Outcomes Of PCI Research Articles

The Outcomes of Primary PCI and Importance of Clinical Characteristics of the Patient on Presentation

Background: Acute St-segment elevation myocardial infarction (STEMI) is one of the most important cardiac emergency. Primary percutaneous intervention (PPCI) is the gold standard treatment of STEMI according to the American college of cardiology guidelines.Objectives: The goal of this research was to determine the In-hospital outcome of primary percutaneous intervention (PPCI) at Lady Reading hospital, Peshawar and its association to the clinical characteristics of the patient on presentation.Materials and Methods: A total of 90 patients with ST elevation Myocardial infarction (MI) and undergoing PPCI were enrolled in to this prospective observational study conducted in department of Cardiology from 23th March, 2023 to 22nd August, 2023. Enrolled patients were followed during hospital stay to determine major adverse cardiovascular events (MACES), which included outcomes of mortality, recurrent MI, need for repeat revascularization, Acute renal failure (ARF), angina, CVA, acute LVF, Cardiogenic shock and stent thrombosis. Results: The most common adverse event was acute LVF (11.1%) followed by cardiogenic shock (7.8%) and angina (6.7%) Furthermore, logistic regression analysis results showed a strong relationship between pulse rate recorded on presentation and MACE outcomes.Conclusion: Low rates of re-procedures and mortality during hospitalization were found, Ensuring the safety and efficacy of PPCI; higher pulse rates may be associated with a higher risk of unfavorable outcomes.Keywords: Coronary lesion, MACE, PPCI, STEMI.

Influence of pathophysiological patterns of coronary artery disease on the safety and efficacy of percutaneous coronary intervention

Abstract Background Impaired blood flow after PCI, reflected by low FFR, portends a worse prognosis. Prior to intervention, pressure gradient distributions offer insights into the likelihood of subsequent PCI success. The pullback pressure gradient (PPG) serves as a quantifiable measure of CAD patterns: values approximating 1 signify focal disease, while values approaching 0 suggest diffuse disease. This study aimed to assess the impact of pathophysiological CAD patterns on the safety and efficacy of PCI. Methods PPG Global was a prospective, investigator-initiated, multicenter study, single-arm that enrolled patients with at least one lesion with an FFR ≤ 0.80 scheduled to be treated by PCI. The study enrolled 1004 patients (1057 vessels). A standardised physiological assessment was performed, including online PPG calculation from manual FFR pullbacks. CAD patterns were defined as predominantly focal or diffuse disease based on the median PPG value. The study was powered to ascertain the predictive capacity of PPG for optimal PCI results (defined as FFR≥0.88 after PCI) as assessed by the AUC. Immediate PCI outcomes were assessed using post-PCI FFR and CFR. Following PCI, biomarkers (troponin) were collected. An independent clinical events committee adjudicated periprocedural myocardial infarction. The assessment of peri-procedural myocardial infarction (MI) adhered to the criteria outlined in the 4th Universal Definition of Myocardial Infarction. Target vessel failure (TVF) was defined as cardiac death, myocardial infarction and target vessel revascularisation. Results One thousand and four patients with 1057 vessels were included. The mean FFR was 0.68 ± 0.12, PPG 0.62 ± 0.17, post-PCI FFR 0.87 ± 0.07, and post-PCI CFR was 3.19 ± 1.93. PPG was significantly correlated with the change in FFR after PCI (r=0.65, 95% CI: 0.61-0.69, p<0.001) and showed an area under the curve of 0.82 (95% CI: 0.79-0.84) to predict optimal revascularisation. Suboptimal FFR (<0.88) after an angiographically successful PCI occurred in 471 vessels (53.5%) and was significantly higher in patients with diffuse disease (37.1% vs 74.0%, p<0.001). The change in CFR was sixfold higher in patients with high PPG (delta CFR focal 1.18 ± 1.94 and diffuse 0.19 ± 1.52, p<0.001). The rate of in-hospital TVF was similar between patients with focal vs diffuse disease (5.1% vs 8.5%, p=0.060). The incidence of periprocedural MI was significantly higher in patients with diffuse disease (5.9% vs 9.8%, p=0.050; OR 1.83, 95% CI 1.02 to 3.34). Conclusions Pathophysiological CAD patterns distinctly affect the safety and efficacy of PCI. PCI in focal disease was associated with improved physiological outcomes and a lower rate of periprocedural myocardial infarction compared to diffuse disease. Quantifying PPG before intervention reliably predicted post-PCI FFR. Further investigation through a randomised trial is warranted to explore the potential advantages of a PPG-guided PCI strategy.PPG and Revascularisation OutcomesPPG and FFR correlation Pre and Post-PCI

