Elective Coronary Intervention Research Articles

Contrast-induced nephropathy: nursing interventions - a scoping review

Abstract Introduction Contrast-induced nephropathy (CIN) refers to a reduction in renal function following contrast administration, excluding other causes. It is characterized by na increase in creatinine levels of 0.5mg/dl or greater, or a 25% increase over baseline creatinine, occurring 48 to 72 hours post-contrast administration and lasting for 2 to 5 days (Santos et al., 2011). Antunes et al. (2013) refers that the CIN is the 3rd cause of acute renal insufficiency (ARI) and that CIN may develop in up to 55% of patients who receive contrast exposure during coronary angiography and of these may result in 12,6% requiring dialysis among high-risk groups following percutaneous coronary intervention (PCI) (Wu et al., 2022). Objective This review aims to map the available evidence regarding nursing interventions to prevent contrast-induced nephropathy in patients undergoing PCI. Methods The review follows the methodology proposed by the Joanna Briggs Institute guided by the PCC (Population, Concept, Context) strategy. Were identified 44 articles by MEDLINE Complete (via PubMed), CINAHL Complete (via EBSCO) e SciELO, and analyzed/ selected through PRISMA Scr flowchart. Four articles were included. Results These articles revealed that the incidence of CIN varies based on risk factors such as age, hypertension, and pre-existing chronic kidney disease. As there is no specific treatment for contrast-induced nephropathy, prevention strategies are essential. Nursing professionals have a significant and privileged role in the pre-, intra-, and post-procedural phases, and thus, are best positioned to implement prevention strategies for CIN. In general, hospitals that implemented improvement interventions reduced CIN by 21% compared to the pre-intervention phase. Compared to patients with pre-existing CKD, the reduction was 28% (Lambert et al., 2017). Teams also report important successes in implementing improvements, such as changing behavior with greater awareness of CIN prevention strategies, implementing the hydration protocol, standardizing medical prescriptions and minimizing the volume of contrast administered. Conclusions Nursing plays a crucial and privileged role in preventing CIN. Key interventions involve conducting a thorough initial assessment to identify individuals at risk for CIN (considering factors such as age, comorbidities, nephrotoxic medication, and dehydration). Pioli et al. (2023) found that oral hydration can be effective in the process of preventing CIN, before and after elective percutaneous procedures. It concluded that the oral hydration protocol carried out by nurses proved to be as effective as the hospital intravenous hydration protocol in protecting the kidneys of individuals at risk of developing CIN associated with elective coronary interventions (Picture 1). By implementing these strategies, nursing professionals can effectively contribute to reducing the incidence of contrast-induced nephropathy in patients undergoing PCI.

Effect of Curcuminoids on Contrast-Induced Acute Kidney Injury after Elective Coronary Angiography or Intervention: A Pilot Randomized, Double-Blind, Placebo-Controlled Study

Introduction: The role of curcuminoids, a striking antioxidant, in prevention of contrast-induced acute kidney injury (CI-AKI) remains unknown. We aimed to evaluate the efficacy and safety of curcuminoids in preventing CI-AKI in patients undergoing elective coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Methods: We randomized 114 patients who were undergoing elective CAG and/or PCI to receive curcuminoids, 4 g/day (1 day before and 1 day after the procedure, n = 56), or placebo (n = 58). Serum creatinine was assessed at baseline, 12, 24, and 48 h after contrast exposure. The primary endpoint was development of CI-AKI defined as serum creatinine increase ≥0.3 mg/dL within 48 h after contrast exposure. The secondary endpoint was the occurrence of kidney injury defined by >30% increase in urine neutrophil gelatinase-associated lipocalin (NGAL). Results: Baseline characteristics were comparable between the two groups. Seven (12.7%) in curcuminoids group and eight (14.0%) in placebo group developed CI-AKI (p = 0.84). The incidence of increased urine NGAL was comparable in the placebo and curcuminoids group (39.6% vs. 50%, respectively; p = 0.34). None in both groups had drug-related adverse events. Conclusion: This is a pilot study to demonstrate the safety and tolerability of curcuminoids in patients undergoing elective CAG and/or PCI. Curcuminoids have no protective effects against kidney injury after elective CAG and/or PCI.

