Higher Major Adverse Cardiac Events Research Articles

Equipment entrapment/loss during chronic total occlusion percutaneous coronary intervention.

There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed the baseline clinical and angiographic characteristics and outcomes of equipment loss/entrapment at 43 US and non-US centers between 2017 and 2023. Equipment loss/entrapment was reported in 40 (0.4%) of 10 719 cases during the study period. These included guidewire entrapment/fracture (n = 21), microcatheter entrapment/fracture (n = 11), stent loss (n = 8) and balloon entrapment/fracture/rupture (n = 5). The equipment loss/entrapment cases were more likely to have moderate to severe calcification, longer lesion length, higher J-CTO and PROGRESS-CTO complications scores, and use of the retrograde approach compared with the remaining cases. Retrieval was attempted in 71.4% of the guidewire, 90.9% of the microcatheter, 100% of the stent loss, and 100% of the balloon cases, and was successful in 26.7%, 30.0%, 50%, and 40% of the cases, respectively. Procedures complicated by equipment loss/entrapment had higher procedure and fluoroscopy time, contrast volume and patient air kerma radiation dose, lower procedural (60.0% vs 85.6%, P less than .001) and technical (75.0% vs 86.8%, P = .05) success, and higher incidence of major adverse cardiac events (MACE) (17.5% vs 1.8%, P less than .001), acute MI (7.5% vs 0.4%, P less than .001), emergency coronary artery bypass graft (CABG) (2.5% vs 0.1%, P = .03), perforation (20.0% vs 4.9%, P less than .001), and death (7.5% vs 0.4%, P less than .001). Equipment loss is a rare complication of CTO PCI; it is more common in complex CTOs and is associated with lower technical success and higher MACE.

Outcomes after surgical revascularization in diabetic patients.

Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05-1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10-2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12-3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87-1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.

Psychosocial stress and well-being in patients presenting with acute myocardial infarction in a tertiary care center

BackgroundPsychosocial factors such as stress have been previously implicated as a risk factor for cardiovascular diseases (CVDs). There is little evidence regarding the prevalence of stress among patients with acute myocardial infarction (AMI). MethodsA total of 903 patients with AMI enrolled in the North Indian ST-Segment Elevation Myocardial Infarction (NORIN-STEMI) registry were included in this study. Perceived stress in these subjects was evaluated using the Perceived Stress Scale-10 questionnaire while the World health Organization (WHO-5) Well-being Index was used to evaluate psychological well-being. All these patients were followed up for one month and major adverse cardiac events (MACE) were determined. ResultsA majority of patients with AMI had either severe (478 [52.9%]) or moderate stress (347 [38.4%]) while low stress levels were observed in 78 [8.6%] patients. Additionally, most of the patients with AMI (478 [53%]) had WHO-5 well-being index <50%. Subjects with severe stress were younger (50.86 ± 13.31; P < 0.0001), more likely to be males (403 [84.30%]; P = 0.027), were less likely to have optimal level of physical activity (P < 0.0001) and had lower WHO-5 well-being score (45.54 ± 1.94%; P < 0.0001) as compared to those with low and moderate stress levels. On 30-days follow-up, subjects with moderate/severe stress had higher MACE however, the difference was non-significant (2.1% vs 1.04%; P = 0.42). ConclusionA high prevalence of perceived stress and low well-being index was observed in patients presenting with AMI in India.

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention.

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.

Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study.

We aimed to classify individuals with RA and ≥2 additional long-term conditions (LTCs) and describe the association between different LTC classes, number of LTCs and adverse health outcomes. We used UK Biobank participants who reported RA (n=5,625) and employed latent class analysis (LCA) to create classes of LTC combinations for those with ≥2 additional LTCs. Cox-proportional hazard and negative binomial regression were used to compare the risk of all-cause mortality, major adverse cardiac events (MACE), and number of emergency hospitalisations over an 11-year follow-up across the different LTC classes and in those with RA plus one additional LTC. Persons with RA without LTCs were the reference group. Analyses were adjusted for demographic characteristics, smoking, BMI, alcohol consumption and physical activity. A total of 2,566 (46%) participants reported ≥2 LTCs in addition to RA. This involved 1,138 distinct LTC combinations of which 86% were reported by ≤2 individuals. LCA identified 5 morbidity-classes. The distinctive condition in the class with the highest mortality was cancer (class 5; HR 2.66 95%CI (1.91-3.70)). The highest MACE (HR 2.95 95%CI (2.11-4.14)) and emergency hospitalisations (rate ratio 3.01 (2.56-3.54)) were observed in class 3 which comprised asthma, COPD & CHD. There was an increase in mortality, MACE and emergency hospital admissions within each class as the number of LTCs increased. The risk of adverse health outcomes in RA varied with different patterns of multimorbidity. The pattern of multimorbidity should be considered in risk assessment and formulating management plans in patients with RA.

