Complication Of Percutaneous Coronary Intervention Research Articles

Usefulness of Adding Pre-procedural Glycemia to the Mehran Score to Enhance Its Ability to Predict Contrast-induced Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention Development and Validation of a Predictive Model

The Mehran score is the most widely accepted tool for predicting contrast-induced acute kidney injury (CI-AKI), a major complication of percutaneous coronary intervention (PCI). Similarly, abnormal fasting pre-procedural glycemia (FPG) represents a modifiable risk factor for CI-AKI, but it is not included in current risk models for CI-AKI prediction. We sought to analyze whether adding FPG to the Mehran score improves its ability to predict CI-AKI following PCI. We analyzed 671 consecutive patients undergoing PCI (age 69 [63,75] years, 23% females), regardless of their diabetic status, to derive a revised Mehran score obtained by including FPG in the original Mehran score (Derivation Cohort). The new risk model (GlyMehr) was externally validated in 673 consecutive patients (Validation Cohort) (age 69 [62,76] years, 21% females). In the Derivation Cohort, both FPG and the original Mehran score predicted CI-AKI (AUC 0.703 and 0.673, respectively). The GlyMehr score showed a better predictive ability when compared with the Mehran score both in the Derivation Cohort (AUC 0.749, 95%CI 0.662 to 0.836; p=0.0016) and the Validation Cohort (AUC 0.848, 95%CI, 0.792 to 0.903; p=0.0008). In the overall population (n=1344), the GlyMehr score confirmed its independent and incremental predictive ability regardless of diabetic status (p ≤0.0034) or unstable/stable coronary syndromes (p ≤0.0272). In conclusion, adding FPG to the Mehran score significantly enhances our ability to predict CI-AKI. The GlyMehr score may contribute to improve the clinical management of patients undergoing PCI by identifying those at high risk of CI-AKI and potentially detecting modifiable risk factors.

Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in Patients with Periprocedural Myocardial Injury.

Background Periprocedural myocardial injury (PMI) is a most common complication of percutaneous coronary intervention (PCI). Microembolization and inflammation underlying PMI could lead to coronary microvascular dysfunction (CMD) and vice versa. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI. Methods 268 patients suspected with stable coronary artery disease (CAD) and scheduled for elective coronary angiography were enrolled. RHI was measured by using the Endo-PAT2000™ device before angiography. The association among RHI, PMI, and cardiovascular events was further assessed. Results In this cohort, 189 patients (70.5%) were diagnosed with CAD and 119 patients (44.4%) underwent drug-eluting stent (DES) implantation. Compared with patients without CAD, CAD patients had lower RHI (1.88 ± 0.55 vs. 2.02 ± 0.58, P < 0.05). Patients with PMI had a lower RHI before angiography (1.75 ± 0.37 vs. 1.95 ± 0.50, P < 0.05). Receiver operating characteristic curve analysis of RHI revealed an area under the curve (AUC) of 0.61, with a sensitivity of 62.7% and specificity of 50.0% to predict PMI. Moreover, we found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07–10.22, P < 0.05). Conclusions RHI assessment through PAT could be a promising method to predict PMI before the procedure. RHI is associated with increased risk of long-term adverse cardiac events after DES implantation.

Pericardial tamponade after chronic total occlusion revascularization: a case report and literature review

Pericardial tamponade is a complication of percutaneous coronary intervention (PCI) with extremely high mortality. The rupture of coronary artery causes hypotension and shock, eventually resulting in death due to pericardial tamponade. Because of the complex operation in revascularization of chronic total occlusion (CTO-PCI) lesion, the incidence of pericardial tamponade increases. Usually, we use coronary angiogram to identify the rupture of coronary artery after PCI by the contrast agent. We presented a 67-year-old woman with pericardial tamponade after CTO revascularization. She had chest pain and out of breath for nearly two years. The coronary angiogram showed three branch lesion and CTO lesion of the right coronary artery (RCA). After revascularization of the RCA CTO lesion, the pericardial effusion and low blood pressure occurred, but we didn't find the leak of contrast agents during the final angiography. Then the patient was transferred to cardiac surgery department for emergency thoracotomy. They found the hematoma on the surface of the RCA and finally discharged without any symptoms. Our case approved: (I) there was still the possibility of coronary artery rupture even the coronary angiogram showed no contrast agent leakage from the coronary artery after PCI; (II) the combined use of IVUS and coronary angiogram may improve the accuracy and safety of CTO revascularization procedure.

Inflammation during Percutaneous Coronary Intervention-Prognostic Value, Mechanisms and Therapeutic Targets.