Coronary angiography and intervention after transcatheter aortic valve implantation (TAVI): the nationwide SWEDEHEART registry

Abstract Background Coronary access after transcatheter aortic valve implantation (TAVI) can be challenging and complicate percutaneous coronary intervention (PCI). Therefore, pre-existing severe coronary stenosis is usually treated either before or during the TAVI procedure. However, due to the progressive nature of coronary artery disease (CAD), some patients require urgent or elective coronary angiography and intervention after their TAVI procedure. Purpose To assess the indication, the incidence, and feasibility of coronary angiography and intervention after TAVI. Methods All patients undergoing TAVI between 2008 and 2021 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. SWENTRY was further linked to the Swedish Coronar Angiography and Angioplasty Registry (SCAAR) and the National Cause of Death Registry. Results Among 8819 patients undergoing TAVI, 697 angiograms were performed in 515 patients (5.8%) after TAVI (43.1 % after balloon-expandable bioprosthesis, 49.5 % after self-expandable bioprosthesis) at a median follow up of 841 days (interquartile range: 346 to 1457 days). PCI was performed in 347 patients (49.8%) with a success rate of 92.5% with no significant differences between patients implanted with balloon-expandable and self-expandable bioprostheses (93.0% vs.91.5%; p=0.62). The most common indications for PCI after TAVI were non-ST elevation acute coronary syndrome (NSTE-ACS) (45.8%), chronic coronary syndrome (30.3%), ST elevation myocardial infarction (6.9%) and congestive heart failure (3.5%). The cumulative incidence of angiograms with or without PCI at 30 days, 1 year, 2 years and 5 years were 6.9, 37.2, 60.2 and 90.2 percent of the total number of angiograms respectively (Figure). Conclusion Coronary angiogram and interventions after TAVI are rare, with an incidence declining over time after TAVI. The main indication for coronary angiogram and PCI was NSTE-ACS. PCIs were successfully performed after TAVI, with no apparent differences between balloon-expandable and self-expandable bioprostheses.

Predictors of non-calcified plaque presence and future adverse cardiovascular events in symptomatic rural Appalachian patients with a zero coronary artery calcium score

BackgroundCoronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment. MethodsA retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years. ResultsBased on logistic regression, age (OR 1.039, 95% CI [1.020–1.058], p ​< ​0.001), diabetes mellitus (OR 2.192, 95% CI [1.307–3.676], p ​< ​0.003), tobacco use (OR 1.748, 95% CI [1.157–2.643], p ​< ​0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003–1.015], p ​< ​0.002), and hypertension (OR 1.613, 95% CI [1.024–2.540], p ​< ​0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p ​< ​0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26–128.26], p ​< ​0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025–4.627], p ​< ​0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension. ConclusionNCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.

Psychosocial outcomes after a home cardiac rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac Rehabilitation Programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home-CRP model has been introduced. Purpose To evaluate the results in terms of improvement of psychosocial outcomes and changes in employment situation with home-CRP. Methods Cross-Sectional Observational study that included patients of both sexes, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home CRP. Information was collected from the computerized clinical history of the patients (diseased vessels, degree and type of revascularization, risk stratification). Data was collected at the beginning and in the end after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, anxiety/ depression (measured by HADS: Hospital Anxiety and Depression scale) and employment status. Results A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non ST elevation myocardial infarction (NSTEMI) in 45.7%, 31.8% had STEMI, 17.9% after elective coronary interventions ,3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9%, by surgery in 14.5% and 4.6% of patients received only medical treatment. At baseline, 33.5% obese and 55% smoked at index admission. After two months of home PRHC we obtained a reduction of 85.5% in smoking (p&amp;lt;0.001), a loss of 4.6 kg of weight in obese people (p=0.125), reduction of anxiety (p= 0.0012) and depression (p=0.0013) amongst those who had a HADS scale higher than 10, and improvement in employment status with return to work in 61,2% (p&amp;lt;0.001). Conclusions The present study indicates that home- cardiac rehabilitation programs reduce anxiety, depression and improve return to work after acute coronary syndrome.

