Number Of Percutaneous Coronary Interventions Research Articles

Cardioprotection with levocarnitine intracoronary administration during percutaneous coronary interventions

Currently, the number of percutaneous coronary interventions (PCI) performed in acute and chronic forms of coronary heart disease continues to grow: every year their number reaches at least 5,000,000 worldwide, and more than 200,000 of them in Russia. The main causes of postoperative mortality are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium from ischemia/reperfusion under conditions of balloon expansion and stenting of the affected coronary arteries. The review presents experimental and clinical literature data on the successful use of levocarnitine for cardioprotection in patients with various forms of coronary heart disease and patients with chronic heart failure, both with intravenous administration and as part of a cardioplegic solution during heart surgery. The intracoronary route of administration of levocarnitine solution during PCI in high-risk patients (elderly and senile patients, with multivessel lesions of the coronary bed, difficulties in conducting the intervention) is substantiated. The description of two clinical cases of the use of the technique in elderly patients with acute forms of coronary heart disease with multivessel lesion is given. The postoperative period proceeded without complications with smooth dynamics of biomarkers (troponin I, total creatinephosphokinase, MB-fraction of creatinephosphokinase, lactate dehydrogenase), ischemic ECG shifts were little pronounced. The expected results of the application of the technique are a reduction in intraoperative and postoperative complications of ischemia/ reperfusion and an increase in the effectiveness of the clinical results of PCI in high-risk patients.

Shaping the Future of Coronary Interventions by Highlighting Coronary Anatomy and Reducing Contrast Volume

Coronary interventions, and specifically the number of percutaneous coronary intervention (PCI) procedures, are increasing, together with their complexity. Contrast media administration during those procedures assists in visualising vessels anatomy, but also increases the risk of contrast-induced nephropathy (CIN), which remains one of the most common complications, and has been associated with poor clinical outcomes. Dynamic Coronary Roadmap (DCR) is a technology that creates a dynamic, motion-compensated, real-time view of the coronary anatomy overlaid on a 2D fluoroscopic image, creating a coloured map that adjusts automatically, and providing continuous visual feedback on the positioning of wires and catheters. The technology, which is already being used in clinical practice, has posed the promise of not only assisting in navigating wires and catheters, but also reducing the use of contrast during PCI. DCR4Contrast was a randomised clinical trial conducted in the USA, Europe, and Israel that enrolled more than 356 patients. The primary endpoint for the study was the reduction in contrast administered with the use of DCR, compared with the control group. The secondary endpoint was the potential reduction in the number of cineangiography runs. In the trial, DCR reduced the total contrast volume per PCI procedure by an average of 28.8%, and reduced the number of contrast-enhanced cineangiography runs per procedure by 26.3%. It was also demonstrated that the more complex the PCI procedure, the larger the reduction in contrast with DCR. Here, interventional cardiology experts discussed the need for contrast reduction, and the evidence for DCR.

Association of mortality rates and availability of emergency and specialized, including high-tech, medical services for acute coronary syndrome in the Russian Federation

