Outcomes Of Percutaneous Coronary Intervention Research Articles

Time Trends in Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention: Meta-Analysis on Sex Differences.

Percutaneous coronary intervention (PCI) is considered the procedure of choice for patients with acute coronary syndrome (ACS), as it significantly improves cardiovascular outcomes. However, considerable uncertainty persists regarding the potential sex differences in PCI outcomes, due to conflicting results in previous studies. This meta-analysis aims to evaluate potential sex-related differences in cardiovascular adverse outcomes after PCI among ACS patients. The primary outcome was major adverse cardiovascular events (MACE) and its components. Outcomes were examined in various time frames including: short-term (within 1month after PCI), mid-term (within 1year), and long-term (within >1year). A random effects model was used to estimate risk ratios (RR) and 95%CIs. Among 32 trials, at short-term, PCI was associated with a higher risk of MACE (risk ratio [RR]: 1.43; 95%CI: 1.10-1.86), all-cause mortality (RR: 2.51; 95%CI: 1.70-3.71), and myocardial infarction (RR: 1.33; 95%CI: 1.00-1.77) in women compared with men. Over the long-term, women had a higher risk of MACE (RR: 1.11; 95%CI: 1.01-1.22), all-cause mortality (RR: 1.29; 95%CI: 1.17-1.42), and cardiovascular mortality (RR: 1.30; 95%CI: 1.11-1.52), when compared with men. However, the analysis for stroke and repeat revascularization showed no significant difference between the 2groups in the long- and short-term. In the meta-analysis of PCI-related trials in ACS, women have a higher risk of adverse cardiovascular outcomes compared with men.

Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity

Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity

Comparative Outcomes of Left Main and Non-Left Main Percutaneous Coronary Intervention from the Excellence in Coronary Artery Disease (XLCAD) Registry.

There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries. 873 consecutive patients undergoing LM PCI (n=256) and non-LM PCI (n=617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events. Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p<0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p=0.026). Mean number of lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (p<0.001). Multivessel PCI was performed in 68.8% LM and 21% non-LM PCI patients (p<0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days post-procedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p=0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p=0.080) groups. One-year MACE was significantly higher in LM vs. non-LM PCI (12.9% vs. 8.4%, respectively; p=0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p=0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p=0.074). In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group.

Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease.

Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs. A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs. The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group. The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.

Temporal Trends and Outcomes of Rotational Atherectomy: A Single-Centre Experience.

Rotational atherectomy (RA) is widely used for the management of calcified coronary stenoses. However, there is limited data on its use, trends, and outcomes. We sought to report our twelve-year experience with RA and explore the trends and outcomes of percutaneous coronary intervention (PCI) with this device. Our institutional PCI database was queried to identify all cases of RA-PCI performed between January 2009 and December 2020. We analysed peri-procedural outcomes and major adverse cardiovascular events (MACE) during follow-up: cardiovascular death, myocardial infarction, and target lesion revascularization. 410 procedures (2.8% of total PCI volume) in 388 patients were included. Mean age was 72.3±9.3 years, 74.0% were male, 53.6% had diabetes, and 33.8% presented with acute coronary syndrome. There was a significant increase in median SYNTAX score (ptrend=0.003) and the proportion of type B2/C lesions (ptrend=0.003). Transradial access was preferred (60.0% overall) with a growing trend over time (ptrend=0.003). Maximum burr size was <1.75 mm in 88.0% of cases (burr-to-artery ratio of 0.49±0.07). Angiographic success rate was consistently high (96.6% overall). Complications were recorded in 9.0% of procedures, with a temporal decline (ptrend=0.029). Clinical follow-up was available for 357 patients (median time of 40 months). At one year, MACE rate was 12.1%. with no significant temporal changes. RA-PCI was a safe and effective procedure with a high rate of angiographic success and few complications, particularly in recent years, in line with significant technical improvements. The MACE incidence is acceptable considering the clinical risk and angiographic complexity.

Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes

Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as “predominantly diffuse” or “focal” according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological “focal severity” was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a “major gradient”. A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59–0.80). The prevalence of “predominantly diffuse” CAD and “major gradient” were 68.6% and 85.8%, respectively. A “Predominantly diffuse” pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47–1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0–32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE.Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672Unique Identifier: NCT04390672 (registration date 15/05/2020)

Evaluation of Peer Review of Percutaneous Coronary Intervention Operator Performance.

