History Of PCI Research Articles

Imaging behind occluded areas with an iatrogenic perforated balloon: A safe, practical, and simple new method of visualizing the distal lumen in total occlusion.

In the present study, we investigated the effectiveness and reliability of a new method that reveals whether guidewire advanced distal to the lesion is in the lumen in patients with acute (ATO) or chronic coronary total occlusion (CTO). Forty-one patients with symptomatic ATO and 22 patients with CTO who were admitted into our catheterization laboratory between January 2016 and March 2017 were included. In patients in whom antegrade filling could not be demonstrated after passing 0.014″ guidewire beyond the total lesion, a 1.25 × 15 mm balloon was punctured with a needle outside the operative field to visualize the total lesion. This perforated balloon was then used to deliver an opaque substance through this hole to visualize the distal part. The mean age of our 63 patients was 66 ± 12 years. They had diabetes (57%), hypertension (100%), and a history of PCI (85%). The mean procedural time was 27 ± 6.8 min, and the mean volume of contrast material used was 93.9 ± 24 mL. This technique was 100% successful in accurately demonstrating the distal lumen and preventing complications. This new method we developed is much simpler and more useful than other methods for visualization of the true lumen because we can re-orient the balloon at the time of opaque injection and use 190 cm guidewire without additional costs. Additionally, one balloon is sufficient for the operation.

Tako-tsubo cardiomyopathy in a radical operation for carcinoma of colon patient with PCI history.

Tako-tsubo cardiomyopathy in a radical operation for carcinoma of colon patient with PCI history.

Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease.

BackgroundThe characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.AimThe present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.MethodsThis prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions >70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.ResultsPatients with insignificant CAD were significantly younger (61 vs. 67 years, p < 0.001), more likely to be females (41% vs. 23%, p = 0.006), less likely to smoke (p = 0.006), less likely to have diabetes mellitus (p < 0.001), and less likely to have history of CAD (p = 0.042) or prior PCI (p = 0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p < 0.001), less likely to have heart failure at presentation (9% vs 30%, p < 0.001), less likely to have ischemic ST-segment changes on presentation (10% vs 46%, p < 0.001), lower peak troponin (p < 0.001) and CK-MB levels (p < 0.001), with lower LDL-C (p = 0.006), and higher HDL-C level (p = 0.020). They were less likely to be treated with b-blockers (p = 0.002), ACEI/ARBS (p = 0.007), and higher rates of calcium channel blocker therapy (p < 0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p = 0.009), need for revascularization (p = 0.035), recurrent chest pain (p = 0.009), and cardiogenic shock (p = 0.029).ConclusionPatients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.

The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry.

The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.

Abstract 11893: The Impact of Statin Therapy on Survival Following Inpatient Cardiac Arrest

Introduction: Over 200,000 hospitalized patients suffer cardiac arrest annually with a high morbidity and mortality following cardiopulmonary resuscitation (CPR). The aim of this study was to examine factors associated with survival post CPR in hospitalized patients. Hypothesis: Pre-arrest statin therapy is associated with improved survival. Methods: A retrospective analysis of consecutive hospitalized patients that underwent CPR between 4/2012 to 12/2013 at Beaumont Hospital. Patients with CPR perioperatively, in the setting of trauma, during pregnancy and postpartum were excluded, also patients or their surrogates who elected palliative care/hospice were excluded. Univariable and a step-down logistic regression multivariable analysis were performed. Results: Of 124 patients included in the study, 80 patients died, whereas 44 patients survived. Pre-arrest clinical factors and CPR characteristics associated with survival on univariable analysis were: History of PCI in 36.4% of survivors compared to 16.5% of those who did not survive (p=0.013). Hyperlipidemia was more common in survivors (68.2% versus 32.5%, p=0.001), as well as being on statins (76.7% versus 43%, p=0.0004). Those who did not survive were more likely to have active cancer (16.3% versus 2.3%, p=0.018), less likely to have a shockable rhythm (7.9% versus 27.9%, p=0.003), and more likely to have CPR ≥ 15 minutes (82.4% versus 19.5%, p&lt;0.0001). On multivariable analysis, CPR duration and statin therapy were the only factors associated with survival. Those who did not survive were more likely to have CPR ≥ 15 minutes (Adjusted OR 18.08, 95% CI 6.5-50.5, p&lt;0.001) and less likely to be on statin therapy before cardiac arrest ( Adjusted OR 0.29, 95% CI : 0.10-0.83 p= 0.021) with C-Statistic of 0.86. Conclusion: This study suggests that being on statin therapy is associated with high likelihood of survival following CPR. Further studies are needed to confirm this finding.

