Outcomes Of PCI Research Articles

One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry

BackgroundChronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD).ObjectiveThe outcome following revascularization using contemporary technologies (new-generation abluminal sirolimus-eluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m2) and in patients with hemodialysis (HD) is unknown.Methodse-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year.ResultsA total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04–3.08]), target vessel failure (OR, 2.44 [95% CI 2.01–2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87–2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93–2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79–1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001).ConclusionIn this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up.Graphic abstractOne-year summary outcomes of contemporary PCI in renal insufficiency. CKD chronic kidney disease, POCE patient oriented composite endpoint, MACE major adverse cardiovascular events, TLF target lesion failure, TLR target lesion revascularization, ST stent thrombosis

Effect of Previous PCI on In-Hospital and Long Term Outcomes of the Subsequent PCI

Effect of Previous PCI on In-Hospital and Long Term Outcomes of the Subsequent PCI

P5522ST elevation myocardial infarction networks: relationship of hub-spoke distance with transfer time and clinical outcomes in rescue PCI

Abstract Background In the establishment of ST elevation myocardial infarction (STEMI) systems of care, transfer times between primary care units (PCU) and the cardiac catheterization lab (CCL) are pillars to therapeutic success. Objective: To analyze the relationship between PCU-CCL distance with transport time and main clinical outcomes in STEMI patients (p) treated with pharmaco-invasive therapy (PIT) and referred for rescue PCI after failed fibrinolysis. Methods Between January 2010 and December 2018, of the 2241 patients who received tenecteplase in PCU inserted in a large city STEMI network, 801 (35.7%) evolved without reperfusion criteria after 90 minutes (persistence of chest pain, less than 50% reduction on ST elevation or hemodynamic instability), being urgently transferred to the CCL. The PCU were divided according to the distance to the tertiary center in Group 1: between 5 and 9km (N=208p), Group 2: between 16 and 18km (N=315p) and Group 3: between 22 and 30km=266p). Considering an alpha of 0.05, sample size n=801 and an effect size of 0.11, a power of 0.80 was obtained. Results The groups were comparable for baseline features (Table 1). Group 2 (intermediate distances) had the highest median transport time (G1 260 interquartile 145–437 min vs G2 355 interquartile 206–573 min vs G3 241 interquartile 125–418 min; p&lt;0.01 for G2). There were no differences between the groups regarding cardiogenic shock (G1 24.5% vs G2 23.3% vs G3 24.1%, p=0.9) or in-hospital death (G1 17.4% vs G2 12.3% vs G3 13.0%, p=0.2). Table 1. Group's baseline features G1: Short distances G2: Intermediate distances G3: Long distances p value (5–9 km) N=208 (16–18 km) N=315 (22–30 km) N=266 Age (median) 57.5 (51–64) 57 (49–66) 59 (52–67) 0.27 Female 29.7% 28.3% 35.1% 0.19 Hypertension 67.3% 60.9% 64.4% 0.31 Diabetes 37.0% 32.1% 37.8% 0.30 Renal failure 10.3% 9.7% 6.3% 0.21 Anterior STEMI 56.1% 58.4% 62.4% 0.36 Pain-to-needle time (median min) 197.5 (137–330) 195 (120–295) 195 (125–345) 0.38 Conclusion In STEMI patients with failed fibrinolysis treated with pharmaco-invasive therapy, the PCU-CCL distance was not related to transfer time or to outcomes of in-hospital death and cardiogenic shock. The longer transport time of hospitals located at intermediate distance can possibly reflect local logistical difficulties and are not due to hub-spoke distance. Continuous improvement in structuring and coordination of public STEMI networks is aimed.