PS-C14-3: HEART RATE RECOVERY IN CORONARY ARTERY DISEASE PATIENTS WITH HYPERTENSION: RELATIONSHIP WITH CLINICAL FEATURES AND LEFT VENTRICULAR REMODELLING

Objective: Heart rate recovery after treadmill exercise testing reflects autonomic dysfunction and is related to higher major adverse cardiac events. Numerous studies suggested the correlation of Heart rate recovery with hypertension and left ventricular remodeling. This study aimed to assess factors related to HRR in coronary artery disease patients who have undergone revascularization and Beta-blocker. Design and method: This cross-sectional study includes CAD patients who came to the outpatient clinic for six to 24 months after hospitalization in Dr. Hasan Sadikin General Hospital from February to August 2021. All patients undergo treadmill tests and transthoracic echocardiography. The treadmill stress test is conducted using Bruce or Modified Bruce Protocol. Transthoracic echocardiography is conducted using GE Vivid 7 ultrasound machine. Heart rate recovery at one minute defines as abnormal if &lt; 18 beats per minute. The t test was used for continuous variables, and the Chi-square or Fisher exact test was used for categorical data. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 63 consecutive coronary artery disease patients with (n = 43, HP) and without (n = 20, NHP) were included in this study. All subjects underwent treadmill exercise testing. Up to 90% of patients have undergone revascularization by percutaneous coronary intervention or coronary artery bypass graft. All patients on Beta-blocker therapy. Peak heart rate (152 ± 29 vs. 132 ± 24, p = 0.010) and Heart rate recovery at one minute (129 ± 18 vs. 118 ± 19, p = 0.025) were significantly higher in the NHP group. Older age and lower peak heart rate were associated with lower heart rate recovery at one minute in the HP group. The previous history, such as diabetes, smoking history, ejection fraction, left wall mass index, and functional capacity, does not correlate with heart rate recovery at one minute in NHP or HP group. Conclusion: The present results demonstrate that heart rate recovery at one minute is affected by older age and peak heart rate. The left ventricular remodelling and other risk factors and their associations in coronary artery disease population who have undergone revascularization and are on beta-blocker medications should be investigated more with larger samples.

COMPARISON OF CLINICAL OUTCOMES OF CALCIFIED AND NON-CALCIFIED CORONARY ARTERY LESION INTERVENTION UNDER IVUS GUIDANCE -AN EXPERIENCE FROM A SOUTH ASIAN COUNTRY, PAKISTAN

Objectives: Intralesional coronary artery calcification (CAC) is an important prognostic marker in terms of target lesion failure, target vessel revascularization and clinical outcomes. Intravascular ultrasound (IVUS) plays a pivotal role in the optimal management of calcified coronary arteries. We aimed to determine the clinical outcomes of IVUS guided intervention of calcified coronary lesions in a South Asian country.&#x0D; Methodology: We retrospectively studied a total of 134 consecutive patients, who underwent IVUS guided assessment of coronary arteries from January 2013 to March 2020 at a single center. Patients were categorized into two groups: those with coronary artery calcification (CAC, n=77) and without coronary artery calcification (non-CAC, n=57). The mean duration of follow-up was 40.3 ± 30.1 months. The two groups were compared based on their clinical characteristics, management, in-hospital events, follow-up, and major adverse cardiac events (MACEs) that included cardiovascular death, non-fatal MI, life-threatening arrhythmia, bleeding, heart failure, stroke, and target vessel revascularization.&#x0D; Results: A total of 134 patients were included who had undergone IVUS and were divided into two groups patients with CAC (n=77) and non-CAC (n=57). Majority of the patients were male (n=97 [72.3%]), the mean age at presentation was 63.1 ± 12.9 years. In CAC group the most common risk factor was Age of the patient then dyslipidemia (n=68[88%] followed by hypertension (n=64[83%]) and diabetes mellitus (n=44[57%]), CAC group patients were more commonly presented with acute coronary syndrome (n=59[76.6%]), had prior PCI (n=40[52%]), had more LM disease (n=34 [44%], p=value 0.005), significant number of prior stent-ISR (n=27[47%]) p=0.024. Having CAC is associated with higher MACE (17 out of 26 events).&#x0D; Conclusion: Patients with CAC have more comorbidities and more commonly present with acute coronary syndrome. MACEs were recorded higher in the CAC group although the results are not statistically significant.

