Initial Percutaneous Coronary Intervention Research Articles

The impact of perceived stress on the prognosis in patients undergoing percutaneous coronary intervention.

To assess the impact of perceived stress levels in patients undergoing percutaneous coronary intervention (PCI) on the occurrence of major adverse cardiovascular events (MACEs) within a 6-month follow-up period postprocedure. A cohort of 339 hospitalized patients with coronary heart disease undergoing initial PCI was prospectively enrolled in the Department of Cardiology at two branches of Zhongda Hospital Affiliated to Southeast University between January 2022 and July 2022. Baseline data including demographic and clinical characteristics, along with the Chinese Perceived Stress Scale (CPSS), were collected. The occurrence of MACE was evaluated at 3 and 6 months post-PCI. Kaplan-Meier survival analysis and Cox regression models were engaged to analyze the relationship between perceived stress and MACE within 6 months after PCI. MACE occurred in 16.22% (55/339) of patients during the 6 following months. High CPSS at baseline was significantly associated with an increasing risk of short-term MACE occurrence (HR: 6.48, 95% confidence interval: 2.98-14.11, P < 0.05). High perceived stress during the baseline period after PCI was significantly correlated with increased incidence of MACE within 6 months postprocedure. The perceived stress level could help to identify patients undergoing PCI at heightened risk of short-term MACE.

Predictive Value of Tpeak-to-Tend/QT for Early Ventricular Arrhythmias and Arrhythmogenic Death in Patients with Anterior ST Elevation Myocardial Infarction

BackgroundPatients with anterior ST elevation myocardial infarction (STEMI) are vulnerable to life-threatening ventricular arrhythmia and arrhythmic death. This study aimed to investigate the predictive value of Tpeak-to-Tend (TpTe) and TpTe/QT ratio in patients with anterior STEMI on admission for the occurrence of in-hospital life-threatening ventricular arrhythmias and arrhythmic death. MethodsThis observational cross-sectional research was performed on patients with anterior STEMI who showed up within 12 hours of the beginning of symptoms and received the initial percutaneous coronary intervention (pPCI). The primary study endpoints included the assessment of sustained ventricular arrhythmias and all-cause/arrhythmic deaths throughout the hospitalization. Data collection involved clinical history, vital signs monitoring, ECG measurements, LVEF evaluation, and performance of pPCI procedures. ResultsThe studied patients had a mean age of 53 ± 11 years. Patients with arrhythmic events displayed a significant rise in QT dispersion, TpTe, TpTe/QT, and arrhythmic death rates (P < 0.05). A multivariate logistic regression examination revealed that HR (with an OR of 1.037 and a 95% CI of 1.004 to 1.071, P = 0.027), TpTe (with an OR of 1.025 and a 95% CI of 1.004 to 1.047, P = 0.022), and TpTe/QT (with an OR of 5.464 and a 95% CI of 2.027 to 14.726, P = 0.001) were found to be significant predictors of arrhythmic events or mortality. ConclusionIn patients with anterior STEMI, TpTe and TpTe/QT ratio are significant predictors of in-hospital VA and arrhythmic death. Higher TpTe and TpTe/QT values are linked to a higher risk of these occurrences.

Initial Percutaneous Coronary Intervention (PCI) Outcomes in a New Regional Cath Lab Without Cardiac Surgical Support On-Site

Initial Percutaneous Coronary Intervention (PCI) Outcomes in a New Regional Cath Lab Without Cardiac Surgical Support On-Site

The potential of the transformer-based survival analysis model, SurvTrace, for predicting recurrent cardiovascular events and stratifying high-risk patients with ischemic heart disease.