Aim. To study the impact of the availability of emergency and specialized, including high-tech, medical services for patients with acute coronary syndrome on mortality in Russia.Material and methods. We used the cointegration of time series characterizing mortality from acute coronary syndrome (ACS) and following parameters for the availability of emergency and specialized, including high-tech, care for ACS in Russia for the period from 2016 to 2021 according to the "Monitoring of interventions to reduce mortality from coronary artery disease": the proportion of ambulance visits for ACS with response time <20 minutes; the proportion of patients with ST-elevation ACS (STE-ACS) hospitalized within 12 hours from symptom onset; proportion of patients with STE-ACS admitted to hospital within 2 hours of symptom onset; proportion of patients with ACS admitted to specialized departments; proportion of patients with STE-ACS with prehospital thrombolysis; proportion of patients with STE-ACS with thrombolysis; proportion of patients with STE-ACS who underwent percutaneous coronary intervention (PCI); proportion of patients with non-ST-elevation ACS (NSTE-ACS) who underwent PCI; the proportion of patients with STE-ACS admitted before 12 hours from the onset of symptoms who underwent PCI; proportion of patients with ACS who underwent coronary artery bypass grafting. To rank the availability indicators, the elasticity (E) coefficient was used, which characterizes the strength of the relationship between the factor and the result, which shows the change in the result value per 1% change in the factor.Results. According to contribution decrement to reducing mortality, the factors of health care availibility for patients with ACS-STE were arranged as follows (coefficient of elasticity and determination (R2) is indicated in brackets): "The proportion of patients with ACS-STE who underwent PCI" (E=1,5%; R2=0,60), "Proportion of patients with STE-ACS with prehospital thrombolysis" (E=1,1%; R2=0,91), "Proportion of patients with STE-ACS with thrombolysis" (E=1,0%; R2=0,96 ), "Proportion of patients with STE-ACS admitted before 12 h who underwent PCI" (E=0,9%; R2=0,94), "Proportion of patients with STE-ACS admitted to hospital before 12 h from the symptom onset" (E=0,5%; R2=0,97), "Proportion of patients with STE-ACS hospitalized <2 hours from the symptom onset" (E=0,2%; R2=0,95). A significant resource in reducing mortality in ACS is the reduction in ambulance response time in ACS (E=2,3%; R2=0,87) and compliance with specialized hospitalization of patients with ACS (E=1,8%; R2=0,73), but in reducing mortality in NSTE-ACS, the proportion of patients with NSTE-ACS who underwent PCI (E=1,7%; R2=0,72).Conclusion. An analysis of the impact of the availability of emergency and specialized, including high-tech, medical services for patients with ACS in Russia showed that the greatest contribution to mortality reduction in STE-ACS is made by time reduction in PCI and an increase in the use of thrombolytic therapy, mainly at the prehospital stage, in NSTE-ACS — an increase in the number of PCIs, and in ACS in general, strict compliance with specialized hospitalization of patients and a reduction in ambulance response time in ACS.

Effect of frailty on major bleeding in octogenarian patients undergoing percutaneous coronary intervention.

There has been an increase in the number of percutaneous coronary intervention (PCI) procedures performed in octogenarian patients due to increased life expectancy and developments in modern medicine. Frailty is associated with the aging process, gradual loss of multiple body functions, and poor health outcomes. We examined the association between frailty and major bleeding in octogenarian patients undergoing PCI. We retrospectively analyzed the records of two local research hospitals in Turkey. In total, 244 patients were enrolled in this study. Patients were divided into two groups based on their Clinical Frailty Scale (CFS) score. The non-frail group included patients with CFS scores of 1 (very fit) to 4 (living with very mild frailty), while the frail group included those with CFS scores of 5 (living with mild frailty) to 9 (terminally ill). Of the 244 patients, 131 were classified into the non-frail group and 113 into the frail group. Ticagrelor use was significantly more common in the non-frail group (31.3% vs. 20.4%, p=0.036). Major bleeding was more common in the frail than non-frail group (20.4% vs. 6.1%, p<0.001). The rates of stroke and all-cause death were higher in the frail than in non-frail group (stroke 15.9% vs. 3.8%, p<0.001, as well as all-cause mortality rate (27.4% vs. 2.3%, p<0.001). Frailty is an independent predictor of major bleeding in patients undergoing PCI for acute coronary syndrome. Use of the P2Y12 inhibitor ticagrelor increases the risk of major bleeding in frail patients.

Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group.

Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, have increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications, and the importance of adequate training and education.

The Impact of the COVID-19 Pandemic on Coronary Interventional Cardiology Activity in King Abdulaziz Medical City: A Retrospective Study.