Comorbidity characteristics of multiple myeloma patients diagnosed in Finland 2005–2016

Multiple myeloma (MM) patients are predominantly elderly with comorbidities that have an impact on patient mortality and treatment decisions. We previously reported the patient characteristics and overall survival outcomes of the Finnish MM cohort diagnosed between 2005 and 2016 in a nationwide retrospective registry study comprising 3,851 adults. Here, we report detailed comorbidity characteristics for this real-world Finnish MM population at cohort entry and during follow-up. Data on diagnoses and causes of death were obtained from Finnish healthcare data registries and interrogated using various multistate time-to-event models. In the year preceding MM diagnosis, comorbidities (as per Charlson Comorbidity Index definition) were recorded in 38.0% of the cohort, of which 27.9% presented with pre-existing cardiovascular disease (CVD) and 4.8% had suffered a major adverse cardiac event (MACE). At 2 years post-MM diagnosis, cumulative incidence for CVD and MACE more than doubled to 57.1% and 11.4%, respectively, and only 31.9% of the cohort remained CVD-free. Prevalent secondary malignancies were recorded in 16.8% of the patient population at MM diagnosis, with cumulative incidence increasing steadily to 27.5% at 2 years and 33% at 5 years post-diagnosis. The main cause of mortality attributed to MM, CVD, secondary malignancy, or other causes remained stable throughout the follow-up, at an average of 74.2%, 9.4%, 9.8%, and 6.5%, respectively. Prevalence of CVDs and secondary malignancies is high in Finnish patients at MM diagnosis, with older male patients suffering from higher MACE and mortality risk. Proper recording and management of comorbidities alongside novel treatments remain crucial for optimal MM management.

Elevated shock index and modified shock index are associated with mortality and major adverse cardiac events in patients with acute myocardial infarction: A systematic review and meta-analysis

Background Blood pressure (BP) and heart rate (HR) have been studied extensively to predict unfavourable outcomes in patients suffering from an acute myocardial infarction (AMI). Shock index (SI) and modified shock index (MSI) are two new emerging parameters that incorporate BP and HR into their calculations, thereby improving the predictive value of each HR and BP alone in AMI patients. Thus, our aim was to determine the prognostic utility of SI and MSI in AMI patients. Methods We searched PubMed, ProQuest, EBSCO Host, and Europe PMC from conception to May 2022. Studies were eligible if they evaluated the relationship of SI and MSI with all-cause mortality and major adverse cardiac events. Results A total of 16 studies involving 80,195 participants met the inclusion criteria and were included in this meta-analysis. Our study revealed significantly higher all-cause mortality risk for patients with high SI and MSI compared to patients with low indices, regardless of the periods of outcomes, study population, or diverse cut-off values. Moreover, both increased SI and MSI also predicted higher major adverse cardiac event rates. Conclusions According to our findings, both SI and MSI in the emergency department can predict all-cause mortality and major adverse cardiac events in patients with acute myocardial infarction. Given this growing body of evidence, as well as the fact that SI and MSI are very simple objective indices derived from two readily available vital signs, they should be used in daily clinical practice to risk stratify patients presenting with acute myocardial infarction. PROSPERO registration CRD42022329558.

