Outcomes Of Percutaneous Coronary Intervention Research Articles

No difference on angiographic features between women and men in patients with acute coronary syndrome: insights from the ADDICT-ICCU study

Abstract Background Previous studies have observed poorer outcomes in women with acute coronary syndrome (ACS). Angiographic features and angioplasty techniques to explain this difference between women and men have rarely been analyzed in recent studies. Purpose To analyze by a core laboratory angiographic finding, coronary artery disease (CAD) complexity and percutaneous intervention outcomes in women and men in patients with ACS. Methods From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1575 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for ACS (n=379) with an independent angiographic core laboratory evaluation. The prevalence, location, and severity of CAD (lesion≥50%), the Syntax score, the residual Syntax score and the characteristics of percutaneous coronary intervention (PCI) were compared between women and men. The primary endpoint was Major Adverse Cardiac Events (MACE) defined by death, resuscitated cardiac arrest, or cardiogenic shock. Results Among the 379 patients with ACS (mean age: 63±13 years), 23% were women (n= 86) and 77% were men (n=286). Cardiovascular risk factors and CAD history were well balanced between women and men except for active smoking with less smokers in women (59% vs 81%, p<0.001). Regarding location of CAD (stenosis ≥50%), there was no significant difference between women and men: left anterior descending artery (56% vs 57%; p=0.90), circumflex (28% vs 39%; p=0.12) and right coronary artery (50% vs 48%; p=0.81). No difference was found for baseline Syntax score (7.98 vs 9.64; p=0.13). Women and men have a similar rate of multivessels disease (44% vs 50%; p=0.46) and 3 vessels disease (16% vs 20%; p=0.57). Concerning PCI, Syntax score of the culprit lesion was significantly lower in women (4.5 vs 5.5, p=0.02). Women and men received a similar number of stents (2.3 vs 2.4; p=0.33). Stent length (28.9 vs. 30.3, p=0.43) or stent diameter (3.1 vs 3.2; p= 0.11) were not significantly different. Final TIMI 3 flow was found in 92.9% of women and 88.1% of men (p=0.23). The rate of procedural complications was low in both groups. At the end of the procedure, the residual Syntax score was similar in women and men (4.4 vs 5.4; p= 0.34). The rate of in-hospital MACE was not different between women and men (4.7% vs 4.4%; p=0.91). Conclusion In this study with an independent angiographic core laboratory analysis of ACS patients, no difference between women and men regarding CAD severity or PCI outcomes was observed. Other reasons should be considered if a difference in prognosis exists between women and men.Angiographic features in Women and menAngiographic analysis by Core Laboratory

Intravascular ultrasonography guided percuatneous coronary intervention with everolimus-eluting stents or bypass surgery for multivessel coronary artery disease: post-hoc analysis of the BEST study

Abstract Background Previous studies suggested that intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) improved clinical outcomes compared with coronary angiography (CAG)-guided PCI in complex coronary artery disease. Objectives We compared long-term clinical outcomes of IVUS-guided PCI with everolimus-eluting stent and coronary-artery bypass grafting (CABG) in multivessel coronary disease (MVD). Methods Among 880 patients with MVD enrolled in the BEST Extended Follow-up study, 333 patients underwent IVUS-guided PCI and 131 patients underwent CAG-guided PCI, which were compared with 401patients underwent CABG. The primary endpoint was the composite of death from any cause, myocardial infarction, or target-vessel revascularization during a median follow-up of 11.8 years (interquartile range, 10.6 to 12.5 years). Results During an extended follow-up, primary endpoint occurred in 75 patients (22.8%) in the IVUS-guided PCI group, in 58 patients (44.38%) in the CAG-guided PCI group, and in 95 patients (24.0%) in the CABG group. Compared with the CABG group, the IVUS-guided PCI group had a similar rate of primary endpoint (adjusted hazard ratio [HR], 1.013; 95% confidence interval [CI], 0.747-1.374; P=0.93), whereas the CAG-guided PCI group had a significantly higher risk of clinical events (adjusted HR, 2.231; 95% CI, 1.582-3.145; P<0.001). Similarly, whereas the IVUS-guided PCI group had similar rate (adjusted HR, 0.845; 95% CI, 0.605-1.181; P=0.324), the CAG guided PCI group had the significantly higher rate of the safety composite of death, stroke and myocardial infarction (adjusted HR, 2.016; 95% CI, 1.405-2.895; P<0.001) compared with the CABG group. However, both IVUS- and CAG-guided PCI groups had significantly higher rate of any repeat revascularization than CABG group. Conclusions In patients with MVD, IVUS-guided PCI appeared to be an safe and effective alternative to CABG. This study advocated the routine use of intravascular imaging during PCI for MVD.KM curve of outcomesPrimary and secondary outcome

Percutaneous treatment of left main coronary artery disease - temporal trends from large registry and ten-year follow-up. a single centre experience