Clinical outcomes after a home cardiac rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home CRP model has been introduced. Purpose To evaluate the results in terms of control of cardiovascular risk factors (CVRF) and changes in functional capacity with home CRP. Methods Cross-sectional observational study that included 173 patients, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home PRHC. Electronic medical records were analyzed to collect data on baseline clinical variables at the entrance and exit after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, total cholesterol, LDLc, HDLc, triglycerides, HBA1c, METS in stress test and employment status. Results A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non-ST-elevation myocardial infarction (NSTEMI) in 45.7% of patients, 31.8% had STEMI, 17.9% after elective coronary interventions, 3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9% while 14.5% by surgery. Baseline 45.7% of patients were hypertensive, 71.7% dyslipidemic, 33.5% obese, 15.7% diabetic, and 14 % smoked at index admission. After two months of home CRP we obtained a reduction of 85.5% in smoking (p&amp;lt;0.001), improvement in lipid control (p&amp;lt;0.001), with a mean LDLc of 54.5 mg/dl, a loss of 4.6 kg of weight in obese people and improvement in 1.50 METS (p&amp;lt;0.0001). Conclusions The present study indicates that home cardiac rehabilitation programs are a valid alternative in low- and moderate-risk patients after acute coronary syndrome.

Feasibility of hybrid telerehabilitation as a component of the Managed Care after Acute Myocardial Infarction (MC-AMI) program in a 12-month follow-up: experience from a single center.

Managed Care after Myocardial Infarction (MC‑AMI [KOS-Zawał]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC‑AMI. We evaluated the feasibility of HTR as a component of MC‑AMI and assessed its safety and acceptance by patients. One‑year all‑cause mortality among the patients participating and not participating in MC‑AMI was analyzed. The MC‑AMI group included 114 patients who underwent a 5‑week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12‑month MC‑AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC‑AMI group was formed using propensity score matching to compare 1‑year all‑cause mortality between the patients participating and not participating in MC-AMI. HTR significantly improved the functional capacity assessed in the stress test and was well‑received by the patients. In the study group, nonfatal non-ST‑segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC‑AMI participants, whereas in the non-MC‑AMI group, 1‑year all‑cause mortality was 3.5%. The log‑rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04). HTR as a component of MC‑AMI was a feasible, safe, and well‑accepted form of cardiac rehabilitation. Participation in MC‑AMI including HTR was associated with a significantly lower risk of 1‑year all‑cause mortality, as compared with not taking part in the rehabilitation program.

Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions.

Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.

Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention.

Percutaneous coronary intervention is performed routinely in the management of myocardial infarction with obstructive coronary disease, but intervention to arteries supplying nonviable myocardium may be harmful. It is important therefore to establish myocardial viability, and there is an unmet need in current clinical practice for real time viability assessment to aid in decision making. Transcoronary pacing to assess myocardial electrophysiological parameters may be a novel viability assessment technique which could be used in this regard. Coronary intervention was carried out according to standard departmental procedure with standard equipment. An exchange length coronary guidewire was passed into both target and reference coronary vessels and an over-the-wire balloon or microcatheter was used to insulate the guidewire and allow electrophysiological parameters to be assessed. Readings were obtained from all major epicardial vessels and substantial branches. At each position, an intracoronary electrocardiogram was recorded, and R wave amplitude was measured. Transcoronary pacing was then performed to establish threshold and impedance for each myocardial segment. A viability cardiac MRI scan was performed for each patient. A standard segmental model was used to determine viability in each segment using an 'infarct score' based on degree of late gadolinium enhancement. Studies were reported blinded to the electrical parameters obtained from the coronary guidewire. The primary outcome was the relationship between pacing threshold and myocardial segment infarct score. Secondary outcomes included the relationship between segmental infarct score and R wave height, and between segmental infarct score and pacing impedance. Data were collected on the feasibility of studying the coronary segments as well as safety. Sixty-five patients presenting with stable coronary artery disease or acute coronary syndromes to Leeds General Infirmary between September 2019 and August 2021 were included in the study. Electrophysiological parameters from segments with an infarct score of zero were obtained, with wide variances seen, with no significant difference in impedance or threshold in any territory. There was a significant difference in sensitivity for segments in the right coronary artery territory for both elective and acute patients. This likely relates to reduced myocardial mass in these territories. No significant association between infarct score and sensitivity, impedance or threshold were seen. This study has established intracoronary electrophysiological parameters in both normal myocardium and areas of myocardial scar. No reliable association was seen between impedance, threshold or R wave amplitude and degree of myocardial viability, contrasting with prior findings from our group and others. More work is therefore required to fully understand the role of transcoronary pacing in this setting.

