Efficacy Of Percutaneous Coronary Intervention Research Articles

Ivabradinum supplements the clinical efficacy of percutaneous coronary intervention in patients with coronary heart disease with stable angina

The review is devoted to the role of ivabradinum in the procedure of percutaneous coronary intervention (PCI) in patients with ischemic heart disease with stable angina. It is reported that reperfusion of the myocardium with PCI, even in combination with modern drug therapy, does not have a complete clinical effect. The authors substantiate the possibility of completing the clinical effect of PCI in such patients by prescribing ivabradinum. The drug reduces the heart rate more than with medication without it.

Safety and Efficacy of Percutaneous Coronary Intervention via Transradial Versus Transfemoral Approach in Bypass Grafts.

We compared the efficacy and safety of the transradial approach percutaneous coronary intervention (TRA-PCI) and transfemoral approach percutaneous coronary intervention (TFA-PCI) for bypass grafts lesions. Patients (n = 184) were retrospectively enrolled. Less contrast was used during the procedure in the TRA group than in the TFA group, 201.5 (45.5) mL versus 221.5 (49.1) mL, P = .004, although fluoroscopy time was longer in the TRA group, 22.5 (6.3) minutes versus 20.3 (6.1) minutes; P = .017. The incidence of net adverse clinical events (NACEs) was lower in the TRA group than in the TFA group (3.1% vs 8.8%, respectively, P = .111). The incidence of Bleeding Academic Research Consortium type 3 and 5 bleeding (0% vs 5.5%, respectively, P = .022) was significantly lower in the TRA group than in the TFA group. For 1-year outcomes, there was no difference in the incidence of major adverse cardiovascular events (7.5% vs 9.9%, respectively, P = .569). In conclusion, TRA-PCI was associated with a lower rate of in-hospital NACEs mainly attributed to lower rates of major bleeding. The TRA-PCI showed comparable feasibility and efficacy in bypass grafts as compared with TFA-PCI when carried out by experienced operators.

Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina

BackgroundLeft main coronary artery (LMCA) compression is increasingly recognized as a cause of angina in pulmonary arterial hypertension (PAH). ObjectivesThis study aimed to evaluate the prevalence of LMCA extrinsic compression from a dilated pulmonary artery (PA) in patients with PAH and angina or angina-like symptoms, determine the usefulness of screening with computed tomography coronary angiography (CTCA), and assess the safety and efficacy of percutaneous coronary interventions (PCIs). MethodsAll patients with PAH and angina or angina-like symptoms attending the center between May 1, 2008, and December 31, 2013, underwent CTCA. Patients with confirmed LMCA stenosis on selective coronary angiography had PCI. ResultsOf 765 patients with PAH, 121 had angina or angina-like symptoms. Ninety-four patients had abnormal CTCA based on the relationship between the PA and the LMCA and underwent selective coronary angiography. LMCA stenosis ≥50% was detected in 48 of the 94 patients. Forty-five patients underwent PCI with stenting, of whom 41 had sustained angina symptom relief. The 3 other patients had surgical PA reduction plasty. Nine months after PCI, 5 patients had LMCA restenosis and PCI was successfully repeated. The best predictor of LMCA stenosis ≥50% was a PA diameter ≥40 mm. Rates for death or double-lung transplant and the composite rates for death, double-lung transplant, or restenosis at 36 months were 5% and 30%, respectively. ConclusionsThe prevalence of LMCA compression in patients with PAH and angina is high. These results suggest that CTCA is indicated in patients with PAH and angina or angina-like symptoms. PCI was well tolerated, improved symptoms, and resulted in favorable long-term outcomes.

Clinical efficacy of percutaneous coronary intervention in patients with coronary artery disease with low left ventricular ejection fraction in the long term

Clinical efficacy of percutaneous coronary intervention in patients with coronary artery disease with low left ventricular ejection fraction in the long term

Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for patients with multivessel and unprotected left main coronary artery disease.