Abstract Background Due to a large amount of jeopardized myocardium, patients with significant left main coronary artery (LMCA) stenosis have an increased risk of death. For years coronary artery bypass grafting has been considered as the treatment of choice. Recent years brought evidence that led to the reconsideration of percutaneous coronary intervention (PCI) as a valuable alternative. Purpose The purpose of this study was to assess temporal trends in clinical practice and analyse the very long-term outcomes of LMCA PCI in a large tertiary hospital in Poland. Methods Group of 998 individuals undergoing LMCA PCI was selected from medical records of 44,989 patients hospitalized in years 2008-2021. Data on mortality were obtained from the Centre for Information Technology. Temporal trends were calculated for period 2008-2014 as compared to 2015-2021. The 10-year event rate was calculated with the Kaplan-Meier estimator, univariate (ULR), and multivariate logistic regression (MLR). Results The rate of LMCA PCI increased from 2.21% in 2008 to 6.88% in 2021 (p<0.001). 736 (73.8%) patients were male, the median age was 71 years (interquartile range 16). 409 (41.0%) of patients presented with acute coronary syndrome (ACS), 545 (54.6%) with chronic coronary syndrome (CCS). In the analysed periods concomitant diabetes mellitus (DM) rate increased from 27.44% to 42.5% (p<0.001), use of intravascular imaging (IVI) increased from 22.28% to 42.72% (p<0.001), use of rotational atherectomy increased from 8.36% to 18.94% (p<0.001). The 30-day mortality decreased from 10.31% to 4.23% (p<0.001), and 1-year mortality decreased from 18.66% to 12.05% (p=0.007). In the 10-year follow-up 399 (40.0%) patients died. In ULR, death was associated with femoral access (OR 1.766, 95% CI 1.308-2.386) and absorbed radiation dose (OR for increase in 1 Gy 1.192, 95% CI 1.080-1.304). The provisional stenting yielded better performance than two-stent techniques (OR 0.635, 95% CI 0.491-0.821). In MLR, death at 10 years was associated with age (OR 1.028, 95% CI 1.007-1.050), ACS (OR 1.725, 95% CI 1.134-2.624), atrial fibrillation (OR 1.540, 95% CI 1.002-2.367), lower glomerular filtration rate (OR for decrease in 1 ml/min/1.73 m2 1.011, 95% CI 1.001-1.022), and lower left ventricular ejection fraction (OR for decrease in 1% 1.045, 95% CI 1.029-1.060). Better outcomes were associated with previous revascularization (OR 0.668, 95% CI 0.453-0.986), use of IVI (OR 0.518, 95% CI 0.353-0.759), drug-eluting stents (OR 0.238, 95% CI 0.106-0.536) and bigger balloon diameter used for stent optimization (OR for increase in 1 mm 0.889, 95% CI 0.801-0.986). Conclusions In the analysed period the rate of LMCA PCI, number of complex procedures, and co-morbidities increased, yet the prognosis has improved. The 10-year death rate analysis revealed that advancements in percutaneous device technology and procedural techniques are associated with more favourable outcomes.

Outcomes of chronic total occlussion recanalization in patients with prior bypass-surgery: an updated systematic review and meta-analysis of real world registries

Abstract Background Recanalization of chronic total occlusion (CTO) coronary lesions by percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) is still considered a challenging scenario due to the complexity of coronary lesions as well as the requirement of CTO PCI advanced techniques. The aim of this study is to compare clinical outcomes of patients undergoing CTO PCI with and without CABG surgery. Methods We conducted a systematic review and meta-analysis of observational studies that compared in-hospital outcomes of CTO PCI in patients with vs. without prior CABG published in Medline from inception until December 2022. The results are synthesized in a quantitative manner with random effects models. Categorical variables were compared using the chi-square test, whereas continuous variables were compared using a 2-sample Student's t-test. Statistical heterogeneity was assessed by I2 statistics: I2 statistic >50% was considered substantial, and I2 >75% was considered considerable. The Review Manager Software version 5.3.5. (The Cochrane Collaboration, 2014) was used to calculate summary statistics (odds ratios [ORs] with 95% confidence intervals [CIs]). Results Eleven observational studies with a total of 35,666 patients were included, of whom 7,005 patients had a history of CABG. Prior CABG patients were older, (68.1 ± 9.0 vs. 64.1 ± 10.7 years; p < 0.001), and had more complex coronary lesions (J-CTO score: 3.2 ± 1.4 vs. 2.5 ± 1.4; p < 0.001). Prior CABG was associated with lower technical success (66.6% vs. 78.5%; OR 0.53 [95% CI: 0.43 to 0.65]; p < 0.00001, I2 = 84%) as well as lower procedural success (OR 0.64 [95% CI: 0.57 to 0.71]; p < 0.00001, I2 = 0%) as compared with patients with no prior CABG (Figure 1A and Figure 1B). Prior CABG patients had a higher incidence of in-hospital mortality (0.7% vs. 0.4%; OR: 2.00 [95% CI: 1.32 to 3.05]; p = 0.001, I2 = 9%, Figure 2A), coronary perforation (3.7% vs. 2.3%; OR: 1.64 [95% CI: 1.15 to 2.33]; p < 0.006, I2 = 74%, Figure 2B), and myocardial infarction (1.7% vs. 0.7%; OR: 2.57 [95% CI: 1.73 to 3.81]; p < 0.00001, I2 = 12%), but a lower incidence of cardiac tamponade (0.2% vs. 0.9%; OR: 0.36 [95% CI: 0.17 to 0.77]; p = 0.09, I2 = 0%, Figure 2C) compared with those without prior CABG. Both groups had a similar incidence of acute cerebrovascular events (0.2% vs. 0.1%; OR: 1.70 [95% CI: 0.75 to 3.88]; p = 0.21, I2 = 0%), major bleeding (1.4% vs. 1.2%; OR: 1.24 [95% CI: 0.96 to 1.61]; p = 0.09, I2 = 0%) and vascular complications (1.4% vs. 0.9%; OR: 1.50 [95% CI: 0.93 to 2.41]; p = 0.10, I2 = 0%). Conclusion Prior CABG patients undergoing CTO PCI presented a higher risk of in-hospital mortality and perioperative procedural complications although the risk of tamponade was lower.Figure 1A and Figure 1BFigure 2A, 2B and 2C