Periprocedural myocardial injury and myocardial infarction (MI) are not infrequent complications of percutaneous coronary intervention (PCI) and are associated with greater short- and long-term mortality. There is an abundance of preclinical and observational data demonstrating that high levels of pre-, intra- and post-procedural inflammation are associated with a higher incidence of periprocedural myonecrosis as well as future ischaemic events, heart failure hospitalisations and cardiac-related mortality. Beyond inflammation associated with the underlying coronary pathology, PCI itself elicits an acute inflammatory response. PCI-induced inflammation is driven by a combination of direct endothelial damage, liberation of intra-plaque proinflammatory debris and reperfusion injury. Therefore, anti-inflammatory medications, such as colchicine, may provide a novel means of improving PCI outcomes in both the short- and long-term. This review summarises periprocedural MI epidemiology and pathophysiology, evaluates the prognostic value of pre-, intra- and post-procedural inflammation, dissects the mechanisms involved in the acute inflammatory response to PCI and discusses the potential for periprocedural anti-inflammatory treatment.

Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection

ObjectiveTo investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer...

Clinical Outcomes of Self-Made Polyurethane-Covered Stent Implantation for the Treatment of Coronary Artery Perforations.

Objectives The present study aimed to investigate the short- and long-term clinical outcomes of self-made polyurethane-covered stents (PU-CS) in patients for the management of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI). Background Coronary artery perforation is reckoned as a serious complication in PCI and associated with considerable morbidity and mortality. Covered stents have been used for treating the life-threatening CAP during PCI. But in some catheterization laboratories, no commercial CS is immediately available when there is an urgent need for CS to rescue the coronary rupture site. Methods We retrospectively identified 24 patients who underwent 31 self-made PU-CS implantations due to CAP in Zhongshan Hospital, Fudan University, from June 2015 to January 2020. Results The total procedural success rate of CS to seal the perforation was 79.2%. Nine patients (37.5%) developed cardiac tamponade, of which 8 patients (33.3%) underwent pericardiocentesis and 4 patients (16.7%) underwent cardiac surgeries. Except for 4 cardiac death cases (16.7%), none of myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) was reported during hospital stay. Data from 22 patients (91.7%) were available at 610.4 ± 420.9 days of follow-up. Major adverse cardiac events (MACE) occurred in 6 patients (27.3%), including 5 cases of cardiac death and one TLR case. Conclusions Self-made PU-CS demonstrates high rates of successful delivery and sealing of severe CAP during PCI. Although the in-hospital mortality remains high after PU-CS implantation, the long-term follow-up shows favorable clinical outcomes, indicating the feasibility of PU-CS in treating CAP.

Stimulator of Interferon Genes (STING) regulates Re‐endothelialization Following Vascular Injury

Percutaneous coronary interventions (PCI) are commonly used to improve blood flow in Peripheral Artery Disease. Complications of PCI are delayed re-endothelialization and endothelial cell (EC) dysfunction leading to adverse clinical outcomes. Stimulator of Interferon Genes (STING), canonically activated downstream of the cGAS enzyme, is a signaling hub molecule modulating immune responses triggered by self-derived and/or foreign DNA. We hypothesized that EC-intrinsic STING regulates re-endothelialization in response to vascular injury. We modeled PCI in WT, STING-/-, and in a newly generated inducible vascular EC- specific mouse (VECad5Cre-ERT2STINGfl/fl mice: EC-STING-/-) using the wire induced carotid injury model. We used Evans Blue Dye injection post injury to identify the areas denuded of EC and quantified the % of non-blue (re-endothelialized) area. We found that WT mice had complete re-endothelialization five days post injury (95.16 ± 2.77 %). In contrast, injured carotid arteries in STING-/- mice exhibited a decrease in re-endothelialization at the same timepoint (43.57 ± 9.79%). Moreover, EC-STING-/- mice recapitulated the delayed re-endothelialization (10.45 ± 1.56% in Tamoxifen treated mice to induce excision of STING in EC, compared to 40 ± 1.28% observed in vehicle treated VECad5Cre-ERT2STINGfl/fl control mice 5 days post scratch) in the injured arteries, supporting a role of EC STING in re-endothelialization post injury. To further investigate this EC-specific effect of STING mechanistically in vitro, we performed scratch assays on WT and STING mouse heart EC (MHEC) monolayers, as well as on human EC monolayers lacking STING after CRISPR knock down and imaged wound healing in real time by IncuCyte. WT MHEC and HUVEC completely covered the scratch area within 24 hours, and 4 hours, respectively, whereas both EC lacking STING were delayed healing the scratch. Additionally, we found that the healing response was independent of cGAS, since cGAS KD HUVEC had similar post- scratch recovery time as control HUVEC. Ongoing experiments investigate the mechanisms involved in this novel STING dependent, cGAS-independent pathway of EC response to injury, as well as the consequences of EC-STING in adverse chronic vascular remodeling.