Twelve-month outcome of robotic assisted PCI

Abstract Background Robotics in interventional cardiology (R-PCI) is a technique with high potential for optimising the outcome of patients with coronary heart disease. In order to compare R-PCI with conventional, manual PCI (M-PCI), it is necessary to analyse both the index procedure during the initial hospital stay and, in particular, the long-term outcome. Methods We report twelve-month follow up data of our prospective FRiK registry, started in mid 2021. This registry focuses on success rates and safety, radiation dose of patients and personnel as well as long-term outcome (after 6 and 12 months). Moreover, R-PCI is compared with M-PCI in these categories. Results 73 patients received R-PCI. PCI success rate was 100%, with 17.8% requiring manual assistance. Rate of complications (MACE - major adverse cardiovascular events) was 0%. Compared with 152 M-PCI patients, treated by the same interventionalists, there was a higher median procedural time (diagnostic and intervention) 102.5 (82.8-123.5) min vs. 73 (51-101.5) (p<0.001) and fluoroscopy time 18.3 (14.4-26.6) min vs. 16.2 (9.8-23.4) min (p=0.037) in R-PCI patients. However, there was no significant difference between the dose-area product 4062 (2337-5990) cGycm² vs. 3747 (2238-5904) cGycm² (p=0.878) and contrast volume use 180 (140-250) ml vs. 180 (135-235) ml (p=0.370, figure 1). Twelve months after the intervention, all patients in both groups were alive. R-PCI and M-PCI had comparable rates of rehospitalisation (11.4% vs. 8.1%, p=0.903) and unscheduled PCI (4.3% vs. 2.7%, p=0.932, figure 2). Target vessel failure occurred in one vs. two patients in the R-PCI and M-PCI group, respectively (1.4% vs. 1.3%, p=0.932). Conclusion R-PCI showed a high success rate, low rates for need of manual assistance, and a very high safety profile without any complications. Also at 12-month follow-up, R-PCI was comparable to the M-PCI in all categories.Comparison of procedural characteristicsComparison of twelve-month outcome

TCT-817 Impact of Pulmonary Hypertension on Outcomes of PCI in Acute Myocardial Infarction: A Contemporary 5-Year Nationwide Analysis

TCT-817 Impact of Pulmonary Hypertension on Outcomes of PCI in Acute Myocardial Infarction: A Contemporary 5-Year Nationwide Analysis

TCT-257 Impact of Diabetes on Coronary Artery Disease Patterns and PCI Outcomes

TCT-257 Impact of Diabetes on Coronary Artery Disease Patterns and PCI Outcomes

TCT-282 Real-World Outcomes of Impella-Guided PCI in STEMI Patients With Cardiogenic Shock: A Nationwide Analysis From 2016 to 2020

TCT-282 Real-World Outcomes of Impella-Guided PCI in STEMI Patients With Cardiogenic Shock: A Nationwide Analysis From 2016 to 2020

TCT-274 Trends and Outcomes of Impella-Supported PCI in NSTEMI Patients With Cardiogenic Shock

TCT-274 Trends and Outcomes of Impella-Supported PCI in NSTEMI Patients With Cardiogenic Shock

TCT-71 Technological Advances Are Associated With Better Clinical Outcomes of PCI in Patients With Unprotected Left Main Disease

TCT-71 Technological Advances Are Associated With Better Clinical Outcomes of PCI in Patients With Unprotected Left Main Disease

Impact of Proximal LAD Lesions on Long-term PCI Outcomes in Pakistani Patients

Impact of Proximal LAD Lesions on Long-term PCI Outcomes in Pakistani Patients

“Bitter-Sweet Symphony”: Comparing PCI Outcomes in Diabetics and Non-Diabetics in a Busy West of Sydney PCI Centre

“Bitter-Sweet Symphony”: Comparing PCI Outcomes in Diabetics and Non-Diabetics in a Busy West of Sydney PCI Centre

Coronary Artery Calcium and Aging: Physiological Basis, Assessment, and Treatment Options in Percutaneous Coronary Intervention.

Coronary artery calcification is a complex anatomical and histological pathology with different pathways that contribute to calcium deposit and calcification progression. As part of the atherosclerotic process, extensive calcifications are becoming more common and are associated with poorer PCI outcomes if not properly addressed. Since no drug has shown to be effective in changing this process once it is started, proper knowledge of the underlying pathogenesis and how to diagnose and manage it is essential in contemporary coronary intervention. Atherosclerosis is a pandemic disease, quickly spreading across the world and not limited anymore to the industrialized Western world. In this paper, we review the role of intracoronary imaging and the main technologies available and propose a simple and rational algorithm for the choice of a preferential first strategy in the treatment of severely calcified coronary atherosclerosis, followed by three emblematic cases on how we successively applied it.