Ischemic heart disease is a leading cause of death worldwide, and its importance is increasing with the aging population. The aim of this study was to evaluate the accuracy of SurvTrace, a survival analysis model using the Transformer-a state-of-the-art deep learning method-for predicting recurrent cardiovascular events and stratifying high-risk patients. The model's performance was compared to that of a conventional scoring system utilizing real-world data from cardiovascular patients. This study consecutively enrolled patients who underwent percutaneous coronary intervention (PCI) at the Department of Cardiovascular Medicine, University of Tokyo Hospital, between 2005 and 2019. Each patient's initial PCI at our hospital was designated as the index procedure, and a composite of major adverse cardiovascular events (MACE) was monitored for up to two years post-index event. Data regarding patient background, clinical presentation, medical history, medications, and perioperative complications were collected to predict MACE. The performance of two models-a conventional scoring system proposed by Wilson et al. and the Transformer-based model SurvTrace-was evaluated using Harrell's c-index, Kaplan-Meier curves, and log-rank tests. A total of 3938 cases were included in the study, with 394 used as the test dataset and the remaining 3544 used for model training. SurvTrace exhibited a mean c-index of 0.72 (95% confidence intervals (CI): 0.69-0.76), which indicated higher prognostic accuracy compared with the conventional scoring system's 0.64 (95% CI: 0.64-0.64). Moreover, SurvTrace demonstrated superior risk stratification ability, effectively distinguishing between the high-risk group and other risk categories in terms of event occurrence. In contrast, the conventional system only showed a significant difference between the low-risk and high-risk groups. This study based on real-world cardiovascular patient data underscores the potential of the Transformer-based survival analysis model, SurvTrace, for predicting recurrent cardiovascular events and stratifying high-risk patients.

Widespread use of proton pump inhibitors or potassium-competitive acid blocker has changed the status of gastrointestinal bleeding in patients with ischemic heart disease: real-world data from high volume centers

BackgroundAlthough proton pump inhibitors (PPIs) or potassium-competitive acid blocker (PCAB) are useful in peptic ulcer prevention, their efficacy in preventing other gastrointestinal bleeding remains unclear. This study aimed to identify the status of gastrointestinal bleeding in the modern era when PPIs are widely used.MethodsThis study included patients who underwent percutaneous coronary intervention (PCI) between 2018 and 2019 at two high-volume centers. Patients were categorized based on whether they experienced gastrointestinal bleeding within 2 years of PCI into groups A (patients who experienced gastrointestinal bleeding within 2 years after PCI) and B (patients who did not experience gastrointestinal bleeding).ResultsGroups A and B included 21 (4.1%) and 494 (95.9%) patients, respectively (a total of 515 patients). Age at the initial PCI (77.8±2.4 and 72.0±0.5 years in groups A and B, respectively; p = 0.02), weight (53.8±3.2 and 61.8±0.7 kg in groups A and B, respectively; p = 0.01), and concomitant warfarin use (14.3% and 2.0% in groups A and B, respectively; p = 0.0005) were significantly different between the groups. The high bleeding risk rate (90.5% and 47.6% in groups A and B, respectively; p = 0.0001) was significantly different between the groups. A total of 95.9% of patients were taking PPIs or PCAB without significant differences between the groups. However, only one patient, who was taking steroids, had a gastric ulcer during PCAB treatment.ConclusionsAcid-related upper gastrointestinal bleeding is largely controlled by PPIs in post-PCI patients. Furthermore, the risk factors for non-acid-related bleeding include older age, lower weight, and concomitant warfarin use.

One-Year Outcome of Drug-Coated Balloon vs. Drug-Eluting Stent in Patients Undergoing Initial Percutaneous Coronary Intervention (PCI) for De Novo Lesion.