Ticagrelor versus clopidogrel for complex percutaneous coronary intervention in chronic coronary syndrome: a post-hoc analysis of the ALPHEUS study

Abstract Background Whether ticagrelor utilization in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) could prevent type 4 myocardial infarction (MI) or myocardial injury as compared to clopidogrel is unknown. Purposes To evaluate the frequency and outcomes of complex PCI in stable coronary patients and the efficacy of ticagrelor versus clopidogrel in these patients randomized in the ALPHEUS trial. Methods All PCI procedures were blindly reviewed by two core laboratory readers and classified as complex if they had at least one of the following criteria: stent length ≥60 mm, two-stent bifurcation, use of atherectomy, left main, bypass graft, chronic total occlusion, use of guide catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b MI and major myocardial injury, defined by the 3rd and 4th universal definition of MI, during the 48h after PCI. Angiographic complications and the composite of death, MI, stroke at 48 hours and at 30 days were also evaluated. We compared the event rates in the randomized groups according to the presence or not of complex PCI criteria and evaluated the interaction with the randomization to ticagrelor or clopidogrel. Results Among the 1866 patients randomized, 910 (48.3%) PCI were classified as complex PCI and 956 (51.7%) as not complex. Multiple criteria of complex PCI were found in 14.4% (2 criteria) and 9.1% (≥3 criteria) of the patients. The primary endpoint was more frequent in complex PCI than in the not-complex PCI (45.6% vs 26.6%; p<0.001) driven by higher rates of type 4MI and angiographic complications (12.2% vs 4.8 %; p<0.001 and 19.3% vs 8.6%; p<0.05, respectively). The composite of death, MI, stroke at 48 hours (12.7% vs 5.1 %; p<0.05) and at 30 days (13.4% vs 5.3%; p<0.05) were also more frequent in complex PCI. No interaction was found between the complexity of PCI and the randomized treatment for the primary endpoint (p for interaction = 0.35) nor the secondary endpoints. Conclusions Complex PCI patients have higher rates of periprocedural and cardiovascular events which are not reduced by ticagrelor as compared with clopidogrel.

Fractional-flow reserve use in coronary artery revascularization: a 78.897 patients systematic review and meta-analysis

Abstract Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in the guidelines of revascularization for patients presenting with coronary artery disease (CAD) with intermediate lesion severity. However, recently published studies comparing FFR-guided PCI with non-physiology guided revascularization strategies have reported conflicting result. Methods The PubMed and Embase databases were searched for randomized clinical trials and observational studies comparing FFR-guided PCI with non-physiology-guided revascularization strategies (angiography-guided, intracoronary imaging-guided, coronary artery bypass grafting) in patients with CAD. Data were pooled by meta-analysis using a random-effects model. Results 26 studies enrolling 78,897 patients were included. Patients undergoing FFR-guided PCI as compared to those undergoing non-physiology guided coronary revascularization had a lower risk of all-cause mortality (OR 0.79 95% CI 0.64-0.99, I2=53%) and myocardial infarction (OR 0.74 95% CI 0.59-0.93, I2=44.7%). However, no differences between groups were found in terms of MACE (OR 0.86 95% CI 0.72-1.03, I2=72.3%) and repeat revascularization (OR 1 95% CI 0.82-1.20, I2=43.2%). Conclusions Among patients with CAD, FFR-guided PCI as compared to non-physiology-guided revascularization was associated with a lower risk of all-cause mortality and MI.Clinical outcomes in patients undergoingFFR-guided PCI as compared to non-physio

Intracoronary imaging guided percutaneous coronary intervention of stent restenosis: does it make a difference?