P45945-years clinical outcomes of patients underwent percutaneous coronary intervention for calcified lesions with rotational atherectomy and second-generation drug eluting stent

Abstract Background Percutaneous coronary Intervention (PCI) with rotational atherectomy (RA) was useful for severe calcified lesions. However, the long-term clinical outcomes of PCI with second-generation drug eluting stent (DES) following RA has been still unclear. Purpose The purpose of this study was to investigate the long-term clinical outcomes of RA followed by second-generation DES. Methods We retrospectively enrolled 254 consecutive patients treated with second-generation DES following RA. The primary outcome was the cumulative 5-year incidence of MACE, defined as cardiac death, myocardial infarction, clinically-driven target lesion revascularization and definite stent thrombosis. Results The incidence of MACE was 22.8% at 5-years. Multivariate analysis showed 3 predictors of MACE, hemodialysis, diabetic mellitus and extremely angulated lesions (&gt;90°).Significantly higher MACE was observed in the high-risk (≥2 risk factors) group, compared with the low-risk (2&lt; risk factors) group (68.7% vs. 18.7%, P&lt;0.001, Figure). Multivariate analysis for MACE at 5 year Hazard ratio (95% Confidence Interval) P-value Diabetic Mellitus 2.58 (1.35–4.91) 0.004 Hemodialysis 4.57 (1.64–12.76) 0.004 extremely angulated (&gt;90°) 3.08 (1.06–8.93) 0.04 Kaplan-Meier curves for 5-years MACE Conclusions The long-term clinical outcomes of PCI for severely calcified lesions was acceptable. However, the clinical outcomes of patients classified high risk cohort was unsatisfactory.

P3586Influence of morphological features of intracoronary thrombi on ST segment resolution in patients with STEMI after primary PCI

Abstract Background Coronary artery thrombosis is a key element in the onset of STEMI and its further course. Coronary clots significantly vary in their morphological features and types. Perhaps, it may be caused by individual differences in thrombus formation that could have a strong influence on STEMI course and prognosis. Purpose To elucidate the influence of morphological features of intracoronary thrombi (IT) on ST-segment resolution (the outcome) after primary PCI in patients with STEMI. Methods The study included 100 patients with STEMI (female 22%, male 78%) aged 57.81±10.26 years, who underwent PCI with manual thromboaspiration within the first 12 hours (mean 7.22±3.74 h) after the onset of symptoms. The obtained ITs were examined morphologically after hematoxylin &amp; eosin staining by the standard method and by the method proposed by prof. Zerbino that allows determining the antiquity of fibrin according to its color. Each IT was classified by five morphological features: 1) “old” or “fresh” (according to Zerbino's staining); 2) with or without layered structure; and presence or absence of 3) microchannels, 4) peripheral infiltration with neutrophil leukocytes, 5) elements of atherosclerotic plaque. Correlations between these features and incidence of ST-segment resolution in 60 minutes after primary PCI for more than 50% from baseline were analyzed. Results Neither IT antiquity nor presence of the atherosclerotic plaque elements had any significant correlations with ST-segment resolution. Significant positive correlation was revealed with peripheral neutrophil infiltration (r=0.42, p&lt;0.05), and negative correlations were found with layered arrangement IT (r=−0.31, p&lt;0.05) and presence of microchannels (r=−0.56, p&lt;0.05). Statistically significant mathematical prognostic model of ST-segment resolution was obtained after analysis of the co-influence of all five morphological features on the outcome using logistic regression method. It included three IT features significantly correlating with ST-segment resolution: Z = 1.13 − 0.51*V1 − 0.57*V2 − 0.94*V3 where V1 – IT with layered arrangement of fibrin, V2 – IT with microchannels' formation, V3 – IT with peripheral areas of infiltration by the neutrophil leukocytes (1 for the presence of the feature, 0 for its absence). “Old” IT with layered structure Conclusions Morphological features of IT in patients with acute STEMI appear to have significant influence on the primary PCI outcomes. They may be important predictors of the disease course and treatments efficacy. Further investigations of the IT peculiarities and their influences on the course of STEMI may help to improve therapy. Acknowledgement/Funding Study financial support was made by authors