Case-based peer review of percutaneous coronary intervention (PCI) is used by many hospitals for quality improvement and to make decisions regarding physician competency. However, there are no studies testing the reliability or validity of peer review for PCI performance evaluation. We recruited interventional cardiologists from 12 Veterans Affairs Health System facilities throughout the United States to provide PCI cases for review. Ten reviewers performed blinded reviews such that each case was reviewed twice. Cases were rated on a scale of 1 to 5 (with 5 being the best) for 6 care domains (Appropriateness, Lesion Suitability, Strategy, Technical Performance, Outcome, and Documentation) with a summary performance score calculated as the average of all domains. Separately, reviewers determined whether the standard of care was met. Interobserver reliability of the summary performance score was calculated using interclass correlation coefficient. We examined procedural complications and 30-day mortality and major adverse cardiac events for all PCIs performed by these operators from 2019 to 2022 when stratified in tertiles by summary performance score. Of the 65 cases provided by 13 operators, the mean summary performance score was 3.90 (SD=0.78) out of 5. The interclass correlation coefficient was 0.53, indicating moderate interobserver reliability. For 19 cases (29.2%), 1 reviewer indicated that the performance did not meet the standard of care; however, the second reviewer disagreed in all these cases. Average performance scores ranged from 3.35 to 4.38. Among the 3390 PCIs performed by reviewed cardiologists from 2019 to 2022, the lowest-rated tertile had higher rates of complications (2.9% versus 1.8%, P<0.01) and major adverse cardiac events (10.6% versus 8.0%, P<0.01) compared with the highest-rated tertile. Case-based peer review identifies variation in physician performance that is correlated with PCI outcomes. However, reviewer disagreements about the standard of care raise concerns about the use of peer review for high-stakes assessments of physician competency.

Timing and Outcomes of PCI in Conjunction With TAVR With Balloon-Expandable Valves.

The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is debatable. The aim of this study was to compare outcomes based on the timing of PCI in stable coronary artery disease patients undergoing TAVR. Leveraging the STS/ACC TVT Registry and Medicare Linkage, we analyzed patients with stable coronary artery disease undergoing PCI and TAVR between 2015 and 2023 using the SAPIEN 3 balloon-expandable valve platform. This analysis included patients who underwent PCI within ±90days of the index TAVR procedure. All-cause mortality, stroke, and a composite of mortality and stroke were analyzed up to 3 years using Medicare Linkage. Of the 51,480 patients who underwent PCI and TAVR with SAPIEN 3 platforms during the study period, 84.7% had PCI within 90days before TAVR, 13.9% had concomitant PCI, and 1.4% had PCI within 90days after TAVR. In the propensity-matched analysis, patients undergoing PCI before TAVR had better outcomes in terms of all cause-mortality (38.1% vs 38.8%; P=0.013) and a composite of mortality and stroke (42.8% vs 43.5%; P=0.012) compared with the ones undergoing concomitant PCI at 3-year follow-up. Major vascular complications were higher in patients undergoing concomitant PCI and TAVR (2% vs 1.4%; P=0.003) CONCLUSIONS: Patients undergoing concomitant PCI and TAVR had higher major vascular complications, and slightly higher composite of all-cause mortality and stroke compared with those who underwent PCI within 90days before the TAVR procedure.

Intravascular Imaging-Guided Percutaneous Coronary Intervention in Patients With End-Stage Renal Disease on Maintenance Dialysis.

Patients with end-stage renal disease (ESRD) are at a higher risk of cardiovascular diseases. Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) or intravascular ultrasound (IVUS) has been shown to result in better clinical outcomes than angiography guidance. Nevertheless, the clinical outcomes of IVI-guided PCI in ESRD patients remain uncertain. This study aimed to compare the clinical outcomes of OCT- and IVUS-guided PCIs in ESRD patients and to report the trend of IVI-guided PCI in Taiwan. Patients with ESRD on maintenance dialysis, who underwent OCT- or IVUS-guided PCI from 2015 to 2021, were compared by propensity-score matching. The primary outcome was composite cardiovascular outcomes, including coronary revascularization, cardiovascular death, and acute myocardial infarction. In 2021, IVI was used to guide PCIs in 27% (15,613 of 57,845) of general and 27.5% (1,754 of 6,387) of ESRD patients. Among 4,759 eligible ESRD patients, 443 and 4,316 patients underwent OCT- and IVUS-guided PCIs, respectively. After matching, the incidence of the primary outcome was comparable between the OCT and IVUS groups (42.1 [95%CI: 36.2-48.0] vs 47.6 [95%CI: 43.0-52.2] events per 100 person-years; HR: 0.88; 95%CI: 0.74-1.06). The results were similar for all components of the primary outcome and in subgroup analyses. The number of PCI- and IVI-guided procedures has progressively increased in the past decade in Taiwan in both the general and ESRD populations. Among ESRD patients on maintenance dialysis, the clinical outcomes were comparable between OCT- and IVUS-guided PCI.