Abstract Background In-stent restenosis (ISR) remains the most common cause of stent failure after percutaneous coronary intervention (PCI). Compared to coronary angiography (CA), intracoronary imaging (ICI) provides a more accurate and detailed characterization of the degree of ISR and may help identify the underlying pathophysiological mechanism. Although recommended in the European guidelines, the impact of ICI in clinical outcomes in ISR is still under discussion. Purpose Our study aimed to analyze and compare clinical outcomes between CA PCI (group 1 - G1) and ICI-guided PCI (Intravascular ultrasound (IVUS) or optical coherence tomography (OCT)) (group 2 - G2). Methods We performed a retrospective single-center review of all consecutive patients with ISR treated in our center from September 2014 to January 2022. Patients with acute stent thrombosis were excluded. Primary endpoint was defined as death by all causes and secondary endpoint as a composite of cardiovascular (CV) mortality, culprit ISR PCI and ischemic stroke. Results 130 patients were included (mean age 66.23 ± 11.832 years, 77.7% male and mean follow-up period (FUP) 48.70 ± 27.356 months). Mean left ventricular ejection fraction was 50.19 ± 10.509%, 66.2% had dyslipidemia, 45.3% hypertension, 38.5% diabetes, 36.2% heart failure and 29.2% previous multivessel PCI. A total of 142 ISR lesions from 136 arteries were treated and ICI was used in 37 (28.5%) patients (IVUS in 16 (12.3%) and OCT in 21 (16.2%)). The ISR coronary segment and pattern is described in Table 1. The mechanism for ISR was identified in 23 lesions. The most common indication for coronary angiography was stable angina in 34.6% and NSTEMI in 31.5% and ISR was the culprit in 128 (98.5%) of the cases. The groups were well matched regarding baseline characteristics and comorbidities. PCI strategy was more often drug-eluting stenting (DES) vs drug-coated balloon (DCB) in group 2 (DES 18.3% vs 51.4% and DCB 81.7% vs 43.2% in G1 and G2 respectively). And, as expected, treatment of bifurcation lesions was more frequent in group 2 (9.7% G1 vs 30.6% G2). During the FUP there were 10 (7.7%) CV deaths and 19 (14.6%) non-CV deaths (19 in G1 and 0 in G2). The composite outcome of CV mortality, ischemic stroke and culprit ISR PCI occurred in 19 (20.2%) patients in G1 and 1 (2.7%) patient in G2. The use of ICI was associated with reduced all-cause mortality (HR=0.667 [95% CI 0.584-0.760], p=0.011) and reduced composite outcome (B (95%CI): -0.251 (-0.455 - -0.046), p=0.017). No difference between IVUS or OCT was found. The PCI strategy (DES vs DCB), stent type, length or diameter were not predictors of outcomes. Conclusion In IRS PCI, the use of ICI compared to standard of care CA was associated with a reduction in all-cause mortality and composite outcome of CV mortality, culprit ISR PCI and ischemic stroke. The strategy of PCI differed with DES being used more frequently than DCB. No difference between IVUS or OCT was found.

Impact of the size-dependent difference of excimer laser coronary angioplasty in ST-elevation acute myocardial infarction; nuclear scintigraphy findings

Abstract Background Excimer laser coronary angioplasty (ELCA) is reported to provide a good percutaneous coronary intervention (PCI) outcome. The current lineups of laser catheter sizes are 0.9-mm, 1.4-mm, and 1.7-mm catheter diameters. Although the cross ability and irradiation time is better in smaller catheter size, the available irradiation area is more significant in larger catheter size; however, it is unknown the difference in laser catheter size impacts good results in patients with ST-elevation myocardial infarction (STEMI). Aim To investigate the relationship between the laser catheter size and clinical outcome in patients with STEMI. Methods and Results We retrospectively enrolled 123 consecutive patients with STEMI who underwent primary PCI (median age: 67 [69-72] years, male: 102 [82.9%]). Patients were divided into 0.9-mm-catheter diameter group (small group, n = 47) and 1.4/1.7-mm-catheter diameter group (large group, n = 76). The patients’ characteristics, procedural results, peak creatine kinase/ creatinine kinase-myocardial band, final thrombolysis in myocardial infarction flow, and periprocedural complications were collected. Furthermore, from nuclear scintigraphy data based on a 17-segment model with a 5-point scoring system, which was calculated via the difference between 123I-BMIPP at 3-7 days and 99mTc-tetrofosmin at 3-6 months following PCI, the improvement of ejection fraction (EF) and myocardial salvage through summed rest score (SRS) were investigated. There was no significant difference in patients’ characteristics, PCI procedure, and results between the two groups. The occurrence of coronary slow flow was similar between the two groups. On the other hand, nuclear scintigraphy data demonstrated that the improvement of EF and SRS were significantly better in the small group (EF; 13.3% vs. 7.6%, p=0.016, SRS; 18 vs. 5, p=0.012, respectively). Conclusions The nuclear scintigraphy findings showed that ELCA with small catheter size is feasible in patients with STEMI.Figure 1

Routinely available inflammation biomarkers as predictors of adverse outcomes following coronary angiography