Elevated shock index and modified shock index are associated with mortality and major adverse cardiac events in patients with acute myocardial infarction: A systematic review and meta-analysis

Background Blood pressure (BP) and heart rate (HR) have been studied extensively to predict unfavourable outcomes in patients suffering from an acute myocardial infarction (AMI). Shock index (SI) and modified shock index (MSI) are two new emerging parameters that incorporate BP and HR into their calculations, thereby improving the predictive value of each HR and BP alone in AMI patients. Thus, our aim was to determine the prognostic utility of SI and MSI in AMI patients. Methods We searched PubMed, ProQuest, EBSCO Host, and Europe PMC from conception to May 2022. Studies were eligible if they evaluated the relationship of SI and MSI with all-cause mortality and major adverse cardiac events. Results A total of 16 studies involving 80,195 participants met the inclusion criteria and were included in this meta-analysis. Our study revealed significantly higher all-cause mortality risk for patients with high SI and MSI compared to patients with low indices, regardless of the periods of outcomes, study population, or diverse cut-off values. Moreover, both increased SI and MSI also predicted higher major adverse cardiac events rates. Conclusions According to our findings, both SI and MSI in the emergency department can predict all-cause mortality and major adverse cardiac events in patients with acute myocardial infarction. Given this growing body of evidence, as well as the fact that SI and MSI are very simple objective indices derived from two readily available vital signs, they should be used in daily clinical practice to risk stratify patients presenting with acute myocardial infarction. PROSPER registration CRD42022329558.

Risk Burden of Coronary Perforation in Chronic Total Occlusion Recanalization: Latin American CTO Registry Analysis.

BackgroundCoronary perforation is a life‐threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited.Methods and ResultsData from LATAM (Latin American)‐CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30‐day, 1‐year major adverse cardiac events of coronary perforation using time‐to‐event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention‐Chronic total occlusions scores were 2.0 (1.0–3.0) and 1.0 (0.0–2.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1‐year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%; P<0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6 months (P=0.04) and 1 year (P<0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time (P<0.01), Multicenter CTO Registry in Japan score ≥2 (P=0.05), antegrade knuckle wire (P=0.04), and right coronary artery CTO PCI (P=0.05).ConclusionsCoronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6 months and 1 year follow‐up.

Prophylactic Mechanical Circulatory Support Use in Elective Percutaneous Coronary Intervention for Patients With Stable Coronary Artery Disease.

Mechanical circulatory support (MCS) devices can be used in high-risk percutaneous coronary intervention (PCI). Our objective was to describe trends and outcomes of prophylactic MCS use in elective PCI for patients with stable coronary artery disease in the American College of Cardiology National Cardiovascular Data Registry's CathPCI registry. Among 2 108 715 consecutive patients with stable coronary artery disease undergoing elective PCI in the CathPCI registry between 2009 and 2018, we examined patterns of prophylactic use of MCS. Propensity score models with inverse probability of treatment weighting compared effectiveness (in-hospital death, cardiogenic shock, or new heart failure) and safety (stroke, tamponade, major bleeding, or vascular complication requiring treatment) between patients treated with intra-aortic balloon pump versus other MCS (Impella or extracorporeal membrane oxygenation). Overall, 6905 (0.3%) patients underwent elective PCI with prophylactic MCS. MCS use trended up from 0.2% of elective PCIs in 2009 to 0.6% in 2018 (P<0.0001), driven by other MCS (P<0.0001), whereas intra-aortic balloon pump use remained low and constant (P=0.12). In-hospital major adverse cardiac events and cardiovascular complications occurred in 7.1% and 18.8% of elective PCI patients with prophylactic MCS use and 0.5% and 2.3% of patients without prophylactic MCS use. Intra-aortic balloon pump use was associated with a higher risk of major adverse cardiac events (9.6% versus 6.0%, adjusted odds ratio, 1.59 [95% CI, 1.32-1.91]) but lower risk of complications (18.2% versus 19.1%, adjusted odds ratio, 0.88 [95% CI, 0.77-0.99]) than use of other MCS. The use of prophylactic MCS has increased over time for elective PCI in patients with stable coronary artery disease. Intra-aortic balloon pump was associated with higher major adverse cardiac events but lower risk of procedural complications compared with other MCS.

Comparison Between Treatment Strategies of Carotid Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.