Colchicine to Prevent Periprocedural Myocardial Injury in Percutaneous Coronary Intervention: The COPE-PCI Pilot Trial.

Periprocedural myocardial infarction and injury (PM-injury) are the most common complications of percutaneous coronary intervention (PCI) and are associated with future adverse cardiac events. Inflammation plays a pivotal role in the development of PM-injury. In this randomized pilot trial, we assessed the effect of an anti-inflammatory medication colchicine on periprocedural myocardial injury. Patients undergoing PCI for stable angina or non–ST-segment–elevation myocardial infarction were randomized to oral colchicine (1 mg followed by 0.5 mg 1 hour later) or placebo, 6 to 24 hours preprocedure. Blood samples were taken immediately pre- and 24-hours post-PCI. The primary outcome, periprocedural myocardial infarction, was defined by an increase in post-PCI troponin >5×99th% upper reference limit when the pre-PCI troponin was normal, or >20% increase in post-PCI troponin when the pre-PCI troponin was raised, including supporting evidence of new myocardial ischemia. Major PM-injury was defined as per periprocedural myocardial infarction without supporting evidence of new myocardial ischemia. Minor PM-injury was defined by post-PCI troponin increase >99th% upper reference limit but ≤5×99th% upper reference limit. A total of 196 patients met inclusion criteria and were randomized. One hundred twenty-one patients were excluded (no PCI, unstable troponin before PCI, or poor-quality measurements) leaving a study population of 75 patients. Thirty-six patients were randomized to colchicine and 39 to placebo preprocedure. Forty-four presented with non–ST-segment–elevation myocardial infarction and 31 with stable angina. High-sensitive (hs) troponin-I pre-PCI was similar between treatment groups (colchicine: 79 ng/L [4–1336] versus placebo: 35 [5–448], P=0.42). Absolute change in hs-troponin-I (calculated as 24-hour post-PCI minus pre-PCI measurements) was significantly lower in the colchicine group: 59 (1–221) versus placebo: 166 (53–530), P=0.02. No patients developed periprocedural myocardial infarction in either group. Significantly fewer patients developed major PM-injury: 11 (31%) versus 21 (54%), P=0.04 or minor PM-injury: 21 (58%) versus 33 (85%), P=0.01, if given colchicine pre-PCI. In this randomized pilot trial, colchicine given 6 to 24 hours pre-PCI reduces periprocedural myocardial injury.

Trends in contrast-induced acute kidney injury rate after percutaneous coronary interventions in coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Contrast-induced acute kidney injury remains one of the dangerous complications of percutaneous coronary interventions, in spite of the evolution of contrast media and prevention strategies. Many researchers assume that this syndrome is not as frequent as it used to be and its clinical importance is overestimated. Purpose. The aim of the study was to assess the rates of contrast-induced acute kidney injury in a prospective study in patients with chronic coronary syndromes after percutaneous coronary interventions in 2012 and 2017 respectively. Methods. 1023 patients with chronic coronary syndromes and indications for the interventions with intra-arterial contrast media administration were included in the prospective open cohort study. 561 patients were enrolled in 2012 and 462 in 2017 respectively. The contrast media remained the same both in 2012 and 2017. Preventive measures included the administration of 0,9% saline 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after procedure. The primary endpoint was the development of contrast-induced acute kidney injury. Results. The incidence of contrast-induced acute kidney injury decreased more than 3 times in 2017 than in 2012 (6% vs. 18,5%, 28 patients vs 104 patients respectively). The difference was statistically significant (p &amp;lt; 0,0001). The patients included in the study in 2017 were older, had higher body mass index and had more risk factors, than the ones enrolled in 2012. We organised several conferences for all the cardiologist involved in the treatment of patients undergoing percutaneous coronary intervention, as well as were printing materials describing the risk assessment and preventive measures that should be done in patients with chronic coronary syndromes before percutaneous coronary interventions (eg, stopping metformin and nephrotoxic drugs). Conclusion. The prevalence of contrast-induced acute kidney injury is decreasing not only due to the evolution of contrast media and preventive strategies, but also due to the higher level of education of all the doctors about the syndrome and its prognosis, as well as available preventive measures and treatment options.

