Coronary Artery Intervention Research Articles

Association of health insurance status with coronary risk factors, coronary artery disease, interventions and outcomes in India

ObjectiveCoronary artery disease (CAD) related hospitalization and interventions are associated with catastrophic out-of-pocket health expenditure in India. To evaluate differences in risk factors, disease severity, management and outcomes in uninsured vs insured CAD patients we performed a study. MethodsSuccessive CAD patients who underwent percutaneous intervention (PCI) at our centre were enrolled from January 2018 to June 2021. Clinical, angiographic and intervention data were periodically uploaded in the American College of Cardiology CathPCI platform. Descriptive statistics are reported. Results4672 CAD patients (men 3736, women 936) were included; uninsured were 2166 (46%), government insurance was in 1635 (36%) and private insurance in 871 (18%). Mean age was 60.1 ± 11 years, uninsured <50y were 21.6% vs 14.0% and 20.3% with government and private insurance. Among the uninsured prevalence of raised total and non-HDL cholesterol, any tobacco use, ST-elevation myocardial infarction (STEMI) and ejection fraction <30% were more (p < 0.01). In the STEMI group (n = 1985), rates of primary PCI were the highest in those with private insurance (38.7%) compared to others. Multivessel stenting (≥2 stents) was more among the insured patients. Median length of hospital stay was similar in the three groups. In-hospital mortality was slightly more in the uninsured (1.43%), compared to government (0.88) and privately insured (0.82) (p = 0.242). The cost of hospitalization and procedures was the highest among uninsured (US$ 2240, IQR 1877–2783) compared to government (US$ 1977, IQR 1653–2437) and privately insured (US$ 2013, IQR 1668–2633) (p < 0.001). ConclusionsUninsured CAD patients in India are younger with more risk factors, acute coronary syndrome, STEMI, multivessel disease and coronary stenting compared to those with government or private insurance. The uninsured bear significantly greater direct costs with slightly greater mortality.

Left Ventricular Support for Unprotected Left Main Coronary Artery Interventions (The Dayton Heart and Vascular Impella Registry).

Coronary artery bypass grafting is the standard of care for patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is an alternative. We investigated a retrospective cohort of patients who underwent LM PCI from January 2010 to March 2014 (n = 89). Obstructive LM disease was defined as 50% angiographic obstruction of luminal flow, and the primary endpoint was inhospital mortality. Ventricular assist device (VAD) was defined as the use of either intra-aortic balloon pump (IABP) or Impella 2.5 devices before, during, or following PCI. A total of 89 patients with LM PCI were divided into those with (n = 39) and without (n = 50) VAD support. The former group was further divided into those with support from either Impella 2.5 (n = 28) or IABP (n = 11). Age, race, and gender did not differ between patients who received unassisted LM-PCI from those with VAD support (P = 0.142, 1.0, and 0.776, respectively). The angiographic stenosis of atherosclerotic lesions in LM, proximal left anterior descending artery, and other native/surgical coronary vessels was similar between the groups. The duration of hospitalization was significantly longer for patients with VAD support compared to those without (7.19 ± 6.89 vs. 2.78 ± 3.39, P < 0.001). The incidence of cardiogenic shock and inhospital mortality was significantly higher in the VAD group (P = 0.009 and 0.001, respectively). Overall, inhospital mortality was 9% (8/89). The IABP and Impella 2.5 groups had mortality proportions of 46% (5/11) and 11% (3/28), respectively; P = 0.028. For all patients, inhospital mortality was higher for those with versus without cardiogenic shock (56% or 5/9 vs. 4% or 3/80; P < 0.001), and for those with versus without left ventricular systolic function <40% (17% vs. 2%;P < 0.025). In a selected group of patients with LM disease, unsupported PCI appears to be a feasible and safe procedure. In high-risk patients, the use of Impella 2.5 appears to be superior to IABP in LM PCI resulting in favorable short-term outcomes.

Percutaneous Intervention With GuideLiner Catheter in 4 Patients With Anomalous Coronary Artery Originating From Opposite Sinus of Valsalva.

Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.