The COVID-19 pandemic has decreased the number of patients undergoing coronary interventional procedures. This study aimed to identify the impact of the COVID-19 pandemic on the volume of patients and the types of interventional cardiology procedures performed at King Abdulaziz Cardiac Center(KACC) in Riyadh, Saudi Arabia. A retrospective chart review was undertaken with a sample size of 301 patients aged over 18 years, who underwent various cardiac interventions at King Abdulaziz Cardiac Center (KACC) between March 15, 2019, and February 29, 2020 (prior to the pandemic, group A), and between March 1, 2020, and March 15, 2021 (during the pandemic, group B). The BESTCare 2.0 system (ezCaretech,Seoul, South Korea) was used to collect data, Microsoft Office Excel (Microsoft® Corp., Redmond, WA) was utilized for data entry, and the Statistical Package for Social Sciences software(IBM SPSS Statistics, Armonk, NY) was employed for data analysis. There was a 21.4% decrease in the number of procedures performed during the pandemic. The largest age group within the population was ≥60 years, comprising 43.5% and 52.3% of groups A and B, respectively. Most patients had a body mass index (BMI) of >30, i.e., 43.5% of patients before the pandemic and 47.7% after the pandemic. In group A,39.9% were smokers and60.6% in group B. The prevalence of hypertension and obesity was higher in group B, i.e., 77.3% and 42.3%, respectively. The incidence of ST-elevation myocardial infarction (STEMI) was 39.9% in group A and 39.4% in group B. For non-ST-elevation myocardial infarction (NSTEMI), the comparable statistics were 56.5% and 49.2%, respectively. In groups A and B, readmission frequencies were 17.9% and 20%, respectively. The study indicates a minor decline in the number of percutaneous coronary interventions (PCIs) conducted in the interventional cardiology department of King Abdulaziz Cardiac Center (KACC) immediately following the COVID-19 outbreak, reflecting a steady activity in the center.

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence.

Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors.

Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal

IntroductionThe COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity. ObjectivesTo quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years. MethodsData on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017–2019). ResultsThe total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (−36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, −25% (p<0.019), −20% (p<0.068) and −59% (p<0.001). ConclusionsCompared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.

Evaluation of the influential factors on the mortality of patients with acute myocardial infarction

Introduction: Death caused by myocardial infarction (MI) usually occurs during the first hours after the onset of symptoms. Therefore, to manage, treat and decrease the mortality rate of these patients, early hospital admission is important. Objectives: We aimed to investigate the impact of the influential factors on mortality of patients with MI. Patients and Methods: In this case-control study, MI patients who were referred to the Ardabil Alavi Hospital, Ardabil university of medical sciences, Ardabil, Iran between April 2017 and April 2018 were included. The patients that had died due to MI were considered as the case group (n=27) and 27 matched patients that had died due to other causes were selected as the control group. Linear logistic regression was employed to analyze the data. Results: The mean age of the patients in the case group was significantly higher than in the control group (75.1±11.7 versus 63.;1±11.6, P=0.001). The history of non-cardiac diseases in the case group (44.4%) was significantly higher than in the control group (7.4%; P=0.002). The number of PCIs (percutaneous coronary interventions) that were conducted in the case group (40.7%) was significantly lower than in the control group (74.1%; p=0.013). The time distance between hospital admission and PCI performance in the case group (110.9 minutes) was significantly higher than in the control group (56 minutes; P=0.001). However, the mean of delay time from the onset of symptoms to hospital admission (the patient delay) and from hospital admission to receiving treatment (the health system delay) was similar between the two groups. Conclusion: This study showed that the number of performed PCIs, history of non-cardiac disorders and the interval between the onset of symptoms and PCI performance are significantly associated with the morality of MI patients.

Does the previous stenting affects the outcome of coronary artery bypass grafting in patients with multivessel disease