Drug-eluting stents (DES) are the major treatment option in percutaneous coronary intervention (PCI). Recently, drug-coated balloon (DCB) utilization has been increasing globally, leading to the expected new strategy of "stent-less PCI." This study aimed to evaluate the one-year outcome of DCB compared to DES. Patients who underwent initial PCI for de novo lesions in our institution from January 2018 to December 2021 (n=337) were subjected to retrospective analysis. Among them, 75 patients were treated with DCB, while 262 patients were treated with DES. Target lesion failure (TLF) was evaluated during the follow-up period. The proportion of PCIs for ACS was significantly lower in the DCB group (DCB, n=23, 30.7% vs. DES, n=143, 54.6%; p=0.001). The median device diameter and length in the DES group were larger than those in the DCB group (DCB, 2.60 mm vs. DES, 2.98 mm; p<0.001; DCB, 19.1 mm vs. DES, 25.2 mm; p<0.001). There was no significant difference between the DCB and DES groups in lesion calcification. The proportion of ostial lesions was significantly higher in the DCB group (DCB, n=13, 17.3% vs. DES, n=21, 8.0%; p=0.018). The cumulative rate of TLF (DCB, n=5, 6.7% vs. DES, n=18, 6.9%; p=0.951) did not significantly differ between the DCB and DES groups. DCB may be as effective a strategy as DES in the patient who underwent initial PCI for a de novo lesion.

The Influence of Coronavirus Infection on the Results of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

Objective — to determine the impact of coronavirus infection incidence on the post-procedural condition of patients after percutaneous coronary intervention (PCI). Materials and methods. This single-centre study was conducted at the «Ukrainian Children’s Cardiac Center, Clinic for Adults» from June 1, 2020, to December 31, 2021. A total of 158 patients participated, of whom 78 had a history of COVID-19 infection and 80 did not, all with stable obstructive coronary artery disease (CAD). All patients underwent PCI, and their long-term outcomes were evaluated within a 6-month period. The study endpoints included repeated myocardial revascularization (defined as narrowing of the stented lumen by more than 70 % in diameter or acute stent thrombosis) and an assessment of CAD progres­sion (formation or progression of atherosclerotic plaques compared to baseline coronary angio­graphy). Results and discussion. The frequency of repeated coronary angio in the first 6 months after PCI due to tension angina or acute coronary syndrome was equal to 10 (12.8 %) patients in the COVID-19 +-group and 3 (3.8 %) cases in the COVID-19 — –group (p &lt; 0.05). According to the study data, patients with coronavirus infection tended to reach endpoints more quickly during the 6-month follow-up, in contrast to patients who did not have the incidence of COVID-19 during the same period. The frequency of repeated PCI within 6 months after the primary PCI in the group of patients with previous PCI was higher — 8 cases out of 78 patients compared to patients in the second group who did not suffer from COVID-19 in the first 6 months after the initial PCI (2 cases out of 80, c2 = 4 .0, p = 0.045). Conclusions. Patients with a mild and moderate course of coronavirus infection and existing stable coronary heart disease with atherosclerotic lesions of the coronary arteries were more likely to undergo repeat PCI within 6 months of the initial PCI. The most common causes of repeat PCI in patients with previous COVID-19 were thrombosis and restenosis of the stent, as well as progression of stenosis at a site other than the location of the previous PCI.

Impact of Target Lesion Revascularization on Long-Term Mortality After Percutaneous Coronary Intervention for Left Main Disease