Impact of Smoking on Long-Term Revascularization Success and Complications in Multivessel Percutaneous Coronary Intervention: A Retrospective Cohort Study

Background: Smoking is a major modifiable risk factor in coronary artery disease (CAD) and is associated with adverse outcomes following percutaneous coronary intervention (PCI). PCI, widely utilized for revascularization in multivessel CAD, aims to restore coronary blood flow and reduce ischemic complications. However, smokers face increased risks of restenosis and major adverse cardiac events (MACE) after PCI, highlighting a need for further investigation into these associations. Objective: This study aimed to assess the impact of smoking on revascularization success and complications in patients undergoing multivessel PCI. Methods: A retrospective cohort study was conducted at a tertiary cardiovascular center, evaluating clinical data from patients who underwent PCI from January 1, 2023, to December 31, 2023. Patients aged 18 and older with confirmed multivessel CAD were included. Participants were divided into smokers (N=779) and non-smokers (N=779) based on documented smoking status. All patients underwent PCI with either drug-eluting stents (DES) or drug-eluting balloons (DEB), followed by standard dual antiplatelet therapy. The primary outcome was revascularization success, defined as achieving TIMI grade ≥2. Secondary outcomes included incidences of MACE and restenosis. Statistical analyses were performed using SPSS v27, with t-tests and chi-square tests used for continuous and categorical variables, respectively. Logistic regression adjusted for confounders. Results: Revascularization success was significantly lower in smokers (69.8%) compared to non-smokers (81.6%) (p &lt; 0.001). Smokers also exhibited higher rates of MACE (15.5%) and restenosis (12.6%) versus 8.4% and 7.3% in non-smokers, respectively (p &lt; 0.001 for both outcomes). Conclusion: Smoking negatively affects revascularization success and increases MACE and restenosis risks in multivessel PCI patients. These findings underscore the importance of tailored therapeutic strategies and smoking cessation efforts to improve PCI outcomes in this high-risk group.

Nationwide trends and outcomes of percutaneous coronary intervention for stable ischemic heart disease in end-stage kidney disease: a longitudinal study.

Patients with end-stage kidney disease (ESKD) are at high risk for coronary artery disease. We investigate the trends and outcomes of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in patients with ESKD. We utilized the United States Renal Data System [2010-2018] to include adult patients with ESKD on dialysis for at least 3 months who underwent PCI for SIHD. Patients with myocardial infarction during index hospitalization, history of coronary artery bypass graft or renal transplantation and without Medicare AB coverage were excluded. Trends and related outcomes, including mortality and revascularization rate, were studied. The mean age was 65.1 years with 57.5% male and a majority White (64.5%). The dialysis duration was ≤5 years in 83.3% patients. Hypertension (97.6%) and diabetes mellitus (76.8%) were the most common comorbidities. PCI procedures per 1,000 ESKD patients dropped from 6.2 in 2010 to 2.6 in 2018 (P<0.001) while the index hospitalization mortality increased from 0.9% to 3.0% (P<0.001). The 30-day and 1-year mortality also significantly increased from 3.2% to 6.1% and 26.5% to 31.9%, respectively. However, 1-year repeat revascularization rates dropped from 19.8% to 17.0% between 2010-2018 (P<0.001). A significant increase in comorbidity burden was also noted. We demonstrate a consistent decrease in PCI rates for SIHD in ESKD patients. However, the in-hospital mortality has increased significantly, in part, due to an increasing high-risk profile of these patients. Our results call for individualized clinical decision-making when exploring revascularization options in ESRD patients with SIHD.

Percutaneous coronary intervention (PCI) in patients of rheumatoid arthritis(RA): A systematic review and meta-analysis.

