PCI In Patients Research Articles

Prognostic Impact of Decline in Platelet Count in Underwent in PCI

Background: Reduced platelet count after PCI has occurred as a potential predictor of patients’ outcomes over the past few years. Defining post-PCI platelet count reduction as above, a significant relationship between post-PCI platelet reduction and adverse clinical events such as bleeding, thrombocytopenia and higher mortality was observed. Objective: The purpose of this research was to determine the significance of platelet count reduction for the prognosis of PCI patients. Methods: This prospective analysis was carried out at Department of Cardiology, PAEC Hospital, Islamabad, from 1st August 2024 till 31st December 2024. The study included 213 patients with CAD who underwent PCI. The inclusion criteria included that patients were ≥18 years of age. Secondary end points were BARC adjudicated bleeding events and all-cause mortality. Gastrointestinal bleeding was categorized as minor (BARC types 1 and 2), and major (BARC types 3 and 5) Results: The mean age of the participants was 63.2 ± 10.5 years, with males contributed to (71.8%). The most frequent coexisting conditions were hypertension in (52.6%) of cases and diabetes mellitus in (37.1%) of cases; there was no significant difference in the prevalence of comorbidities among the groups (p=0.653, p=0.950, respectively). MI was in the significant decline group (27.9%) as compared with moderate (10.2%) and minimal decline groups (5.6%), p < 0.01. Conclusions: According to our study, larger post-PCI drop in platelet count is related to increased risk of MI, ST, TVR, major bleeding events and death. These results suggest that platelet count should be checked periodically and appropriate interventions should be offered to enhance patient’s prognosis.

Patterns of medication use and potential drug-drug interactions in post-PCI patients: A study from Iran

BackgroundPost-percutaneous coronary intervention (PCI) patients often require complex medication regimens to prevent adverse cardiovascular events. However, these regimens can lead to potential drug-drug interactions (pDDIs) and polypharmacy, posing significant clinical challenges. This study aims to evaluate the pattern of medication use, prevalence, and correlates of pDDIs and polypharmacy among post-PCI patients in Shiraz, Iran. MethodsA cross-sectional study was conducted on 9019 PCI patients in Shiraz. Patient data, including demographics, medical history, and medication lists, were collected and analyzed. The Anatomical Therapeutic Chemical (ATC) classification system was applied. pDDIs were identified using the Lexicomp database, and their severity was classified. Factors associated with significant pDDIs and polypharmacy were assessed using multivariable modeling. ResultsThe study found that 91.6 % of patients received statin prescriptions and 94.5 % were on antiplatelet therapy. Notably, 82.8 % were identified with at least one pDDI, with 80.4 % having significant interactions (Categories C, D, or X). Common potential interactions included aspirin with clopidogrel and rosuvastatin. Polypharmacy was prevalent in 73.6 % of patients, associated with higher risks of interactions. Factors such as polypharmacy, male gender, diabetes mellitus, and heart failure were significant predictors of pDDIs. ConclusionsThe study underscores the high prevalence of pDDIs and polypharmacy among post-PCI patients, revealing a critical gap between clinical guidelines and drug interaction databases. Updating interaction databases to reflect current clinical practices and enhancing collaboration between database developers and guideline authors are essential for improving medication safety and patient outcomes.