Angiographic and clinical impact of balloon inflation time in percutaneous coronary interventions with sirolimus-coated balloon: A subanalysis of the EASTBOURNE study

IntroductionPercutaneous coronary intervention (PCI) with drug-coated balloon (DCB) is an attractive strategy for the treatment of obstructive coronary artery disease (CAD). The implantation technique strongly influences the outcome of DCB PCI: accurate and adequate lesion preparation, short delivery time and sufficient DCB inflation time are deemed crucial to warrant adequate drug transfer and mitigate the risk of immediate vessel recoil and flow-limiting dissections. However, the optimal DCB inflation time is unclear, current consensus documents suggesting 30–60 s based on Experts' opinion. However, clinical studies comparing the prognostic role of different inflation times are scarce and mainly involve paclitaxel-coated balloons. In this study we aimed to assess the impact of different inflation times in patients undergoing PCI with a sirolimus-coated balloon (SCB). MethodsWe conducted a post-hoc analysis of the prospective, multicenter, EASTBOURNE study, classified into two study groups according to balloon inflation time: long (>30 s) versus short (≤30 s). The primary endpoint was target lesion revascularization (TLR) at 24-month follow-up. Secondary clinical endpoints were major adverse clinical events (MACE), death, non-fatal myocardial infarction (MI), and BARC 2–5 bleedings. Furthermore, angiographic endpoints (the rate of bailout stenting and post-procedural TIMI flow <3) were also addressed. ResultsA total of 2289 lesions (2092 in the long inflation group, 197 in the short inflation group) were included in the analysis. Median balloon inflation time was 60 s in the long inflation and 30 s in the short inflation group. The two study groups experienced a similar rate of TLR [6.2 % in the short versus 6.3 % in the long inflation group, p = 1.00] as well MACE (p = 0.683), death (p = 0.102), non-fatal MI (p = 0.822), and BARC 2–5 bleedings (p = 0.252). These results were consistent when considering subpopulations with different target lesion phenotypes (in-stent restenosis, de-novo lesions, large and small vessels). Interesting, the rate of bailout stent implantation and post-procedural TIMI flow <3 was higher in the short SCB inflation time, as compared to the standard strategy. ConclusionsShort vs. long SCB inflation time is associated with a higher need of bailout stenting after PCI with SCB, with similar clinical outcomes at 24-month follow-up.

The Impact of Sickle Cell Disease on Acute Coronary Syndrome and PCI Outcomes: A Retrospective Observational Study

Introduction: Sickle cell disease (SCD) is a genetic disorder that is widely observed on a global scale and known for its substantial negative impact on health and mortality. The purpose of this research was to explore how SCD influences the outcomes of acute coronary syndrome (ACS) and Percutaneous Coronary Intervention (PCI). Methods: A retrospective observational analysis was conducted using the National Inpatient Sample (NIS) data for the year 2020. Adult patients with concurrent ACS and SCD diagnoses were included in the study. Demographic information, clinical characteristics, in-hospital outcomes, and PCI complications were examined and compared between ACS patients with and without SCD. Results: Among a total of 779,895 ACS patients, 1495 had coexisting SCD. SCD patiets exhibited distinct demographic features, such as younger age (mean age: 59 vs. 66 years), predominantly female (53% vs. 35%), and primarily African American (91% vs. 11%). Comorbid conditions such as hypertension and chronic lung disease were more prevalent in SCD patients. While inpatient mortality odds did not significantly differ, SCD patients demonstrated slightly shorter lengths of stay in cases of STEMI and NSTEMI/UA. Notably, SCD patients faced a statistically significant increased risk of coronary dissection, highlighting a unique complication in this population. Although an increased incidence of atrial fibrillation and acute heart failure was observed in SCD patients, statistical significance was not achieved. Conclusions: This study provides valuable insight into the intricate interplay between SCD and ACS outcomes. SCD patients presented with distinctive demographic and clinical profiles that influenced their experience with ACS. The elevated risk of coronary dissection emphasizes the necessity for tailored interventions and careful management in SCD patients. These findings underscore the need for further research to elucidate underlying mechanisms and optimize treatment strategies for individuals with both SCD and ACS.