Outcome of Primary PCI in STEMI Addict Patients

Outcome of Primary PCI in STEMI Addict Patients

Follow-Up Outcomes of Pre-Hospital Thrombolysis and Primary PCI in Outer Metropolitan Management of STEMI

Background: Primary PCI (pPCI) is preferred management with improved outcomes in STEMI [[1]Keeley E.C. et al.Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials.The Lancet. 2006; 367 (doi:10.1016/s0140-6736(06)68148-8): 579-588Abstract Full Text Full Text PDF PubMed Scopus (458) Google Scholar], however previous reviews demonstrate comparable, in-hospital results for early, pre-hospital thrombolysis in regional centres with large catchment zones [[2]May, A. et al. (2016). Review of In-Hospital Outcomes of Thrombolysis and Primary PCI in Outer Metropolitan Management of STEMI. Heart, Lung and Circulation, Volume 25, S63.Google Scholar]. Methods: Retrospective analysis of patients presenting with STEMI at two outer metropolitan centres over a 5-year period (2014–2019), where PCI was available during working hours, with a strategy of pre-hospital thrombolysis otherwise. Patients were excluded if incomplete data precluded follow-up. The primary outcome was a composite of major adverse cardiac events (MACE) including myocardial infarction (MI), unplanned revascularisation, readmission for heart failure and all-cause mortality. Secondary outcomes included severe bleeding, TIMI-III flow rates and death from any cause. Follow up was conducted to 1-year from the index event. Results: 450 consecutive patients presented with STEMI, with 425 analysed after exclusions. 117 (27.5%) underwent pPCI while 308 (72.5%) had initial thrombolysis. Average age was 63.9 years and 76.9% were male. Of the thrombolysis group, 56.5% successfully re-perfused while 43.5% required rescue PCI (rPCI) and 296 (96%) underwent coronary angiography. Rates of TIMI-III flow post angiogram were higher in the thrombolysis group 96.0% vs 85.9% (p = 0.0147). There were no significant differences in MACE at 1-month or 1-year or all-cause mortality. Major bleeding was higher at 1-month after thrombolysis 4.5% vs 2.6% (p = 0.36) but did not reach significance, likely due to inadequate power. Conclusion: Our experience shows pre-hospital thrombolysis remains a safe alternative to pPCI, especially in regional centres, with no clinically significant differences in 1- and 12-month outcomes.

Radial vs Femoral - A Paradigm Shift to Improve PCI Outcomes in Acute Coronary Syndromes

Radial vs Femoral - A Paradigm Shift to Improve PCI Outcomes in Acute Coronary Syndromes

New-generation drug-eluting stents for left main coronary artery disease according to the EXCEL trial enrollment criteria: Insights from the all-comers, international, multicenter DELTA-2 registry

BackgroundPercutaneous coronary intervention (PCI) has been established as an alternative treatment option to coronary artery by-pass graft (CABG) surgery in patients with left main coronary artery disease (LMCAD). Whether the findings of randomized controlled trials are applicable to a real-world patient population is unclear. MethodsWe compared the outcomes of PCI with new-generation DES in the all-comer, international, multicenter DELTA-2 registry retrospectively evaluating mid-term clinical outcomes with the historical CABG cohort enrolled in the DELTA-1 registry according to the EXCEL key inclusion or exclusion criteria. The primary endpoint was the composite of death, myocardial infarction, or stroke at the median time of follow-up time of 501 days. The consistency of the effect of DELTA-2 PCI versus DELTA-1 CABG according to the EXCEL enrollment criteria was tested using propensity score-adjusted Cox regression models. ResultsOut of 3986 patients enrolled in the DELTA-2 PCI registry, 2418 were EXCEL candidates and 1568 were not EXCEL candidates. The occurrence of the primary endpoint was higher among non-EXCEL candidates compared with EXCEL candidates (15.4% vs. 6.9%; hazard ratio 2.52; 95% confidence interval 2.00–3.16; p < 0.001). Among 901 patients enrolled in the historical DELTA-1 CABG cohort, 471 were EXCEL candidates and 430 were not EXCEL candidates. When comparing the DELTA-2 PCI with the DELTA-1 CABG cohort, the occurrence of the primary endpoint was lower in the PCI group compared with the historical CABG cohort among EXCEL candidates (6.9% vs. 10.7%; adjusted hazard ratio: 0.65; 95% confidence interval: 0.45–0.92), while no significant difference was observed among non-EXCEL candidates (15.4% vs. 12.5%; adjusted hazard ratio: 0.94; 95% confidence interval: 0.67–1.33) with evidence of statistical interaction (adjusted interaction p-value = 0.002). ConclusionsIn a real-world population, PCI can be selected more favorably as an alternative to CABG in patients fulfilling the enrollment criteria of the EXCEL trial.