BackgroundAlthough target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) disease is not rare, its timing of occurrence and prognostic impact on long-term mortality is uncertain. ObjectivesThis study sought to investigate TLR incidence over time and its impact on mortality after PCI with drug-eluting stents (DES) for LMCA disease. MethodsUsing a pooled data from 4 multicenter observational registries (IRIS-DES [Interventional Cardiology Research Incorporation Society-Drug-Eluting Stents], IRIS-MAIN [Interventional Cardiology Research Incorporation Society-Left MAIN Revascularization], MAIN-COMPARE [Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization], and PRECOMBAT [PREmier of Randomized COMparison of Bypass Surgery versus AngioplasTy Using Drug-Eluting Stent in Patients with Left Main Coronary Artery Disease]), we evaluated 1,397 patients with LMCA disease treated with DES and available long-term mortality data. The association between TLR and the 10-year risk of mortality was examined by multivariable Cox proportional hazards regression, with TLR as a time-varying covariate. ResultsDuring maximum follow-up of 10 years (median 6.8 years), TLR occurred in 118 patients and its 10-year cumulative incidence was 10.8%. TLR mostly occurred within 2 years after initial PCI and decreased over time: early-stage TLR (within 2 years) in 73 (61.9%) patients and late-stage TLR (beyond 2 years) in 45 (38.1%) patients. Among all TLR patients, 23 patients underwent coronary artery bypass grafting and 95 underwent repeat PCI. In the time-varying multivariable Cox model, the presence of TLR was not significantly associated with an increased risk of mortality (adjusted HR: 0.90; 95% CI: 0.50-1.63; P = 0.73). ConclusionsAlthough the incidence of ischemia-driven TLR was mostly common within 2 years after left main PCI, TLR occurred steadily during the 10-year follow-up period. However, given that such patients were optimally revascularized, the prognostic impact of TLR on mortality was not substantial. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133; Observational Study for Left Main Disease Treatment [IRIS-MAIN]; NCT01341327; Ten-Year Outcomes of Stents Versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease [MAIN COMPARE]; NCT02791412; Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968)

Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction.

Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI. The presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT-SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all-cause death or renal replacement therapy at 30-day follow-up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23-6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64-2.13, p = 0.64; and OR 1.01, 95% CI 0.59-1.73, p = 0.54; respectively) within 30 days of follow-up. In time-to-event Kaplan-Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52-2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36-2.65, p < 0.001) and renal replacement therapy during 30-day follow-up (HR 2.99, 95% CI 1.69-5.31, p < 0.001). Concomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS.

The difficulty of revascularization at myocardial infarction with ST-segment elevation during the military conflict: clinical scenarios. Review

Russian military aggression against Ukraine challenged serious difficulties in the treatment of acute myocardial infarction with ST segment elevation (STEMI). Continuous stress, depression and insufficient pharmacotherapy resulted in the chronic coronary syndrome exacerbation, the increased number of STEMI cases and increased mortality because of the absence of timely myocardial reperfusion. The golden standard of the STEMI treatment is percutaneous coronary intervention (PCI), the result of which is the most effective reperfusion and patients’ survival. At the military conditions PCI possibility is restricted. The alternative to this method should be the fibrinolytic therapy, which has recently been rarely used as a reperfusion method in acute STEMI due to the availability of a network of catheter laboratories. The optimal variant of treatment at the condition of complicated logistical circumstances during the military time must be pharmacoinvasive strategy based on fibrinolysis and further PCI. Since the capabilities of reperfusion centers differ in the regions of Ukraine depending on the distance from the war zone, treatment strategies may be different. The main task in the STEMI treatment always must be the earliest renovation of myocardial circulation in the ischemic myocardium.&#x0D; The authors highlighted scenarios of STEMI treatment at the condition of military conflict where pharmacoinvasive strategy might have advantages in case of difficulties with providing quick access to percutaneous coronary intervention.&#x0D; When choosing a treatment strategy for acute STEMI, it is important to consider the specific conditions, the resources of the medical system, and the availability of medical care. The use of pharmacoinvasive strategy may be useful if the initial PCI is delayed beyond the recommended time, allowing for early reperfusion and improving treatment outcomes.

Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization

Abstract Background The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI or CABG. Methods The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed. Results A total of 330 (220 RR after initial PCI and 110 RR after initial CABG) out of 1800 patients (18.3%) underwent RR within 5 years from initial revascularization. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs 13.7%, p&amp;lt;0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs 26.1%, adjusted HR: 1.17, 95% CI: 0.93-1.48, p=0.187). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs 17.6%, adjusted HR: 2.09, 95% CI: 1.21-3.61, p=0.008). Conclusions In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies.Graphic Abstract

Incidence of restenosis after drug-coated balloon percutaneous coronary intervention in patients with diabetes mellitus - a single-centre experience