Abstract Background Inflammatory activation plays a pivotal role in the development and progression of atherosclerosis and subsequently in coronary artery disease (CAD). Several biomarkers of inflammation such as C-reactive protein (CRP), leucocytes, and neutrophile-to-lymphocyte ratio (NLR), are considerable predictors of adverse events in CAD patients. The presence of underlying inflammation may also affect net outcomes of patients undergoing coronary angiography and percutaneous coronary intervention (PCI). However, the association between inflammatory activation and patient outcomes after coronary angiography remain widely unclear. Purpose The study goal was to investigate the predictive value of routinely used inflammation biomarkers including CRP, leukocytes and NLR in a large all-comer patient population undergoing coronary angiography. We aimed to gain additional insights into the association of inflammatory markers with patient outcomes to take a step towards personalized risk stratification for CAD patients. Methods A total of 12 642 patients undergoing coronary angiography between 2010 and 2021 with full laboratory analysis were enrolled in this observational study. CRP, leucocytes and NLR were analysed for possible effects on all-cause and cardiovascular mortality. We further investigated target lesion revascularization (TLR) after PCI in the presence of underlying inflammation as an intervention-specific endpoint. Results 3300 (26%) patients presented with acute coronary syndromes (ACS) and 4145 (33%) patients were treated with PCI. All investigated inflammatory biomarkers (CRP, leukocytes, NLR) were significantly associated with all-cause mortality and especially with cardiovascular mortality in both acute and elective patients. This association remained highly significant after adjusting for demographic and clinical variables. While CRP was strongly related with cardiovascular mortality in STEMI patients (ad. HR per 1 SD: 1.35 [95%-CI: 1.14 – 1.59]), no significant association was observed in NSTEMI patients (ad. HR per 1 SD: 1.04 [95%-CI: 0.92 – 1.17]; p for interaction: 0.007; figure 1). Notably, CRP was not found to be associated with TLR in patients undergoing acute or elective PCI (ad. HR per 1 SD: 0.99 [95%-CI: 0.88 – 1.11]; p-value: 0.857). However, we found a highly significant association between NLR and TLR in both acute and elective patients (ad. HR per 1SD: 1.27 [95%-CI: 1.12 – 1.43]; p-value: <0.001). Conclusion Inflammatory activation is associated with increased mortality in patients undergoing coronary angiography. Although the impact of inflammation on interventional outcomes may be assumed, our study did not show significant associations between CRP and TLR. However, NLR emerged as a robust predictor of adverse events after PCI. Thus, while CRP does not impact the interventional outcome of PCI, a modulation of the cellular immune response does.Figure 1

The Impact of Hypothyroidism on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Introduction: Hypothyroidism either subclinical (SCH) or overt is independently associated with an increased risk of coronary artery disease (CAD). The combined effects of SCH and overt hypothyroidism on clinical outcomes after percutaneous coronary intervention (PCI) are largely unknown. Aim: The aim of the study is to assess the impact of subclinical and overt hypothyroidism among patients presenting with CAD undergoing PCI. Materials and Methods: A total of 102 patients who were referred to the Madras Medical Mission Hospital for PCI from September 2020 to March 2021 were enrolled in the study. These patients were categorized into three groups. Each group has 34 patients and was followed for one year. Group 1: Patients with normal TSH levels (TSH-0.45 -5mlU/Liter) and euthyroid at T3, T4 levels. Group 2: Patients with subclinical hypothyroidism with elevated TSH levels (TSH=5-15mlU/liter) and normal thyroid with T3, T4 levels. Group 3: Patients with a family history of overt hypothyroidism or high TSH levels(<15mlU/liter) and low T3 and T4 levels [16]. Results: We applied ANOVA to find the PCI outcomes. A p-value of <0.05 was accepted as significant. Age (p-0.03), recent myocardial infarction (p-0.04), diabetes mellitus (p<0.001), HbA1C (p-0.012), and systolic blood pressure (p-0.04) were found to be significant. Post-PCI bleeding complications (p<0.001) during one month, six months, and one-year follow-up were the main observation of the study. Conclusion: The prior history of DM and elevated HbA1c levels observed in the overt hypothyroid group indicate that DM was one of the key factors associated with overt hypothyroidism. Despite the fact that PCI was safe for patients with hypothyroidism, the risk of early post-PCI bleeding was of concern.

Abstract 16086: Impact of Amyloidosis on the Outcomes of Percutaneous Coronary Intervention Recipients: A Nationwide Analysis

Background: Interest in amyloidosis is increasing, primarily due to its high prevalence and recent advances in diagnostic and treatment modalities. The role of amyloidosis in aortic stenosis is established, and in coronary artery disease (CAD) outcomes are being reported. We aim to study the impact of amyloidosis on the outcomes of inpatient percutaneous coronary intervention (PCI) recipients. Methods: We conducted a cross-sectional cohort study using the nationwide inpatient sample (NIS) 2018-19. We included 457,730 adult inpatients with CAD managed with PCI and further divided by the presence of a co-diagnosis of amyloidosis. A logistic regression model was used to evaluate the odds ratio (OR) of the association between amyloidosis and various outcomes in PCI recipients.Results: Out of the total of 457,730 patients included, 30,905 (6.75%) had amyloidosis. Mean age (66.3 vs. 65.9), female sex (35.6% vs. 32.1%), and African American race (11.6% vs. 9.4%) were higher in the amyloidosis cohort (all P<0.001). The amyloidosis cohort also had a higher incidence of acute kidney injury (AKI) (29.9% vs. 15.5%), complications of surgical care (1.7% vs. 0.7%), complications of cardiovascular implant (9.5% vs. 8.5%), major loss of function (54.7% vs. 27.8%), length of stay (LOS) in days (6.3 vs. 3.8), total charges in $ (166,001 vs. 121,718), and in-hospital mortality (4.7% vs. 2.6%) compared to non-amyloidosis cohort (all P<0.001). Amyloidosis was associated with higher odds of in-hospital mortality (OR 1.3, 95CI 1.23-1.39, p<0.001), AKI (OR 1.89, 95CI 1.83-1.94, p<0.001), and complications of surgical care (OR 2.05, 95CI 1.87-2.26, p<0.001) but not with complications of cardiovascular implant (OR 1.01, 95CI 0.97-1.05, p=0.703). Conclusions: Amyloidosis is associated with worse outcomes in inpatient recipients of PCI. Further studies are needed to assess the implications, safety, and outcomes of elective PCI in patients with amyloidosis.

