Guideline For Percutaneous Coronary Intervention Research Articles

Temporal trends in percutaneous coronary intervention in Australia: A retrospective analysis from 2000–2021

ObjectiveThe aim of this study was to describe the trend in percutaneous coronary intervention (PCI) with insertion of a stent in Australia from 2000/01 to 2020/21 and investigate trends in same-day versus non-same-day discharge following PCI. A secondary aim was to compare the rate of coronary artery bypass grafting (CABG) with PCI procedures, while a third aim was to compare marked PCI trend changes with the PCI guidelines during the study period. BackgroundPCI with stent deployment is the most common form of interventional treatment for coronary artery disease, and its use has been expanding since 2000. However, there is a lack of descriptive studies of the national trend in Australia. MethodsAll procedures for PCI and CABG were extracted across 21 years (2000/01 to 2020/21) from the Australian Institute of Health and Welfare data. Age-standardized rates were calculated using the Australian standard population as of June 2001. The ratio of PCI to CABG procedures was also calculated. Trends for PCI were stratified by age, gender, and same-day or overnight discharge episodes. Linear regression analysis was done to compare the age-standardized rates across different age categories. Segmented regression analysis was performed to ascertain the change in the age-standardized rates of PCI during the study period. Whether the changepoints in the trend were matched with guideline updates was also assessed. ResultsThere were 751 728 PCI procedures in persons aged 30 years and above between 2000/01 and 2020/21. The age-standardized rate for the study period showed that persons aged 60-74 years had a higher rate of procedures (102.7) compared to persons aged 30-59 years (81.3) and 75 years and older (61.8) (P < 0.001). There were two statistically significant changepoints in the overall trend; 2005/06 and 2013/14, matched with the change in PCI guidelines. Despite the lower number of procedures for same-day discharge episodes, there has been an increasing trend since 2014/15. More than two-thirds of all stenting procedures were the insertion of a single stent. PCI to CABG procedure ratio increased from 0.6 in 2000/01 to 1.8 in 2020/21. ConclusionsThere was a varying trend in the age-standardized rate of PCI with a peak in 2005/06. The trend appears to be stabilizing in the later part of the study period, but the rate for same-day discharge episodes showed an increasing trend after 2014/15. There is consistency with changepoints in the trend and updated PCI guideline recommendations. The ratio of PCI with insertion of a stent to CABG procedure increased substantially across the study period.

Review and Key Takeaways of the 2021 Percutaneous Coronary Intervention Guidelines.

The 2021 Percutaneous Coronary Intervention guidelines completed by American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions provide a set of guidelines regarding revascularization strategies. With emphasis on equity of care, multidisciplinary heart team use, revascularization for acute coronary syndrome, and stable ischemic heart disease, the guidelines create a thorough framework with recommendations regarding therapeutic strategies. In this comprehensive review, our aim is to summarize the 2021 revascularization guidelines and analyze key points regarding each recommendation.

172 - Considering geographic constraints: a reevaluation of same-day discharge after percutaneous coronary intervention guidelines

172 - Considering geographic constraints: a reevaluation of same-day discharge after percutaneous coronary intervention guidelines

Chinese guidelines for percutaneous coronary intervention in patients with left main bifurcation disease.

Chinese guidelines for percutaneous coronary intervention in patients with left main bifurcation disease.

Chinese Guideline for Percutaneous Coronary Intervention in Patients with Left Main Bifurcation Disease

The coronary left main (LM) artery is characterized by large caliber, length varying from &lt;8 to &gt;15 mm, and 2 large daughter vessels branching from it; it supplies blood to a large area (&gt;75%) of the myocardium. LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels. Thus, the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time. With developments in percutaneous techniques, design, and materials of drug-eluting stents; intravascular imaging; new generation of antiplatelet medications; and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting, implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions. Mirroring the anatomical complexity of the LM, stenting LM bifurcations is technically demanding, and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium. Therefore, the Chinese Society of Cardiology designed a writing committee with members from 3 working groups (ie, clinical research, intravascular imaging and physiology, and interventional cardiology) for the first time, to write a guideline on percutaneous treatment for LM bifurcation lesions, with view to improve the procedural quality and clinical outcomes. This guideline consists of introduction, anatomical description of the LM tree, risk stratification, strategies of revascularization, antiplatelet strategy, follow-up, and long-term management for patients with LM bifurcation lesions.