Abstract Background and aim Diabetes mellitus (DM) is related to higher rates of complications after coronary revascularization.1 The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, however data on outcomes in DM is scarce. 2 The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without DM receiving DCB PCI. Material and methods The registry included patients undergoing a DCB PCI at our university hospital centre from February 2011 to January 2022 (n=645). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. An FUP angiography was performed in 50% of patients (n=317), with a median FUP of 6 (interquartile range 3-17) months. Results Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. DM was present in 35% (n=223) of patients, equally in both sexes, and was associated with a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke; as well as arterial hypertension, and renal insufficiency. No age difference was noted between groups. At initial PCI, more DM patients had multivessel coronary disease and ISR as the indication for DCB (DM vs non-DM: 41% vs 31%, p=0.023). After DCB, no group difference was noted in regards to the need for a bail-out PCI. FUP was performed in an equal percentage of patients in both groups (54% vs 48%, p=0.181), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.879), the need for target lesion PCI (14% vs. 13%, p=0.863), or the use of anti-anginal drugs. Conclusion The findings of our single-centre analysis show that although DM is related to more advanced comorbidities it does not increase the risk of target lesion restenosis after DCB PCI. DCB PCI should be considered as a therapeutic option in candidate patients regardless of DM status.Comparison between diabetic and non diab

Age-Stratified Prevalence and Relative Prognostic Significance of Traditional Atherosclerotic Risk Factors: A Report from the Nationwide Registry of Percutaneous Coronary Interventions in Japan.

Background The prevalence of traditional atherosclerotic risk factors (TARFs) and their association with clinical profiles or mortality in percutaneous coronary intervention remain unclear. Methods and Results The study analyzed 559 452 patients who underwent initial percutaneous coronary intervention between 2012 and 2019 in Japan. TARFs were defined as male sex, hypertension, dyslipidemia, diabetes, smoking, and chronic kidney disease. We calculated the relative importance according to R2 and machine learning models to assess the impact of TARFs on clinical profile and in-hospital mortality. The relative contribution (RC) of each TARF was defined as the average percentage of the relative importance calculated from these models. The age-specific prevalence of TARFs, except for chronic kidney disease, formed an inverted U-shape with significantly different peaks and percentages. In the logistic regression model and relative risk model, smoking was most strongly associated with acute myocardial infarction (adjusted odds ratio [OR], 1.62 [95% CI, 1.60-1.64]; RC, 47.1%) and premature coronary artery disease (adjusted unstandardized beta coefficient, 2.68 [95% CI, 2.65-2.71], RC, 42.2%). Diabetes was most strongly associated with multivessel disease (adjusted unstandardized beta coefficient, 0.068 [95% CI, 0.066-0.070], RC, 59.4%). The absence of dyslipidemia was most strongly associated with presentation of cardiogenic shock (adjusted OR, 0.62 [95% CI, 0.61-0.64], RC, 34.2%) and in-hospital mortality (adjusted OR, 0.44 [95% CI, 0.41-0.46], RC, 39.8%). These specific associations were consistently observed regardless of adjustment or stratification by age. Conclusions Our analysis showed a significant variation in the age-specific prevalence of TARFs. Further, their contribution to clinical profiles and mortality also varied widely.

Development of a prediction model for exercise tolerance decline in the exercise assessment of patients with acute myocardial infarction undergoing percutaneous coronary intervention revascularization in the acute phase.

