Multiple Vessel Coronary Artery Disease Research Articles

Triggering type and long-term survival following ST segment elevation-myocardial infarction treated with primary percutaneous coronary intervention.

Physical and emotional stress are recognized triggers of acute coronary syndromes, including ST segment elevation-myocardial infarction (STEMI). We have previously shown that identifiable triggers precede symptoms in over one-third of STEMI patients and inversely correlate with the extent of coronary artery disease (CAD). This study aims to investigate the association between trigger type (physical vs. emotional) and long-term mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI). This retrospective, single-center observational study included all patients admitted with an STEMI diagnosis from January 2008 to December 2013. Physical and emotional triggers were identified retrospectively from patient records. Mortality data were obtained from the Israeli Ministry of Health. Of 1345 consecutive STEMI patients treated with primary PCI, mortality data were available for 1267 patients (median age: 61 years). A trigger preceding symptoms onset was identified in 36.5% of patients, with 85% experiencing physical stress and 15% emotional stress. Triggered STEMI patients tended to be younger with fewer comorbidities and lower incidence of multiple vessel CAD compared with nontriggered patients. Notably, emotionally triggered STEMI patients exhibited improved long-term survival compared with those without emotional triggers or with physical triggers. predictor of enhanced long-term survival post-PCI compared with physical triggering. Emotional triggering was identified as an independent. Patients with emotionally triggered STEMI showed less extensive CAD and improved long-term survival following PCI compared with those with physically triggered STEMI. These findings highlight the importance of considering both the presence and type of trigger in the management of STEMI patients and their long-term prognosis.

The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review.

Cardiovascular disease has remained one of the leading causes of mortality in the world. The basic pathophysiology of coronary artery disease (CAD) is a reduction of the blood flow in coronary vessels, leading to restricted blood flow to the heart muscle. Both modifiable and non-modifiable risk factors contribute to its multifactorial etiology. The clinical presentation ranges from asymptomatic to typical symptoms like chest pain, shortness of breath, and left arm or jaw pain. The purpose of this review is to investigate and analyze the variation of CAD depending on the biological sex, age, race, or ethnicity and how it might differ in the studied population while comparing the symptoms and prognosis of CAD. For this research, PubMed's database was used. A total of 926 articles were selected using pre-determined inclusion and exclusion criteria, with 74 articles eligible to be included in the narrative review. Studies were selected from the general population of patients with CAD, regardless of their severity, stage of diagnosis, and treatment plan. The scale for the assessment of non-systematic review articles (SANRA) was used to assess the quality of the study. As humans age, the incidence of CAD increases, and people over 75 are more likely to have multiple-vessel CAD. It has been observed that South Asians have the highest rate of CAD at 24%, while the White population has the lowest at 8%. The prevalence of CAD also depends on race, with the White population having the lowest rate at 3.2%, followed by Hispanics at 5%, Black women at 5.2%, and Black men at 5.7%. Younger Black women tend to have more chest pain. Men with CAD commonly experience chest pain, and women are more likely to present with atypical symptoms. Modifiable risk factors such as smoking and alcoholism are more commonly observed in young men than in young women. Coronary artery disease in the elderly, female, minority, and Black patients is associated with a higher mortality rate. Acknowledging the prevalence of certain risk factors, signs, results, and responses to treatment in certain socio-demographic groups, as well as the provision and accessibility of diagnosis and treatment, would lead to a better outcome for all individuals. The impact of this shift can range from an earlier diagnosis of CAD to a faster and more customized treatment plan tailored to each patient's individual requirements.

Long-term results of myocardial revascularization by direct and sequential venous grafts in multiple-vessel coronary artery disease