BackgroundDuring the past decade, the number of percutaneous coronary interventions (PCI) performed before coronary artery bypass grafting (CABG) has risen significantly. Patients with more serious coronary pathology are referred for CABG, which can affect the postoperative outcome.Patients and methodsOutcomes of 60 CABG patients, who were recruited in a prospective comparative study, were compared. Group A (n = 30) underwent primary CABG and group B (n = 30), had prior PCI before CABG.ResultsTotal morbidity was substantially higher in the second group than in the first, with six patients in group A (nonstent group) and 19 patients in group B being affected (stent group). Inotropes and intraaortic balloon pump were used more in the previous PCI community than in group A. Group B had a longer ICU stay (50.45 ± 33.49 h in group A vs. 79.56 ± 60.44 h in group B).ConclusionPrevious PCI can have a detrimental effect on the morbidity outcome of the subsequent CABG. However, postoperative mortality has not been affected significantly. Thus, percutaneous coronary revascularization should be carefully weighed against the increased risk of CABG afterward. The guidelines for intervention should be strictly followed, particularly in patients with complex coronary lesions who are more likely to be referred for CABG.

OCT utilization: Summary statistics from the LightLab clinical initiative.

The study describes the evolution of optical coherence tomography (OCT) adoption and performance during percutaneous coronary intervention (PCI) following implementation of a standardized LightLab (LL) workflow. The purpose of the LL Clinical Initiative was to evaluate the impact of a standardized workflow on physician efficiency, decision making, and image quality. The LL Clinical Initiative is a multicenter, prospective, observational clinical program. Data were collected from 48 physicians at 17 U.S. centers from 01/21/19 to 06/08/21. The study included 401 OCT-guided PCIs during the baseline phase and 1898 during the LL workflow phases. The baseline phase consisted of physicians utilizing OCT at their discretion. After completing the baseline phase, the workflow progressed through multiple phases culminating in the expansion phase, which focused on addressing greater procedural complexity. The LL workflow utilized OCT to assess plaque Morphology, lesion Length, and vessel Diameter before PCI, and optimized results by treating Medial edge dissection, stent mal-Apposition, and stent under-eXpansion (MLD MAX). High-level summary statistics were generated to elucidate trends. After program implementation, there was a rise in the number of PCIs where the LL workflow was utilized compared to the baseline phase (68% during the expansion phase vs. 41% at baseline; p for trend <0.0001). Adoption of the LL workflow was associated with progressively greater procedural and lesion complexity when OCT was performed pre- and post-PCI (87% vs. 52%, p < 0.0001; 55% vs. 37%, p < 0.0001, respectively). In addition, the quality of OCT imaging obtained improved after LL workflow introduction, with over 95% of pre- and post-PCI pullback quality considered usable during the expansion phase. Finally, there was a reduction in time spent on OCT interpretation, both pre-PCI (4.6 min vs. 7.5 min, p < 0.0001) and post-PCI (2.9 min vs. 5.3 min, p < 0.0001). After completion of the standardized OCT-guided workflow, there was greater uptake of OCT imaging, incorporation in more complex procedures, procedural efficiency, and image quality.

Remote clinical quality management of endovascular care

Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p&lt;0.001). The frequency of performing PCI increased by 1.46 times (p&lt;0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI.

Assessment of the role of IL6 and IL10 gene polymorphisms as a risk factor for the development of restenosis in patients after implantation of drug-eluting stents

Relevance. Currently, the number of percutaneous coronary interventions continues to increase, which leads to an increase in the absolute number of restenosis cases, which is the main complication of the long-term postoperative period. The search for risk factors responsible for restenosis and artery re-narrowing mechanisms in order to prevent this complication is an important goal in interventional cardiology. Risk factors for the restenosis development include clinical, angiographic and genetic factors. An active search for biomolecular markers associated with the coronary artery restenosis is currently underway. Objective: to study the role of polymorphic variants C-174G of the IL6 gene and C-819T of the IL10 gene as a risk factor for the development of restenosis in patients after stent implantation. Materials and Methods : The study included 113 patients with stable coronary artery disease, who had previously undergone balloon angioplasty and implantation of drug-eluting stents, and 62 patients with intact arteries that were included to the control group. Statistical data processing was carried out using the R-language program and the SPSS Statistics 20 software package. Results: GG genotype for IL6 gene was associated with the development of coronary artery disease. In the subgroup of patients over 65 years of age and instent restenosis, the GG genotype was significantly less frequent. The homozygous CC genotype for IL10 gene was associated with rapid angiographic in-stent restenosis progression.