The present study aims to investigate the outcomes of Percutaneous coronary intervention (PCI) in patients with Rheumatoid arthritis (RA). A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 15th September 2023. All statistical analyses were conducted using Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95% confidence interval (CI). Eight observational studies were selected to conduct the analysis. A statistically significant increase in major adverse cardiovascular event (MACE) was seen in RA patients after undergoing PCI as compared to the control group (OR=1.18 (1.16, 1.21); p<0.00001; I2=0%). There was no significant difference found in the long-term revascularization outcome between the RA and non-RA patients (OR=1.18 (0.81, 1.71); p=0.39; I2=93%). Survival rates of all-cause mortality in the long-term outcome were statistically insignificant among the two groups (OR=1.21 (0.84, 1.74); p=0.31; I2=99%). Percutaneous coronary intervention is an important intervention to reduce morbidity and mortality but special precautions and attention should be made when it comes to patients with RA. Different precautions such as close monitoring for medication interaction, and tailored post-procedural care are essential in reducing morbidity and mortality.

Long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting in women, a meta-analysis

BackgroundDespite the advances in the last decades for treatment of ischemic heart disease, women continue to experience poorer prognosis than men and currently, there is a gap in knowledge regarding the optimal revascularization strategy in women.ObjectiveCompare the long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for the treatment of stable ischemic heart disease in women.MethodsA systematic search was conducted including randomized clinical trials (RCTs) comparing PCI with drug-eluting stents with CABG. The primary outcome were the composite outcomes of death, stroke or myocardial infarction (MI) and death, stroke, MI or repeat revascularization. Secondary outcomes included the individual components of the primary outcomes. Pooled hazard ratios with 95% confidence intervals were calculated in a fixed- effects meta-analysis using the inverse of variance method. Risk of bias and sensitivity analyses were also conducted.ResultsSix multicenter, RCTs were included after eligibility assessment. Median follow-up was 6.25 years (IQR: 5- 2.5). A significant benefit for CABG over PCI was observed for the primary composite outcomes of death, stroke, MI (HR = 1.24; 95% CI 1.01–1.52; p = 0.037) and death, stroke, MI or repeat revascularization (HR = 1.60; 95% CI 1.25–2.03; p < 0.000).ConclusionIn the present study-level metanalysis, CABG is associated with a lower risk of major adverse cardiovascular events than PCI at long term follow-up in women.

Fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials.

The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI. To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD. We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p=0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p=0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p=0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI. FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates. 4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.

Comparison of outcomes of Impella-assisted high-risk percutaneous coronary intervention in patients with and without prior coronary artery bypass graft.

Limited data is available regarding in-hospital outcomes of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with Impella with and without a prior history of coronary artery bypass grafting (CABG). We performed a retrospective study from the Nationwide Inpatient Sample from year 2016 to 2020. We identified patients who underwent Impella and percutaneous coronary intervention on the same day and excluded those with cardiogenic shock. Subsequently, we stratified them into those with and without prior CABG. During the study period, 18 925 patients underwent HR-PCI. Among these, 2043 (10.8%) patients had prior CABG. Patients without prior CABG had a higher percentage of acute coronary syndrome at presentation (62.7 vs 56.1%, P = 0.008). The proportion of females was significantly higher in those without prior CABG (32.4 vs 21.7%, P < 0.001). On multivariate analysis, there was no statistically significant difference in the in-hospital mortality (5.8% in CABG vs 8.5% in non-CABG, P = 0.52). Patients without prior CABG had higher rates of acute kidney injury, major bleeding, and blood transfusions. There were no significant differences in rates of cardiac arrest, ventricular arrhythmias, acute stroke, coronary dissections, and coronary perforations. Those without prior CABG had a longer duration of hospitalization (6.8 vs 9.3 days, P < 0.001) and higher hospital charges ($292 267 vs $322 206, P < 0.035). Our study highlights that a history of previous CABG does not increase the risk of in-hospital mortality in patients undergoing Impella-assisted HR-PCI but is associated with reduced rates of complications.