Objectives:To compare the efficacy and safety of percutaneous coronary intervention using second-generation drug-eluting stents with those of coronary artery bypass grafting among patients with multivessel disease and/or unprotected left main coronary artery disease in terms of mortality, myocardial infarction, repeat revascularization, and angina.Background:Although coronary artery disease is a leading cause of death in the Western world and in many developing countries, its optimal treatment is still a matter of controversy. Several studies have examined the clinical safety and efficacy of percutaneous coronary intervention using first-generation drug-eluting stents over coronary artery bypass grafting in patients with multivessel disease and/or unprotected left main coronary artery disease. However, this study compared the efficacy of percutaneous coronary intervention using second-generation drug-eluting stents to that of coronary artery bypass grafting for multivessel disease and/or unprotected left main coronary artery disease.Methods:This was a prospective single-center cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital. In total, 140 patients (94% men and 6% women) with chronic coronary artery disease undergoing revascularization with either percutaneous coronary intervention using second-generation drug-eluting stents or coronary artery bypass grafting were evaluated. We examined the differences in clinical outcomes between coronary artery bypass grafting and percutaneous coronary intervention at 1-year follow-up.Results:Percutaneous coronary intervention with second-generation drug-eluting stents as opposed to coronary artery bypass grafting resulted in similar rates of mortality (5.7% vs 11.4%, respectively; p = 0.135), myocardial infarction (0% vs 4.3%, respectively), repeat revascularization (4.3% vs 8.6%, respectively; p = 0.115) and angina (10% vs 18.6%, respectively; p = 0.153).Conclusion:In this patient population, percutaneous coronary intervention with second-generation drug-eluting stents was not inferior to coronary artery bypass grafting in terms of mortality, myocardial infarction, repeat revascularization, or angina.

Performance of the XLIMUS Sirolimus‐Eluting Coronary Stent in Very Complex Lesions

Stent delivery failure may occur especially when treating complex coronary artery stenosis. XLIMUS (CARDIONOVUM GmbH, Bonn, Germany) is a new sirolimus-eluting stent (SES) with the following features: 1) cobalt chromium stent platform, with low (73 μm) strut thickness, (2) biodegradable polymer, and 3) potent antiproliferative drug (Sirolimus). Preliminary data suggest that XLIMUS SES may be ideal for the treatment of complex lesions. In this registry, we assessed the deliverability, safety, and efficacy of percutaneous coronary interventions (PCI) using the XLIMUS SES in patients undergoing elective PCI in native coronary vessels for complex de novo lesions, including severe calcification, severe tortuosity, and chronic total occlusion. The primary objective of the study is the delivery success of the XLIMUS SES. The secondary objective is the 1-year rate of major adverse cardiac events (MACE; including all-cause death, nonfatal myocardial infarction, and repeat revascularization). A total of 200 consecutive patients with 255 lesions were included. Delivery success was obtained in 196 (98%) patients and in 251 (98.4%) lesions. The XLIMUS SES was successfully implanted on the first attempt with a single guidewire in 176 (88%) patients and in 208 (81.6%) lesions. Additional techniques to facilitate stent delivery (i.e., buddy wire, anchoring-balloon, or GuideLiner catheter) were necessary in 47 (18.4%) lesions. Failure in XLIMUS SES implantation occurred in 4 (1.6%) lesions. MACE rate at 1 year was 9%. This registry supports the positive performance of the XLIMUS SES in the treatment of complex coronary artery lesions.

Resultados de los stents Resolute Integrity y Promus Element en el infarto de miocardio: análisis del ensayo aleatorizado DUTCH PEERS (TWENTE II)