Abstract 14163: Mathematical Model for Predicting Survival in Elderly (Above 80 Years) Population After Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

Introduction: Advancement in interventional cardiology has increased the number of percutaneous coronary intervention (PCI) in the elderly. However, clinicians still face tough decision making to select elderly patients who can receive Primary PCI and have improved survival. This study aimed to identify factors that influence the survival in elderly population undergoing PPCI for treatment of ST elevation myocardial infraction (STEMI). Methods: We analyzed the data at our cardiac center prospectively during 2010- 2019 and developed a mathematical model using multi-parameter regression analysis using SPSS and OriginPro data visualization. Results: The factors which may predict survival were identified with help of mathematical model developed on the basis of clinical parameters reported at the time of STEMI presentation and details of the PCI procedure in 248 patients (male = 124, Age 85.78±3.43 years, , female= 124, Age 85.78± 4.08 years, ). The data visualization is shown in figure 1 and the developed model equation is as follows: Y (survival in months) = 126.865 - 0.258 (± 0.030) (Hb in g/dl) - 0.105(± 0.034) (Creatinine in umol/L) - 0.228 (± 0.112) (eGFR in ml/min/1.73 m 2 ) - 4.174 (±2.443) (triglycerides in mmol/l) - 1.201 (± 1.232) (LDL in mmol/l) - 0.001(±0.002) (Call to balloon time in minutes) + 16.874 (±3.119) (log 10 radiation dose)- 1.224(±0.352) Age at time of presentation) (N = 248, R = 0.636, F= 18.043, p = 0.00) Conclusions: Our study shows that hemoglobin, kidney function, lipid profile, call to balloon time, age of the patient at time of STEMI presentation and radiation dose used during the procedure may be important predictors for the survival of patient after PPCI. Nevertheless the patient age at the time of STEMI is negatively correlated with survival period. Similarly, early intervention in event of STEMI will decrease call to balloon time thereby increasing post-procedure survival in elderly patients .

Abstract 11546: Ten-Year Trends in the Nationwide Clinical Outcome After Percutaneous Coronary Intervention

Introduction: We investigated the 10-year trends in the clinical outcome of percutaneous coronary intervention (PCI) in an unselected all-comer nationwide cohort. Hypothesis: Mortality following PCI is a key quality measurement in clinical practice and should be investigated within the context of the changing clinical comorbidities. Methods: Patients undergoing PCI for the first time between 2006 and 2015 from database of the National Health Insurance Service of Korea were included and followed until death or being censored by December 2016. Results: A total of 437,436 patients was included. Patients were divided into quartile subgroups according to a clinical score that predicting 1-year death risk. Over the decade, the annual number of PCI increased from 32,098 to 51,990 (p&lt;0.001). The proportion of patients with higher risk quartiles increased, whereas lower risk quartiles decreased (p&lt;0.001). The 1-year cumulative incidence rate of death did not change in the population with 1st (0.9% to 0.8%) and 2nd (1.3% to 1.3%) risk score quartiles, whereas it increased in the population with 3rd (3.4% to 5.1%) and 4th (15.5% to 19.4%) risk score quartiles (p&lt;0.001 by restrictive mean survival time). Conclusions: This real-world data analysis showed that the number, proportion, and the risk of high-risk patients increased over the decade in Korea.

Development of Minimally Invasive Cardiac Surgery Technologies as a Direction That Affects the Reduction of Mortality from Cardiovascular Diseases (on the Example of the Nizhny Novgorod Region)