Early cardiopulmonary exercise test (CPET) may predict the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, data from CPET to assess the exercise capacity of patients with AMI PCI are still scarce. This study aimed to evaluate the safety of the CPET and assess the predictors and clinical influence of exercise capacity measured by CPET in patients with AMI within 1 week after PCI. A total of 275 patients with AMI who underwent PCI in the acute phase were selected. Reduced exercise capacity was defined as peak oxygen uptake (VO2peak) <16 mL/kg/min. According to VO2peak, patients were divided into a normal exercise tolerance group and a reduced exercise tolerance group. The general clinical conditions were compared between the 2 groups to investigate the safety of CPET and the influencing factors of exercise tolerance. A nomogram model for predicting patients' exercise capacity was further developed. Clinical outcomes were recorded. The median time of CPET in all patients was 5 days after PCI. Among the 275 patients, exercise tolerance decreased in 90 cases (32.72%). Multivariate logic analysis showed that E/e', age, glycosylated hemoglobin, and estimated glomerular filtration rate (eGFR) were independent predictors of early exercise capacity reduction in these patients. Utilizing the correlation coefficients from pre-assessment clinical and CPET indicators within the logistic regression framework, we constructed a nomogram model to forecast the diminishing exercise tolerance in AMI patients. The predictive accuracy of this model, as indicated by a C-index of 0.771 and an area under the receiver operating characteristic (ROC) curve of 0.771 (95% CI: 0.710-0.832), demonstrates its potential as a robust tool in clinical settings. During a follow-up of 24 months, the incidence of clinical outcomes in patients with low exercise tolerance was significantly higher than that in patients with normal exercise tolerance, among which all-cause mortality and reinfarction were statistically different (P=0.009 and P=0.043). The reduced exercise capacity in patients with AMI after initial PCI is related to age, diastolic dysfunction, renal function, and blood glucose control, which may lead to poor clinical prognosis. The nomogram prediction model performed well in predicting the declining exercise tolerance of patients with AMI.

Outcomes of same-day discharge following percutaneous coronary intervention in a rural population.

Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Areacodes 4-10 were used to define rural status. A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio [aOR]: 0.20, 95% confidence interval [CI]: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.

Interrelationship of psychological and sociological factors after a first percutaneous coronary intervention (PCI) : Implications for secondary prevention

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): This study is supported with a young investigator grant from Vísindaráð Landspítala [the science committee of Landspitali-University Hospital] awarded to dr. Erla Svansdóttir. Background Coronary artery disease (CAD) is a leading cause of death, disability, and health-care burden worldwide. Advances in medical technology combined with identification of CAD risk factors has resulted in lower CAD mortality rates in western countries in the past decades. Secondary prevention constitutes a crucial factor for hindering further CAD development by helping patients with risk factor modification. Psychological and sociological factors have been identified as risk factors for progression of CAD and adverse well-being following adverse CAD events, and should be given consideration in secondary prevention. Purpose The aim of this study was to assess the prevalence of psycho- and sociological factors in patients undergoing a first Percutaneous Coronary Intervention (PCI) and to explore how the interrelationship of these factors affect patients’ well-being. This study is a part of a larger study investigating the psychological well-being and rehabilitation success of patients after an initial PCI procedure up to six months post-PCI. Methods Participants were 97 patients (mean age 60±7.6 years) who underwent a PCI in Iceland from December 2021 to May 2022. Questionnaires assessing somatic symptoms, anxiety, depression, perceived stress, cardiac anxiety, and distress personality were administered during hospitalization. Results Majority of participants were male (79%), in a relationship (79%), had secondary/higher education (83%), worked full time (72%) and lived in the capital area (69%). Overall, nearly half of PCI patients showed some depression symptoms (47%) and 38% some anxiety symptoms. Of these, 15% and 10% had moderate or severe symptoms of depression and anxiety, respectively. Women scored higher than men on cardiac anxiety and cardiac-related avoidance (p’s&amp;lt;0.05). Age had a negative correlation with somatic symptom scores (r=-0.26, p&amp;lt;0.05), anxiety (r=-0.32, p&amp;lt;0.01), cardiac anxiety (r=-0.24, p&amp;lt;0.01), cardiac fear and worry (r=-0.39, p&amp;lt;0.01) and social inhibition (r=-0.26, p&amp;lt;0.01). Higher education level was linked with lower anxiety, depression, perceived stress, negative affectivity and social inhibition (table 1). Not being in a relationship was associated with more somatic symptoms (ß=0.27), perceived stress (ß=0.24) and cardiac-related avoidance (ß=0.25), independent of age, gender, and education status (see table 2, all p’s&amp;lt;0.05). In secondary analyses patients not in a relationship had higher odds of current smoking (OR 5.4, 95% CI:1.7-17.6) and of having some depression symptoms (OR 2.7, 95% CI:1.0-7.4). Conclusion Nearly half of PCI patients in Iceland had some depression or anxiety symptoms, and psychological distress was higher among patients of younger age or lower education levels. Single patients may pose a group in need of specific support in secondary prevention given their elevated somatic symptoms, cardiac-related avoidance and perceived stress which may hinder rehabilitation efforts.

