significantly greater than those in the drug therapy group (all P<0.05). The SAQ scores of two dimensions (angina stability and angina frequency) were both higher in the PCI group than those in the drug therapy group in 6 months of post-operation (all P<0.05). There was no significant difference in cognitive function before and after the treatment in the 2 groups (P>0.05). There was no significant difference in cognitive function between the PCI group and the drug therapy group (P>0.05). In the PCI group, physical function, role physical, bodily pain, and role emotional were positively correlated with cognitive function (r=0.207, 0.182, 0.184, 0.176 respectively, all P<0.05). In the drug therapy group, there was no correlation between quality of life and cognitive function. Conclusion: The quality of life for the patients is improved in the PCI group and the drug therapy group, but the improvement degree in the PCI group is more obvious. Both PCI and drug therapy do not result in the decrease of cognitive function, and there is no difference between the 2 groups. There is positive correlation between quality of life and cognitive function in the PCI group, there is no correlation between quality of life and cognitive function in the drug therapy group.

Adjustment for Atherosclerosis Diagnosis Distorts the Effects of Percutaneous Coronary Intervention and the Ranking of Hospital Performance.

BackgroundCoronary atherosclerosis raises the risk of acute myocardial infarction (AMI), and is usually included in AMI risk‐adjustment models. Percutaneous coronary intervention (PCI) does not cause atherosclerosis, but may contribute to the notation of atherosclerosis in administrative claims. We investigated how adjustment for atherosclerosis affects rankings of hospitals that perform PCI.Methods and ResultsThis was a retrospective cohort study of 414 715 Medicare beneficiaries hospitalized for AMI between 2009 and 2011. The outcome was 30‐day mortality. Regression models determined the association between patient characteristics and mortality. Rankings of the 100 largest PCI and non‐PCI hospitals were assessed with and without atherosclerosis adjustment. Patients admitted to PCI hospitals or receiving interventional cardiology more frequently had an atherosclerosis diagnosis. In adjustment models, atherosclerosis was associated, implausibly, with a 42% reduction in odds of mortality (odds ratio=0.58, P<0.0001). Without adjustment for atherosclerosis, the number of expected lives saved by PCI hospitals increased by 62% (P<0.001). Hospital rankings also changed: 72 of the 100 largest PCI hospitals had better ranks without atherosclerosis adjustment, while 77 of the largest non‐PCI hospitals had worse ranks (P<0.001).ConclusionsAtherosclerosis is almost always noted in patients with AMI who undergo interventional cardiology but less often in medically managed patients, so adjustment for its notation likely removes part of the effect of interventional treatment. Therefore, hospitals performing more extensive imaging and more PCIs have higher atherosclerosis diagnosis rates, making their patients appear healthier and artificially reducing the expected mortality rate against which they are benchmarked. Thus, atherosclerosis adjustment is detrimental to hospitals providing more thorough AMI care.

Effects of percutaneous coronary intervention in patients aged 70 years and over with chronic total occlusion lesions