TCT-256 Impact of Coronary Artery Tortuosity on PCI Outcomes: An Individual Patient-Data Pooled Analysis From 6 Randomized Controlled Trials

TCT-256 Impact of Coronary Artery Tortuosity on PCI Outcomes: An Individual Patient-Data Pooled Analysis From 6 Randomized Controlled Trials

TCT-370 Increased specialisation of Chronic Total Occlusion PCI improves success rates but increases procedural complexity: A single centre experience

Outcomes for chronic total occlusion (CTO) PCI have improved significantly. Putative reasons for this include improved strategies, devices and expertise. In this observational study we compared the outcomes of CTO PCI conducted in a large non-surgical cardiac centre before and after the

TCT-25 Radial artery access and outcomes for left main stem PCI: an analysis of 19,482 cases from the British Cardiovascular Intervention Society national database

Although the predictors and outcomes of radial versus femoral access are well defined for unselected PCI procedures and certain sub-groups, there are few data for patients undergoing left main stem percutaneous coronary intervention (LMS-PCI). The aim of the present study was to address these

TCT-531 Percutaneous Coronary Intervention versus Optimal Medical Treatment for Chronic Total Occlusion: A Meta-analysis

Previous studies comparing outcomes of PCI versus OMT for CTO lesions have shown conflicting results. Most patients with CTO are usually managed medically because of higher procedure complications and lower procedural success rates with PCI. We aimed to compare the outcomes of PCI versus optimal

P2727Success rate and clinical outcome of left main PCI in patients with AMI complicated by cardiogenic shock. Results of the ALKK-registry

P2727Success rate and clinical outcome of left main PCI in patients with AMI complicated by cardiogenic shock. Results of the ALKK-registry

P2646COMBO PCI outcomes in patients categorized by baseline PARIS bleeding risk score: from the global MASCOT registry

P2646COMBO PCI outcomes in patients categorized by baseline PARIS bleeding risk score: from the global MASCOT registry

OUTCOMES OF FFR-GUIDED PCI IN INTERMEDIATE CORONARY ARTERY LESIONS

Background: Indication for treatment of intermediate coronary artery lesions is wavering. Worldwide studies showed the role of FFR in guiding the treatment for these cases. Objective: To study the outcomes of FFR-guided PCI in intermediate coronary artery lesions. Method: Cohort study with comparative analysis of 12-month MACE between two groups: Medical treatment with FFR &gt; 0.8 and PCI with FFR ≤ 0.8. Results: 40 stenosis lesions with FFR ≤ 0.8 (57.14%) was treated by PCI and 30 stenosis lesions with FFR &gt; 0.8 treated by medical therapy. The percentage stenotic diameter cut-off was &gt;55.62% on QCA with Sp 60% and Se 75%. There was no significant difference in MACE between two groups after 12-month follow-up. Conclusions: FFR has important role in guiding treatment for intermediate coronary artery lesions. Key words: ffR-guided, coronary arery

TCTAP A-066 Effect of Controlled Blood Pressure on Outcomes of PCI in CKD Patients

TCTAP A-066 Effect of Controlled Blood Pressure on Outcomes of PCI in CKD Patients

Role of plasma levels of CA-125 in predicting outcome of primary PCI after acute myocardial infarction in male patients.