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ состояния прямых и секвенциальных аутовенозных кондуитов в отдаленном периоде после коронарного шунтирования. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Оценили данные коронароангиографии и шунтографии 258 пациентов, прооперированных в период с 2015 по 2020 г. Критерием включения было шунтирование коронарных артерий аутовенозными прямыми или секвенциальными кондуитами, исключая переднюю межжелудочковую артерию. Проведен сравнительный анализ 505 прямых и 124 секвенциальных трансплантатов. Изучены отдаленные результаты шунтирования и основные анатомо-топографические факторы венечного русла, оказывающие влияние на функциональную состоятельность венозных кондуитов. <h3>РЕЗУЛЬТАТЫ</h3> Удовлетворительная функция кондуитов независимо от типа шунта выявлена в 79,3% случаев, дисфункция шунтов — в 3,1%, окклюзия — в 17,6%. Функциональная состоятельность прямых шунтов достоверно ниже секвенциальных (78,4 против 83,1%, <i>p</i>&lt;0,05). Секвенциальные кондуиты лучше работают как при шунтировании сосудов диаметром &gt;1,5 мм, так и артерий диаметром &lt;1,5 мм (88,5% против 82,0% (для артерий &gt;1,5 мм) и 76,6% против 63,2% (для артерий ≤1,5 мм), <i>p</i>&lt;0,05). При этом функция разных типов кондуитов не зависит от бассейна шунтирования. <h3>ВЫВОД</h3> При реваскуляризации артерий диаметром &lt;1,5 мм предпочтение следует отдавать секвенциальным типам анастомозов. При этом необходимо учитывать, что состояние коронарной артерии, с которой сформирован дистальный анастомоз, определяет функциональную состоятельность всего кондуита.

Abstract 9859: Randomized Comparison of Bare Metal Stents Plus Colchicine vs Drug Eluting Stents: Preliminary Analysis of the Orca Trial (Oral Colchicine in Argentina)

Background: The use of colchicine has been associated with reduction of adverse cardiac events in patients with coronary artery disease (CAD). The role of this drug after percutaneous coronary intervention (PCI) with bare metal stents (BMS) has not been evaluated against isolated PCI with drug eluting stents (DES). Aim: The study was designed to test an improved cost-effectiveness with BMS plus colchicine (group BMS+C) compared to DES alone (group DES), provided its noninferiority in terms of major adverse cardiac events (MACE) at 1 year. Methods: This is a prospective, multicenter, randomized controlled trial performed in 4 centers. The trial has been registered at clinicaltrials.gov (NCT04382443). Study protocol and informed consent have been approved by an Independent Ethical and Review Board Committee and were presented to Argentina National regulatory authorities for Health, Technology and Medications. Patients in the BMS+C group received 0.5mg oral doses twice a day of colchicine for 3 months. Outpatient visits were scheduled at 1, 3, 6 and 12 months as well as at 3 and 5 years. Primary endpoints were to compare cost-effectiveness and MACE defined as composite of death, myocardial infarction (MI), cerebrovascular accident and ischemia-driven target vessel revascularization. Results: During February 2020 to April 2022, 412 patients with clinically indicated PCI were randomized in the study. Because 2 patients with COVID 19 at the time of randomization were excluded, the final study population was composed of 410 patients (205 patients in each group). Baseline demographic and angiographic characteristics were well balanced diabetes 19.5% vs 21.4%, Acute Coronary Syndromes 78% vs 75%, ST elevation MI 23% vs 21% multiple vessel CAD 44% vs 46%, culprit left anterior descending artery 58% vs 57.8%, peripheral vascular disease 3.4% in BMS+C and DES groups respectively.2.9% of patients in BMS+C didn’t complete the treatment for side effects (diarrhea). Presently, patients were follow at mean of 381 days ( range 45 to 839),1 -year follow-up was completed in 61%. Conclusion: A 3-month treatment with colchicine after PCI with BMS was feasible and safe. Final 1-year clinical outcomes and cost-effectiveness results will be available at the time of presentation.

Coronary Artery Bypass Grafting In Young Patients: A Retrospective Review at Queen Alia Heart Institute

Background: Coronary artery bypass grafting (CABG) is the ‘Gold Standard’ for patients with multiple vessel coronary artery disease (CAD). Younger patients presenting with coronary artery disease requiring surgery may represent a distinct subgroup with the main goal for coronary revascularization being long term patency of the performed grafts to improve outcome. Objective: The aim of this study was to check if young patients need surgery urgently for operative revascularization or electively. Also, check the potential advances regarding long-term patency using combined venous and arterial revascularization, and finally the overall mortality in young group of patients after CABG. Methods: Between January 2018 to January 2022, 526 patients below the age of 50 years underwent Coronary Artery Bypass Grafting CABG for coronary artery disease CAD in Queen Alia Heart Institute QAHI, We retrospectively analyzed the perioperative data and evaluated patients’ outcome. Results: In 25% of the patients, CABG was performed as an emergency procedure for STEMI or NSTEMI within 36 hours. Another 27% of the patients were operated urgently for unstable angina or myocardial infarction within the last weeks and only 48% of the patients were purely elective cases. We performed only venous bypass grafts in 12%, and combined venous and arterial revascularization in 88%. Patients received 2.8 ± 1 bypass grafts overall. Overall in-hospital mortality in this cohort was low with 1% (n = 1). Conclusions: The majority of the young patients below the age of 50 years present urgently for operative revascularization. Besides, the potential advances regarding long-term patency using total arterial revascularization, only about half of the young patients are feasible for this approach. Overall, early outcome in this group is excellent with mortality below one percent.