Timing of inopressor initiation in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Introduction Inotropes and vasopressors (inopressors) are commonly used in the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS). The characteristics of patients subjected to early or late initiation of inopressors are not yet described, and the impact of timing on outcomes remains uncertain. Purpose This retrospective real-world data study aims to identify patient-, treatment-, and outcome characteristics of AMICS patients treated with early- or late initiated inopressors. Methods The Netherlands Heart Registration (NHR) prospectively records baseline, procedural, and outcome data for PCI patients. Between 2017-2021, additional retrospective data on CS patients were collected by fourteen Dutch hospitals. Patients were categorized based on the timing of inopressor initiation, either early (pre PCI) or solely late (at the cathlab or within 24 hours after PCI). Patients presenting with an out of hospital cardiac arrest were excluded. Missing data were imputed through multiple imputation (30x). Multivariable logistic regression analysis was performed to evaluate the association between the timing of inopressor initiation and 30-day mortality, adjusting for univariate significant confounders among variables known at admission. Results A total of 956 consecutive CS patients were included of whom 418 (43.7%) and 538 (57.3%) patients were subjected to early and late initiation of inopressors respectively. The most frequently used drug in both groups was noradrenaline. At baseline, patients in the early initiation group were younger (67.4 vs. 70.0 years, p <0.001), presented with a lower mean arterial pressure (MAP) (72.5 vs. 76.3, p = 0.048) and higher lactate (4.2 vs. 3.6, p = 0.012), and presented with a NSTEMI more often (36.0% vs. 14.2%, p <0.001). They also had a higher prevalence of previous myocardial infarction (33.9% vs. 22.9%, p <0.001) and previous CABG (14.3% vs. 6.2%, p <0.001). Moreover, 30-day mortality rates were higher in the early initiated group (48.6% vs. 37.6%, pLogrank <0.001). After multivariate adjustment for age, admission MAP and lactate, early inopressor initiation remained independently associated with 30-day mortality (OR 1.44, 95%-CI 1.08-1.98) compared to late initiation. Conclusion In this Dutch cohort of CS patients undergoing PCI, baseline- treatment- and outcome characteristics differed between patient categories receiving either early or late initiated inopressors. Patients who were subjected to early initiated inopressors were younger, presented with worse hemodynamics, had a more extensive cardiovascular medical history and higher 30-day mortality rates. The results of this study reemphasize the importance of identifying patients who benefit from inopressors.30-day mortality late vs. earlyTable patient characteristics

A study of intracoronary thrombolytic agents in high thrombotic burden lesions during primary PCI

Abstract Objectives High thrombus burden during Primary PCI begets worst possible outcomes, studies on adjunctive intracoronary thrombolytic agents show heterogeneous1,2 results & have limited long term follow-up. Although early studies support mechanical thrombectomy devices, larger randomized trial show that they are not able to reduce the MACE3, 4. There is no randomised clinical data for sustained mechanical thrombectomy devices till now. Purpose of the study The main purpose of this study is to analyse long term outcomes of low bleeding risk group patients undergoing Primary PCI with high thrombus burden, receiving intracoronary thrombolytic agents as an adjunctive therapy. Methods In this prospective observational single centre study, we analysed one year follow-up data of 108 consecutive primary PCI patients with high thrombus burden (G4, G5) and low bleeding risk, who were stratified into two groups basing on whether they receive intracoronary thrombolytic agent as an adjunctive agent before stent implantation. The primary outcome was NACE (Net Adverse Clinical Events, which include MACE, Death, ST/MI, major bleeding events), secondary outcomes include the individual components of the primary outcomes when analysed separately. Results The primary outcome events occurred in 21 patients (26%) in Primary stent group(PS, n=80), whereas it occurred in 2 patients(6%) in primary intra coronary thrombolysis group(PIT, n=28). Log-Rank (Mantel Cox) NACE curves show that PS group has high events when compared to PIT group(26% Vs 7%, p value – 0.042, Hazard ratio - 2.56; 95% CI - 0.76 – 8.57), there is no statistically significant difference in all other key secondary outcome event curves. Conclusion In patients presenting with STEMI, undergoing primary PCI, with high thrombus burden & low bleeding risk group, those receiving intracoronary thrombolytic agent as the adjunctive therapy before stent implantation, are able to reduce the NACE event rates during the one year of follow-up.Fig1:Log Rank (Mantel Cox) NACE curve

Prognostic Value of Estimated Glucose Disposal Rate and Systemic Immune-Inflammation Index in Non-Diabetic Patients Undergoing PCI for Chronic Total Occlusion.