IntroductionIn patients undergoing coronary artery bypass grafting (CABG), stroke is a major complication that increases morbidity and mortality. The presence of carotid stenosis (CS) increases risk of stroke, and the optimal treatment remains uncertain due to the lack of randomized clinical trials. The aim of this study is to compare three management approaches to CS in patients submitted to CABG.MethodsFrom 2005 to 2015, 79 consecutive patients with significant CS submitted to CABG were retrospectively evaluated. Patients were divided in three groups, according to CS treatment: 17 underwent staged carotid endarterectomy (CEA)-CABG, 26 underwent synchronous CEA-CABG, and 36 underwent isolated CABG without carotid intervention. The primary outcomes were composed by 30-day postoperative acute myocardial infarction (MI), 30-day postoperative stroke, and death due to all causes during the follow-up.ResultsPatients were evaluated during an average 2.05 years (95% confidence interval = 1.51-2.60) of follow-up. Major adverse cardiac events, including death, postoperative MI, and postoperative stroke, occurred in 76.5% of the staged group, 34.6% of the synchronous group, and 33.3% of the isolated CABG group (P=0.007). As for MI, the rates were 29.4%, 3.85%, and 11.1% (P=0.045), respectively. There was no statistically significant difference in total mortality rates (35.3%, 30.8%, and 25.0%, respectively; P=0,72) and stroke (29.4%, 7.7%, and 8.3%, respectively; P=0,064) between groups.ConclusionStaged CEA-CABG is associated with higher major adverse cardiac events and MI rate when compared to the strategy of synchronous and isolated CABG, but without statistically difference in total mortality during the entire follow-up.

Abstract 13587: Long-Term Outcomes of CT-Derived Fractional Flow Reserve in the Emergency Department

Introduction: In acute chest pain (ACP) patients, CT-derived fraction flow reserve (FFRCT) is feasible and adjudicates need for immediate coronary revascularization. There are no long-term outcome studies of FFRCT in ACP. Hypothesis: In ACP patients, FFRCT is safe and associated with favorable outcomes when negative. Methods: ACP patients with no known coronary artery disease or definitive acute coronary syndrome undergoing coronary CTA with FFRCT were compared to those having CTA alone for the composite major adverse cardiac event (MACE) endpoint of death, nonfatal myocardial infarction, unplanned percutaneous (PCI) or surgical (CABG) revascularization over 2 years. FFRCT ≤ 0.80 was considered positive for hemodynamically significant stenosis. Results: From September 2015 to July 2018, 2,568 ACP patients (mean age 55 years, 52% female) underwent CTA of which 236 (10%) had FFRCT (156 negative, 80 positive). Of the total, 1629 (63.2%) had normal coronaries, and 43 (1.7%) were uninterpretable. FFRCT patients were older (p&lt;0.001) with more diabetes mellitus (18.2% vs. 12.2%, p = 0.009), hypertension (50.8% vs. 38.2%, p&lt;0.001), hyperlipidemia (43.6% vs. 25.4%, p&lt;0.001), and &gt;25% stenosis on CTA (93% vs. 13.6%, p&lt;0.001). Positive FFRCT was associated with higher MACE (10% vs. 2.1%, p&lt;0.001). With comparable stenosis on CTA, positive FFRCT had higher MACE compared to negative FFRCT or CTA alone (Table 1). Conclusions: In ACP patients, negative FFRCT and CTA alone are comparable for MACE. Positive FFRCT portends higher MACE at 2 years within similar stenosis categories. FFRCT can provide incremental value to ACP evaluation with coronary CTA.

Sex-differences in outcomes after percutaneous coronary intervention of chronic total occlusions: insights from a large single-center registry

Abstract Introduction Patients undergoing PCI of chronic total occlusions (CTO) are at high risk of both periprocedural and post-procedural adverse events. Whether sex-differences in outcomes exist after PCI of CTO remains unclear. Purpose We sought to investigate sex-differences in outcomes after CTO-PCI among an unselected real-world cohort of patients. Methods In our single-center retrospective study, patients who underwent elective CTO intervention from January 2000 to December 2019 were included. The primary endpoint of interest was major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year of follow-up. Results A total 1897 patients were included of which 368 were women (19.4%). Women were older (67±11.3 years vs. 62.6±10.9 years) and had a higher prevalence of comorbidities including diabetes and chronic kidney disease. Women had higher rates of procedure-related complications including increased risk of post-procedural bleeding requiring blood transfusion (3.0% vs 1.1%; p=0.007), and acute vessel closure (1.36% vs 0.2%; p=0.009). In multivariable-adjusted models for baseline confounders, female sex was associated with higher risk of MACE and TVR (Table 1). Conclusion Gender differences in CTO management are observed, with fewer females going for CTO revascularization in contemporary practice. Female sex is associated with procedural-related complications, higher MACE, and TVR even after successful CTO intervention. Funding Acknowledgement Type of funding sources: None.