Abstract 11870: The -174 G&gt;C Interleukin-6 Gene Polymorphism is Associated With Angiographic Progression of Non-culprit Coronary Plaques in a Mid-term Period

Hypothesis: Inflammation is the key process underlying the course of CAD. Interleukin-6 (IL-6) is an upstream key regulator of inflammation. Single nucleotide polymorphisms (SNPs) of inflammatory genes, reportedly influence the outcomes of CAD patients. We sought to evaluate the impact of -174 G&gt;C IL-6 SNP in patients with established CAD. Methods: We examined previous angiographies of patients with a PCI history, who were prospectively re-investigated for stable/unstable angina after &gt;12 months. We defined progression of CAD by qCA as the emergence of a new culprit lesion. We genotyped patients to their Mendelian randomization group of -174 G&gt;C IL-6 SNP (rs1800795). The probability for CAD progression was evaluated with the Kaplan-Meier and Cox model analysis including age, hypertension, family history, dyslipidemia and diabetes. Results: A total of 157 patients were included with a median follow-up time of 48 months. Genotype distribution was: GG: 30, CC: 55, GC: 72, C variant: 58%, frequencies were in Hardy-Weinberg equilibrium: χ 2 =0.54, p=0.46. Baseline characteristics were evenly distributed. Serum levels of IL-6 differed significantly: CC 5.58±2.52, GG 2.73±1.08, GC 4.04±1.86 mg/L, p&lt;0.001. At 48 months, carriers of IL-6 C allele had 52.8% cumulative probability for progression vs 13.3% G allele, p=0.005. Results were confirmed in multivariate analysis: C allele HR: 5.09, 95% CI (1.55, 16.7), p=0.007, family history HR: 2.46, 95% CI (1.43, 4.23), p=0.001, dyslipidemia HR: 1.47, 95% CI (1.02, 2.11), p=0.041. Conclusions: Patients with established CAD, carrying the -174 C allele of IL-6 gene, had increased risk for progression of non-culprit plaques in a 4-year period. C allele significantly contributed to CAD progression along with family history and dyslipidemia.

TCTAP C-170 VLST Due to Coronary Artery Deformation After Sirolimus-eluting Stent Implantation

### Patient initials or identifier number 73-year-old female ### Relevant clinical history and physical exam Case is a 73-year-old female who had a history of PCI for LAD lesion with sirolimus-eluting stent before 5 years. After the six-month follow up CAG showed coronary artery deformation at

TCTAP C-040 Complex Intervention of a Protruding LM Stent

### Patient initials or identifier number sd ### Relevant clinical history and physical exam A 59 year old female with long standing diabetes and hypertension and history of PCI to ostial Left Main (LM) – Left Anterior Descending artery (LAD) in March 2013. During a subsequent follow up in

Abstract 121: Association between Diabetes Mellitus and Angina Assessed Using a Mobile Technology Platform in Patients Undergoing Percutaneous Coronary Intervention