Comparison between drug-coated balloons and drug-eluting stents in very small coronary artery interventions

The optimal management of very small vessel (reference diameter from 2.0 to 2.25 mm) in percutaneous coronary interventions (PCIs) is controversial. We aimed to compare the efficacy and safety of drug-coated balloons (DCBs) and drug-eluting stents (DESs) for de-novo very small vessel interventions. We conducted a retrospective analysis of consecutive patients who received very small vessel PCI with a DCB or DES between January 2018 and March 2021. The outcome measures were the incidence of ischemia-driven target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCEs) within 1 year after PCI. MACCEs were defined as the composite of ischemia-driven TLR, all-cause death, non-fatal acute coronary syndrome, stroke, or heart failure requiring hospitalization. A total of 205 patients undergoing PCI with a DCB or DES were enrolled in this study. The procedural complication rate was 2.5% in the DES group and 1.7% in the DCB group (P = 1.000). After 1-year of follow-up, the cumulative incidence of TLR was 7.2% in the DCB group and 4.9% in the DES group (P = 0.530). The cumulative incidence of MACCEs was 10.6% in the DCB group and 12.7% in the DES group (P = 0.769). Only female gender, acute coronary syndrome on presentation, and dual antiplatelet therapy duration < 3 months were significantly associated with MACCEs at 1 year, but the use of DCB or DES was not. The use of DCBs or DESs in de novo very small vessel intervention was not associated with different outcomes at 1 year.

One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery.

BackgroundPatients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native saphenous vein graft (SVG) PCI after CABG.MethodsWe performed a retrospective study in a tertiary reference cardiac center of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Arterial graft PCIs were excluded. Multivariable Cox regression analysis with propensity matching was performed, and major adverse cardiac events (MACE) outcomes including death or myocardial infarction (MI) or revascularization were assessed at 1-year after each index procedure.ResultsA total of 435 PCI were performed in 401 patients (209 had native PCI and 192 had graft PCI). Target lesions were classified as following: 235 (54%) native coronary arteries and 200 (46%) SVG. Propensity matching resulted in 167 matched pairs. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049–2.837) which was primarily driven by increased incidence in revascularization (HR 2.218, 95% CI 1.193–4.122) and MI (HR 2.248, 95% CI 1.220–4.142) and with no significant difference in mortality (HR 1.118, 95% CI 0.435–2.870).ConclusionsCompared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.

LDL goal as a risk factor target in the post-intervention outpatient cardiology population

Abstract Funding Acknowledgements Type of funding sources: None. Background The relationship between an acute coronary event and cholesterol levels has been immensely researched, specifically the low-density lipoprotein (LDL) component of cholesterol. According to the Canadian guidelines, LDL cholesterol should be below 1.8 mmol/L if the patient has suffered an acute cardiac event. The European guidelines suggests that LDL target concentration should be below 1.4 mmol/L if the patient has had a previous cardiac event. European guidelines also lowered the LDL recommendations to less than 1 mmol/L if the patient has had 2 previous cardiac event in the previous 2 years. Purpose Assess the concordance of one Canadian cardiology clinic to the European LDL guidelines in patients with coronary artery disease. Methods Patients were randomly selected from a single centre outpatient Cardiology practice between January and June 2021. All patients were selected by 1 researcher. The patients selected must have been diagnosed with coronary artery disease by Angiography and undergone intervention in the form of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The blood cholesterol levels were evaluated before and after intervention. Results 101 patients were randomly selected for this study. Data encompassed 83 males and 18 females ages 43 to 88. Before the intervention, 15 patients had an LDL level below 1.4 mmol/L, 29 patients had an LDL level below 1.8 mmol/L. After the intervention, the number of patients with LDL &amp;lt;1.4 mmol/L was 50 and LDL&amp;lt;1.8 was 85. This population was divided by risk factors and the LDL levels were compared before and after intervention. 9 patients were known to be smokers, their LDL levels were on average 2.73 mmol/L before intervention and 1.3 mmol/L after intervention. 31 patients were known diabetic, their LDL levels were on average 2.15 mmol/L before intervention and 1.43 mmol/L after intervention. 69 patients had hypertension, their LDL levels were 2.36 mmol/L before intervention and 1.46 mmol/L after intervention. Of the 30 patient who had a positive family history, the LDL on average was 2.39 mmol/L before intervention and 1.84 mmol/L after intervention. Positive family history was contingent on having an immediate female relative with age &amp;lt;65 or immediate male relative with age &amp;lt;55 having had a cardiac event or coronary intervention. Conclusions The number of individuals on appropriate cholesterol medications after intervention increased thereby reducing the LDL concentration. The data shows that in a sample of the typical Canadian population, 84% of patients were adequately managed after a coronary artery intervention according to the Canadian guidelines. According to the UK guidelines, only 29.5% are being adequately managed. The North American guidelines will likely incorporate the new LDL targets into upcoming revisions and therefore more aggressive risk factor management will be required to meet the new target goals.