Introduction and objectivesIn acute myocardial infarction (MI), novel highly deliverable drug-eluting stents (DES) may be particularly valuable as their flexible stent designs might reduce device-induced traumas to culprit lesions. The aim of the study was to assess the safety and efficacy of percutaneous coronary interventions with 2 novel durable polymer-coated DES in patients with acute MI. MethodsThe prospective, randomized DUTCH PEERS (TWENTE II) multicenter trial compares Resolute Integrity and Promus Element stents in 1811 all-comer patients, of whom 817 (45.1%) were treated for ST-segment elevation MI or non—ST-segment elevation MI and the 2-year outcome is available in 99.9%. The primary clinical endpoint is target vessel failure (TVF), a composite of cardiac death, target vessel related MI, or target vessel revascularization. ResultsOf all 817 patients treated for acute MI, 421 (51.5%) were treated with Resolute Integrity and 396 (48.5%) with Promus Element stents. At the 2-year follow-up, the rates of TVF (7.4% vs 6.1%; P = .45), target lesion revascularization (3.1% vs 2.8%; P = .79), and definite stent thrombosis (1.0% vs 0.5%; P = .69) were low for both stent groups. Consistent with these findings in all patients with acute MI, outcomes for the 2 DES were favorable and similar in both, with 370 patients with ST-segment elevation MI (TVF: 5.1% vs 4.9%; P = .81) and 447 patients with non—ST-segment elevation MI (TVF: 9.0% vs 7.5%; P = .56). ConclusionsResolute Integrity and Promus Element stents were both safe and efficacious in treating patients with acute MI. The present 2-year follow-up data underline the safety of using these devices in this particular clinical setting.Full English text available from:www.revespcardiol.org/en

Outcome After Myocardial Infarction Treated With Resolute Integrity and Promus Element Stents: Insights From the DUTCH PEERS (TWENTE II) Randomized Trial

Introduction and objectivesIn acute myocardial infarction (MI), novel highly deliverable drug-eluting stents (DES) may be particularly valuable as their flexible stent designs might reduce device-induced traumas to culprit lesions. The aim of the study was to assess the safety and efficacy of percutaneous coronary interventions with 2 novel durable polymer-coated DES in patients with acute MI. MethodsThe prospective, randomized DUTCH PEERS (TWENTE II) multicenter trial compares Resolute Integrity and Promus Element stents in 1811 all-comer patients, of whom 817 (45.1%) were treated for ST-segment elevation MI or non—ST-segment elevation MI and the 2-year outcome is available in 99.9%. The primary clinical endpoint is target vessel failure (TVF), a composite of cardiac death, target vessel related MI, or target vessel revascularization. ResultsOf all 817 patients treated for acute MI, 421 (51.5%) were treated with Resolute Integrity and 396 (48.5%) with Promus Element stents. At the 2-year follow-up, the rates of TVF (7.4% vs 6.1%; P = .45), target lesion revascularization (3.1% vs 2.8%; P = .79), and definite stent thrombosis (1.0% vs 0.5%; P = .69) were low for both stent groups. Consistent with these findings in all patients with acute MI, outcomes for the 2 DES were favorable and similar in both, with 370 patients with ST-segment elevation MI (TVF, 5.1% vs 4.9%; P = .81) and 447 patients with non—ST-segment elevation MI (TVF, 9.0% vs 7.5%; P = .56). ConclusionsResolute Integrity and Promus Element stents were both safe and efficacious in treating patients with acute MI. The present 2-year follow-up data underline the safety of using these devices in this particular clinical setting.

Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI.

Coronary artery disease (CAD) is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), but its clinical relevance is controversial. At present, the optimal means of defining CAD in patients undergoing TAVI with respect to its prognostic implications and the assessment of myocardial ischaemia is not known. For this reason, the best treatment options are a matter for debate, and current guidelines do not recommend revascularization. As the indications for TAVI expand, the lack of any rigorous means of guiding coronary revascularization might negatively affect the clinical outcomes of future patients. In this Review, we summarize the methods of assessing CAD in TAVI populations, and the data on the safety and efficacy of percutaneous coronary intervention in patients undergoing TAVI. We discuss the putative effects of aortic stenosis on the functional assessment of CAD using pressure or flow wires or by noninvasive stress testing. We propose that a new, well-validated method of assessing CAD as a cause of myocardial ischaemia--which distinguishes it from myocardial infarction, previous revascularization, or non-flow-limiting disease--in patients with severe aortic stenosis is needed to guide revascularization in the current era of TAVI.

Utilidad del intervencionismo coronario percutáneo en el paciente con cardiopatía isquémica crónica

Utilidad del intervencionismo coronario percutáneo en el paciente con cardiopatía isquémica crónica

Curcumin Attenuates Rapamycin-induced Cell Injury of Vascular Endothelial Cells.