Background: Empiric data on whether patients with diabetes suffer a differing burden of angina are conflicting. Population studies have found similar or less angina in patients with diabetes, whereas studies in patients with ACS or MI have found more angina. Few studies have incorporated coronary angiographic findings. Methods: We examined all 203 patients undergoing non-emergent PCI at our institution who completed a baseline patient-reported outcomes survey using a novel mobile technology platform integrated with the EMR between January-September, 2014. The primary exposure was diabetes status. The primary outcome was angina burden as measured by the Seattle Angina Questionnaire (SAQ) Short Form summary score (lower scores indicate worse angina). We additionally examined SAQ sub-scores for angina severity, physical limitation, and quality of life. Additional covariates selected a priori included age, race, gender, smoking, hypertension, dyslipidemia, history of MI, PCI, or heart failure, CAD presentation (asymptomatic, stable angina, UA, or NSTEMI), and number of major epicardial vessels with ≥50% stenosis on angiography. Analyses were performed using multivariable linear regression. Results: In our study, 79 patients (39%) had diabetes. Mean SAQ summary score for patients with diabetes was 55.2 (SD 28.3) versus 64.3 (SD 25.4) among patients without diabetes. In the unadjusted model, diabetes was associated with a significantly lower SAQ summary score (B: -9.1; 95% CI: -16.83, -1.38), which persisted in the fully adjusted model (B: -7.36; 95% CI: -14.19, -0.52). This effect was driven by sub-scores for angina severity (B: -7.45; 95% CI: -14.67, -0.24) and physical limitation (B: -10.88, 95% CI: -19.03, -2.72), with no association between diabetes and quality of life. Conclusion: Patients undergoing PCI with diabetes had worse burden of angina relative to those without diabetes, despite controlling for historical and angiography findings. This effect was driven by angina severity and physical limitation. Our results can guide future clinical decision-making regarding angina symptoms in this high-risk diabetic cohort. Furthermore, our study demonstrates that using a mobile technology platform is feasible for routine assessment of angina in patients with and without diabetes undergoing PCI.

Study of the Relation between Plasma PTX3 Levels and Preclinical Atherosclerotic Cardiovascular Complications in Type 2 Diabetic Patients

Type 2 diabetes is contemporarily a major social and epidemiological problem and among others is a strong risk factor for cardiovascular diseases. Pentraxin 3 a potential early biomarker of the atherrosclerosis, is an acute phase reactant produced by the peripheral tissues where the inflammation takes place. to assess PTX3 plasma levels in metabolic syndrome patients compared to control subjects and their potential associations with anthropometric and clinical components of the syndrome as well as with carotid artery intima-media thickness (cIMT), a marker of subclinical atherosclerosis. This study was conducted on 58 type 2 diabetic patients(34 men and 24 women ) as well as 30 age and sex matched non diabetic control subjects (12 men and 18 women ) the following tests were done FBS , lipid profile (Total serum cholesterol, triglyceride level and HDL cholesterol level). The LDL cholesterol level was estimated .In addition, we performed basic biochemical blood analysis (ALT,AST,CBC and TSH), Hemoglobin A1c and Plasma PTX3. Mean plasma PTX3concentration turned out to be significantly higher in patients with history of myocardial infarction,CABG and PCI (p=0.01) . PTX3 was associated with outcomes in acute MI patients. PTX3 was associated with fatal events, and adverse clinical outcomes in heart failure patients.

Relationship between triglyceride HDL-cholesterol ratio and severity of coronary artery disease in patient with acute coronary syndrome

Cardiovascular Disease (CVD) is the leading cause of death worldwide, responsible for one third of death. Coronary artery Disease (CAD) is the most common cause. Dyslipidaemia is one of the major contributors of increased CAD risk. High LDL-C, high TG and low HDL-C have all been as predictors for CAD risk. TG/HDL-C ratio could be a very important, easy, non-invasive means of predicting the presence and extent of coronary atherosclerosis. The aim of this study was to evaluate the association between TG/HDL-C ratio and the extent of CAD assessed by coronary angiogram in our setting. This cross sectional analytical study has been done in the Department of Cardiology, Sir Salimullah Medical College &amp; Mitford Hospital. A total 118 patients with newly diagnosed ACS, undergoing coronary angiogram in were selected purposively. Previous history of PCI or CABG, patients getting lipid lowering drugs, patient with congenital heart disease or vulvular heart disease was excluded. Angiographic severity of coronary artery disease was assessed by 2 indices – vessels score’ and ‘Lesion score’. Smoking was found in highest percentage (65.3%) and half of the patient’s risk factor were hypertension (51.7%) and overweight (50.8%). The relationship between vessel score with TG/HDL-C ratio shows that among patients with triple vessel disease on coronary angiogram, 93% had high (?4) TG/HDL-C ratio whereas among double vessel disease patients, 82% patients had high (?4) TG/HDL-C ratio. The 157 association between atherosclerosis lesion score with TG/HDL-C ratio shows that with the increase level atherosclerosis TG/HDL-C ratio also increased. A subject with low HDL (&lt;40 mg/dl for male and &lt;50 mg/dl for female) had 4.75 times increase in odds of having coronary artery disease while a subject with high LDL (&gt;100 mg/dl) had 2.60 (95% CI 1.55% to 14.26%) times increase in odds of having coronary artery disease. In this study high TG/HDL-C ratio (&gt;4) was found with severity of CAD in relation to vessel score and atherosclerosis lesion score. High TG/HDL-C ratio indicates an atherogenic plaque and a significant risk for the development of coronary artery disease. In this study high TG/HDL-C ratio was found as the most powerful predictor of coronary heart disease among all the lipid variables examined. This finding can help us to find out high risk ACS patient and plan for treatment strategy of severe CAD in our population.Bangladesh Med J. 2014 Sep; 43 (3): 157-161