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

In 1997, the first ambulatory off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis was performed via xiphoid approach, an intervention known today as the MINI-OPCAB operation. This operation has been performed in more than 150 patients around the world for the management of single and multiple vessel coronary artery disease, and 70 of those cases underwent the procedure in our Foundation from 1997 to 2021, showing no operative mortality or reintervention rates, low conversion rates, early hospital discharge, and 100% graft patency at the follow-ups. The minimally invasive direct coronary artery bypass (MIDCAB) procedure was introduced in 1994 by Benetti from Argentina, and was developed based on our previous experience performing off-pump coronary surgery by manipulating the ascending aorta through a left-sided small thoracotomy. Although it represents one of the most common minimally invasive procedures done worldwide, the original technique is not easy to reproduce, and in most cases the pleura is opened, which increases patients pain, morbidity, hospital length of stay, and hinders the realization of immediate hybrid revascularization after the procedure. The latest minimally invasive approaches for CABG include robotic-assisted procedures, in which the IMAs are harvested using robotic technology or the whole procedure is done using robotic technology. This approach has shown adequate short-term clinical results, however, there are no studies available reporting the procedure’s long-term results. Conclusion: The MINI-OPCAB operation is a friendly approach to perform Minimally Invasive Coronary Bypass Surgery in old, high-risk, multivessel coronary artery disease patients, and it represents a good intervention alternative for the majority of cardiac surgeons and cardiac specialized centers. We also consider this approach as ideal for patients who further require Hybrid Revascularization; however, more experience is needed to validate this initials results.

Double Product as a Predictor of Coronary Artery Disease in Males with Normal Blood Pressure

Abstract Aim: This study investigates whether in males with normal blood pressure that underwent exercise stress test Double Product (DB) or Double Product Ratios to workload (DPR) are self-sufficient in predicting the presence of coronary artery disease (CAD). Method: 78 male patients with normal blood pressure went through bicycle exercise stress test (EST) and within four weeks they underwent coronary angiography. 34 of them resulted with normal coronary arteries and 44 of them were diagnosed with one or multiple vessel CAD. Pressure rate double product was calculated in rest, in the first stage of the exercise test, in the peak of exercise, and also in the second, fourth and sixth minutes of recovery of the stress test. Also, the ratios of pressure rate double product with the workload, which reflects the relative growth of double product to the workload, were calculated. The results were compared between the two groups, the one with normal coronary arteries, and those with abnormal coronary angiography. Results: DP in rest and in the first stage of the exercise are not significantly different for normotensive males with or without CAD, while the peak DB value of the exercise, as well as the econd and sixth minutes of the recovery are significantly lower for the group of patients with CAD. The starting peak workloads were significantly lower in the patients’ group with CAD (p=0.0002 and p&lt;0.0001). On the other hand, the double product to workload ratio at the first stage was significantly lower in males with normal blood pressure and CAD. Significant lower DPR are detected also in the fourth and sixth minutes of recovery. Conclusion: The values of DP in the peak exercise and at the second and sixth minutes of the recovery phase are significantly lower in normotensive males with abnormal coronary angiography compared to those with normal coronary arteries, and these findings can be used to detect the presence of CAD despite the ECG changes and they are not affected by the baseline characteristics of the patients. The ratios between DP and workload at the first stage, and in the fourth and sixth minutes of recovery are significantly lower in normotensive male patients with coronary artery disease compared to those without CAD and can be independent predictive parameters for the disease.

When 7 times angioplasty on Saphenous Vein graft would not compete the Native vessel Percutaneous Coronary intervention

Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

Prognostic value of modified Syntax Score in high- and medium-risk patients with multiple-vessel coronary artery disease and involvement of the left main coronary artery

Prognostic value of modified Syntax Score in high- and medium-risk patients with multiple-vessel coronary artery disease and involvement of the left main coronary artery

Impact of high triglyceride/high-density lipoprotein cholesterol ratio (insulin resistance) in ST-segment elevation myocardial infarction.

The ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) has been proposed as an easily obtainable atherogenic marker and high TG/HDL-C ratio is associated with insulin resistance. This study investigated the associated between a high TG/HDL-C ratio and cardiovascular mortality in patients with ST-segment elevation myocardial infarction (STEMI), with or without diabetes mellitus (DM).Between January 2005 and December 2014, 1661 patients with STEMI underwent primary percutaneous coronary intervention in our hospital. Of these, 289 were classified into group 1 (with both DM and a high TG/HDL-C ratio), 295 into group 2 (with DM, but without a high TG/HDL-C ratio), 501 into group 3 (without DM, but a high TG/HDL-C ratio), and 576 into group 4 (without DM or a high TG/HDL-C ratio).Older age, longer chest pain to reperfusion time, poor hemodynamic condition, and higher prevalence of multiple vessel coronary artery disease were noted in those with DM. Poor outcomes including higher 30-day and 1-year cardiovascular mortality and all-cause mortality rates were noted in those with DM but without a high TG/HDL-C ratio. Patients with DM but without a high TG/HDL-C ratio had a Hazard ratio of 3.637 for cardiovascular mortality relative to those without DM, but without a high TG/HDL-C ratio.Even though a high TG/HDL-C ratio is associated with insulin resistance, patients with or without DM, but with a high TG/HDL-C ratio had better 30-day and 1-year outcomes.

Surgical strategies and long-term outcomes of total arterial coronary artery bypass grafting: a series of 208 patients

Objective: To examine the short and long-term clinical outcomes of total arterial coronary artery bypass grafting. Methods: Clinic data of 208 patients with left main and multiple vessel coronary artery disease and undertaken total arterial coronary artery bypass grafting from February 2009 to December 2019 in Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. There were 188 males and 20 females with an age of (54.7±10.7) years (range: 32 to 79 years). The harvest of arterial conduits and grafting strategies were depended upon the individual patient characteristics and surgeon's experience. Left internal thoracic artery (LITA) was applied in 207 cases, right internal thoracic artery (RITA) in 38 cases (bilateral internal thoracic artery (BITA) in 37 cases), and radial artery (RA) in 187 cases (188 grafts). The graft number per case was 2.6±0.7 (range: 2 to 4). Surgical procedures was completed with off-pump technique in 98.1% patients (204/208). Subgroup analysis was carried out between subgroup BITA (n=37) and subgroup SITA (single ITA+RA) (n=171). The t test, χ(2) test or Fisher exact test were used to compare the clinic characteristics between the two subgroups. The Kaplan-Meier curve was used to estimate the rate of late mortality, major adverse cardiac cerebrovascular event (MACCE), and target vessel revascularization (TVR). A Cox proportional hazards model was used to identify the independent prognosis factors of late mortality. Results: The overall mortality within 30 days postoperatively was 1.4%(3/208). The incidences of perioperative MACCE, re-operation for bleeding and deep sternal wound infection (DSWI) were 1.9%(4/208), 0.5%(1/208) and 1.4%(3/208), respectively. Perioperative myocardial infarction and TVR were not observed. There was no significant difference of 30-day mortality, MACCE, bleeding and DSWI between subgroup BITA and SITA+RA (all P>0.05). In a follow-up period of (5.4±2.8)years (range: 0.2 to 10.9 years), the incidence of all-cause mortality at 1-, 5- and 10-year was 2.3%, 3.4% and 6.9%, respectively. The incidence of MACCE was 3.9%,11.2% and 28.5%, respectively. The rate of TVR was 0.4%, 3.7% and 11.9%, respectively. Age>65 was an independent prognosis factor of late mortality (HR=1.125, 95% CI:1.050 to 1.205, P<0.01). Conclusions: Total arterial coronary bypass grafting is safe and achievable with proper patient selection and surgical strategies. It significantly decreases the risks of late mortality and repeated revascularization.

Complete myocardial revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts for coronary artery bypass surgery

Complete revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts is still actual problem for cardiac surgeons. The main causes of the absence of conduits for coronary artery bypass surgery are aging of population, increased incidence of repeated coronary artery bypass surgery and prevalence of varicose vein disease of the lower extremities. The most perspective approaches characterized by acceptable early and long-term postoperative outcomes are bilateral internal mammary artery grafting, sequential bypass including autoarterial grafts, as well as hybrid revascularization methods. However, treatment strategy is individualized in each patient.