Although drug-eluting stents (DES) effectively improve the clinical efficacy of percutaneous coronary intervention, a high risk of late stent thrombosis and in-stent restenosis also exists after DES implantation. Anti-smooth muscle proliferation drugs, such as rapamycin, coating stents, not only inhibit the growth of vascular smooth muscle cells but also inhibit vascular endothelial cells and delay the reendothelialization. Therefore, the development of an ideal agent that protects vascular endothelial cells from rapamycin-eluting stents is of great importance for the next generation of DES. In this study, we demonstrated that rapamycin significantly inhibited the growth of rat aortic endothelial cells in both dose- and time-dependent manner in vitro. Cell apoptosis was increased and migration was decreased by rapamycin treatments in rat aortic endothelial cells in vitro. Surprisingly, treatment with curcumin, an active ingredient of turmeric, significantly reversed these detrimental effects of rapamycin. Moreover, curcumin increased the expression of vascular nitric oxide synthases (eNOS), which was decreased by rapamycin. Furthermore, caveolin-1, the inhibitor of eNOS, was decreased by curcumin. Knockdown of eNOS by small interfering RNA significantly abrogated the protective effects of curcumin. Taken together, our results suggest that curcumin antagonizes the detrimental effect of rapamycin on aortic endothelial cells in vitro through upregulating eNOS. Therefore, curcumin is a promising combined agent for the rescue of DES-induced reendothelialization delay.

Markers of inflammation and antioxidant enzyme activities in restenosis following percutaneous coronary intervention

The efficacy of percutaneous coronary intervention (PCI) is often compromised by the need for repeat revascularization, because of restenosis development. Numerous studies have tried to establish the predictive value of different biochemical markers of restenosis, with conflicting results. The aim of this study was to assess the prognostic significance of inflammatory and lipid markers, and major antioxidant enzyme activity for the development of in-stent restenosis (ISR) following PCI. Serum high sensitive C-reactive protein (hs-CRP), soluble intercellular cell adhesion molecule-1 (sICAM-1), transforming growth factor-beta (TGF-?), lipoprotein(a) and oxidized low-density lipoprotein (oxLDL) levels, as well as serum extracellular superoxide dismutase (EC-SOD) and catalase (CAT) activity were determined in 44 patients before stent implantation procedure, and after 6-month follow-up. Results after follow-up revealed that, in patients that developed angiografically confirmed ISR, the increase in serum hs-CRP levels was significanty higher, compared to those without stenosis. Stent implantation induced compensatory increase in serum antioxidant enzyme activities at follow-up, with significantly lower CAT activity in patients with ISR, possibly contributing to stenosis development. No significant changes in circulating levels of ICAM-1, TGF-?, oxLDL and Lp(a) were observed between the groups. In conclusion, serum hs-CRP level and CAT activity may be considered as useful biochemical markers for monitoring patients during follow-up after stent implantation.

Complete infarct-related artery revascularization in acute myocardial infarction patients. CORAMI Registry.

IntroductionThere are still limited data on the occurrence of multiple stenotic lesions within the infarct-related artery (IRA) in acute myocardial infarction (MI), and there is no consensus on the optimal treatment of this patient subgroup, which varies between centers and operators.AimTo analyse the clinical efficacy of percutaneous coronary intervention (PCI) strategy of culprit lesion only in patients with myocardial infarction.Material and methodsPatients with acute MI with the presence of at least two significant lesions in the IRA – (1) the target culprit lesion which required immediate stenting (> 50–100% stenosis) and (2) a second distal critical lesion (70–90%) – were included in the registry. Both lesions in the IRA were considered to be independent lesions requiring two separate stent platforms to be covered (no overlap). The decision on the treatment strategy of either complete (CR) or culprit-lesion-only (CLO) revascularization was at the discretion of the operator.ResultsThere were altogether 95 patients enrolled in the registry, 63 (66%) in the group with CR of the IRA and 32 (34%) with CLO revascularization, which did not differ in terms of baseline demographics. In-hospital and long-term outcomes were similar between the groups. Stent thrombosis at 1 year occurred in 1.6% in CR and in 6.2% in CLO groups respectively (statistically not significant). There were no patients from the CLO group who had a planned percutaneous coronary intervention (PCI) of the 2nd lesion in the IRA during 1-year observation.ConclusionsAt 1 year the clinical outcome was similar between those with complete and CLO PCI. Complete coverage of significant lesions did not increase the risk of stent thrombosis or need for repeated revascularization in long-term observation.