Status of β-blocker use and heart rate control in Chinese patients with stable coronary artery disease

To observe the current status of β-blocker (BB) use and heart rate control in Chinese patients with stable coronary artery disease (SCAD) based on subgroup data of the prospective observational longitudinal registry of patients with stable coronary artery disease (CLARIFY). The CLARIFY study is an international prospective observational registry of outpatients with SCAD. From November 2009 to July 2010, patients with SCAD were enrolled, and demographic information, clinical indicators, medication and blood flow reconstruction were collected. Patients were divided in three mutually exclusive categories by baseline pulse palpation heart rate(HR)≤60 beats per minute (bpm)(n=397), 61-69 bpm(n=782), and ≥70 bpm(n=1 443). The patients were also divided into taking BB or not taking BB groups. The aim of present study is to describe and analyze the current status and factors related to the HR control and BB use in the Chinese subgroup of CLARIFY. A total of 2 622 patients were enrolled from 56 centers across China. The mean age was (63.6±10.3) years old with 75.6% (1 983) male patients, 55.0% (1 443) patients had HR≥70 bpm. Mean HR measure by electrocardiogram(ECG) was (69.4±10.2)bpm, 50.9% (1 334 cases) patients had myocardial infarction(MI) history. A total of 21.9%(575 cases) patients had anginal symptoms; coronary angiography was performed in 88.8%(2 327 cases) of the patients. 76.2%(1 997 cases) patients were treated with BB (any molecule and any dose), 2.7% (70 cases) with digoxin or derivatives, 3.9% (103 cases) with verapamil or diltiazem, and 1.8% (47 cases) with amiodarone or dronedarone and 0.1%(2 cases) received ivabradine. BB use was similar among 3 HR groups(P>0.05). The independent risk factors associated with HR≥70 bpm were diabetes(OR=1.31), current smoker(OR=1.57), chronic heart failure(CHF) with NYHA Ⅲ (OR=2.13) and increased diastolic blood pressure (OR=1.30). Conversely, high physical activity (OR=0.61), former smoker (OR=0.76) and history of percutaneous coronary intervention(PCI, OR=0.80) were associated with lower risk of HR≥70 bpm (all P<0.05). The independent risk factors associated with non-BB use were older age (OR=1.11, 95%CI 1.01-1.47, P=0.005), lower diastolic blood pressure (OR=1.47, 95%CI 1.32-1.68, P=0.012), no history of MI (OR=1.86, 95%CI 1.43-2.44, P<0.001) or PCI (OR=1.94, 95%CI 1.55-3.73, P<0.001), asthma/chronic obstructive pulmonary disease (OR=1.32, 95%CI 1.15-1.99, P<0.001). A total of 76.2% Chinese SCAD patients received BB medication but more than half of them did not reach the optimal HR. Clinical characteristics including diabetes, current smoker, CHF, increased diastolic blood pressure and no PCI were associated with poorly controlled HR(≥70 bpm). More efforts including adjusting the type and dose of heart rate lowering drugs are needed to achieve optimal HR control in Chinese SCAD patients. Clinical Trail Registry International Standard Randomized Controlled Trial, ISRCTN43070564.