Detection of Functionally Significant Coronary Artery Disease: Role of Regional Post Systolic Shortening.

Background:The main goal of this manuscript was to evaluate the diagnostic value of the global and regional postsystolic shortening (PSS) parameters, assessed by two-dimensional (2D) speckle-tracking echocardiography, at rest and during dobutamine stress for the detection of functionally significant coronary artery stenoses in patients with moderate pretest probability of stable coronary artery disease (CAD).Methods:Dobutamine stress echocardiography (DSE) and adenosine stress myocardial perfusion imaging by cardiac magnetic resonance (CMR-MPI) were performed on 83 patients with moderate pretest probability of stable CAD and left ventricle ejection fraction ≥55%. CAD was defined as ≥50% diameter stenoses on invasive coronary artery angiography (CAA) validated as hemodynamically significant by CMR-MPI. According to invasive CAA and CMR-MPI results, patients were divided into two groups: Nonpathologic CAD (−) group: 38 (45.8%) and pathologic CAD (+) group: 45 (54.2%).Results:There were no significant differences in clinical characteristics, conventional 2D echocardiography between the two groups at rest and during low dobutamine dose. Regional postsystolic index (PSI) during recovery phase had the highest area under the receiver operating characteristic curve (AUC) (AUC 0.882, sensitivity 87%, specificity 92%) for the detection of functionally significant one-vessel disease. During high dobutamine dose, regional PSI had sensitivity 78% and specificity 81% (AUC 0.78) to detect significant CAD. Regional PSI remained the same tendency remains for the detection of multiple-vessel CAD. Other myocardial deformation parameters were less sensitive and specific during high dobutamine dose and recovery phase.Conclusions:PSS parameters showed to be sensitive and specific in detecting hemodynamically significant coronary artery stenosis in patients with stable CAD with moderate pretest probability. The study revealed that the assessment of regional PSI performed during recovery improves the diagnostic accuracy of DSE for the detection of functionally significant CAD.

The effect of complete revascularization in patients with ST-segment elevation myocardial infarction with Killip class ≥ III

Background:The effect of complete revascularization (CR) on high-risk patients with ST-segment elevation myocardial infarction (STEMI) has remains a controversial issue, especially on patients in a critical condition. The aim of this study was to explore the effect of CR on patients with STEMI with Killip class ≥ III.Methods:From January 2008 to December 2014, 185 patients diagnosed with STEMI with Killip class ≥ III and multiple vessel coronary artery disease received primary percutaneous coronary intervention (PCI). Eighty-nine patients underwent culprit-only PCI, and the remaining 96 patients underwent immediate or staged PCI for CR. Out of the 96 patients in the CR group, 51 patients underwent immediate CR, and 45 patients underwent CR during the same hospitalization. Thirty-day and 1-year clinical outcomes were compared between the culprit-only PCI group and the CR group as well as between the immediate CR group and staged CR group.Results:There was a trend toward a lower incidence of post-PCI acute kidney injury in the culprit-only PCI group when compared with the CR group (14.8% vs. 26.0%; P = 0.069). Thirty-day and 1-year cardiovascular mortality and all-cause mortality were similar between the culprit-only PCI group and CR group. Decreased 1-year cardiovascular mortality and all-cause mortality were noted in the staged CR group compared with the immediate CR group.Conclusionwas associated a higher possibility of post-PCI acute kidney injury and did not seem to improve 30-day or 1-year clinical outcomes. Patients undergoing staged CR during the same hospitalization had better clinical outcomes.

Surgical treatment of patient with recurrent pulmonary embolism, right and left atrial free-floating thrombus, patent foramen ovale and multiple-vessel coronary artery disease

Surgical treatment of patient with recurrent pulmonary embolism, right and left atrial free-floating thrombus, patent foramen ovale and multiple-vessel coronary artery disease

Surgical approach in patients with bilateral carotid lesion and multiple-vessel coronary artery disease

Surgical approach in patients with bilateral carotid lesion and multiple-vessel coronary artery disease

Simultaneous surgery for multiple-vessel coronary artery disease and aortic occlusion followed by critical lower limb ischemia

Simultaneous surgery for multiple-vessel coronary artery disease and aortic occlusion followed by critical lower limb ischemia

Second vs. first-generation drug-eluting stents in complex lesions subsets: 3 years' follow-up of ERACI IV study.