Introduction: Cancer antigen 125 (CA-125) is a tumor marker of ovarian cancer, which has shown to be increased in different cardiovascular diseases. Although the prognostic role of CA-125 in heart failure and coronary heart disease is well-established, there is little known about its role in acute myocardial infarction (AMI). In this study we aimed to evaluate the serum levels of CA-125 in patients with AMI and its prognostic role in evaluating the in-hospital outcome of AMI. Methods: We evaluated 120 male patients with AMI and 120 male normal subjects. CA-125 levels were measured upon the patient’s admission to hospital. The in-hospital major adverse cardiac events (MACE) and its predictors were also recorded for AMI patients. Results: CA-125 levels were significantly higher in AMI patients compared to normal subjects (7.99±6.83 vs. 5.70±4.62, P = 0.003). We found significant positive correlations between CA-125 levels with creatine kinase-MB (CKMB) (r=0.621, P < 0.001) and CTnI (r=0.491, P < 0.001). The in-hospital MACE was observed in 19 cases (15.8%). Patients with MACE had significantly higher value of CA-125, CKMB and CTnI and lower LVEF compared to patients without MACE. CKMB (OR=0.967, 95% CI [0.943-0.991], P = 0.007) and CA-125 levels (OR=0.821, 95% CI [0.688-0.979], P = 0.02) were independent predictors of MACE. Conclusion: Serum CA-125 levels are significantly higher in male patients with AMI compared to normal subjects and have a significant role in predicting in-hospital MACE after AMI. In patients with higher CA-125 more aggressive treatment and close observation should be performed in order to reduce the possible adverse outcomes.

Optical coherence tomography-guided percutaneous coronary intervention compared with other imaging guidance: a meta-analysis.

The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n = 1753) and OCT-guidance versus IVUS-guidance (n = 1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p = 0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p = 0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p = 0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p = 0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p = 0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p = 0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p = 0.47), MI (OR 0.56 [0.12, 2.70] p = 0.47), ST (OR 0.43 [0.06, 2.95] p = 0.39), and TLR(OR 0.99 [0.45, 2.18] p = 0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.

Abstract 21347: Percutaneous Coronary Intervention With Drug Eluting Stents is as Efficacious as Coronary Artery Bypass Grafting in Unprotected Left Main Disease: A Meta Analysis

Background: CABG is the preferred revascularization strategy for unprotected left main disease. Multiple small scale trials and registry data showed that PCI with Drug Eluting Stents is a non-inferior strategy and is a Class IIa ACC/AHA recommendation in a high surgical risk patient with favorable anatomy. However, two recent large scale randomized trials have shown conflicting evidence. We conducted a meta-analysis of the existing data to compare the long term outcomes of PCI with DES vs CABG for left main stenosis. Methods: 4 randomized and 8 non-randomized studies involving 10,284 patients were included. The primary endpoint was a composite of death, stroke or MI at three years or longer. Secondary end points were MACCE (death, stroke, MI or repeat revascularization) and it's individual components. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. The Mantel-Haenszel random effects model was used to calculate the combined odds ratio for outcomes. An independent analysis was performed for the randomized data only. Results: There was no significant difference in the primary composite outcome between PCI and CABG at long term follow up. However the MACCE was significantly higher in PCI, primarily driven by significantly high repeat revascularization. The stroke rate was lower in PCI, although not significant. Analysis of randomized data also yielded similar results. A subgroup analysis stratified by SYNTAX score showed that MACCE and repeat revascularization were not significantly different between PCI and CABG in low to intermediate SYNTAX score (&lt;33) while they were significantly higher in PCI in high SYNTAX score. Conclusion: There was no significant difference in the primary composite outcome between PCI with DES and CABG at long term follow up. Repeat Revascularization in PCI was also not different from CABG in left main stenosis with low SYNTAX score. PCI with DES can be considered as a reasonable alternate strategy in isolated left main stenosis.