Assessment of silent brain injury in patients undergoing elective percutaneous coronary intervention due to chronic total occlusion

Objective: Silent brain infarcts (SBI) are thromboembolic complications associated with cardiac surgery, diagnostic angiography, and percutaneous interventions. Serum neuron-specific enolase (NSE) is the proven biomarker for measuring neuronal damage. This study aimed to evaluate the incidence of SBI, defined as elevated NSE after coronary chronic total occlusion (CTO) intervention and elective coronary stenting. Design: The study population consisted of two patient groups: the CTO group included consecutive patients with coronary CTO intervention, and the control group consisted of patients who underwent elective coronary intervention. NSE blood levels were measured before and 12–18 h after the procedure. NSE blood levels of >20 ng/mL were considered SBI. Results: A total of 108 patients were included in the study. Of these, 55 (50.9%) had SBI after the procedure. The SBI rate was 59.7% in the CTO group and 39.1% in the control group. Patients with SBI were more likely to have diabetes mellitus, hyperlipidemia, higher HbA1c, higher total stent length, and longer procedural time. Multivariate logistic regression analysis showed that CTO procedure (odds ratio [OR]: 3.129; 95% confidence interval [CI]: 1.246–7.858; p < 0.015) and diabetes mellitus (OR: 2.93; 95% CI: 1.185–7.291; p < 0.020) are independent predictors of SBI. Conclusion: Our data suggest that SBI occurs more frequently after CTO intervention than after non-CTO intervention. Intervention complexity and patient clinical characteristics may explain the increased incidence.

Psychometric evaluation of the Coronary Revascularisation Outcome Questionnaire (CROQ) in Norwegian patients admitted to elective coronary angiography and possible percutaneous coronary intervention

BackgroundThe Coronary Revascularisation Outcome Questionnaire (CROQ) measures health-related quality of life and outcome of invasive revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The CROQ has not been properly validated in Norwegian patient populations. The aim of this study was to examine the psychometric properties of the Norwegian CROQ in patients admitted to elective coronary angiographic assessment and receiving PCI. Moreover, to examine its discriminative ability to detect disease severity and effects of invasive coronary treatment.MethodsThe patients (N = 280, Mage = 66.9, SDage = 8.91) completed the CROQ, prior to an elective coronary angiography and at one year follow-up. Analyses included internal consistency, floor and ceiling effects, and confirmatory and exploratory factor analyses of the CROQ. Convergent validity was evaluated by comparing CROQ scores with the RAND-12 measure. Sensitivity to treatment was examined by comparing pre-post effect size differences between the PCI treatment and non-treatment group.ResultsSignificant stenosis qualifying for a PCI was detected in 121 (35.1%) patients. The model fit of the original CROQ factor model was inadequate in the PCI group. All but one of the CROQ items demonstrated ceiling effects. The CROQ failed to discriminate between patients’ disease severity prior to the coronary angiography, or improvement in those receiving versus not receiving PCI.ConclusionThe present study of the Norwegian version of the CROQ identified serious problems with the factor structure, ceiling effects, and lack of sensitivity for disease severity and effects of invasive treatment. Currently, one cannot recommend the use of CROQ in clinical practice.