Abstract 12519: Age Impacts the Interpretation of Myocardial Blood Flow Values in Cardiac PET/CT

Introduction: Quantitative myocardial blood flow (MBF) obtained via Rb82 PET/CT using regadenoson provides the ability to assess ischemia through analysis of stress MBF and coronary flow reserve (CFR), the augmentation of flow expressed as a stress/rest ratio. It is unknown to what extent, if any, age-related changes in arteries (i.e. arterial stiffening, atherosclerosis) impact MBF and, thus, the interpretation of ischemia. Hypothesis: MBF values change as a function of age and impact PET interpretation. Methods: Patients who underwent PET/CT from May 2013 to April 2015 with normal perfusion images and no history of PCI or CABG were included (n=3329, 1720 women, 1498 men). Rest MBF, stress MBF, and CFR) (mL/min/g) were recorded in all vessels separated by gender and by age &lt;60 or ≥60. Analysis was conducted on individual vessels and global estimates were calculated averaging all vessels. Estimated average median differences between age &lt;60 and ≥60 were adjusted for traditional cardiovascular risk factors (BMI, smoking, diabetes, hypertension, hyperlipidemia, family history). Results: Effects of Age on Global MBF Adjusted for Traditional Risk Factors Conclusions: In patients ≥60 years of age with normal perfusion imaging, rest MBF increases, stress MBF decreases, and the resultant CFR is decreased, all statistically significant. This may reflect a higher fixed level of vasodilation in older vessels at rest and a more limited ability to vasodilate with stress independent of other CV risk factors. Given the increasing use of PET/CT for ischemia assessment, it is important to recognize expected MBF changes with age to decrease false positive studies and unwarranted invasive testing.

13 Natural history and clinical significance of infarct zone extracellular volume and remodelling in survivors of acute STEMI

Background The natural history and clinical significance of myocardial extracellular volume (ECV) in infarcted myocardium post-STEMI is uncertain. ECV can be estimated by cardiac magnetic resonance imaging (CMR). We measured infarct ECV of STEMI survivors, and assessed the relationships with clinical findings. Methods STEMI survivors were enrolled in a cohort study (BHF MR-MI study – NCT02072850). CMR was performed at 1.5 Tesla (Siemens MAGNETOM Avanto) 2 days and 6 months post-MI. T1 MOLLI mapping was performed pre- and 15 min post-contrast (0.15 mmol/kg gadoterate meglumin). ECV was calculated as the difference in relaxation rate (R1 = 1/T1) for myocardium and LV blood pool pre- vs. post-contrast, corrected for haematocrit (HCT). The percentage change in infarct ECV was calculated (%ΔECV). Results 129 patients (59 ± 11 years; 98 (76%) male) were included. Infarct ECV at baseline and follow-up was similar (49.5(9.3)% vs. 49.4 ± = (10.9)%; p = 0.904). The within-subject change in ECV varied markedly (1.0% (20.0%)). In multiple linear regression, TIMI coronary flow grade 2 pre-PCI, TIMI coronary flow grade 3 pre-PCI, a history of previous PCI and initial infarct size were independently associated with%ΔECV (all p Conclusion %ΔECV is associated with measures of MI severity, and portends worsening LV volume. Infarct ECV represents a novel biomarker for infarct characterisation in STEMI patients.

TCTAP C-179 Renal Angioplasty Assisted Renal Denervation: Hybrid Strategy in a Patient with Resistant Hypertension and Renal Artery Stenosis

### Patient initials or identifier number 22304779 CYL ### Relevant clinical history and physical exam The 62-year-old female has resistant hypertension, type 2 DM, hyperlipidemia and a history of PCI for coronary artery disease. Her 24-hour systolic blood pressure was above 150 mmHg despite

Analysis of lipid-lowering therapy and factors affecting regularity of statin intake in patients with cardiovascular disease enrolled in the PROFILE registry