Chronic total occlusion (CTO) is a complex lesion of coronary artery disease (CAD) with a detection rate of approximately 25% on coronary angiography. CTO patients generally experience poor quality of life and prognosis. This study aims to evaluate the association between the estimated glucose disposal rate (eGDR), a surrogate marker for insulin resistance (IR), and the prognosis of CTO PCI patients, as well as to investigate the potential role of the systemic immune-inflammation index (SII) in this process. We retrospectively included 1482 non-diabetic patients who underwent successful CTO PCI at Anzhen Hospital between January 2018 and December 2021. The primary endpoint was major adverse cardiovascular events (MACEs). Clinical characteristics, biochemical markers, and interventional records were collected, and the eGDR and SII were calculated. Cox regression, restricted cubic splines (RCSs), receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves were used to assess associations. MACEs occurred in 158 patients (10.67%). Patients with MACEs had lower eGDR and higher SII levels. A high eGDR significantly reduced MACE risk (Q4 vs. Q1: HR 0.06, 95% CI 0.03-0.12), while a high SII increased it (Q4 vs. Q1: HR 3.32, 95% CI 1.78-6.33). The combination of low eGDRs and high SIIs predicted the highest MACE risk (HR 4.36, 95% CI 2.71-6.01). The SII partially mediated the relationship between eGDR and MACEs. A low eGDR and high SII are significant predictors of poor prognosis in non-diabetic CTO PCI patients. Combining the eGDR and the SII provides a comprehensive assessment for better predicting cardiovascular outcomes.

Impact of Routine Case Volume on Door-to-Device Time for Primary PCI Patients: The Concept of a Designated Primary PCI Cath Lab at a Large Volume Cardiac Center

Impact of Routine Case Volume on Door-to-Device Time for Primary PCI Patients: The Concept of a Designated Primary PCI Cath Lab at a Large Volume Cardiac Center

ST Segment Resolution in Post Primary PCI Patients at Lady Reading Hospital Peshawar

Background: Primary Percutaneous coronary interventions is the standard of care for ST segment elevation. There is strong association of ST segment resolution and short and long term clinical outcomes in STEMI patients after reperfusion. This is a simple, convenient and easily available tool to evaluate reperfusion therapy and predict clinical outcomes.Objective: To find out ST Segment Resolution in ST elevation MI patients undergoing Primary PCI at Lady Reading Hospital PeshawarMaterials and Methods: A descriptive cross-sectional study was conducted at cardiology department lady reading hospital Peshawar. The study population consisted of admitted STEMI Patients with successful primary PCI.Twelve lead surface ECG obtained before and 30 minutes after successful PCI. Percentage ST Resolution (STR) was calculated for the single lead with maximal ST elevation. Patients were divided into two groups 1. Those with Complete STR (>70% STR) and 2. Patients with Incomplete STR (<70% STR).Results: Between 2nd Jan 2023 to 30th November 2023, 213 STEMI were included in the study. Mean presentation time from symptom onset was 3.97 ±1.99 SD hours, while FMC to device time was 80min. Complete ST segment resolution was noted in 73% patients. Patients with no complete ST segment resolution were elderly and had longer presentation time for PCI. Also this was more frequent in LAD territory than RCA. Conclusion: PPCI is associated with high rates of STR in STEMI patients with significantly higher rates of STR if offered earlier and in younger patients.Keywords: Primary PCI, ST resolution, ST elevation MI

Three years' registry on myocardial perfusion imaging patients in Ain shams university nuclear cardiology unit

Abstract Background The development in nuclear myocardial perfusion imaging (MPI) has provided diagnostic and prognostic implications in CAD patients, leading to an explosive increase in the performanceofthesestudies. Thisexpansionofimagingspectrumisassociatedwithwidespread concern regarding imaging utilization and increased healthcare costs. There is no comparative data that guide the use of these modalities with respect to appropriateness and patients’ benefit. Targeted data collection, through registry studies, enable analysis of both quality and outcomes with big advantages of reflecting real world daily practice and identifying the gaps in care which may not otherwise be feasible in high-quality randomized control trials. Objective To explore the extent to which stress myocardial perfusion imaging (MPI) studies met published appropriate use criteria (AUC), and the real world practice in the nuclear cardiology unit of Ain shams University. Patients and Methods It was a retrospective cohort study that included 2598 patients who underwent myocardial perfusion imaging in Ain Shams university nuclear cardiology unit throughout the period from January 2017 to December2019. All patients were subjected to thorough demographic data, history of cardiovascular risk factors (arterial hypertension, diabetes mellitus, smoking, family history of premature cardiovascular diseases), indication of the test, preprocedural ECG, ejection fraction by echocardiography, previous coronary angiography and PCI or CABG, calculation of pretest probability and Framingham risk score, determination of appropriateness use criteria and stress-rest Tc 99m imaging to detect the presence of ischemia and one day Tc 99m imaging to detect viability. Results The study included 2598 patients with mean age of 57.76 years, with male predominance (68.1%), 38.2% were diabetics and 53% had hypertension. The most common indications to undergo MPI was the exclusion of CAD as a cause of chest pain in 38.8% of patients followed by the evaluation of symptomatic post PCI patients in 21.9%. Moreover 63.8% of patients showed appropriate tests, while 18.6% of patients showed uncertain tests. Whereas 17.6% of patients had inappropriate studies. 81% of appropriate tests showed positive results of SPECT. Whereas in the inappropriate and the uncertain category, the negative test for ischemia predominated. Conclusion We have established that appropriateness criteria are effective in identifying appropriateness of SPECT in a university center located in Cairo. Also, we concluded that in our unit the appropriate tests were more prominent than inappropriate and unclassified tests. Most of the appropriate studies were positive for ischemia. While, most of the inappropriate and uncertain tests were normal and the commonest cause of referral for MPI was exclusion of CAD as a cause of chest pain.