Objective To evaluate the clinical impact of percutaneous coronary intervention (PCI) on prognosis in elderly patients (≥70 years old) with coronary artery chronic total occlusion (CTO). Methods A total of 445 consecutive patients with a angiography-confirmed CTO lesions registered from January 2011 to December 2013 were divided into the elderly group (≥70 years) and the non-elderly group (<70 years). The primary endpoints measured were defined as the composite outcomes of hospitalization due to angina, re-infarction, heart failure, repeat re-vascularization, and cardiac death at 36 months follow-up. Results The elderly group included 200 patients (44.9%) and the non-elderly group included 245 patients (55.1%). During the follow-up, the proportions of coronary lesion were significantly higher in the elderly group with left main (LM) disease (45, 22.5%), three-vessel disease (166, 83.0%) and J-CTO score≥2 (64, 32.0%) than in the non-elderly group with diseases of LM, three-vessel, and J-CTO score ≥2〔(34, 13.9%); (180, 73.5%); (57, 23.3%), respectively〕(χ2=5.607, 5.782, 4.243; P=0.018, 0.016, 0.039). The ratio of the patients undergoing PCI-reperfusion therapy of CTO was higher in non-elderly group (109/275, 39.6%) than in elderly group (53/222, 23.9%) (χ2=13.891, P<0.001), while CTO PCI success rate was similar between the two groups (38 patients, 71.7% vs.90 patients, 82.6%, χ2=2.541, P=0.111). The elderly group versus non-elderly group showed that the 3-year cardiac mortality rate was 12.5% (25 patients) versus 3.3% (8 patients) (χ2=13.677, P<0.011), and the incidence rate of 3-year primary endpoint was 31.5% (63 patients) versus 22.9% (56 patients) (χ2=4.199, P=0.040). Among the elderly group, patients without CTOs re-vascularized by PCI had a greater tendency toward higher risk of hospitalization due to angina, re-infarction, heart failure, or repeat re-vascularization than patients with CTOs re-vascularized by PCI (34/149, 22.8% vs.3/33, 9.1%, χ2=3.143, P=0.076), while they had comparable incidence of 3-year cardiac death (19/149, 12.8% vs.5/33, 15.2%, χ2=0.007, P=0.933). Multivariate analysis revealed that after adjusting for baseline and procedure differences, LM combined with three vessel disease (OR=3.804, 95%CI: 1.274 to 11.356, P=0.017) remained an independent predictor for 3-year cardiac mortality in elderly patients with CTOs. Conclusions Elderly patients with CTO have mostly a serious coronary artery disease and a poor prognosis.Although CTO is re-vascularized by PCI, long-term clinical outcome seems not more to be improved in elderly patients with CTOs.LM combined with three-vessel disease might be an independent predictor for 3-year cardiac mortality in elderly CTO patients. Key words: Angioplasty, transluminal, percutaneous coronary; Coronary occlusion

Effects of social support and impact of event on posttraumatic growth of patients after percutaneous coronary intervention

Objective To identify the effects of social support and impact of event on posttraumatic growth of patients after percutaneous coronary intervention, and to provided basis for individualized interventions. Methods A cross-sectional survey was conducted on 337 patients after percutaneous coronary intervention. The instruments included the social support rating Scale(SSRS), impact of event scale-revised (IES-R), the posttraumatic growth inventory(PTGI). Results The patients′ PTG level was 57.16±14.96, the total score of Impact of Event Scale-Revised was (31.83±12.94),and the total score of Social support was 3(9.17±9.70). Social support was positively correlated with posttraumatic growth, whereas impact of event was negatively correlated with posttraumatic growth (P<0.05) . Structural equation modeling analysis showed that impact of event directly negative effect PTG and social support, and indirectly affected PTG through social support. Conclusions The level of posttraumatic growth of patients after percutaneous coronary intervention was medium, and the posttraumatic stress symptoms was serious, while the patients′ have acquired social support was better. Clinical medical works should give more social support to patients in order to improve the effect of percutaneous coronary intervention and relieve symptoms of post-traumatic stress, so as to promote the posttraumatic growth of patient with coronary heart disease. Key words: Coronary heart disease; Percutaneous coronary intervention; Social support; Stress; Posttraumatic growth

Effect of Percutaneous Coronary Intervention on Heart Rate Variability in Coronary Artery Disease Patients.

Patients with coronary artery disease (CAD) have a state of autonomic imbalance with a sympathetic predominance. Autonomic dysfunction has been linked to an increased risk of cardiovascular morbidity and mortality. Heart rate variability (HRV) analysis is one of the most encouraging non-invasive diagnostic models and is increasingly used for the assessment of autonomic dysfunction. Percutaneous coronary intervention (PCI) is considered the gold standard in CAD treatment. Revascularisation through PCI eliminates the state of sympathetic hyperactivity, restores the normal cardiac autonomic modulation that can be assessed by HRV measurement.