The potential of triglyceride-glucose index in improving the prediction of post-percutaneous coronary intervention clinical outcomes: a systematic review and meta-analysis

Introduction Despite percutaneous coronary intervention is the current preferred reperfusion modality, the incidence of major adverse cardiovascular events (MACE) is still high. Currently, GRACE score is used for predicting PCI outcomes. The TyG (triglyceride-glucose) index, a potential predictor based on insulin resistance of cardiovascular disease, has not been considered in the GRACE score. Objective To assess the potential of the TyG index in predicting cardiovascular adverse clinical outcomes in patients undergoing PCI. Method Following PRISMA guidelines, the authors reviewed literature from five databases. We included studies investigating post-PCI outcomes based on the TyG index level. Effect size was estimated using RevMan to calculate pooled odds ratio and mean difference, and R software to perform diagnostic test accuracy. Results Overall, 31,671 post-PCI patients with acute coronary syndrome were included in this study. A significant difference in TyG index was found between patients who experienced MACE and those who did not [MD: 0.3 (0.2–0.4), p < .05]. Higher TyG index was strongly correlated with higher MACE [OR: 2.01 (1.45–2.77), p < .05], especially revascularization [OR: 2.40 (1.72–3.36), p < .05], followed by myocardial infarction [OR: 1.80 (2.41–2.86), p < .05], death [OR: 1.36 (0.86–2.15), p = .19], and stroke [OR: 1.09 (0.79–1.50), p = .59]. Tyg Index showed 55% sensitivity, 60% specificity, and 0.612 accuracy. The addition of the TyG index to the GRACE scoring improved the predictive model’s AUC (0.746 vs. 0.809). Conclusion This systematic review and meta-analysis comprises evidence-based results for the correlation of TyG index and post-PCI outcomes, demonstrating modest sensitivity, specificity, accuracy, and enhanced predictive value of GRACE score.

A-32 | Nationwide Analysis of the Outcomes of Multivessel PCI versus Culprit Vessel-Only PCI in Patients With NSTEMI: A Nationwide Retrospective Observational Study

A-32 | Nationwide Analysis of the Outcomes of Multivessel PCI versus Culprit Vessel-Only PCI in Patients With NSTEMI: A Nationwide Retrospective Observational Study

A-36 | In-hospital Outcomes of PCI in patients admitted for spontaneous coronary artery dissection (From a National Population-Based Cohort Study Between 2016-2020)

A-36 | In-hospital Outcomes of PCI in patients admitted for spontaneous coronary artery dissection (From a National Population-Based Cohort Study Between 2016-2020)

OR6-9 | Recent Trends in PCI Outcomes for Older Acute Coronary Syndrome Patients with a History of CABG: 2016-2020

OR6-9 | Recent Trends in PCI Outcomes for Older Acute Coronary Syndrome Patients with a History of CABG: 2016-2020

Effect of non-alcoholic fatty liver disease on outcome of primary pci in non-diabetic stemi patients

Effect of non-alcoholic fatty liver disease on outcome of primary pci in non-diabetic stemi patients

Ten-year outcomes post percutaneous coronary intervention in cardiac transplant recipients

BackgroundCardiac allograft vasculopathy (CAV) is one of the major late causes of mortality in cardiac transplant recipients beyond the first year. Given the lack of longer term data for PCI in cardiac transplant recipients, we report ten year follow up of such cardiac transplant recipients who underwent PCI at Mayo Clinic. MethodsA retrospective observational study was conducted that included cardiac transplant recipients who underwent PCI at the Mayo Clinic. Continuous variables were presented as mean (SD) or median (IQR) and discrete variables were presented as frequency (percentage). ResultsThirty-eight consecutive cardiac transplant recipients underwent PCI from January 1, 1995, to June 30, 2023, at the Mayo Clinic. The median age of the cohort was 61.00 years (IQR:51.00–70.00) comprised predominantly of men (65.80%), and 47.40% of the cohort presented with an acute coronary syndrome. The antirejection therapy prior to the PCI included steroids (47.30%), cyclosporine (26.30%), tacrolimus (15.80%), mycophenolate (42.10%), azathioprine (13.10%), & sirolimus (31.57%). Intravascular ultrasound during PCI was utilized in 10.50% of the cases. The median time duration between heart transplant and PCI was 9.00 years (IQR:6.00–13.00 years). Two individuals needed repeat heart transplant for severe CAV. In hospital mortality was 5.20% and the long-term median survival was 7.20 years with a 10-year mortality rate of 65.70%. ConclusionsThis is the first publication reporting ten-year outcomes for PCI in cardiac transplant patients. The salient features for our cohort were a 65.70% mortality rate at 10 years and a median survival of 7.20 years.

Impact of Sickle Cell Disease on Acute Coronary Syndrome and PCI Outcomes

Impact of Sickle Cell Disease on Acute Coronary Syndrome and PCI Outcomes