Spontaneous Resolution of Iatrogenic Aortic Dissection After Coronary Arterial Stenting

Although rare, coronary arterial angiography carries a life-threatening risk of iatrogenic aortic dissection (AD). Given the paucity of data, an optimal treatment option for iatrogenic AD is a conundrum. In this report, we present our experience of spontaneous resolution of AD in a patient with catheter-driven iatrogenic AD during coronary arterial intervention. (Level of Difficulty: Advanced.)

TCTAP C-054 Chronic Total Occlusion Percutaneous Coronary Intervention in Anomalous Right Coronary Artery Arising From Left Coronary Cusp

TCTAP C-054 Chronic Total Occlusion Percutaneous Coronary Intervention in Anomalous Right Coronary Artery Arising From Left Coronary Cusp

Drug-Coated Balloon for Small Coronary Artery Disease in Patients With and Without High-Bleeding Risk in the BASKET-SMALL 2 Trial.

Patients at high-bleeding risk (HBR) undergoing percutaneous coronary intervention represent a challenging patient population. The use of drug-coated balloon (DCB) allows shorter duration of dual antiplatelet therapy compared with drug-eluting stents (DES) and reduces thrombotic risk due to the absence of a permanent implant. The present analysis aimed to investigate if the effect of DCB versus DES differed between patients with and without HBR treated with percutaneous coronary intervention in small coronary arteries. This prespecified subgroup analysis of a multicenter, randomized, noninferiority trial included 758 patients with de novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention, randomized to DCB (n=382) or second-generation DES (n=376). Patients were followed over 3 years for major adverse cardiac events. Of the 758 patients randomized, 155 (20%) had HBR; these patients had higher mortality at 3 years (hazard ratio [95% CI], 3.09 [1.78-5.36]; P<0.001). Rates of major bleeding events were overall low but tended to be lower after DCB versus DES (1.6% versus 3.7%; P=0.064), were similar in patients with HBR (4.5% versus 3.4%) but less frequent in DCB-versus DES-treated patients without HBR (0.9% versus 3.8%). There was no difference in major adverse cardiac events between DCB and DES regardless of bleeding risk (HBR, hazard ratio: 1.16 [0.51-2.62]; P=0.719 versus non-HBR, 0.96 [0.62-1.49]; P=0.863). DCBs were similarly safe and effective as current-generation DES in the treatment of coronary arteries <3 mm, regardless of bleeding risk. In patients treated with DCB, there was a trend towards a reduction of severe bleeding events at 3 years. URL: https://www. gov; Unique identifier: NCT01574534.

TCTAP A-042 Comparison Between Drug-Coated Balloon and Drug-Eluting Stent in Very Small Coronary Artery Intervention

TCTAP A-042 Comparison Between Drug-Coated Balloon and Drug-Eluting Stent in Very Small Coronary Artery Intervention

Effect of Coronary Arterial Dominance Post Primary Percutaneous Coronary Artery Intervention (PCI) during Hospital Stay and at 3-Month Follow-up

Background: Coronary vessel dominance, defined by the coronary artery that supplies the posterior descending artery (PDA) and posterolateral branches, influences the relative contribution of the different coronary arteries to the total left ventricular blood flow. This work aimed to evaluate the prognostic value of coronary arterial dominance post primary PCI, during hospital stay and at 3-month follow-up, which include; cardiac mortality, heart failure, non-fatal myocardial infarction, re-vascularization, stroke/TIA and re-admission for ACS. Methods: This prospective observational study included 100 patients a with STEMI who underwent successful primary percutaneous coronary intervention with TIMI III flow and without procedural complications. Patients were divided into 3 groups according to coronary dominance: Right coronary dominant group (RCD), left coronary dominant group (LCD) and balanced coronary dominant group (BCD). All patients were subjected to transthoracic echocardiogram and coronary angiography and Primary percutaneous coronary intervention. Results: Ticagrelor and clopidogrel during hospital stay and on hospital discharge were significantly used more with RCA group than LCX group and LCX &amp; RCA group (P=0.021, 0.012), (P=0.018, 0.014), respectively. GPIIB/IIIA was significantly more used during hospital stay with RCA group than LCX group and LCX &amp; RCA group(P=0.014). Nitrates was significantly used more on hospital discharge with RCA group than LCX group and LCX &amp; RCA group (P&lt;0.001). Conclusions: Coronary arterial domi¬nance showed significant prognostic value in cases of myocardial Infarction after PCI, heart failure in LCX cases and in revascularization, heart failure, and stroke/TIA cases in RCA. Further, readmission for ACS was the most common outcome in all groups after 3-months follow-up.