Computational Evaluation of Artery Damage in Stent Deployment

This paper aims to evaluate damage in an arterial wall and plaque caused by percutaneous coronary intervention using a finite-element (FE) method. Hyperelastic damage models, verified against experimental results, were used to describe stress-stretch responses of arterial layers and plaque in the lumen; these models are capable to simulate softening behaviour of the tissue due to damage. Abaqus CAE was employed to create the FE models for an artery wall with two constituent layers (media and adventitia), a symmetric uniform plaque, a bioresorbable polymeric stent and a tri-folded expansion balloon. The effect of percutaneous coronary intervention on vessel damage was investigated by simulating the processes of vessel pre-dilation, stent deployment and post-stenting dilation. Energy dissipation density was used to assess the extent of damage in the tissue. Overall, the plaque experienced the most severe damage due to its direct contact with the stent, followed by the media and adventitia layers. Softening of the plaque and the artery due to the pre-dilation-induced damage can facilitate the subsequent stent-deployment process. The plaque and artery experienced heterogeneous damage behaviour after the stent deployment, caused by non-uniform deformation. The post-stenting dilation was effective to achieve a full expansion of the stent but caused additional damage to the artery. The computational evaluation of artery damage can be also potentially used to assess the risk of in-stent restenosis after percutaneous coronary intervention.

Efficacy comparison of 3 strategies for real-world stable coronary artery disease patients with three-vessel disease

Objective: To compare the effectiveness of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical therapy (MT) alone for real-world stable coronary artery disease (SCAD) patients with three-vessel disease (TVD) in mainland China. Methods: A total of 8 943 consecutive cases with TVD hospitalized in our center from April 2004 to February 2011 were screened for this study. In this cohort, 3 435 cases diagnosed as SCAD were analyzed. PCI, CABG, MT alone were performed in 1 313 (38.2%), 1 259 (36.7%) and 863 (25.1%) patients, respectively. Propensity score matching (PSM) analysis using nearest neighbor matching with a 1∶1 ratio was applied, and 758 pairs of CABG and PCI groups, 552 pairs of PCI and MT groups, 639 pairs of CABG and MT groups were selected, respectively. 1- and 2-year clinical outcomes were evaluated among PCI, CABG and MT group. Kaplan-Meier curves and multivariable Cox regression method were used for survival analysis. Results: Significant differences were found at baseline between PCI, CABG and MT group, including age, gender, body mass index, family history of coronary artery disease, hyperlipidemia, diabetes mellitus, previous myocardial infarction, stroke, previous revascularization, peripheral vascular disease, SNYTAX score, left ventricular ejection fraction, hemoglobin, serum creatinine, high-sensitivity C-reactive protein, triglyceride and medication (all P<0.05) . All-cause death rates of 1- and 2-year follow-up of PCI, CABG and MT group were 0.6% (8/1 313), 1.1% (14/1 259), 3.4% (29/863) (P<0.001) and 1.1%(14/1 313), 1.5%(19/1 259), 7.3%(63/863) (P<0.001), respectively. Multivariate Cox regression analysis showed that 1-year MACCE rate (HR=0.51, 95%CI 0.33-0.77, P=0.001) was significantly reduced, due to the significant decrease of myocardial infarction (MI) rate (HR=0.09, 95%CI 0.01-0.76, P=0.027) and repeat revascularization rate (HR=0.21, 95%CI 0.10-0.41, P<0.001) in CABG group compared to PCI group, while all-cause death (HR=1.21, 95%CI 0.48-3.00, P=0.69) and stroke rate (HR=2.31, 95%CI 0.82-6.47, P=0.112) were similar between 2 groups. 2-year outcome showed CABG was associated with higher stroke rate (HR=2.20, 95%CI 1.06-4.55, P=0.034) and lower MI (HR=0.19, 95%CI 0.06-0.59, P=0.004) and repeat revascularization rate (HR=0.22, 95%CI 0.13-0.37, P<0.001), and lower MACCE rate (HR=0.49, 95%CI 0.36-0.68, P<0.001). Compared to MT group, 2-year all-cause death (HR=0.22, 95%CI 0.12-0.42, P<0.001) and MACCE rate (HR=0.63, 95%CI 0.47-0.83, P=0.001) were lower in PCI group, while 2-year all-cause death (HR=0.21, 95%CI 0.13-0.37, P<0.001), MACCE (HR=0.31, 95%CI 0.23-0.42, P<0.001), MI (HR=0.19, 95%CI 0.06-0.60, P=0.004) and repeat revascularization rate (HR=0.24, 95%CI 0.13-0.41, P<0.001) were lower in CABG group. Results of multivariate Cox regression analysis after PSM were consistent with above results. Conclusion: For SCAD patients with TVD, CABG shows better effectiveness by reducing MI and revascularization risk as compared to PCI, even though stroke risk is somehow higher in CABG patients. Patients received MT alone are associated with worse outcomes than those undergoing revascularization strategies.