Abstract 15646: Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

Background: The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study. Methods: We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023. Results: Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p<0.001) and procedural (80.8% vs 86.8%, p<0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p<0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p<0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p<0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar. Conclusions: Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up. Abbreviations: eGFR= estimated glomerular filtration rate

Abstract 12577: Sex Differences in Outcomes of Percutaneous Coronary Intervention for Stable Coronary Artery Disease in Patients With End Stage Kidney Disease

Introduction: End Stage Kidney Disease (ESKD) patients are at a higher risk of morbidity and mortality from cardiovascular diseases, particularly coronary artery disease (CAD). There is paucity of sex related differences in percutaneous coronary intervention (PCI) outcomes in this population. Methods: Patients ≥ 18 years with ESKD on dialysis for at least 3 months and who underwent PCI for stable CAD between years 2010 and 2018 were identified from the United States Renal Data System (USRDS) database. Appropriate ICD-9/10 codes were used to identify the relevant conditions and procedures. Statistical analyses were performed using the SAS 9.4 software. Results: A total 23,115 ESKD patients underwent PCI, of which 42.5% were women. While there was a declining trend of utilization of PCI (Men: 6.6 to 2.8; Women: 6.6 to 2.7 procedures per thousand ESRD patients; p<0.001), the in-hospital mortality (Men:1% to 3.2%, p<0.001; Women:0.7% to 2.8%, p<0.001), 30-day mortality (Men:3% to 6.8%, p<0.001; Women:3.5% to 5.2%, p<0.001) and 1-year mortality (Men: 25.6% to 32.7%, p<0.001; Women: 27.7% to 30.4%, p<0.001) as well as 30-day myocardial infarction (Men: 2.7% to 4%,p<0.001; Women:3.1% to 5.6%, p<0.001) increased in both sexes during the study period. After propensity matching, hospital length of stay (3 days vs 4 days, p<0.001), 30-day readmission (29.4% vs 33.1%, p<0.001) and 1-year incidence of stroke (2.3% vs 3.3%, p<0.001) were higher in women, while other outcomes were not significantly different between men and women. Conclusions: Despite the decreasing utilization of PCI for stable CAD in ESKD patients over the study period, worsening short- and long-term mortality was observed in both sexes. Women were more likely to have a longer hospital stay as well as readmission within 30 days post-procedure.

Abstract 18030: Periprocedural Outcomes of Percutaneous Coronary Interventions in Patients Admitted for Acute Myocardial Infarction and Concomitant COVID-19 Pneumonia: Insight From the National Inpatient Sample

Background: Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement for acute myocardial infarction (MI) is considered standard of care where a culprit lesion is identified. Coronavirus disease - 19 (COVID-19) pneumonia has been associated with a prothrombotic state, however its effects on periprocedural outcomes after PCI are unclear. We analyzed the peri-procedural outcomes in these patients who had concomitant COVID-19 pneumonia in the same hospitalization. Methods: A retrospective cohort study was conducted using the National Inpatient Sample from 2020. 300,840 hospitalizations were identified who underwent PCI and DES for acute MI. These were further stratified based on the presence of COVID-19 using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 300,840 hospitalized patients who underwent PCI for acute MI, 3260 (1.1%) had COVID-19 pneumonia. In-hospital mortality was significantly higher in those with COVID-19 pneumonia (19.1% vs 3.4%; p<0.001). Mean length of stay (LOS) and mean hospital charges (HC) were higher in the presence of COVID-19 (7.83 vs 3.81 days, p<0.001 & $188,533 vs $129,570, p<0.001, respectively). Patients with COVID-19 pneumonia had higher rates of GI bleed (1.53% vs 0.07%, p=0.01), postoperative bleeds (7.0% vs 3.9%, p< 0.001), intracranial hemorrhage (ICH) (0.77% vs 0.12%, p<0.001), cardiac arrest (9.3% vs 3.7%, p<0.001) and cardiogenic shock (12.5% vs 7.3%, p<0.001). Conclusions: Patients who underwent PCI for acute MI and had COVID-19 pneumonia in the same hospitalization had significantly worse outcomes such as mortality, cardiogenic shock, cardiac arrest, postoperative bleeds, intracranial hemorrhage. While severity of COVID pneumonia likely accounts for these worse outcomes, the higher incidence of bleeding (GI, post procedure and intracranial) is concerning and needs further studies to evaluate further.