Effect of Crack Patterns in Calcified Plaque on Lumen Area after Stenting for a Severe Calcified Coronary Artery (from the Optical Frequency Domain Imaging-Guided Percutaneous Coronary Artery Intervention for Calcified Lesion Registry).

Background Severely calcified coronary artery stenting remains a challenge due to stent thrombosis, target vessel failure, and higher mortality. Moreover, optimal vessel preparation for calcified plaque with a crack formation pattern has not been established yet. We aimed to identify the effect of crack formation in calcified plaque in the coronary artery on the lumen area after stenting. Materials and Methods We evaluated 50 consecutive patients undergoing drug-eluting stent implantation for severely calcified lesions by using optical frequency domain imaging (OFDI) (54 lesions); we analyzed OFDI image slices every 3 mm and evaluated the segments of 242 images in those who had the arc of calcium more than 180°. Crack formation in calcified plaque was classified into three types: type 0, no cracks; type 1, no dissection between calcified plaque and vessel wall; and type 2, any dissection between calcified plaque and vessel wall. Results Type 2 had a significantly higher area expansion ratio between preballooning and poststenting (type 0, 196% (interquartile range (IQR), 163–244); type 1, 210% (IQR, 174–244); type 2, 237% (IQR, 203–294)). Conclusions The dissection between calcified plaque and vessel wall was a significant factor affecting lumen area expansion after stenting.

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Non-Protected Left Main Coronary Artery Disease: 1-Year Outcomes in a High Volume Single Center Study.

Introduction: There is clear evidence of a significant reduction in all major cardiovascular adverse events (MACE) by coronary artery bypass grafting (CABG) in left main coronary artery stenosis (LMCS), but revascularization by percutaneous coronary artery intervention (PCI) shows an increasingly important role as an alternative to CABG. Several recent trials aiming to test the difference in mortality between the two types of revascularization found conflicting data. The aim of this study is to determine whether PCI is non-inferior to CABG with respect to the occurrence of MACE at 1 year in patients with significant LMCS. Material and methods: We prospectively enrolled 296 patients with chronic or acute coronary syndromes and significant LM stenosis. The angiography that recommended the revascularization procedure was used for the calculation of the Syntax II score, in order to classify the patients as low-, intermediate- or high-risk. Low- and high-risk patients were revascularized with either PCI or CABG, according to current guidelines, and were included in the subgroup S1. The second subgroup (S0) included intermediate-risk patients (Syntax II score 23–32), in whom the type of revascularization was chosen depending on the decision of the heart team or the patient preference. Patients were monitored according to the chosen mode of revascularization—PCI or CABG. LM revascularization was performed in all the patients. Clinical endpoints included cardiac death, myocardial infarction, need for revascularization and stroke. Patients were evaluated at 1 year after revascularization. Event rates were estimated using the Kaplan–Meier analysis in time to the first event. Results: At 1-year follow-up, a primary endpoint occurred in 35/95 patients in the CABG group and 37/201 in the PCI group. There were no significant differences between the 2 treatment strategies in the 1-year components of the end-point. However, a tendency to higher occurrence of cardiac death (HR = 1.48 CI (0.55–3.9), p = 0.43), necessity of repeat revascularization (HR = 1.7, CI (0.81–3.6), p = 0.16) and stroke (HR = 1.52, CI (1.15–2.93), p = 0.58) were present after CABG. Contrariwise, although without statistical significance, MI was more frequent after PCI (HR = 2, CI (0.78–5.2), p = 0.14). The Kaplan–Meier estimates in subgroups demonstrated the same tendency to higher rates for cardiac death, repeat revascularization and stroke after CABG, and higher rates of MI after PCI. Although without statistical significance, patients with an intermediate-risk showed a slightly lower risk of MACE after PCI than CABG. With the exception of dyslipidemia and gender, other cardiovascular risk factors were in favor of CABG (CKD, obesity). Conclusion: In patients with LMCS, PCI with drug-eluting stents was non-inferior to CABG with respect to the composite of cardiac death, myocardial infarction, repeat revascularization and stroke at 1 year, even in patients with intermediate Syntax II risk score.