Prognostic value of the SYNTAX score on myocardial injury and salvage in STEMI patients after primary percutaneous coronary intervention: a single-center retrospective observational study

BackgroundSYNTAX score (SS) was shown to positively correlate with postprocedural myocardial injury in patients after elective coronary artery intervention, but evidence about the association of SS with myocardial salvage in ST-segment elevation myocardial infarction (STEMI) patients is still needed. This study aimed to evaluate the prognostic value of SS for myocardial injury and salvage assessed by cardiac magnetic resonance (CMR) after primary percutaneous coronary intervention (PCI) in STEMI patients.MethodsThis single-center retrospective study consecutively enrolled STEMI patients who had undergone primary PCI within 12 h from symptom onset. Both angiography and CMR were performed during hospitalization, and patients were divided into low SS (SS ≤ 22), mediate-high SS (SS > 22) groups. Correlation and multivariable analyses were performed.ResultsA total of 149 STEMI patients (96 low SS, 53 mediate-high SS) were included. In terms of myocardial injury parameters, there was a positive correlation (p < 0.001, Spearman r = 0.292) between SS and infarct size (IS), and a negative correlation (p < 0.001, Spearman r = − 0.314) between SS and myocardial salvage index (MSI). In the multivariable model, SS (> 22 as categorical variable, OR = 2.245, 95% CI [1.002–5.053], p = 0.048; as continuous variable, OR = 1.053, 95% CI [1.014–1.095], p = 0.008) was significantly associated with high IS (≥ mean 35.43). The areas under the receiver operating characteristic (ROC) curves of SS for high IS and low MSI (≤ median 28.01) were 0.664 and 0.610.ConclusionsIn STEMI patients undergoing primary PCI, SYNTAX score positively correlated with infarct size and negatively with myocardial salvage, indicating an independent predictive value of the myocardial injury.

Preventive Effect of Shenduning Prescription Combined with Hydration Therapy on Contrast Induced Nephronpathy after Elective Percutaneous Coronary Intervention

Objective — To explore the preventive effect of Shenduning prescription combined with hydration therapy on contrast induced nephronpathy (CIN) after elective percutaneous coronary intervention. Methods — 159 patients undergoing selective coronary intervention were divided into simple hydration group, intensive statin group and Shenduning prescription group randomly, with 53 cases in each group. The simple hydration group received conventional drugs for coronary heart disease and preoperative routine hydration therapy. The intensive statin group received intensive treatment with atorvastatin calcium tablets on the basis of the simple hydration group, and the Shenduning prescription group received Shenduning prescription treatment on the basis of the hydration group. Serum creatinine (Scr), malondialdehyde (MDA), superoxide dismutase (SOD) and glomerular filtration rate (eGFR) were detected by blood samples at 24h before and after operation, as well as 72h after operation respectively. The primary endpoint event was the occurrence of CI-AKI. Results — The Scr level of the intensive statin group and the Shenduning prescription group was significantly lower than that of the simple hydration group, while the eGFR level was significantly higher than that of the simple hydration group, which is of statistical significance (P&lt;0.05). The incidence of CI-AKI was 15.1% in simple hydration group, 5.7% in intensive statin group and 3.8% in Shenduning prescription group respectively after operation (χ2 = 5.194, P=0.075), of which there was significant statistical difference between simple hydration group and Shenduning prescription group (χ2 = 3.975, P=0.046). After 72h of the operation, MDA level in Shenduning prescription group was significantly lower than that in simple hydration group and intensive statin group, while its SOD level was significantly higher than that in simple hydration group and intensive statin group, which is of statistical significance (P&lt;0.05). The proportion of abnormal liver function in intensive statin group and the Shenduning prescription group was 13.1% and 3.8%, respectively, and the difference was statistically significant (χ2 = 4.867, P=0.027). Conclusion — The combination treatment of Shenduning prescription with hydration therapy may protect the patient’s renal function after elective coronary interventional therapy, while reducing the incidence of CIN and the oxidative stress reaction caused by contrast agent, thus effectively reducing adverse reactions.