Effect of Elective Percutaneous Coronary Intervention on Hyperemic Absolute Coronary Blood Flow Volume and Microvascular Resistance.

The hemodynamics involved in the relationship between absolute coronary blood flow (ABF) volume and myocardial resistance (MR) are complex, and the effect of percutaneous coronary intervention (PCI) on their changes remains unclear. The aim of this study was to investigate the differences in hyperemic ABF and MR before and after elective PCI using a thermodilution method. We investigated 28 vessels (right coronary artery, 9; left anterior descending coronary artery, 18; left circumflex coronary artery, 1) from 28 patients with stable angina pectoris undergoing elective PCI. ABF was measured pre- and post-PCI using a pressure-temperature sensor-equipped wire, based on a thermodilution method with a continuous saline infusion of 20 mL/min through a proximally located microcatheter with an end-hole in the target vessel. MR equals distal coronary perfusion pressure divided by ABF at maximal hyperemia. Conventional fractional flow reserve was also measured pre- and post-PCI. Fractional flow reserve increased significantly after PCI (from 0.70 [0.65-0.75] to 0.88 [0.85-0.95]) in all examined territories. ABF also increased significantly (from 137.8 mL/min [86.3-180.8 mL/min] to 173.3 mL/min [137.9-234.3 mL/min] ; increase: 52.8 mL/min [9.7-80.8 mL/min]) while MR decreased in 11 vessels and increased in 17. No significant relationship was detected between these increases in fractional flow reserve and ABF. Both pre- and post-PCI MR distributed in a wide range, and there was a significant relationship between pre-PCI MR and the increase in ABF (r=0.44; P=0.02) although no significant change in MR was observed between pre- and post-PCI (P=0.37). Direct measurement of ABF and MR using thermodilution method offers a feasible approach that could shed a light on previously unclear aspects of coronary hemodynamics.

Effects of Percutaneous Coronary Intervention on Viable Myocardium and Heart Function of Diabetic Patients With Chronic Total Occlusion.

The aim of this study was to compare the effects of percutaneous coronary intervention (PCI) on coronary chronic total occlusion patients with (DM) or without (NDM) diabetes mellitus. A total of 78 patients were divided into DM group and NDM group according to whether the patient has DM. The results of PCI were analyzed using quantitative coronary analysis. In addition, all the patients underwent Tc-MIBI (methoxyisobutylisonitrile) single-photon emission computed tomography (SPECT) and ultrasonic cardiogram in the first week and the sixth month after PCI to evaluate PCI results. During the 6-month follow-up, major adverse cardiac event (MACE) was recorded and analyzed as well. The first and second classes of collateral circulation between the 2 groups have significant differences (P < 0.05). Left ventricular end-diastolic volume index and left ventricular end-systolic volume index were decreased at the sixth month compared with those at the first week. Left ventricular ejection fraction was significantly increased. In both groups, the defect size significantly reduced, and percentage of radionuclide scintigraphic count significantly increased between rest and nitroglycerin interventional SPECT. After 6 months, both groups repeated nitroglycerin interventional SPECT, which showed that defect size was significantly reduced, and the percentage of radionuclide scintigraphic count was significantly increased compared with those of the first week. During the 6-month follow-up, the incidence of MACE between the 2 groups had no significant difference. Percutaneous coronary intervention has beneficial effects on heart functions and MACE when performed on chronic total occlusion patients with and without DM.

Current state of myocardial revascularization in patients with severe left ventricular systolic dysfunction

In most cases, severe left ventricular systolic dysfunction is a consequence of ischemic heart disease. In clinical condition, current recommendations support myocardial revascularization in patients with ischemic cardiomyopathy by performing coronary artery bypass grafting. Information on safety and effectiveness of percutaneous coronary intervention in patients with ischemic heart failure is limited. The aim of this review is to study the current state of this problem.

Effect of Percutaneous Coronary Intervention on Survival in Patients with Stable Ischemic Heart Disease.