Residual SYNTAX score in relation to culprit-plaque characteristics and cardiovascular risk in acute myocardial infarction:an optical coherence tomography study

Abstract Introduction The residual SYNTAX score (rSS) as the SYNTAX remaining after completion of percutaneous coronary intervention (PCI) was proved to be related to poor outcomes. Purpose This study aimed to investigate the association of culprit-plaque morphology with rSS and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 274 STEMI patients undergoing preintervention optical coherence tomography examination were included and divided into 3 groups – rSS=0 (n=72), 0&amp;lt;rss≤8&amp;gt;8 (n=68). Baseline clinical data and culprit-plaque characteristics were compared. MACE was defined as the composite of all-cause death, recurrence of myocardial infarction (MI), stroke and unplanned revascularization of any coronary artery. Results There was a significant difference in the prevalence of plaque ruptures, lipid-rich plaques, and calcification among the three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.04; lipid-rich plaque: 40.3% versus 54.5% versus 69.1%, lowest to highest rSS, p=0.003; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). Multivariate logistic regression analysis indicated that rSS&amp;gt;8 was an independent predictor for plaque rupture (OR: 2.21, 95% CI: 1.19–4.19, P=0.013). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients. In fully adjusted analyses, rSS was independently associated with MACE (HR: 1.06, 95% CI: 1.02–1.10, P=0.005); patients with rSS &amp;gt;8 had higher MACE risk compared to rSS=0 (HR: 2.68, 95% CI: 1.11–6.5, P=0.029). Conclusion In STEMI patients, culprit-plaque morphology was significantly correlated with rSS, and elevated rSS was independently associated with cardiovascular risk.&amp;lt;/rss≤8&amp;gt; Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences OCT findingsSurvival curves according to rSS

Gut Lactobacillus Level Is a Predictive Marker for Coronary Atherosclerotic Lesions Progress and Prognosis in Patients With Acute Coronary Syndrome.

BackgroundGut microbiota dysbiosis can contribute to the progression of atherosclerosis. We investigated the association of the gut microbiota and the severity of coronary artery lesions and prognosis of patients with ACS.MethodsIn this case-control study, 402 ACS patients and 100 controls were enrolled from June 2017 to December 2018. The number of bacterial species was determined by real-time PCR. A SYNTAX score was calculated for all ACS patients based on their coronary angiography results.ResultsCompared with the healthy controls, the gut microbial levels in Escherichia coli, Streptococcus, and Enterobacteriaceae were significantly increased in ACS patients, while the Lactobacillus level was significantly decreased. Lactobacillus level was as an independent predictor of disease severity on the coronary angiography [high vs. low SYNTAX score: adjusted odds ratio (aOR) = 0.024, 95% confidence interval (CI): 0.004–0.155] and myocardial necrosis [high vs. low cardiac troponin T (cTNT): aOR = 0.317, 95% CI: 0.099–0.914]. Subsequently, a higher Lactobacillus level was associated with a lower risk of an all-cause death [adjusted hazard ratio (aHR) = 0.239; 95% CI: 0.093–0.617] and major adverse cardiac events (MACE) in ACS patients (aHR = 0.208; 95% CI: 0.081–0.531). After stratifying by the type of ACS, a higher Lactobacillus level was significantly associated with the decreased risks of high SYNTAX score, all-cause death, and MACE in the STEMI subgroup but not in the NSTEMI and UAP subgroups.ConclusionsLower Lactobacillus levels may indicate a higher risk of a more severe coronary atherosclerotic lesions and myocardial necrosis and worse prognosis for patients with ACS, particularly in the STEMI subgroup.