Outcomes of Optical Coherence Tomography-Guided and Angiography-Guided Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

Background: Despite the administration of timely reperfusion treatment, patients with acute myocardial infarction have a high mortality rate and poor prognosis. The potential impact of intraluminal imaging guidance, such as optical coherence tomography (OCT), on improving patient outcomes has yet to be conclusively studied. Therefore, we conducted a retrospective cohort study to compare OCT-guided primary percutaneous coronary intervention (PCI) versus angiography-guided for patients with ST-segment elevation myocardial infarction (STEMI). Methods: This study enrolled 1396 patients with STEMI who underwent PCI, including 553 patients who underwent OCT-guided PCI and 843 patients who underwent angiography-guided PCI. The clinical outcome was a composite of cardiovascular death, myocardial infarction, admission due to heart failure, stroke, and unplanned revascularization at the 4-year follow-up. Results: The prevalence of major adverse cardiovascular events in OCT-guided group was not significantly lower compared to those without OCT guidance after adjustment (unadjusted hazard ratio (HR), 1.582; 95% confidence interval (CI), 1.300–1.924; p &lt; 0.001; adjusted HR, 1.095; adjusted 95% CI, 0.883–1.358; p = 0.409). The prevalence of cardiovascular death was significantly lower in patients with OCT guidance compared to those without before and after adjustment (unadjusted HR, 3.303; 95% CI, 2.142–5.093; p &lt; 0.001; adjusted HR, 2.025; adjusted 95% CI, 1.225–3.136; p = 0.004). Conclusions: OCT-guided primary PCI used to treat STEMI was associated with reduced long-term cardiovascular death.

Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator Experience on Outcomes.

Percutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center. This study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure. Retrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved. PCI center volume was categorized based on annual number of interventions: low (< 200), intermediate (200-499), and high (≥ 500). Operator experience was assessed by years of practice (low [< 5] and high [≥ 5]) and the number of PCI cases performed annually (low [< 75] and high [≥ 75]). The evaluated PCI outcomes were: PCI failure; procedural complications; PCI-related in-hospital mortality; 1 year post-intervention all-cause mortality. A total of 19,701 patients who underwent PCI were included in the analysis, of whom 17,432 had follow-up data available after 1 year. Of these, 58.1% presented with either ST-elevation or non-ST elevation myocardial infarction/unstable angina, while 41.9% had stable CAD. Nearly half of the patients had triple-vessel or left-main disease, and 8.7% presented with cardiogenic shock. The percent with PCI failure, procedural complications, PCI-related in-hospital death, and 1-year all-cause mortality were 4.9%, 5.1%, 2.7%, and 11.8%, respectively. Despite patients in higher-risk profiles being treated at high-volume PCI centers and by experienced operators, there were no significant differences in PCI failure, PCI-related in-hospital mortality nor 1-year all-cause mortality compared to those treated at low or intermediate volume PCI centers. However, high-volume PCI centers had procedural complications more frequently (4.7%) than did intermediate (3.9%) and low-volume (2.5%) centers (p < 0.001). After adjusting for confounding factors, no significant associations were found between PCI center volume and PCI outcome. Similarly, no significant relationship was found between operator experience and procedural complications, nor 1-year all-cause mortality. Nevertheless, operators with more years of practice were associated with lower PCI-related in-hospital mortality (odds ratio [95% CI] of 0.75 (0.57, 0.98); p < 0.038). Additionally, operators conducting a higher number of PCIs annually tended to have less PCI failures (odds ratio [95% CI] of 0.76 (0.57, 1.01); p = 0.062). A center's PCI volume did not significantly impact PCI outcome. In contrast, operator experience did impact outcomes. This result highlights areas for improvement and can help reform strategies for national PCI systems at both center and operator levels.

Trends in antithrombotic therapy and clinical outcomes for percutaneous coronary intervention in Japan following the 2020 JCS guideline focused update: findings from the SAKURA PCI2 Antithrombotic Registry.