High-Dose Atorvastatin Raises Threshold of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Elective Coronary Intervention: A Randomized Controlled Study

Background. Contrast-induced nephropathy (CIN) is a significant complication of angiographic procedures resulting from injection of iodinated contrast media (CM). Patients with diabetes mellitus (DM) are at the highest risk of CIN. Statins have recently been proposed for protection against CIN due to their antioxidant and anti-inflammatory properties. Aim of Work. To investigate the potential benefit of acute pretreatment with high-dose atorvastatin (80 mg) in reduction of the incidence of CIN in diabetic patients indicated for elective coronary intervention. Patients and Methods. 200 diabetic patients with indication for coronary intervention were enrolled in the study. 100 patients will be randomly assigned to receive atorvastatin (80 mg) just before coronary intervention (statin group) and 100 patients received placebo (control group). CIN was defined as a rise of serum creatinine of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 hours of the angiography. After the procedure, Thrombolysis in Myocardial Infarction (TIMI) flow of the culprit vessel was reported, as well as the volume of used contrast media and time of X-ray exposure. Results. Our study reported a CIN incidence of 12, 18, and 6% among the whole study, placebo, and statin groups, respectively, P value of 0.001. Among the placebo group, CIN is likely to develop after a 13.5-minute X-ray exposure time with a specificity of 73.2% and sensitivity of 77.8%, area under the curve (AUC) of 0.879 (CI: 0.798–0.960), and P value of 0.001, while in the statin group, CIN is likely to develop after 14.5-minute X-ray exposure time with a specificity of 74.5% and sensitivity of 83.3%, AUC of 0.818 (CI: 0.727–0.910), and P value of 0.009. In the placebo group, CIN is likely to develop after injection of 145 ml of contrast media with a specificity of 75.6% and sensitivity of 77.8%, AUC of 0.855 (CI: 0.757–0.952), and P value of 0.001, while in the statin group, CIN is likely to develop after injection of 165 ml of contrast media with a specificity of 84% and sensitivity of 83.3%, AUC of 0.878 (CI: 0.811–0.944), and P value of 0.002. Conclusions. Acute pretreatment with high-dose atorvastatin can effectively protect against CIN and was associated with a marked decrease in the prevalence of CIN in diabetic patients undergoing coronary interventions. Moreover, pretreatment with high-dose atorvastatin raises the threshold of X-ray exposure time and the amount of contrast media beyond which CIN is likely to develop. The trial is registered with NCT04375787.

Preservation of Radial Vasomotor Functions Through the Anatomic Snuffbox: A Prospective Comparison with other Radial Accesses during Coronary Angiography.

To compare radial vasomotor functions at three different access sites namely right, left main radial artery, and left distal radial (LDR) artery. Observational study. Department of Cardiology, EGE University, Turkey, from September 2017 to February 2018. Forty-one patients scheduled for transradial elective coronary angiography and intervention were consecutively enrolled. Access site decision was left free to operators being blind of the study. Main radial vasomotor function measured through flow mediated vasodilation test was compared between other radial access sites on admission, 1 day and 2 months post-catheterisation. Five patients were intervened through the left main radial, whereas the LDR and the right main radial access were used in 17 and 19 patients respectively. In contrast to other radial access sites, LDR approach showed significantly less influenced vasomotor functions the day after the procedure. This feature continued to be preserved for two months of follow-up. Conclusion: Left distal radial branch in the anatomic snuffbox is a reliable access in terms of vasomotor function preservation compared to conventional left and right radial artery accesses. Key Words: Transradial access, Flow mediated vasodilatation, Endothelial function.6re6445.

Radial artery spasm: reviews and updates.

Elective and emergent coronary interventions via transradial access (TRA) are been used increasingly as they carry a reduced risk of complications. Percutaneous coronary intervention via TRA may lead to radial artery spasms (RAS) that may result in prolonged procedure time, cross-over of access site, and other complications. This review article discusses the recent definitions, incidences, pathophysiology, predictive score calculator, efficacy, the safety of the radial cocktails, and treatment of the RAS.