Background.Cardiovascular diseases (CVD) are the leading cause of death in the population. It is necessary to assess the priority areas of investment and development of medical technologies that can effectively influence the reduction of mortality.&#x0D; Aims to study the impact of minimally invasive surgical interventions on population mortality.&#x0D; Materials and methods.During the period from 2009 to 2019 was conducted analysis and assessment of the effect of the number of percutaneous coronary interventions (PCI) performed in the Nizhny Novgorod region, on mortality, including mortality from CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) To study the relationship between these indicators were calculated the Spearman rank correlation coefficient. The prediction was performed using the multiple regression method. To evaluate the initial and predicted data (regression model), we used the cook and Mahalanobis distance indicators.&#x0D; Results.Over 11 years, the region has seen a significant increase in the number of PCI-from 220 to 6048 (27.5 times). During the same time, the total death rate in the region decreased from 17.42 to 14.60 per 1000 population (by 16.2%), fromСМВby 30.7%. A strong negative correlation was found between the number of PCI and mortality from CVD (r = 0.892), from CHD (r = 0.856), and from AMI (r = 0.904). A regression model of the result was developed, taking into account mortality rates and the number of PCI. The cook and Mahalanobis distance indicators indicate a change in the development vector of data variance since 2014, which may be due to changes in the infrastructure and volumes of cardiological and cardiac surgery care.&#x0D; Conclusion.The results of the analysis indicate the high feasibility of further development of cardiac surgery in the region. The resulting regression model can be used in planning the volume of medical care, taking into account the achievement of target demographic indicators and available health resources.

Clinical outcomes of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention By Coronary Flow Capacity Status in Stable Lesions.

Coronary flow capacity (CFC) provides integrated information about coronary flow reserve (CFR) and hyperaemic coronary flow and is useful for identifying coronary flow limitation. The aim of this study was to investigate the effect of percutaneous coronary intervention (PCI) on vessel-related major adverse cardiovascular events (MACE) according to CFC status in stable coronary lesions. From a global, multicentre registry of comprehensive physiological assessment, a total of 1,397 patients (1,694 vessels) were analysed. Low CFC was defined for lesions with reduced CFR and inverse of hyperaemic mean transit time (1/hTmn). A predefined definition of CFC (CFR <2.0 and 1/hTmn less than the corresponding percentile) was assessed first in a multivariable marginal Cox proportional model with the interaction term between CFC status and PCI (performed or not), and then the optimal definition of CFC was explored. We observed a significant interaction between predefined low CFC and PCI (p=0.067). With the optimal definition of CFC (CFR ≤3.2 and 1/hTmn ≤2.8), the HR (95% CI) of PCI was 0.278 (0.103-0.751) and 1.393 (0.783-2.478) in lesions with low and normal CFC, respectively. If lesions with fractional flow reserve (FFR) ≤0.8 and normal CFC had been deferred, the number of PCI would have decreased by 64%. FFR-guided PCI for low CFC lesions was associated with reduced incidence of MACE in low CFC but not in normal CFC lesions. Our results suggest the potential use of CFC in combination with FFR for optimising the indication for PCI by reducing potentially unbeneficial PCI. https://clinicaltrials.gov/ct2/show/NCT03690713.

Percutaneous coronary interventions for ST elevation myocardial infarction in different age groups

Given the global trend of population aging, it is natural to see an increase in the number of percutaneous coronary interventions (PCI) performed in patients of older age groups.The aim of this study was to compare the results of percutaneous coronary interventions (PCI) in different age groups and find a predictors of hospital mortality. Methods. Data were collected from 1649 patients with STEMI who were admitted to the coronary care unit and underwent PCIs from2006 to 2017. Patients were divided into 3 age groups according to World Heals Organization classification. The first group consisted of 850 patients aged from 18 to 59 years, the second group consisted 620 patients aged from 60 to 74 years, and third group consisted of 179 patients aged from 75 years and older. Results. The rate of in-hospital death was statistically significant lower in younger groups (groups 1-2: 2.2 % vs 5.8 %, р&lt;0.001; groups 1-3: 2.2 % vs 16.2 %, р&lt;0.001; 2-3: 5.8 % vs 16.2 %, р&lt;0.001). After multivariate adjustment the independent predictor of death were age (odds ratio (OR) =1.08; 95 % confidence interval (CI) 1.05-1.11, р&lt;0.001), anterior myocardial infarction (OR=2.03; 95 % CI 1.15-3.59, р=0.015), Syntax score (OR=1.05; 95 % CI 1.02-1.09, р=0.001), ventricular arrhythmias (OR=4.98; 95 % CI 2.49-9.96, р&lt;0.001), blood glucose level at admission (OR=1.06; 95 % CI 1.01-1.13, р=0.040), PCI failure (OR=5.05; 95 % CI 2.47-10.3, р&lt;0.001), Killip class III-IV (OR=6.01; 95 % CI 3.12–11.6, р&lt;0.001), total ischemia t-me &gt;180 minutes (OR=4.39; 95 % CI 1.78-10.8, р=0.001). Conclusions. PCIs for STEMI in older age groups were associated with worse in-hospital outcomes. Age, anterior myocardial infarction, Syntax score, ventricular arrhythmias, blood glucose level at admission, PCI failure, Killip class III-IV, total ischemia time &gt;180 minutes were the independent predictor of death.