In April 2020, the Japanese Circulation Society updated guidelines recommending shortened dual antiplatelet therapy (DAPT) for patients at Japanese Version of the High Bleeding Risk (J-HBR), but the impact remains unclear. We conducted a prospective multicenter registry (SAKURA PCI2 Antithrombotic Registry) starting June 2020 (n = 1136), enrolling patients who underwent percutaneous coronary intervention (PCI). Planned DAPT duration, defined as short if less than 3months, was based on patient background post-PCI and physicians' discretion. Planned short DAPT was used in 55.2% of patients, with a similar incidence of J-HBR (68.3% vs. 66.6%, p = 0.55) and a shorter actual DAPT duration (97 vs. 229days, p < 0.001) compared with Planned non-short DAPT. Primary endpoints, major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, non-fatal myocardial infarction, stent thrombosis, and stroke, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (BARC-3/5), occurred similarly across groups (MACCE: 6.5% vs. 7.3%, p = 0.66; BARC-3/5: 3.7% vs. 2.2%, p = 0.14). Independent predictors of MACCE included age ≥ 75, Clinical Frailty Scale ≥ 4, and hemoglobin < 11. Age ≥ 75, severe chronic kidney disease, hemoglobin < 11, and platelets < 100,000 were linked to BARC-3/5. Among BARC 3/5 patients, 41.2% experienced bleeding after switching to single antiplatelet therapy. Planned short DAPT was implemented in 55.2% of patients, showing comparable thrombotic and bleeding outcomes to non-short DAPT.

Comparative Short-Term Outcomes of Double-Kissing Culotte and Culotte Techniques in Acute Coronary Syndrome from the Lower Silesia Culotte Bifurcation Registry.

Background/Objectives: The double-kissing (DK) culotte technique is a modification of the culotte technique that employs initial kissing balloon inflation after first stent implantation. The DK culotte technique may improve strut apposition and procedural outcomes; however, data on its efficacy and safety remain limited. This study aimed to investigate the short-term outcomes of bifurcation percutaneous coronary intervention (PCI) using the DK culotte technique compared with those of the culotte technique in patients with acute coronary syndrome (ACS). Methods: This two-center, observational, retrospective study included patients with ACS. Out of 12,132 screened patients, 117 and 122 underwent DK culotte and culotte PCIs, respectively, with 117 and 57 patients remaining after propensity score matching. The primary endpoint was 1-year target lesion failure (TLF), which included cardiovascular death, target vessel myocardial infarction or clinically indicated target lesion revascularization (TLR). Secondary endpoints included major adverse cardiac events (MACEs) comprising myocardial infarction, cardiac death, and TLR; contrast medium amount (mL); and cumulative radiation dose (mGy). Results: At 1 year, TLF occurred in 7% and 12% of the DK culotte and culotte groups, respectively (p = 0.17). No significant differences were observed in MACEs between the groups (13% DK culotte vs. 19% culotte; p = 0.12). Additionally, the DK culotte technique did not cause higher contrast medium usage or cumulative radiation dosage. Conclusions: No statistically significant differences were found in TLF and MACE reduction between ACS patients treated with the DK culotte technique and the culotte technique. The observed trend favoring the DK culotte needs further validation in prospective studies.

High-Output Mechanical Circulatory Support in Left Main Interventions: The Magenta Elevate High-Risk PCI First-in-Human Study.

The Magenta Elevate is a 9-F, self-expanding, catheter-mounted pump delivered sheathed through a commercially available 10-F femoral introducer over the wire to the left ventricle (LV), providing temporary hemodynamic support up to an equivalent of normal cardiac output. The authors sought to assess the feasibility and outcomes of Elevate-supported high-risk percutaneous coronary intervention (HR-PCI) in a first-in-human study and study the hemodynamic impact of high-output support during prolonged interventional left main coronary artery (LM) occlusions. In this study, 14 patients underwent Elevate-supported HR-PCI, with 8 patients undergoing 20 prolonged (39 ± 16 seconds) balloon occlusions of an unprotected LM. Systolic and diastolic aortic pressures, mean arterial pressure (MAP), and diastolic aorto-left ventricular pressure difference (dΔPAoLV) were determined before and during inflations. There were no major device-related adverse events (primary safety endpoint) and no mortality at 30days. During prolonged LM occlusions, the following changes were observed: There was a significant drop in systolic aortic pressure (-35mmHg [-46 to-23mmHg]; P< 0.0001) accompanied by a significant increase in diastolic pressure (7mmHg [4 to 10mmHg]; P< 0.0055). MAP, which showed a small decrease (-7mmHg [-13 to-2mmHg]; P< 0.001) and dΔPAoLV (-2mmHg [-5 to 4mmHg]; P = 0.51) remained in the normal range. Ventriculo-arterial uncoupling occurred in 13 of 20 LM balloon occlusions. In this first-in-human study, use of the Magenta Elevate low-profile, high-output catheter during HR-PCI was safe and provided substantial cardiac support. During prolonged interventional LM occlusions, the system unloaded the LV, maintaining a normal MAP and dΔPAoLV.