Impact of periprocedural biomarker elevation on mortality in stable angina pectoris patients undergoing elective coronary intervention: a systematic review and meta-analysis including 24 666 patients.

Uncertainty remains regarding the exact prognostic impact of biomarker elevation following percutaneous coronary intervention in patients with stable angina pectoris and the subsequent risk of death. We sought, therefore, to evaluate the effect of periprocedural myocardial infarction on the subsequent mortality risk following percutaneous coronary intervention in patients with stable angina pectoris and normal preprocedural cardiac biomarkers level. After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies with post-procedural cardiac biomarkers data. All-cause mortality and cardiac death were evaluated in subjects with stable angina pectoris who underwent an elective coronary intervention. Fourteen studies with 24 666 patients were included. The mean age was 64.2 years ± 9.8 with about 3-quarters (74.9%) of these patients being men. The mean duration of follow-up was 18.1 months ± 14.3. Periprocedural myocardial infarction, based on study-specific biomarker criteria, occurred in 14.3% of the patients. Periprocedural myocardial infarction conferred a statistically significant increase in the risk of all-cause mortality (odds ratio, 1.62; 95% confidence interval, 1.30-2.01; P < 0.0001; I = 0%); where reported separately, cardiac death was also significantly increase (odds ratio, 2.77; 95% confidence interval, 1.60-4.80; P = 0.0003; I = 0%). The occurrence of periprocedural myocardial infarction after an elective percutaneous coronary intervention in patients with stable angina pectoris is associated with a statistically significant increase in subsequent all-cause mortality and cardiac mortality.

565 Thirty-Day Complications Following Elective Coronary Angiography and Percutaneous Coronary Intervention: A Population-Wide Cohort Study

565 Thirty-Day Complications Following Elective Coronary Angiography and Percutaneous Coronary Intervention: A Population-Wide Cohort Study

Identification of patients at higher risk for myocardial injury following elective coronary artery intervention.

To evaluate myocardial injury and infarction (MI) following elective percutaneous coronary intervention (PCI). The substantially higher analytical power of high-sensitivity troponin (hsTn) assays allows detection of minor cardiac troponin (cTn) levels, which may be useful in monitoring myocardial injury and guiding therapies. Serial hsTnT measurements were conducted in patients undergoing elective PCI and were related to the extent of coronary artery disease (CAD) as reflected by the SYNTAX score risk categories and American College of Cardiology/American Heart Association classification of coronary lesions. Myocardial injury and MI were diagnosed according to the second and third versions of universal MI definition. The study population consisted of 530 patients, who were grouped into low (41.3%), intermediate (35.4%), and high (23.3%) SYNTAX risk categories. The treated coronary lesions were classified into A 7.8%, B1 24.1%, B2 21.1%, C1 24.6%, and C2 22.4%. Postprocedural hsTnT increases correlated significantly with the complexity of treated coronary lesions (p < .05) and CAD magnitude (p < .05). Rates of MI type 4a according to the second and third MI definition criteria were 98 (27.5%) and 15 (4.2%) cases in patients with normal baseline hsTnT values (N = 357, 67.4%), as well as 137 (79.2%) and 27 (15.6%) cases in those with elevated baseline hsTnT values (N = 173, 32.6%), respectively. After elective PCI, cTn releases correlate significantly with lesion complexity and CAD extent. Use of hsTnT assay enables precise monitoring of PCI-related myocardial injury and may identify patients at higher risk for ischemic events, who may benefit from potent platelet inhibition, which needs to be investigated in randomized trials.

TCT-423 Periprocedural Myocardial Infarction Is Associated With Mortality in Stable Angina Pectoris Patients Undergoing Elective Coronary Intervention

Uncertainty remains regarding the exact prognostic impact of biomarker elevation following percutaneous coronary intervention in patients with stable angina pectoris (SAP) and the subsequent risk of death. This study sought, therefore, to evaluate the effect of periprocedural myocardial infarction (