Prevelence of Multivessel Anatomy in Primary Percutaneous Coronary Intervention (PCI) after Acute ST Elevation Myocardial Infarction

Objective: This study aims to determine the frequency of multivessel anatomy in patients with Primary Percutaneous Coronary Intervention (PPCI) after Acute ST-Elevation Myocardial Infarction (STEMI). Methodology: From February 2017 to August 2017, this descriptive cross-sectional study was conducted in National Institute of Cardiovascular Diseases Karachi. P-value&lt;0.05 was considered statistically significant. Patients of Either gender, having comorbid of Diabetic, hypertensive, obese, smokers or ex-smokers, from age ≥35 years and ≤65 years were included for the research subject. However, patients with a previous history of coronary angioplasty or thrombolytic therapy, valvular heart disease, CABG, and all those patients with non-ST-elevation myocardial infarction (NSTEMI) do not meet the criteria for STEMI on electrocardiography were excluded. Result: A total of 97 patients were evaluated with a mean age of 52.5 and standard deviation ±9.76 and weight mean was 68.65±10.86. A significant result was observed with the help of chi-square t-test analysis in the stratification for MVDA. Age was proportionally related to MVDA with a p-value of 0.001. Diabetes Mellitus is another significant factor in association with MVDA with a p-value of 0.001. Hypertension and current smoking status in association with multivessel disease reflect moderate evident significance while gender and ex smoking status have no association with MVDA. Conclusion: Patients with multi-vessel disease comprise the majority of patients undergoing PCI today and will likely remain so. With improved techniques, stents, and adjunctive drugs, outcomes have improved significantly. Keywords: Multivessel Disease Anatomy (MVDA), Standard Modified Cardiovascular Risk Factor (SMuRF), Primary Percutaneous Coronary Artery Intervention (PPCI), Acute ST segment Elevation Myocardial Infarction (STEMI)

Comprehensive Assessment of the Left Ventricular Systolic Function in the Elderly with Acute Myocardial Infarction Using Echocardiography.

AimTo evaluate the left ventricular (LV) systolic function in elderly with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI).MethodsForty NSTEMI and forty STEMI patients after undergoing percutaneous coronary artery intervention (PCI) were enrolled. The myocardial segments were supplied by the infarct-related artery (Myo-IRA) which were indicated by the selective coronary arteriography (SCA). The LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV) and ejection fraction (LVEF) were acquired by 4D LV Volume Tom Tec. LV longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) of Myo-IRA segments, LV rotational peak degree in the base (rot-base) and in the apex (rot-apex), and twist were acquired by strain analysis software. Forty older healthy individuals were included as normal controls.ResultsThe LVEF of the NSTEMI and STEMI patients at 1 week after PCI were significantly lower (P<0.05), then, this parameter was improved in both groups after 3 months, but was still significantly lower than that of the controls (P<0.05). The LPSS, RPSS, CPSS of the Myo−IRA segments, rot−Base, rot−Apex and twist in both groups were significantly lower than those in the controls. The LPSS and CPSS of the Myo-IRA segments, rot−Base, rot−Apex and twist in NSTEMI patients were obviously higher than those in STEMI patients in 1 week and 3 months after PCI (P<0.05). After 3 months, the RPSS of NSTEMI patients was improved notably and was obviously higher than that of STEMI patients (P<0.05). All these values in STEMI and NSTEMI patients were improved after 3 months, apart from LPSS in STEMI patients (P>0.05), but were still significantly lower than those in the controls (P<0.05).ConclusionRT-3DE and STI can sensitively assess LV systolic function with different extents of transmural damage.

Nrf2 participates in the protective effect of exogenous mitochondria against mitochondrial dysfunction in myocardial ischaemic and hypoxic injury