Although percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES-1) did not show a benefit in terms of death rate and myocardial infarction (MI) compared to bypass surgery (coronary artery bypass graft [CABG]), DES platforms have seen a remarkable improvement in the last few years, and a significant increase in their safety and efficacy was observed in randomized controlled trials and observational studies in comparison with DES-1 in patients with coronary artery disease (CAD). One-year results from the ERACI IV registry using a second-generation DES (DES-2) demonstrated significantly greater efficacy and safety in patients with multiple vessel CAD, including diabetics, compared to DES-1. Long-term results are yet unknown. The ERACI IV registry was a multicenter, prospective and controlled open-label study conducted in 9 sites in Argentina during 2013 and 2014, which evaluated a DES-2 for the treatment of patients with multiple vessel CAD including unprotected left main disease (ULMD) and diabetes. The primary endpoint was to compare the composite of death of any cause, MI and cerebrovascular accident (CVA) as hard endpoints with ERACI III DES-1 arm. Secondary endpoints included each component of the primary endpoint and target vessel revascularization (TVR) as major adverse cardiovascular events (MACCE) and stent thrombosis. We include a modified Syntax Score (SS) taking in account functional revascularization, treating lesions ≥70% in vessels ≥ 2.00 mm, whereas severe lesions in vessels < 2.0 mm and intermediate lesions were not rated. Baseline characteristics were similar between groups, with higher numbers of diabetics and 3-vessel/ULMD (P=0.02 and P=0.003, respectively) in ERACI IV. At 34.7 months' follow-up, the incidence of the composite of death/MI/CVA between ERACI IV and ERACI III (4.9% vs. 13.7%, P<0.001); unplanned new revascularization (5.3% vs. 14.2%, P<0.001) and MACCE (9.3% vs. 22.7%, P<0.001), were significantly lower in ERACI IV DES-2. MACCE rate was similar in diabetics, (5.8%) and nondiabetics (7.0%). After performing a matched propensity score, MACCE remain significantly lower in ERACI IV (P = 0.005). Incidence of stent thrombosis was lower although not significantly between groups, (0.9% vs. 3.1% in ERACI IV and III, respectively; P=0.13). The use of DES-2 in patients with complex lesions subsets together with a functional PCI strategy were associated with a remarkable low incidence of adverse events at 3 years' follow-up and the benefit was also seen in in diabetic population. Late outcome of this study strongly validated our lesion PCI scoring and assessment.

Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting

Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term. We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared. The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038). RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB.

The Unplanned Postoperative Coronary Angiogram after CABG: Identifying the Patients at Risk

Objectives Coronary artery bypass grafting (CABG) is the "gold standard" for patients with multiple vessel coronary artery disease (CAD). However, there is no "gold standard" to control bypass patency immediately postoperatively. "Post-completion" control angiogram (CA) is not routinely performed. We retrospectively analyzed the data of all patients undergoing urgent coronary angiogram post-CABG at our center. Methods Between January 2005 and June 2011, a total of 6,025 patients underwent CABG (isolated or combined) for CAD in our hospital. In patients who underwent urgent postoperative CA, high serum cardiac enzymes (>100 CK-MB), severe new ECG changes, or unexpected low left ventricular function were present. Results A total of 106 patients (1.8%) underwent post-CABG urgent coronary angiogram. Overall 30-day mortality in this cohort was 8.5%. The average time between the cardiac operation and the coronary angiogram in these patients was 3.41 ± 5.68 days. The rates for an urgent coronary angiogram were 1.3% (n = 25), 2% (n = 65), and 1.8% (n = 16) for total arterial, combined arterial, and venous and solely venous CABG, respectively. Twenty-four percent of patients underwent CABG bypass revision, while 32% of the patients underwent PTCA, stenting, or both. Younger patients, female patients, smaller patients, and patients receiving a combined arterial and venous revascularization were at a higher risk for an unplanned postoperative CA in the multivariate risk analysis. Conclusion This study shows that the necessity for urgent post-CABG coronary angiogram is low (1.8%). However, more than half of the patients undergoing postoperative coronary angiogram needed reintervention, and, in spite of it, had high mortality. "Completion" control angiogram is not always feasible, patients at higher risk (e.g., female patients) should be identified and post-CABG coronary angiogram performed as soon as possible without undue delay, or a primary hybrid approach with an intraoperative CA should be applied.