Chinese guideline for percutaneous coronary intervention in patients with left main bifurcation disease

左主干分叉病变因解剖部位的特殊性，其血运重建策略一直是临床上争论的焦点。随着经皮冠状动脉介入治疗技术的进步、药物洗脱支架材料和工艺的改进、腔内影像学的发展、新型抗血小板药物的应用以及近年来国内外相关随机对照研究结果提供的有力的循证医学证据，介入治疗已经成为左主干分叉病变的重要治疗策略之一。为了进一步规范左主干分叉病变介入治疗，提高我国左主干分叉病变介入治疗整体水平，中华医学会心血管病学分会心血管临床研究学组、冠状动脉腔内影像及生理学学组和介入心脏病学组组织相关专家联合撰写了该指南。该指南包括前言、左主干分叉病变的解剖学特点及危险评分系统、左主干分叉病变血运重建策略选择、介入治疗术后双联抗血小板策略、术后随访及长期管理。该指南的颁布和实施将为规范我国左主干分叉病变的介入治疗发挥积极作用。.

Modified Coronary Pharmaco-Mechanical Thrombectomy Technique

The most recent percutaneous coronary intervention guidelines recommend against the routine use of aspiration thrombectomy in all STEMI cases1; however, abstaining from the use of any thrombectomy device, in the setting of large thrombotic burden, does not seem to be a reasonable approach either. Recent data on continuous aspiration thrombectomy are encouraging2 in this regard and minimize concern about the slightly higher stroke risk seen with manual aspiration catheter use.3 However, certain challenging subsets of very large thrombi do not even respond adequately to the continuous aspiration mechanical thrombectomy and traditional percutaneous coronary intervention techniques.

Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)

BackgroundIn 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry.MethodsThe QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization.ResultsFrom 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009).ConclusionOur data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.

Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility?

BACKGROUNDPercutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy. AIMTo reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODSThis was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion. RESULTSThe study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (< 24 h) in 34% of patients, subacute (> 24 h to 30 d) in 26%, and late (> 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years.CONCLUSIONPCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes.

Is it time to refresh the heart team? New paradigms for shared decision making

### Learning objectives Traditionally composed of an interventional cardiologist, non-invasive cardiologist and a cardiac surgeon, the ‘heart team’ (HT), involves a multidisciplinary approach to decision making for cardiovascular patients. Following...

Correction to: 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the

Correction to: 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and

Chinese guideline for percutaneous coronary intervention(2016)

Chinese guideline for percutaneous coronary intervention(2016)

2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial Infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography

2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial Infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and

Acute coronary syndromes

Acute coronary syndromes

Editors' Picks for 2014 and a Look into the Future.