The obesity paradox in ST-segment elevation myocardial infarction patients: A meta-analysis.

The aim of this study was to investigate whether there was a difference in survival after initial percutaneous coronary intervention (PCI) among ST-segment elevation myocardial infarction (STEMI) patients with different body mass index (BMI). Literature retrieval was conducted on PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain the published studies on the survival of STEMI patients with different BMI after initial PCI from the establishment of the database to 2022. All statistical analyses were performed using STATA16.0. Two hundred thirty-nine studies were retrieved, and 12 studies were eventually included. Meta-analysis showed that overweight patients [OR=0.66, 95% CI (0.58, 0.76), p < .001] and obese patients [OR=0.60, 95% CI (0.51, 0.72), p < .001] had lower in-hospital mortality than healthy-weight patients. Overweight patients [OR=0.66, 95% CI (0.58, 0.74), p < .001] and obese patients [OR=0.62, 95% CI (0.53, 0.72), p < .001] had lower short-term mortality than healthy-weight patients. In addition, overweight patients [OR=0.63, 95% CI (0.58, 0.69), p < .001] and obese patients [OR=0.59, 95% CI (0.52, 0.66), p < .001] also had lower long-term mortality than healthy-weight patients. There was no significant difference in in-hospital mortality [OR=1.06, 95% CI (0.89, 1.27), p > .05], short-term mortality [OR=1.04, 95% CI (0.89, 1.22), p > .05], and long-term mortality [OR=1.07, 95% CI (0.95, 1.20), p > .05] between overweight and obese patients. This meta-analysis confirmed an obesity paradox in STEMI patients following PCI. The obesity paradox exists in in-hospital, short-term, and long-term conditions.

TO CHALLENGE OR AVOID? POSSIBLE ASPIRIN ALLERGY IN PATIENTS WITH CHRONIC IDIOPATHIC URTICARIA AND ANGIOEDEMA

<h3>Introduction</h3> Aspirin remains an important component of dual antiplatelet therapy following percutaneous coronary intervention (PCI). Despite studies showing safety in discontinuing aspirin post PCI through use of P2Y12 inhibitor therapy plus anticoagulation, no large, randomized trials evaluate an initial aspirin-free regimen post PCI without systemic anticoagulation. Aspirin intolerances occur in 20% of patients, with only 2% being true allergies. Most aspirin intolerances are linked to asthma, rhinitis, and chronic idiopathic urticaria (CIU). Differentiating this population is important for optimizing care. <h3>Case Description</h3> C.P. is a 54-year-old male with CIU referred for evaluation of aspirin allergy prior to coronary angiography with possible PCI. In 2001, C.P. developed right periorbital edema an hour after his third dose of daily aspirin therapy. Antihistamines reduced the swelling within hours, however due to reaction, his physician recommended discontinuing aspirin. He noted taking aspirin as a child and ibuprofen as an adult without incident. An in-clinic open oral drug challenge to aspirin was conducted. The patient was given 1/10^th of the full dose, followed by the remaining dose then monitored for 1 hour. The patient was diagnosed with NSAID exacerbated CIU and discharged with aspirin and antihistamines for control. <h3>Discussion</h3> Without clear guidelines for managing NSAID induced CIU, many physicians recommend avoidance, resulting in suboptimal care. 20-40% of CIU patients have flares triggered by NSAIDs, and many are misdiagnosed with an aspirin allergy. Our case demonstrates that through careful history and oral challenge, aspirin exacerbated CIU can be effectively managed without forgoing quality care.