Abstract 16467: The Prevalence, Racial Distribution, and In Hospital Outcome of Percutaneous Coronary Intervention in Non ST Elevation Myocardial Infarction With Patients With Wild Type Transthyretin Cardiac Amyloidosis

Introduction: Epicardial coronary arteries are also a target for intramural amyloid deposits in cardiac amyloidosis beyond the myocardium. For patients with restrictive cardiomyopathy and some degree of stable chronic angina, the role of coronary revascularization has not been clearly shown to have additional benefits over medical management. In unstable angina and Non-ST-elevation acute coronary syndrome (NSTE-ACS) population, isolated observations have painted a grimmer prognosis. Hypothesis: We hypothesized that wild-type ATTR-CA patients with NSTEMI undergoing Percutaneous coronary interventions (PCI) had poor outcomes. We sought to establish their prevalence and uncover the determinants of these outcomes. Methods: A five-year retrospective inquiry of the National Inpatient Sample (NIS) database from 2016 to 2020 on all the patients admitted with a matching diagnosis to the ICD-10 code of interest. Results: Over the five-year span of our observation, about 1,116,170 patients were admitted to the hospital in the US with an NSTE-ACS diagnosis, of which 99% underwent PCI during the same hospitalization (1,116,065). Among the latter 1,505 patients (1%) had ATTR-CA. The most represented demographics in that subpopulation were men (69%), elderly about 74 years old on average (80%), and Whites (60%). The cumulative mortality rate among the ATTR-CA PCI group was higher (18%) than the general NSTE-ACS PCI (14%). Factors associated with survival at hospital discharge were female sex (p-value 0.008), and black race (p-value 0.019). Meanwhile, Asian race (p-value 0.0001), being in a teaching hospital (p-value 0.0001), medium to large size hospital (p-value 0.0001) were harbingers of poor outcomes including death (18%), prolonged hospitalization (about 9.5 days), and higher healthcare costs (about $127,319). Conclusions: PCI has mortality benefits in STEMI and unstable CAD. However, in the ATTR-CA with unstable CAD, this might not be the case as seen with the staggering 28% risk increase in mortality rates in our study. Percutaneous revascularization in wild-type ATTR-CA deserves its own category when clinicians are weighing the benefits and a multidisciplinary approach should be preferred.

Abstract 14765: Long-Term Outcomes of Second-Generation Drug-Eluting Stents versus Coronary Artery Bypass Graft: A Sistematic Review and Meta-Analysis

Introduction: Long-term data is limited on the comparative outcomes of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) versus coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD). Hypothesis: Our aim was to conduct a systematic review and meta-analysis comparing mortality and cardiovascular outcomes in patients with left main or multivessel CAD who underwent PCI with an S-DES versus CABG with a minimum mean follow-up period of 3 years. Methods: We searched PubMed, Embase, and Cochrane for studies that examined our clinical question. Three reviewers independently performed study selection and data extraction. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. The data from observational studies were extracted and pooled as multivariable-adjusted HR or propensity score matching to minimize confounding. Results: We included 10 studies, 2 of which were randomized controlled trials (RCT), with a total of 25,866 patients, of whom 11,482 (44.3%) underwent PCI. The mean follow-up ranged from 3.0 to 11.8 years. S-DES had a significantly higher risk than CABG for all-cause mortality (HR 1.36; 95% CI 1.10-1.68; p=0.005) and myocardial infarction (MI) (HR 1.89; 95% CI 1.12-3.18; p=0.02). No significant difference between the groups was found for major cardiovascular events (HR 1.10; 95% CI 0.98-1.23; p=0.11) and stroke (HR 0.83; CI: 0.60-1.15; p=0.27). In a subgroup analysis of RCTs, there was no significant difference between patients who underwent S-DES or CABG. Conclusion: In this meta-analysis of RCTs and multivariable or propensity-matched observational studies, our findings suggest that PCI with S-DES is associated with an increased risk of mortality and MI events compared with CABG in patients with left main or multivessel CAD.

Abstract 15585: Robotic versus Manual Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis

Introduction: Robotic percutaneous coronary intervention (PCI), a recent development in managing coronary artery disease, offers potential advantages such as enhanced precision, stability, and radiation protection over traditional manual PCI. Despite these promises, a comprehensive and current comparison of safety and effectiveness between these methods remains to be established. Hypothesis: This study aims to evaluate and compare the outcomes of robotic and manual PCI. Methods: A comprehensive search of electronic databases, including PubMed, EMBASE, and the Cochrane Library, was carried out up to May 2023, aiming to identify studies comparing robotic and manual PCI. The primary outcomes were major cardiovascular events and myocardial infarction rates, and secondary outcomes included contrast volume used (in mL), procedural time (in minutes), and fluoroscopy time (in minutes). Relative risk (RR) for categorical outcomes and mean difference for continuous outcomes were calculated using a random-effects model. All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages. Results: Our search strategy identified eight studies, including 2339 patients (703 in the robotic group and 1636 in the manual group). The pooled RR of major cardiovascular events was 0.91 (95% CI: 0.48-1.70, P=0.76, I2=0%), and myocardial infarction rate was 0.88 (95% CI: 0.43-1.83, P=0.73, I2=0%), indicating no significant difference between robotic and manual PCI. Notably, robotic PCI was associated with a statistically significant mean reduction in the contrast volume of -14.28 mL (95% CI: -23.65 to -4.93, P<0.01, I2=0%). However, the differences in procedural time and fluoroscopy time did not reach statistical significance, with 2.73 minutes (95% CI: -4.71 to 10.17, P=0.47, I2=62%) and -2.15 minutes (95% CI: -4.35 to 0.05, P=0.06, I2=51%) respectively. Conclusions: Compared to its manual counterpart, this study highlights that robotic PCI significantly decreases contrast volume use while maintaining similar outcomes in other procedural parameters. This underscores robotic PCI's potential in interventional cardiology, also indicating the need for more high-quality trials for long-term outcome confirmation.