Percutaneous Coronary Intervention Outcomes Based on Decision-Making Capacity.

BackgroundLong‐term outcomes of percutaneous coronary intervention (PCI) based on patients’ decision‐making ability have not been studied. Our objective was to assess long‐term outcomes after PCI in patients who provided individual versus surrogate consent.Methods and ResultsData were collected retrospectively for patients who underwent PCI at Cleveland Clinic between January 1, 2015 and December 31, 2016. Inclusion criteria consisted of hospitalized patients aged ≥20 years who had PCI. Patients with outpatient PCI, or major surgery 30 days before or 90 days after PCI, were excluded. Patients who underwent PCI with surrogate consent versus individual consent were matched using the propensity analysis. Kaplan–Meier, log rank, t‐statistic, and χ2 tests were used for statistical analysis. The study was approved by the Institutional Review Board at Cleveland Clinic, Ohio. Of 3136 patients who underwent PCI during the study period, 183 had surrogate consent. Propensity matching yielded 149 patients from each group. Two‐year all‐cause mortality was significantly higher in the surrogate consent group (38 [25.5%] versus 16 [10.7%] deaths, log‐rank χ 2=10.16, P<0.001). The 2‐year major adverse cardiac events rate was also significantly higher in the surrogate consent group (60 versus 36 events, log‐rank χ 2=8.36, P=0.003).ConclusionsPatients with surrogate consent had significantly higher all‐cause mortality and higher major adverse cardiac events when compared with patients with individual consent. This study emphasizes the fact that patients with an inability to give consent are at high risk and may need special attention in postprocedural and postdischarge care.

Rotational Atherectomy for the Management of Undilatable In-Stent Restenosis with Single or Multiple Stent Layers

BackgroundThere is no consensus on the best treatment of undilatable coronary in-stent restenosis (ISR) regardless of the number of stent layers. We aimed to evaluate the procedural and clinical outcomes of rotational atherectomy (RA) to treat undilatable coronary ISR with single or multiple stent layers. MethodsWe retrospectively evaluated consecutive patients treated with RA for undilatable ISR with single or multiple stent layers in the Mount Sinai catheterization laboratory between January 2016 and September 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE): a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Clinical outcomes were assessed at one-year post-procedure. ResultsA total of 26 patients were included in the study, in which 18 (69.2%) patients were with multiple stent layers. After RA, 9 (34.6%) were received a new drug-eluting stent, and 6 (23.1%) were treated with intravascular brachytherapy. Angiographic success was achieved in 24 (92.3%) patients, and procedural success was achieved in 22 (84.6%) patients. In-hospital MACE occurred in 4 (15.4%) patients, all due to periprocedural non-Q wave MI. Within one year, MACE occurred in 9 (34.6%) patients with 5 (19.2%) TLR. ConclusionsRA for undilatable ISR with single or multiple stent layers was performed with favorable procedural outcomes and a relatively high MACE rate driven by TLR within one year.

Gender-specific 11-dehydro-thromboxane B2 levels in acute coronary syndrome and its association with clinical outcomes

Despite knowing that females are at a higher risk of major adverse cardiac events (MACE) and poor prognosis after percutaneous transluminal coronary angioplasty (PTCA), there are very few studies focusing on urinary 11-dehyrdo-thromboxane B2 (dh-TxB2) concentration (for aspirin non-responsiveness) differences among males and females. The present prospective observational study aimed to evaluate the dh-TxB2 levels and associate them with clinical outcomes in males and females with acute coronary syndrome (ACS) after PTCA. The dh-TxB2 ELISA assay was carried out twice, at baseline and 6 months follow-up, and outcomes were assessed for 1 year. The average cut-off value of dh-TxB2 was ≥1,496 pg/mg creatinine by the receiver operating characteristic curve estimation. A total of 192 patients (140 men and 52 women) were enrolled. At baseline, 17 (12.1%) males and 7 (13.5%) females had high dh-TxB2 levels, whereas at 6 months, 22 (15.9%) males and 4 (7.8%) females showed high dh-TxB2 levels. The concentration of dh-TxB2 was higher in females than males at baseline. Composite MACE was not different between genders significantly even when the dh-TxB2 levels were high. Women experienced higher MACE incidences than men (13.5% vs. 9.3%).