ObjectiveThe aim of this study was to analyze the quality of lipid-lowering therapy in a cohort of patients with cardiovascular disease enrolled in a Moscow-based registry, and to analyze the factors affecting the regularity of statin administration in this patient category. MethodsThe present study included all patients who successively sought medical advice in the Preventive Pharmacotherapy Department of the Ministry of Healthcare of the Russian Federation between May 1 and December 31, 2011 (n=274). Each patient was given a specially designed questionnaire in order to assess compliance with the prescribed treatment that included the following questions: (1) if they knew, according to the results of previous exams, that they had elevated cholesterol levels (yes, no, don’t know); (2) what method of hypercholesterolemia correction they used (diet, medication, physical exercise, or other); (3) if they were taking any statins (regularly, no, irregularly); and (4) if yes, what statin preparation and what dose they were taking. Patients’ compliance with statin therapy was assessed on the basis of the responses received and the regularity of statin intake. ResultsThe influence of various factors on regularity of statin intake in patients with cardiovascular disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI) for advanced age (>70 years) (OR 0.49); higher statin dose than standard (OR 0.49); hypertension (OR 1.659); history of acute cerebrovascular event (OR 2.019); diabetes (OR 1.023); coronary heart disease (CHD) (OR 4.357); history of myocardial infarction (MI) (OR 4.838); history of coronary angiography/percutaneous coronary intervention (PCI) (OR 5.167). ConclusionsAnalysis of factors with impact on regular compliance with statin therapy showed that the following were most significant: CHD, history of MI, and history of PCI. Previous cerebrovascular events and presence of diabetes did not motivate these patients to take statins on a regular basis.

Analysis of lipid-lowering therapy and factors affecting regularity of statin intake in patients with cardiovascular disease enrolled in the PROFILE registry

ObjectiveThe aim of this study was to analyze the quality of lipid-lowering therapy in a cohort of patients with cardiovascular disease enrolled in a Moscow-based registry, and to analyze the factors affecting the regularity of statin administration in this patient category. MethodsThe present study included all patients who successively sought medical advice in the Preventive Pharmacotherapy Department of the Ministry of Healthcare of the Russian Federation between May 1 and December 31, 2011 (n=274). Each patient was given a specially designed questionnaire in order to assess compliance with the prescribed treatment that included the following questions: (1) if they knew, according to the results of previous exams, that they had elevated cholesterol levels (yes, no, don’t know); (2) what method of hypercholesterolemia correction they used (diet, medication, physical exercise, or other); (3) if they were taking any statins (regularly, no, irregularly); and (4) if yes, what statin preparation and what dose they were taking. Patients’ compliance with statin therapy was assessed on the basis of the responses received and the regularity of statin intake. ResultsThe influence of various factors on regularity of statin intake in patients with cardiovascular disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI) for advanced age (>70 years) (OR 0.49); higher statin dose than standard (OR 0.49); hypertension (OR 1.659); history of acute cerebrovascular event (OR 2.019); diabetes (OR 1.023); coronary heart disease (CHD) (OR 4.357); history of myocardial infarction (MI) (OR 4.838); history of coronary angiography/percutaneous coronary intervention (PCI) (OR 5.167). ConclusionsAnalysis of factors with impact on regular compliance with statin therapy showed that the following were most significant: CHD, history of MI, and history of PCI. Previous cerebrovascular events and presence of diabetes did not motivate these patients to take statins on a regular basis.

Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention

BackgroundContrast induced nephropathy (CIN) is a complication of coronary angiography/percutaneous intervention (PCI). It is known that diabetes is an independent risk factor for CIN, but we have no data regarding the association between CIN and glycemic levels in patients without diabetes. Aim of our study was to evaluate whether high level of glycated-haemoglobin in patients without diabetes is associated with an increased risk of CIN. MethodsA total of 1324 patients without diabetes, undergoing elective/urgent coronary angiography/angioplasty were divided according to quartiles of baseline glycated-haemoglobin. CIN was defined as an absolute ≥0.5mg/dL or a relative ≥25% increase in creatinine level at 24–48h after the procedure. ResultsPatients with elevated glycated-haemoglobin were older, with hypertension, metabolic syndromes, previous history of AMI, PCI and CABG. They had higher gycaemia, fasting-glycaemia and triglycerides but lower HDL-cholesterol. Patients with higher glycated-haemoglobin were more often on therapy with statins, diuretics and calcium-antagonist at admission, had higher basal, 24 and 48h creatinine, lower creatinine clearance and lower ejection fraction. They had the highest incidence of PCI and contrast volume-eGFR rate. CIN occurred in 10.6% of patients with a linear association with glycated-haemoglobin (p=0.001). No relationship was found between glycaemia/fasting glycaemia at admission and CIN. The multivariate analysis confirmed the association between elevated glycated haemoglobin (above the median value 5.7%) and the risk of CIN after adjustment for baseline confounding factors (Adjusted OR [95% CI]=1.69 [1.14–2.51], p=0.009). In fact, the results were consistent in major high-risk subgroups. ConclusionThis is the first study showing that among patients without diabetes undergoing coronary angiography/PCI elevated glycated-haemoglobin but not glucose levels is independently associated with the risk of CIN.