The year 2014 brought a large number of important advances to cardiovascular medicine that are likely to impact the field for many years, if not decades [1]. Herein are our thoughts on the top stories in 2014 and what is likely to remain hot in 2015. In the field of lipids, several studies with proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors demonstrated their potent effects to lower low-density-lipoprotein cholesterol (LDL-C) in a wide variety of patients. In addition to reducing LDL-C by 50% or more, PCSK9 inhibitors have favorable effects on apolipoprotein-B, lipoprotein (a), and triglycerides. Although much less potent than the PCSK9 inhibitors, the cholesterol absorption inhibitor ezetimibe became the first non-statin to demonstrate a reduction in cardiovascular events on top of background statin therapy. In the IMPROVE IT trial (ClinicalTrials.gov NCT 00202878), the addition of ezetimibe to statin therapy decreased average LDL from 69.5 to 53.7 mg/dl and reduced cardiovascular events, without any safety concerns. Although the benefits were relatively modest (10% reduction in cardiovascular death, myocardial infarction (MI), or stroke), this proof of principle bodes well for PCSK9 inhibitors and other drugs in development that lower LDL-C by other mechanisms. In the field of heart failure, a novel approach that combined an angiotensin receptor blocker and a neprilysin inhibitor (LCZ696, valsartan/sacubitril) demonstrated a 20% reduction in hospitalization for heart failure or cardiovascular mortality as compared to enalapril alone. This landmark study demonstrated that dual-acting neurohormonal inhibition further reduced clinical events beyond that obtained with a single inhibitor of the renin-angiotensin system, which had been the gold standard for over 2 decades. In the world of interventional cardiology three developments stand out in 2014. An implantable loop recorder was six times more likely than conventional monitoring to pick up atrial fibrillation (the majority of episodes were asymptomatic) among patients who recently had an ischemic stroke of unknown etiology, while a second study confirmed the benefit of continued long-term monitoring for arrhythmia after a cryptogenic cerebrovascular event. Defying what had been long-standing conventional wisdom, percutaneous coronary intervention (PCI) of “non-culprit” stable lesions in addition to immediate PCI of the infarct-related lesion was shown in two small studies to improve long-term outcomes. These findings resulted in a 180° turn in PCI guidelines and was rapidly incorporated into clinical practice, however the results of a larger trial are eagerly awaited to support this turn. Lastly, the DAPT (ClinicalTrials.gov NCT01106534) trial showed that extended therapy with two oral antiplatelet drugs beyond the usual 12 months post stenting was associated with reduction in very late stent thrombosis and recurrent myocardial infarction, albeit with an increase in bleeding. Looking ahead to 2015, we anticipate a similar number of breakthroughs. Ongoing studies with 3 PCSK9 inhibitors will likely continue to bang a steady and increasingly louder drumbeat. We will learn more about extended duration of dual antiplatelet therapy with ticagrelor + aspirin when the PEGASUS-TIMI 54 (ClinicalTrails.gov NCT01225562) trial reports this spring. Several drugs targeting different mechanisms to treat diabetes are being studied and hold promise to be the first since metformin to reduce cardiovascular events. Ongoing research with percutaneous approaches for treating valvular disease and renovascular hypertension are also likely to make big news in 2015, whether the results are favorable or not. In patients with aortic stenosis the interventional approach (TAVI) is likely to become the standard of care, not only in patients with high surgical risk but in patients with intermediate risk as well. Given the enormous number of analyses that clinical studies and databases generate, a wide variety of opportunities to publish the results is required. We hope that many of you will not only look at Cardiology and Therapy to learn about these advances, but also encourage you to submit your best work to the journal for consideration.

Abstract 18210: Impact of AHA/ACC Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention Guidelines on Real-world Treatment Strategies for Complex Coronary Artery Disease

Introduction: 2011 ACCF/AHA coronary artery bypass grafting (CABG) guideline and percutaneous coronary intervention (PCI) guideline were published on December 2011.The aim of this study is to explore the impact of guidelines’ publication on real-world treatment for three-vessel or left-main coronary artery disease (CAD). Hypothesis: The release of revascularization guidelines has a positive impact on real-world practice and 1-year outcomes of patients with complex CAD. Methods: Between July 2011 and September 2012, patients diagnosed as three-vessel or left-main CAD at Fuwai hospital were consecutively enrolled. We reviewed medical records to abstract detailed in-hospital information. The Corelab calculated SYNTAX Scores according to coronary angiograms. We conducted follow-up at 12 months after the index hospitalization. The end point was major adverse cerebral and cardic event (MACCE) including death, myocardial infarction, stroke and additional revascularization. Patients were then divided into pre-guideline group and post-guideline group according to the conary angiography date. Binary viariables logistic model and Cox model were uesd for baseline and 1-year outcomes comparison respectively Results: 1746 patients were consecutively enrolled. 37.9% (662) were in pre-guideline group, 62.1% (1084) in post-guideline group. There were no significant differences in demographic factors, cardiac surgery risks and SYNTAX Scores between pre- and post-guideline groups. After the publication of 2011 ACCF/AHA guidelines, doctors recommended more patients to choose CABG (pre: 49.0%, post: 55.6%, p&lt;0.05), the surgeons’ consultation rate increased (pre: 41.9%, post: 49.9%, p&lt;0.05), the rate of ad hoc PCI (PCI immediately after coronary angiography) decreased (pre: 47.5%, post: 40.9%, p&lt;0.05). After adjustment for coronary anatomy complexity and cardiac surgery risks using Cox model, pre-guideline group was associated with significantly higher rates of MACCE (HR=1.62, 95% confidential interval: 1.15-2.27). Conclusions: The publication of 2011 ACCF/AHA CABG and PCI guidelines significantly changed real-world treatment for complex CAD in Fuwai hospital, and further improved outcomes.