ASSA14-03-30 Long-term Efficacy of PCI vs CABG for Patients with Multiple Coronary Chronic Total Occlusions

<h3>Backgroud</h3> Data on the efficacy of percutaneous coronary intervention (PCI) for treatment of multiple coronary chronic total occlusion (CTO) lesions are scanty. The optimal revascularisation strategy for multiple coronary CTO disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and PCI. The aim of the present study is to compare the long-term outcomes of DES implantation for multiple coronary CTO lesions compared with CABG. <h3>Methods</h3> We analysed 261 patients who underwent coronary angiography for at least two <i><i>de novo</i></i>CTO lesions in our centre from November 2000 to November 2006. Among them, 118 patients (45.2%) received DES implantation after recanalisation for CTO lesions and 143 patients (54.8%) received CABG. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularisation) and hospitalisation costs were compared. Long-term survival rates were estimated with the Kaplan-Meier method. <h3>Results</h3> Patients in the CABG group were likely to have hyperlipidemia, diabetes mellitus, multivessel disease and higher euroSCORE. The mean follow-up was 4.2 ± 0.7 years in the CABG group and 4.3 ± 0.5 years in the DES group. Total hospitalisation costs were lower (p = 0.017) in the CABG group (median: 107 thousand Yuan) than in the DES group (median: 156 thousand Yuan). Rates of MACCE at 12 months were higher in the PCI group (16.9% vs 11.2% for CABG; P = 0.179), but not statistically significant, in large part because of an increased rate of repeat revascularisation (15.3% vs 7.0%, p = 0.016). The overall survival rate (CABG: 73.4% and DES: 76.2% at 5 years, p = 0.599) and the TVR-free survival rate did not differ between the groups. <h3>Conclusions</h3> This study demonstrates the long-term (up to 5 years) efficacy and safety of DES for treatment of multiple coronary CTO lesions. The long-term survival rate of PCI with DES was comparable to that of CABG for the treatment of multiple coronary CTO. PCI with DES was more costly than CABG. PCI using DES might be an alternative to CABG in selected patients with multiple coronary CTO disease.

Coronary artery treatment with paclitaxel-coated balloon using a BTHC excipient: clinical results of the international real-world DELUX registry

Safety and efficacy of percutaneous coronary interventions using the Pantera Lux paclitaxel-coated balloon have been demonstrated in the PEPPER first-in-man trial. This prospective, multicentre, clinical registry aims to evaluate its safety and efficacy in an international real-world setting in a larger cohort of patients. Between April 2010 and April 2011, 1,064 patients were treated for predominantly diffuse and proliferative in-stent restenosis of bare metal stents (BMS-ISR) and drug-eluting stents (DES-ISR), or for de novo lesions. Clinical device success was obtained in 98.2% of the patients. The study endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and clinically driven target vessel revascularisation, and was 8.5% in the overall, 6.0% in the BMS-ISR, 11.5% in the DES-ISR and 7.0% in the de novo population at six months, and 15.1%, 11.6%, 20.6% and 9.4% at 12 months, respectively. Definitive stent thrombosis occurred in 0.4% of the patients within 12 months. Safety and efficacy of the Pantera Lux paclitaxel-coated balloon was confirmed in a real-world setting with low major adverse cardiac event rates in patients with in-stent restenosis or de novo lesions. (ClinicalTrials.gov: NCT01081366).