Anxiety, depression and sleep problems in PCI patients: a cross-lag panel analysis

Anxiety, depression and sleep problems in PCI patients: a cross-lag panel analysis

The Risk Factors and Hospital Mortality of Percutaneous Coronary Intervention Patients in Prepandemic and During Pandemic COVID-19: A Systematic Review

Highlights: 1. COVID-19 pandemic remains one of the interesting subject to discuss due to its large scale impact. 2. PCI is one of the popularly known method to screen COVID-19, however, depending on the prior screening, this may or may not be conducted. Thus, its frequency is reviewed in this study. - Backgroud: The COVID-19 pandemic is a global health issue that impact healthcare systems. COVID-19 infections affect the risk factors and mortality in patients undergoing PCI. The aim of this study is to determine the differences in risk factors and mortality rates of patients undergoing PCI before and during the COVID-19 pandemic. Method: We performed a systematic search on risk factors and hospital mortality of PCI patients in prepandemic and during pandemic COVID-19. Study reporting patient after year 2022 are excluded. The article published between 2019 - 2022. The literature selection was conducted following the PRISMA algorithm. Result: Eight journals were utilized, ensuring their relevance, compatibility, and adherence to the inclusion and exclusion criteria. In this study, it is explained that there has been a decrease in the number of patients undergoing PCI procedures during the COVID-19 pandemic. The increase of risk factor and there is no significant different hospital mortality of PCI patients before and during pandemic.

The Evaluation of Stent Patency Using Computed Angiography Following Left Main Coronary Artery Stenting

The increased chances of in-stent restenosis have led to repeated coronary angiography and left main percutaneous coronary intervention. However, for the evaluation of coronary arteries, computed tomography angiography (CTA) is regarded as a non-invasive intervention. Objectives: To evaluate the proportion of in-stent restenosis in the left main PCI and to determine the diagnostic efficacy of CTA in detecting in-stent restenosis. Methods: We conducted this study from June 2021 to July 2022. 130 patients were chosen for the study among the 300 LM PCI patients. The CTA was conducted 3 months after the LM PCI. The data were collected and entered into the SPSS software and the descriptive analysis was conducted. Results: In our study, the majority of the patients (n=92, 70.8%) of the patients undergoing PCI from the LM to LAD, and the number of patients who went from LM to LCX was 19 patients (14.6%). Only 14.6% of the patients in our study had bifurcation PCI and all 130 (100%) patients had DES. The average period for the development of ISD was 11 months. Conclusions: CTA is quite efficient in accurately assessing the selected patients who have undergone LM PCI and CTA can be utilized as the 1" line treatment modality.