This study aims to determine if percutaneous coronary intervention (PCI) does improve survival in stable ischemic heart disease (SIHD). The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial will evaluate patients with moderate to severe ischemia and will be the largest randomized trial of an initial management strategy of coronary revascularization (percutaneous or surgical) versus optimal medical therapy alone for SIHD. Although the ISCHEMIA trial may show a benefit with upfront coronary revascularization in this high-risk population, cardiac events after PCI are largely caused by plaque rupture in segments outside of the original stented segment. Furthermore, given the robust data from prior randomized trials, which showed no survival benefit with PCI, and the likelihood that the highest risk patients in ISCHEMIA will be treated with surgery, it is unlikely that the ISCHEMIA trial will show a survival benefit particular to PCI. Although PCI relieves symptoms, the evidence base indicates that it does not prolong survival in SIHD.

Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram.

The present study aimed to assess the mechanisms of effects of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from two different aspects: left ventricular (LV) systolic function assessed by two-dimensional speckle tracking echocardiography (2D-STE) and electrical stability evaluated by late potential on signal-averaged electrocardiogram (SAECG). We conducted a prospective observational study with consecutive CTO-PCI patients. 2D-STE and SAECG were performed before PCI, and after 1-day and 3-months of procedure. 2D-STE computed global longitudinal strain (GLS) and regional longitudinal strain (RLS) in CTO area, collateral blood-supplying donor artery area, and non-CTO/non-donor area. A total of 37 patients (66 ± 11 years, 78% male) were analyzed. RLS in CTO and donor areas and GLS were significantly improved 1-day after the procedure, but these improvements diminished during 3 months. The improvement of RLS in donor area remained significant after 3-months the index procedure (pre-PCI -13.4 ± 4.8% vs. post-3M -15.1 ± 4.5%, P = 0.034). RLS in non-CTO/non-donor area and LV ejection fraction were not influenced. Mitral annulus velocity was improved at 3-month follow-up (5.0 ± 1.4vs. 5.6 ± 1.7cm/s, P = 0.049). Before the procedure, 12 patients (35%) had a late potential. All components of the late potential (filtered QRS duration, root-mean-square voltage in the terminal 40ms, and duration of the low amplitude signal <40μV) were not improved. CTO-PCI improved RLS in the donor area at 3-month follow-up without changes of LV ejection fraction. Although higher prevalence of late potential in the current population compared to healthy population was observed, late potential as a surrogate of arrhythmogenic substrate was not influenced by CTO-PCI.

THE REDUCTION OF HOSPITAL MORTALITY OF MYOCARDIAL INFARCTION IN «PROBLEM GROUPS» – FOCUS ON PATIENTS OVER 75 YEARS

The purpose. The aim of the study was to analyze immediate results of acute myocardial infarction’s treatment in patients older than 75 and to estimae the effectiveness of percutaneous coronary interventions (PCI). Materials and methods: 208 cases of acute myocardial infarction (AMI) in patients older than 75 were reviewed in the study. The control group consisted of 85 (40.9%) cases of emergency primary PCI. For comparison, there was a group of patients who underwent the conservative treatment (123 (59,1%) cases). Results. All the patients in the study regardless of AMI’s treatment were characterized by the following clinical features (p&gt;0.05): high prevalence of cardiovascular and significant somatic diseases, late treatment onset, severe hemodynamically significant pathology of the coronary arteries not only according to the number of affected vessels but also by SYNTAX scale. In general, 123 (59,1%) cases of urgent (emergency and delayed) coronary angiography were performed. The coverage of diagnostic interventions in patients with conservative treatment was 38 (30,9%) cases. This number had statistically significant difference with the PCI group (p&lt;0.05). The advantages of PCI (p&lt;0.05) were obtained for mortality (12,9% – 25,2%) and duration of hospital stay (13,6±0,3 days – 15.43±0.4 days). Conclusion. Reduction of mortality in AMI patients older than 75 is associated with an increase of emergency coronary stenting in the structure of medical activities. Specific complications of PCI are rare, which proves the safety of this method of reperfusion therapy among patients of this age. Patient’s age over 75 years old should not be considered as a limitation for coronary angiography and subsequent stenting.