ACUTE AND MID TERM CLINICAL OUTCOMES IN OCTOGENERIANS REFERRED FOR PCI. REAL WOLD CANADIAN EXPERIENCE

The optimal management of coronary artery disease in the elderly population is challenging. This group of patients isexcluded from clinical trials and usually treated in a conservative manner. Therefore, we aim to evaluate the clinical outcomes of octogenarians referred for PCI in a university hospital center. Between January 2013 and September 2013, 2967 consecutive patients underwent coronary angiogram. A medical chart review was performed and data obtained from clinical and angiographical records. The long term follow-up was obtained by clinical visits or telephone contact. Octogenarians represented 8.5% (n=250). Forty seven (19%) requested surgical treatment for CABG and/or valve replacement. Medical treatment was decided in 55 patients (22%). PCI was the most common treatment and was performed in 148 patients (59%). The mean follow-up period was 295 ±115 days. The mean age was 85±3 years, 49% females, hypertension was present in 85%, diabetes in 36%, dyslipidemia in 62%, smoker in 21%, previous history of PCI in 21%, previous CABG in 13%, atrial fibrillation in 9% and renal failure in 25%. The indication of PCI was mainly ACS (90%). Single vessel disease was noted in 43% of patients, double and triple vessel disease in 31% and 26% respectively. The mean syntax score was 14±9. Procedural success was achieved in 99% of cases. A single stent was used in 55%. DES was implanted in 38% of patients. The in-hospital MACE rate was 7 % (all cause mortality 5%, MI 2% with no stroke or TVR). The long term follow-up was achieved in 142 patients (96%). The MACE rate was 20% (all cause mortality 11%, MI 2%, stroke 1% and TVR 6%). A subgroup analysis of patients older than 85 years (group A, n=81) showed a higher rate of HTN (90% vs. 78%; p=0.042), dyslipidemia (73% vs. 49%; p=0.004), previous CABG (20 % vs. 5%; p=0.006) and triple vessel disease (33% vs.16%; p=0.023) as compared to patients younger than 85 years (group B, n=67) respectively. A trend toward a high rate of in-hospital death was observed in group A as compared to group B (5% vs. 0%; p=0.063). No significant difference was observed regarding in-hospital MI, stroke or TLR. In this selected octogenarian population referred for an invasive approach, PCI was safely performed with good acute and mid term clinical outcome. More clinical trials in this high risk group of patients are warranted.

After the Fall: Politics, the Public Use of History and the Historiography of the Italian Communist Party, 1991–2011

Traditionally, historians described the Italian Communist Party (PCI) as primarily a national party whose strategies had always been largely, if not exclusively, determined by the Italian socio-political environment. Scholars tended to emphasize the merits of the PCI in the construction of Italian democracy and its abiding commitment to the defence of the republican government throughout the postwar period. This view was seriously challenged after the fall of communist regimes in Eastern Europe and the dissolution of the PCI (January 1991), when a strand of ‘revisionist’ literature questioned the PCI’s national character and its democratic credentials. At the same time, the polemical use of these new interpretations in the political arena, along with a new range of historical evidence from the Soviet archives, contributed to turn the debate about the role of the PCI in Italian democracy into a never-ending diatribe. This article is aimed at chronicling the politicization of PCI history and discussing how this affected historiography, in a period characterized, more than ever before, by the political and public use of history.