Abstract 18211: Does Frailty Matter in High Risk PCI

Background: There are limited data depicting the relationship between frailty and in-hospital outcomes for high-risk PCI. Methods: The Cath-PCI registry (2018 - 2020) was used to examine the association of frailty as defined by the Canadian Study of Health and Aging (CSHA) frailty index and in-hospital complications for patients undergoing PCI. We conducted a logistic regression analysis for in-hospital mortality. Results: The sample size was 1,316,390 individuals aged ≥ 65 years undergoing PCI. The frailty distribution was: 78,921 not frail (6.0%), 892,695 pre-frail (67.8%), 284,444 frail (21.6%), and 60,330 severely frail (2.2%). The median age of patients who were frail was 76 years, 39.4% were female, and 87.2% were white. In-hospital rates for any bleeding stratified by frailty status were: not frail: 1.0%, pre-frail: 1.5%, frail 3.3%, severely frail 8.9%. The adjusted odds ratio (aOR) regarding in-hospital mortality among PCI patients at high bedside mortality risk for pre-frail, 2.58 (95% CI: 1.42 - 1.80) for frail, and 5.14 (95% CI: 4.56 - 5.80) for severely frail. The adjusted association for in-hospital mortality across sub-groups stratified by frailty status was: left main PCI ~ pre-frail aOR 1.44 (95% CI: 1.01 - 2.05), frail aOR 2.18 (95% CI: 1.53 - 3.11) and severely frail aOR 3.98 (95% CI: 2.79 - 5.70). While the aORs for chronic total occlusion were ~ pre-frail 1.57 (95% CI: 0.97 - 2.52), frail 2.31 (95% CI: 1.43 - 3.75) and severely frail 6.04 (5.40 - 6.75) and cardiogenic shock ~ pre-frail 1.33 (95% CI: 1.08 - 1.64), frail 1.54 (95% CI: 1.25 - 1.90) and severely frail 2.44 (1.99 - 3.00). Conclusions: Contemporary PCI is commonly performed on frail patients. Frailty is associated with higher risk of mortality across high-risk PCI categories; however, severe frailty depicts a distinct and exceptionally high-risk cohort.

Nursing Intervention Including Meditation and Physiotherapeutic Treatment in Post PCI Chest Pain (Non-Ischemic)

OBJECTIVE: To determine the effectiveness of nursing educational interventions on patients with post PCI non-ischemic chest pain. METHODOLOGY: This experimental study was conducted from December 2017 to May 2018 on 100 post PCI patients. Patients who came with post PCI non-ischemic chest pain and on initial screening on the Numerical Rating Scale (NRS) patients scored 5 to 10 were included. Those who had post PCI ischemic chest pain with complications were excluded from the study. The Short McGill Pain Questionnaire (SMPQ) was used to assess the effectiveness of nursing educational interventions. Analysis of data was performed on SPSS version 21. Percentages were used for categorical variables, and inferential statistics were calculated using the Mann-Whitney Test. Mean and S.D. were calculated at baseline, week two, week four, and week six for both experimental and non-experimental groups. A P-value of 0.05 was considered significant. RESULTS: This study's findings showed that most participants (74%) were males and almost all (99%) were married. The P-value is significant at different intervals between the experimental and control groups at two, four and six weeks with P-values <0.001, <0.001, and <0.001, respectively. CONCLUSION: The findings of this study revealed that nursing interventions help reduce post PCI non-ischemic chest pain levels. This study demonstrates that after nurse-led educational interventions, there were significant differences in scores between interventional and non- interventional groups at different levels after PCI. KEYWORDS: Percutaneous Coronary Intervention, Chest Pain, Numerical Rating Scale, Short McGill Pain Questionnaire.

Outcomes of patients with myocardial infarction and cardiogenic shock treated with culprit vessel-only versus multivessel primary PCI

Introduction and objectivesMultivessel primary percutaneous coronary intervention (pPCI) is still often used in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and multivessel coronary disease (MVD) treated with culprit vessel-only pPCI or multivessel-pPCI during the initial procedure. Material and methodsFrom 2016 to 2020, 23,703 primary PCI patients with STEMI were included in a national all-comers registry of cardiovascular interventions. Of them, 1,213 (5.1%) patients had CS and MVD at admission to the hospital. Initially, 921 (75.9%) patients were treated with culprit vessel (CV)-pPCI and 292 (24.1%) with multivessel (MV)-pPCI. ResultsPatients with 3-vessel disease and left main disease had a higher probability of being treated with MV-pPCI than patients with 2-vessel disease and patients without left main disease (28.5% vs. 18.6%; p < 0.001 and 37.7% vs. 20.6%; p < 0.001). Intra-aortic balloon pump, extracorporeal membrane oxygenation (ECMO), and other mechanical circulatory support systems were more often used in patients with MV-pPCI. Thirty (30)-day and 1-year all-cause mortality rates were similar in the CV-pPCI and MV-pPCI groups (odds ratio, 1.01; 95% confidence interval [CI] 0.77 to 1.32; p = 0.937 and 1.1; 95% CI 0.84 to 1.44; p = 0.477). The presence of 3-vessel disease and the use of ECMO were the strongest adjusted predictors of 30-day and 1-year mortality. ConclusionsOur data from an extensive all-comers registry suggests that selective use of MV-pPCI does not increase the all-cause mortality rate in patients with CS-STEMI and MVD compared to CV-pPCI.