Abstract 15589: Impact of Preprocedural Anemia on In-Hospital and Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

Background: The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 8,633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL for men and <12 g/dL for women. Results: Anemia was present in 1,652 (19%) patients undergoing CTO PCI. These patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p<0.001) and fluoroscopy (45 vs. 40 min; p<0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted HR: 1.63; 95% CI: 1.07-2.49; p=0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p=0.004). Conclusions: Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI.

Abstract 18976: In-Hospital Outcomes in Patients Undergoing Protected Left Main Percutaneous Coronary Intervention With Percutaneous Left Ventricle Assist Device Protection

Introduction: Left main disease (LMCA) is a known risk factor for patients’ poor outcomes. Percutaneous revascularization of LMCA in heart failure patients is associated with a particularly high periprocedural risk. Percutaneously introduced left ventricle assist devices (pLVAD) are a potential tool to improve patient outcomes in these high-risk procedures. Hypothesis: Our study aimed to assess short-term clinical outcomes of protected left main percutaneous coronary intervention with the use of a pLVAD. Methods: A prospective registry of patients with chronic heart failure, undergoing protected LMCA PCI included 66 patients, 89% male, the median age of 71.5 y.o, 40 (60.6%) after prior myocardial infarction, 31 (47%) after prior PCI and 12 (18.2%) after CABG, with CTO RCA in 17 (25.6%) of cases. Percutaneous LVAD was used in all patients, 72% access site was the right femoral artery, additional plaque modification techniques were used in 46 (69.7%) patients, IVL was applied in 25 (37.9%) of cases and high-speed rotational or orbital atherectomy was used in 21 (31.2%) of cases. Median of 3 [2;4] DES was implanted. Results: During the in-hospital follow-up, a significant improvement of the left ventricle ejection fraction was observed (median LVEF 30% post PCI vs22% at baseline, p<0.001) as well as a significant decrease of NTproBNP levels (765 [IQR: 194, 6,370] at discharge vs 7113 pg/ml [IQR:1,945, 15,646] at baseline, p=0.01]. There was 1 in-hospital death due to cardiogenic shock. A safety monitoring revealed 11 hematomas, including 3 cases that needed vascular surgery. Bleeding according to BARC 3a was recorded in 17/66 (28%) and BARC 3b in 3/66 (5%) of cases. Conclusions: Percutaneous LVAD support is a feasible method to perform protected left main PCI with a good safety profile when applied by experienced operators A significant improvement of the LVEF can be observed after left main revascularization Further research is needed to confirm the presented results.

Abstract 11737: Clinical Background and Outcomes of Super-Elderly Patients With Hemodynamically Stable Acute Myocardial Infarction

Background and hypothesis: An increasing proportion of the population is living into their nineties and beyond, as are the number of super-elderly patients (over the age of 90 years) who present with acute myocardial infarction (AMI). The decision to perform emergency revascularization in these patients is difficult because they commonly have multiple comorbidities and are at high risk for invasive procedures. Aims: In order to help stratifying decision-making, this study was planned to clarify the clinical background, in-hospital outcome, and effect of primary percutaneous coronary intervention (PPCI) in super-elderly AMI patients with stable hemodynamics on admission. Methods: Between April 2012 and March 2018, 6,427 hemodynamically stable AMI patients over 90 years of age were identified in a nationwide Japanese administrative database (the JROAD-DPC registry). clinical characteristics, in-hospital occurrence of in-hospital adverse outcomes, and the effect of PPCI were examined. Results: The AMI patients included 4,242 females (66.2%) with a mean BMI of 20.7±4.0 and 2,828 patients (44.0%) with Killip class 1 on admission. The rate of 30-day all-cause mortality was 14.0% and full-score Barthel index, an ordinal scale used to measure performance in activities of daily living (ADL), at discharge was 20.8%. In-hospital complications occurred in 38.2% of patients, which consisted of heart failure after admission (16.0%), life-threatening arrhythmia (3.5%), the use of IABP (3.8%), ECMO (0.2%), mechanical respiration (12.8%), dialysis (1.5%), major bleeding (3.6%), sepsis (1.6%), and pneumonia (10.3%). PPCI was performed in 36,79 patients (57.2%). Patients who underwent PPCI had significantly lower 30-day all-cause mortality (9.4% vs 20.2%, p<0.05) and significantly lower major non-cardiac events (14.9% vs 17.1%, p<0.05). Conclusions: Super-elderly AMI patients (≥90 years of age) were at high-risk for in-hospital mortality rates and In-hospital complications, even if they were hemodynamically stable on admission. PPCI is associated with improved in-hospital outcomes. Therefore, PPCI may provide acceptable outcomes even in these super-elderly AMI patients.