Effect of Percutaneous Coronary Intervention (PCI) on Quality of Life in Patients with Stable Coronary Disease

Background: The most popular form of treatment for coronary disease is percutaneous coronary intervention (PCI). Along with recurrence rates and mortality, quality of life (QoL) is a crucial PCI outcome indicator. Purpose: The purpose of this research was to look at the variables affecting individuals with coronary disease who had undergone PCI's quality of life. The cardiac center of the hospital provided a convenient sampling for this descriptive, cross-sectional research. On a population of 630 patients who had coronary disease, this research was carried out utilizing a standardized questionnaire and individual medical data. Information on general, medical, and psychological traits was gathered using the questionnaire. Descriptive statistics, the independent t-test, one-way variance analysis and Scheffé test were all used to analyze the data. The significant variables in univariate analysis were combined with the key parameters found in a multiple linear regression to identify the factors that strongly affected QoL. Results: We discovered that age, subjective economic status, being the primary caregiver, time since the first PCI, anxiety, and depression all significantly influenced QoL. The Age, primary caregivers and marital status were the strongly significant variables that were proven to have an impact on QoL in patients who had gone through PCI. The period since the initial PCI was among the main clinical factors that were proven to have an impact on QoL. Depression and anxiety were among the important psychosocial traits that were found to have an impact on quality of life. The study's PCI patients' primary caregivers were shown to have the biggest influence on their quality of life. Conclusions: Patients' post-PCI psychological and physical symptoms must be frequently evaluated in order to improve QoL in those who had underwent PCI. In addition, patients with significant functional impairments and those getting family care need intervention measures that aim at enhancing quality of life.

Predictors of Suboptimal Coronary Blood Flow during Primary Percutaneous Intervention

Background and aim: Suboptimal coronary blood flow following first percutaneous coronary intervention (PCI) is a multivariate phenomenon with several causes. Despite substantial research, recognized modifiable risk factors and an effective management plan are lacking. The present study intended to determine the several causes of suboptimal coronary blood flow during primary percutaneous intervention. Patients and Method: A retrospective study was carried out on 486 STEMI patients in the Interventional Cardiology Department, MTI-Hayatabad Medical Complex, Peshawar from June 2021 to May 2022. Patients (age&gt;20 years) presented with initial percutaneous coronary intervention within 12 hours after onset of symptoms were enrolled. Patients’ physical examination, medical history, different risk factors, vital signs assessment, echocardiography, Killip class, laboratory investigation, and post-procedural ECG were recorded along with PCI data and associated catheterization. Clinical outcomes included MACE, ischemia-driven target vessel revascularization, reinfection, cardiac mortality, and post-catheterization were recorded. Descriptive statistics was done in SPSS version 26. Results: Of the total 486 STEMI patients, there were 412 (84.8%) male and 74 (15.2%) females. The overall mean age was 52.62± 8.64 years. The incidence of suboptimal flow (TIMI flow ≤2) and optimal flow (TIMI-3 flow) were 112 (23%) and 374 (77%) respectively. Age [OR 1.041/year: p&lt;0.001], total stent length [OR 1.019 per 1 mm], low SBP [OR 1.021 per mm Hg], thrombus burden grade [OR 1.78], and baseline TIMI flow (≤1) [OR 1.72; p=0.021] were suboptimal flow independent predictors. Cardiac mortality and MACE were significantly higher after 30-days in suboptimal flow as compared to optimal flow. The prevalence of in-hospital mortality in suboptimal flow and optimal flow was 9.1% and 2.1% respectively. Conclusion: The present study found that suboptimal coronary flow after first PCI is substantially associated with higher in-hospital and cardiovascular mortality in STEMI. The most significant predictor of poor coronary flow is predilatation prior to stenting. Keywords: Suboptimal coronary flow, Primary percutaneous intervention, Predictors