Effect of Elevated Lp(a) on Long-Term Outcomes for PCI Patients

Effect of Elevated Lp(a) on Long-Term Outcomes for PCI Patients

Measuring Adverse Cardiovascular Outcomes (MACE) in diabetic vs nondiabetic Primary PCI (PPCI) patients suffering from STEMI in PIC, Lahore

Abstract&#x0D; Introduction:&#x0D; All over the world, particularly in developing countries, Coronary Artery Diseases (CADs) are a major cause of significant morbidity and mortality. Primary PCI (PPCI) is the standard of emergency care in patients suffering from STEMI. The major cardiovascular outcomes (MACE) may be different in diabetic and nondiabetic patients.&#x0D; Objective:&#x0D; This article aims at comparing major adverse cardiovascular outcomes in diabetic and nondiabetic STEMI patients going through pPCI.&#x0D; Study design:&#x0D; Descriptive case series&#x0D; Study setting:&#x0D; Emergency Department, Punjab Institute of Cardiology (PIC), Lahore.&#x0D; Methodology:&#x0D; A total of 245 patients were included out of which 85 were diabetic and 160 were nondiabetic. Post-PPCI in-hospital outcomes were recorded: mortality, cerebrovascular accident, acute and subacute stent thrombosis, heart failure, acute kidney injury and arrhythmias.&#x0D; Results: &#x0D; With mean age of 50.3 ± 9.7 years; mean BMI of 28.0 ± 2.0 kg/m2, risk factors included hypertension (73), family history of IHD (23) and smoking (81). Post-PPCI in hospital outcomes in 85 diabetics were as follows: mortality 0, heart failure in 1 (1.18%), acute stent thrombosis 0; acute kidney injury in 8 patients (9.41%). Among 160 nondiabetic patients, post PPCI outcomes were as follows: mortality 2 (1.25%), heart failure 4 (2.5%), acute stent thrombosis 1 (0.6%) and acute kidney injury 6 (3.75%). The only significant association among PPCI following STEMI and in-hospital outcomes was with acute kidney injury (P = 0.069).&#x0D; Conclusion:&#x0D; For acute STEMI, following the primary percutaneous intervention (PPCI), results among diabetic and nondiabetic patients seem to be favorable in terms of major undesirable outcomes and possible to achieve in PIC, Lahore. PPCI is associated with larger success rate, low mortality rate and complication rates. The hospital's experiences and results can be very valuable in establishing PPCI networks in our nation.&#x0D; Keywords: &#x0D; Primary PCI, Acute STEMI, MACE.

Survival after PCI or CABG for left main stem coronary stenosis. A single institution registry from the NOBLE study period

Objective. To analyze 10 years mortality in an all-comers registry of patients with left main coronary artery stenoses treated with either PCI or CABG. Design. Patients with left main coronary stenoses treated with either PCI or CABG in the period of the NOBLE trial (2010–2015) were all included in an institutional database and registry (University Hospital North Norway). Fifty-six of totally 429 patients were included in the randomized, multicenter and international NOBLE trail; 426 eligible patients from the trial and registry were analyzed for mortality on 20 October 2020. The longest observation time on this date was 3611 days (9.9 years); 205 patients were treated with PCI and 221 with CABG. The patients treated with PCI were 74 ± 10 years vs 68 ± 10 years (CABG). Also, on average the PCI patients had more comorbidities (lower ejection fraction, more peripheral artery disease, more often acute presentation). Results. Survival at the last observation date was 80% for CABG patients vs 48% for PCI. A Cox proportional hazards analysis found PCI to be the strongest independent predictor for mortality (HR = 2.5, 95% CI 1.7–3.7). Also, COPD, chronic kidney disease, age, peripheral vascular disease, cerebrovascular incidents and acute presentation were factor predicting increased 10 years mortality. Conclusion. These data indicate that life expectancy in the overall patient population is shorter for patient treated for left main disease with PCI than with CABG.