In-hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry.

We evaluated the in-hospital outcomes of percutaneous coronary intervention (PCI) for bypass graft vessels (GV-PCI) compared with those of PCI for native vessels (NV-PCI) using data from the Japanese nationwide coronary intervention registry. We included PCI patients (N=748,229) registered between January 2016 and December 2018 from 1,123 centers. We divided patients into three groups: GV-PCI (n=2,745); NV-PCI with a prior coronary artery bypass graft (pCABG) (n=23,932); and NV-PCI without pCABG (n=721,552). GV-PCI implementation was low, and most cases of PCI in pCABG patients were performed in native vessels (89.7%) in contemporary Japanese practice. The risk profile of patients with pCABG was higher than that of those without pCABG. Consequently, GV-PCI patients had a significantly higher in-hospital mortality than NV-PCI patients without pCABG after adjusting for covariates (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.66-3.36, p < .001). Of note, embolic protection devices (EPDs) were used in 18% (n=383) of PCIs for saphenous vein grafts (SVG-PCI) with a significant variation in its use among institutions (number of PCI: hospitals that had never used an EPD vs. EPD used one or more times=240 vs. 345, p < .001). The EPDs used in the SVG-PCI group had a significantly lower prevalence of the slow-flow phenomenon after adjusting for covariates (OR 0.45, 95% CI 0.21-0.91, p=.04). GV-PCI is associated with an increased risk of in-hospital mortality. EDP use in SVG-PCI was associated with a low rate of the slow-flow phenomenon. The usage of EPDs during SVG-PCI is low, with a significant variation among institutions.

Daylight saving time does not seem to be associated with number of percutaneous coronary interventions for acute myocardial infarction in the Netherlands.

BackgroundIn multiple studies, the potential relationship between daylight saving time (DST) and the occurrence of acute myocardial infarction (MI) has been investigated, with mixed results. Using the Dutch Percutaneous Coronary Intervention (PCI) registry facilitated by the Netherlands Heart Registration, we investigated whether the transitions to and from DST interact with the incidence rate of PCI for acute MI.MethodsWe assessed changes in hospital admissions for patients with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) undergoing PCI between 1 January 2015 and 31 December 2018. We compared the incidence rate of PCI procedures during the first 3 or 7 days after the transition with that during a control period (2 weeks before transition plus second week after transition). Incidence rate ratio (IRR) was calculated using Poisson regression. Potential gender differences were also investigated.ResultsA total of 80,970 PCI procedures for STEMI or NSTEMI were performed. No difference in incidence rate a week after the transition to DST in spring was observed for STEMI (IRR 0.95, 95% confidence interval (CI) 0.87–1.03) or NSTEMI (IRR 1.04, 95% CI 0.96–1.12). After the transition from DST in autumn, the IRR was also comparable with the control period (STEMI: 1.03, 95% CI 0.95–1.12, and NSTEMI: 0.98, 95% CI 0.91–1.06). Observing the first 3 days after each transition yielded similar results. Gender-specific results were comparable.ConclusionBased on data from a large, nationwide registry, there was no correlation between the transition to or from DST and a change in the incidence rate of PCI for acute MI.