Imaging Features of Complications after Coronary Interventions and Surgical Procedures.

Coronary artery interventions and surgical procedures are used in the treatment of coronary artery disease and some congenital heart diseases. Cardiac and noncardiac complications can occur at variable times after these procedures, with the clinical presentation ranging from asymptomatic to devastating symptoms. Invasive coronary angiography is the reference standard modality used in the evaluation of coronary arteries, with intravascular US and optical coherence tomography providing high-resolution information regarding the vessel wall. CT is the mostly commonly used noninvasive imaging modality in the evaluation of coronary artery intervention complications and allows assessment of the stent, lumen of the stent, lumen of the coronary arteries, and extracoronary structures. MRI is limited to the evaluation of the proximal coronary arteries but allows comprehensive evaluation of the myocardium, including ischemia and infarction. The authors review the clinical symptoms and pathophysiologic and imaging features of various complications of coronary artery interventions and surgical procedures. Complications of percutaneous coronary interventions are discussed, including restenosis, thrombosis, dissection of coronary arteries or the aorta, coronary wall rupture or perforation, stent deployment failure, stent fracture, stent infection, stent migration or embolism, and reperfusion injury. Complications of several surgical procedures are reviewed, including coronary artery bypass grafting, coronary artery reimplantation procedure (for anomalous origin from opposite sinuses or the pulmonary artery or as part of surgical procedures such as arterial switching surgery and the Bentall and Cabrol procedures), coronary artery unroofing, and the Takeuchi procedure. Online supplemental material is available for this article. ©RSNA, 2021.

Sinus Node Dysfunction due to Occlusion of the Sinus Node Artery during Percutaneous Coronary Intervention.

Background Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO. Methods We retrospectively reviewed 1379 consecutive PCI's involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months. Results Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex's proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month. Conclusion SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.

Abstract P577: An Association Between CHADS-VASc Score Morbidities, Coronary Artery Disease Severity, and Post-Elective Percutaneous Coronary Intervention Stroke and Death

Background: The CHADS-VASc score is a clinical prediction tool used to assess stroke risk in patients with atrial fibrillation or flutter. An association between CHADS-VASc score morbidities and outcomes of elective percutaneous coronary intervention (PCI) has not been well studied. Methods: This cohort study utilized 2015 NY State Angioplasty Registry data and included 33,568 consecutive patients. Patients with prior CABG, shock, or acute coronary syndrome (ACS) within 24-hours of PCI placement were excluded. CHADS-VASc score was calculated by adding 1 point each for positive history of congestive heart failure (CHF), diabetes mellitus (DM), vascular disease, age 65-75 years old, female sex, and 2 points each for age &gt;75 years old and history of stroke. As the Registry does not record history of hypertension, the calculated score used 0 for hypertension in all patients. Results: In the studied cohort, 68.4% were males, mean age 65.5 +/- 11.5 years old. Increased burden of CHADS-VASc morbidities was associated with more advanced CAD, including 3 vessel and left-main (LM) CAD. Of patients with CHADS-VASc score of 0, 16.3% had 3 vessel disease and 0.7% had LM disease, score of 3 had 20% 3 vessel disease and 2.3% LM disease, and score of 6 and/or 7 had 31.2% 3 vessel disease and 5.7% LM disease (p&lt;0.0001). Increased burden of CHADS-VASc morbidities was also associated with increasing incidence of post-elective PCI stroke and mortality. Stroke was observed in 0.03% of cases with score of 0, 0.3% of cases with score of 3, and 1.4% of cases with score of 6 and/or 7 (p&lt;0.0001). Mortality rate was 0.05% in patients with score of 0, 0.7% with score of 3, and 1.4% in patients with score of 6 and/or 7 (p&lt;0.0001). Conclusions: This pilot study indicates that increased burden of CHADS-VASc morbidities is associated with more advanced CAD and increased incidence of post-elective PCI stroke and mortality. These data suggest that the simple CHADS-VASc calculation may be useful in identifying patients at greater risk of post-elective PCI complications, aid in estimating patient prognosis, and provide a reference point for clinicians contemplating PCI in stable CAD patients.