Disparity in coronary artery dimensions in diabetic and non-diabetic population undergoing quantitative coronary angiography in South India: a 2-year prospective analysis

Diabetic subjects have higher prevalence as well as increased risk for coronary artery disease than non-diabetic counterparts. The study was aimed to seek the disparity of vessel diameters among diabetic and non-diabetic patients undergoing quantitative coronary angiography (QCA). The objectives were to compare coronary artery measurements (CAM) between diabetic and non-diabetic patients and also to find the respective segment of coronary artery affected greatest among diabetics by QCA. A cross sectional study was conducted in four cities of India after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study. Among total sample population, non-flow limiting coronaries were seen in 1100(27.5%) cases [167 in NFL diabetic and 933 in NFL non-diabetic group]. We had 2890 (72.2%) patients with diseased coronaries. Ten segments of the coronary arteries were taken for diameter measurements namely, LMCA, LAD (O, P), DIAG, LCx (O, P), OM, RCA (O, P), RAM. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m2BSA). For all arterial segments both indexed and non-indexed measurements of diabetic patients with NFL coronaries had significantly (p&lt;0.01) smaller arterial segments except for RCA-o. Reduced dimensions after post balloon dilatations of PCI, diffused lesions can result in increased chances for in-stent restenosis among diabetics leading to poor outcome following PCI.

Multi-Slice Computed Angiography for The Evaluation of Stent Patency After Left Main Coronary Artery Stenting

Due to the high frequency of in-stent restenosis, repeat coronary angiography and left main percutaneous coronary intervention is recommended. But Computed Tomography Angiography is a noninvasive procedure for evaluating coronary arteries. Objectives: To assess the proportion of InStent restenosis in left main per-Cutaneous coronary intervention and to evaluate diagnostic efficacy of Computed Tomography Angiography in detecting In stent Restenosis. Methods: We assessed 263 consecutive LM PCI patients; 130 patients were chosen for this study procedure as they meet our criteria. CTA was conducted three months following the LM PCI. Results: The vast majority of patients (73.8 %) had PCI from LM to LAD and 16.2 % from LM to LCX. Only 10% of patients had bifurcation PCI, and all patients had DES (100%). The average period for ISR development was 125 months, with ISR rates of 32.2 % in the LM to LAD cohort and 38 % in the LM to LCX cohort. The median time between PCI and CTA was 194 days, with a mean basal heart rate of 69 ± 12 beats per minute. CTA exhibited a positive predictive value of 84.7%. Conclusion: CTA enables an accurate noninvasive assessment of selected patients following LM PCI. And CTA can be used as a first-line treatment instead of coronary angiography.

Impact of Complete or Incomplete Revascularization for Left Main CoronaryDisease: The Extended PRECOMBAT Study.

Whether complete revascularization (CR) or incomplete revascularization (IR) may affect long-term outcomes after PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease is unclear. The authors sought to assess the impact of CR or IR on 10-year outcomes after PCI or CABG for LMCAdisease. In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) 10-year extended study, the authors evaluated the effect of PCI and CABG on long-term outcomes according to completeness of revascularization. The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCE) (composite of mortality from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization). Among 600 randomized patients (PCI, n=300 and CABG, n=300), 416 patients (69.3%) had CR and 184 (30.7%) had IR; 68.3% of PCI patients and 70.3% of CABG patients underwent CR, respectively. The 10-year MACCE rates were not significantly different between PCI and CABG among patients with CR (27.8% vs 25.1%, respectively; adjusted HR: 1.19; 95%CI: 0.81-1.73) and among those with IR (31.6% vs 21.3%, respectively; adjusted HR: 1.64; 95%CI: 0.92-2.92) (P for interaction=0.35). There was also no significant interaction between the status of CR and the relative effect of PCI and CABG on all-cause mortality, serious composite of death, myocardial infarction, or stroke, and repeat revascularization. In this 10-year follow-up of PRECOMBAT, the authors found no significant difference between PCI and CABG in the rates of MACCE and all-cause mortality according to CR or IR status. (Ten-Year Outcomes of PRE-COMBAT Trial [PRECOMBAT], NCT03871127; PREmier of Randomized COMparison of Bypass Surgery Versus AngioplasTy Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT], NCT00422968).