Efficacy of percutaneous coronary intervention in diabetic patients — local results with global impact

Cardiologia CROATICA Introduction: Diabetes mellitus is combined with high risk for the development of coronary artery disease (CAD). Revascularization in diabetic patients is challenged by a more diffuse atherosclerotic coronary disease, a higher propensity to develop re-stenosis and unremitting atherosclerotic progression causing new stenosis. The goal: To assess efficacy, safety and long-term survival of diabetic patients with mutivessel CAD treated with percutaneous coronary intervention (PCI) and drug-eluting stent implantation (DES). Patients and Methods: We included 28 patients with stable/unstable angina or non-ST segment elevation myocardial infarction (age 66±15) and with basal characteristics and inherent risk comorbidities as stated in Table 1. After the coronarography was done and multivessel CAD was confirmed (significant stenosis in more than 2 epicardial vessels and/or stenosis of the left main coronary artery) patients were offered, regarding optimal evidence-based medical possibilities, surgical revascularization or PCI. The latter ones entered the PCI arm of the study and were treated with PCI using DES. After the patients underwent coronarography, SYNTAX score was calculated which classifies patients into low, medium and high SYNTAX score group (SYNTAX score 33). Following PCI, all the patients were treated by using optimal medical therapy (Table 2). The patients were subjected to secondary coronarography after one year of follow-up or earlier based on clinical indication. Results: After the median follow-up of 3.4 years, we found that the highest incidence of major adverse cardiac and cerebrovascular event (MACCE) was observed in high SYNTAX score group (100%) as opposed to absence of MACCE in the low SYNTAX score group (Table 3). The need for repeated revascularization was 14.3% and the overall registered primary outcome prevalence (composite of death, myocardial infarction and stroke) was 21.4%. None of the patients had stroke and the incidence of myocardial infarction was 14.2% (all observed in high SYNTAX score group). Conclusion: The results of our study are comparable to the results of large randomized clinical trials conducted worldwide which studied the efficacy of PCI in multivessel disease as well as compared PCI strategy with surgical revascularization. Therefore, we find that these results indicate the possibilities of implementing and performing state-of-theart cardiovascular procedures even in somewhat small clinical centers as ours whilst obtaining results comparable to the ones achieved in large global centers.

Smooth muscle-specific drug targets for next-generation drug-eluting stent

The occurrence of stent thrombosis is one of the major obstacles limiting the long-term clinical efficacy of percutaneous coronary intervention. The anti-smooth muscle proliferation drugs coated on drug-eluting stents (DES) often indistinguishably block re-endothelialization, an essential step toward successful vascular repair, due to their nonspecific effect on endothelial cells (ECs). Therefore, identification of therapeutic targets that differentially regulate vascular smooth muscle cell (VSMC) and EC proliferation may lead to the development of ideal drugs for the next-generation DES. Our recent studies have shown that CTP synthase 1 (CTPS1) differentially regulates the proliferation of VSMC and EC after vascular injury. Therefore, CTPS1 inhibitors are promising agents for DES. In addition to CTPS1, other factors have also shown cell-specific effects on VSMC and/or EC proliferation and thus may become potential molecular targets for developing drugs to coat stents.

GW24-e1830 Interventional treatment in maintenance hemodialysis patients with acute coronary syndrome

ObjectivesTo observe the efficacy of percutaneous coronary intervention (PCI) in maintenance hemodialysis (MHD) patients with acute coronary syndrome (ACS).MethodsFrom January 2008 to October 2011, we completed PCI in the 38...

GW24-e1270 Long-term efficacy of PCI vs. CABG for patients with multiple coronary chronic total occlusions

ObjectivesData on the efficacy of percutaneous coronary intervention (PCI) for treatment of multiple coronary chronic total occlusion (CTO) lesions are scanty. The optimal revascularisation strategy for multiple coronary CTO disease...

Importance of Plaque Modification Before Coronary Artery Stenting

Lately, the importance of plaque modification prior to stent implantation, particularly the use of cutting and scoring balloons, has been a subject of debate. Pre-treatment or plaque modification before stent implantation is an important step to achieve the best possible result and ensure long term safety and efficacy of percutaneous coronary intervention (PCI). The rationale behind plaque modification is that it may minimise arterial injury and subsequent neointimal proliferation and/or restenosis. Artery scoring before stent implantation gives almost perfect stent apposition with reduced inflation pressure and minimised plaque shifting, it also prevents balloon slippage, alters calcification, increases artery compliance and enhances stent deliverability. Appropriate use of scoring balloons for plaque modification with subsequent stent implantation significantly increases acute and post-procedural results of angioplasty. With bioabsorbable stents and bioresorbable vascular scaffolds, plaque modification will be an essential tool to perform complete ‘vessel repair procedures’.