ObjectiveCoronary artery disease is one of the leading causes of death worldwide. Treatments including coronary artery intervention can cause complications, such as myocardial ischaemia-reperfusion injury (MIRI). Mitochondrial injury or dysfunction is a key pathology of MIRI. Mitochondrial transplantation is considered a promising therapeutic strategy for cardiac-related diseases, but its mechanism is still unclear. Nrf2 is a prominent player in supporting the structural and functional integrity of mitochondria. In our research, we focused on the effect of Nrf2 in the treatment of MIRI by mitochondrial transplantation. H9C2 cells were subjected to hypoxia/reoxygenation (H/R) and MIRI was induced in wild-type and Nrf2−/− mice by surgical ligation of the left coronary artery to elucidate the mechanism in vitro and in vivo, respectively. Exogenous mitochondria were extracted from healthy H9C2 cells and the pectoralis major and administered to H9C2 cells and mice with MIRI, respectively. Mitochondrial internalization, H9C2 cell injury or apoptosis, cardiac injury/function, mitochondrial function, morphology, mitochondrial dynamics, and the expression of components of the Nrf2 pathway were assessed. We found that exogenous mitochondria were internalized into H9C2 cardiomyocytes. Exogenous mitochondrial transplantation attenuated cardiomyocyte injury, cardiomyocyte apoptosis, and mitochondrial dysfunction. Exogenous mitochondrial transplantation increased the expression of Nrf2 and its downstream targets, attenuated cardiomyocyte injury, cardiac dysfunction, apoptosis, mitochondrial dysfunction, and mitochondrial fusion and fission imbalance, and improved mitophagy after MIRI in wild-type mice but not in Nrf2−/− mice. These results suggested that exogenous mitochondria can be internalized into cardiomyocytes and activate the Nrf2 pathway and that exogenous mitochondria improve cardiac function and ameliorate mitochondrial dysfunction via the Nrf2 pathway.

Risk of Cardiovascular Toxicity According to Tumor Laterality Among Older Patients With Early Stage Non-small Cell Lung Cancer Treated With Radiation Therapy

The long-term risk of cardiovascular outcomes from either stereotactic body radiation therapy (SBRT) or three-dimensional conformal radiation therapy (3DCRT) plus intensity-modulated radiation therapy (IMRT) to treat early stage non-small cell lung cancer (NSCLC) is largely unknown. As continued adoption of SBRT accelerates, it is important to delineate unforeseen cardiovascular risks associated with treatment. Does the long-term risk of cardiovascular outcomes for patients with early stage NSCLC treated with either SBRT or 3DCRT plus IMRT differ by tumor laterality? Data from the Surveillance, Epidemiology, and End Results registry linked to Medicare was analyzed to identify a sample of 3,256 patients (1,506 treated with SBRT and 1,750 treated with 3DCRT plus IMRT) with node-negative stage I or IIA NSCLC. Cardiovascular events were identified using diagnosis codes, and outcomes were compared between left- and right-sided tumors. We assumed that tumor laterality was random and that the radiation field for left-sided tumors likely would result in greater dose to cardiac tissues. Cox regression models were fit to quantify the association of laterality on outcomes. Patients were followed up for a median of 2 years. Those treated with SBRT showed no difference in hazard of any cardiovascular outcomes by tumor laterality, including the cardiovascular composite (hazard ratio [HR] comparing left- vsright-sided tumors, 0.98; 95%CI, 0.84-1.15). In contrast, patients treated with 3DCRT plus IMRT showed a greater risk of congestive heart failure (HR, 1.23; 95%CI, 1.01-1.48) and percutaneous coronary artery intervention (HR, 2.24; 95%CI, 1.12-4.47). Patients with left- vsright-sided early stage NSCLC showed similar rates of cardiovascular events when treated with SBRT. However, these patients also showed higher rates of select cardiac events when they were treated with 3DCRT plus IMRT. This study provides evidence that SBRT may provide a safer option over 3DCRT plus IMRT for patients with left-sided early stage NSCLC and underscores the need for long-term follow-up for patients treated with radiation therapy.

Comment on "Mean platelet volume as a simple marker of repeated coronary artery intervention after off-pump technique (OPCAB) procedures - initial report".

Comment on "Mean platelet volume as a simple marker of repeated coronary artery intervention after off-pump technique (OPCAB) procedures - initial report".

Intravascular Lithotripsy Catheter Balloon for Calcified Coronary Artery Intervention for the First 10 Cases at Mackay Base Hospital

The intravascular lithotripsy (IVL) catheter balloon is designed to improve the success rate of intervention for coronary artery calcifications (CAC). IVL is highly attractive option for a regional centre such as Mackay without on-site cardiothoracic surgical service for its superior safety data.

Mean platelet volume as a simple marker of repeated coronary artery intervention after off-pump technique (OPCAB) procedures - initial report. Authors' reply.

Mean platelet volume as a simple marker of repeated coronary artery intervention after off-pump technique (OPCAB) procedures - initial report. Authors' reply.