Entrapment of Broken Guidewire in the Coronary Artery: A Rare Percutaneous Coronary Intervention Complication Requiring Urgent Revascularization

Entrapment of Broken Guidewire in the Coronary Artery: A Rare Percutaneous Coronary Intervention Complication Requiring Urgent Revascularization

Stent-Graft Treatment of Anterior Interventricular Artery Extravasation Type IIICS: a Clinical Case

Background . Every percutaneous coronary intervention (PCI) is potentially causative of severe surgical accidents. Routine manipulations with catheters, guidewire, delivery systems or stents can damage vascular walls leading to immediate complications like extravasation. In interventional cardiology, ruptures occur in 0.19–0.93% of PCI cases. The endovascular surgeon is to immediately react in case of an accident and decide on further action to repair the coronary artery rupture. Materials and methods . The article describes a clinical case of a PCI complication, extravasation type IIICS, during a routine stenting of anterior interventricular artery. Stent­grafting at rapture was decided upon conclusive analysis of the situation. Results and discussion. A percutaneous coronary intervention, including routine surgery, potentially poses diverse complications. Extravasation is an expectable complication type. The endovascular surgeon must be sufficiently experienced to decide on an appropriate tactics. The outcome of stent­graft implantation was satisfactory. Conclusio n. Stent­graft placement may be a method of choice in a PCI complication of surgery like extravasation type IIICS.

Early stent thrombosis confirmed in a cancer patient receiving regorafenib, despite triple antithrombotic therapy: a case report

BackgroundWhile developments in oncology have lengthened survival in patients with cancer, such patients often develop cardiovascular diseases. Thus, percutaneous coronary intervention (PCI) is frequently undertaken in them. Although stent thrombosis remains a fatal complication in stent-based PCI, worldwide consensus panels tend to recommend shorter duration of dual-antiplatelet therapy. This is based on its clinical efficacy that has resulted from technological innovation. However, there is insufficient discussion on the risk of stent thrombosis in cancer patients with coronary artery disease, especially in those undergoing chemotherapeutic regimens that have a risk for thrombosis, such as regimens with the anti-vascular endothelial growth factor. Presented here is a case of early stent thrombosis that occurred in a cancer patient on regorafenib, despite the administration of triple antithrombotic therapy.Case presentationA 66-year-old Japanese male patient received regorafenib for metastatic colorectal carcinoma and apixaban for deep vein thrombosis. Coronary angiography revealed severe stenosis in the proximal left anterior descending artery. A sirolimus-eluting stent was implanted, without malapposition and under-expansion, under intravascular ultrasound guidance while administering a triple antithrombotic therapy (aspirin: 100 mg/day, prasugrel: 3.75 mg/day, and apixaban: 5 mg/day). However, he was admitted to the hospital for exacerbation of heart failure 1 month after PCI. Coronary angiography revealed contrastive defects in the previous stent. Optical frequency domain imaging confirmed stent thrombosis. PCI was successfully performed with perfusion balloon long-inflation. Antithrombotic therapy was enhanced (aspirin: 100 mg/day, ticagrelor: 120 mg/day, and apixaban: 10 mg/day) and regorafenib was discontinued permanently. While ischemic events did not occur thereafter, the patient died due to metastatic carcinoma progression.ConclusionsThis case suggests that anti-vascular endothelial growth factor might contribute to early stent thrombosis, despite triple antithrombotic therapy. Further discussion is needed on the surveillance and management of cancer patients with coronary artery disease receiving chemotherapy, which carries a risk of thrombosis.

Prevalence, clinical determinants and prognostic implications of coronary procedural complications of percutaneous coronary intervention in non-ST-segment elevation myocardial infarction: Insights from the contemporary multinational TAO trial

Few data are available on procedural complications of percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome in the contemporary era. We sought to describe the prevalence of procedural complications of PCI in a non-ST-segment elevation acute coronary syndrome (NSTE ACS) cohort, and to identify their clinical characteristics and association with clinical outcomes. Patients randomized in TAO (Treatment of Acute coronary syndrome with Otamixaban), an international randomized controlled trial (ClinicalTrials.gov Identifier: NCT01076764) that compared otamixaban with unfractionated heparin plus eptifibatide in patients with NSTE ACS who underwent PCI, were included in the analysis. Procedural complications were collected prospectively, categorized and adjudicated by a blinded Clinical Events Committee, with review of angiograms. A multivariable model was constructed to identify independent clinical characteristics associated with procedural complications. A total of 8656 patients with NSTE ACS who were enrolled in the TAO trial underwent PCI, and 451 (5.2%) experienced at least one complication. The most frequent complications were no/slow reflow (1.5%) and dissection with decreased flow (1.2%). Procedural complications were associated with the 7-day ischaemic outcome of death, myocardial infarction or stroke (24.2% vs. 6.0%, odds ratio 5.01, 95% confidence interval 3.96-6.33; P<0.0001) and with Thrombolysis In Myocardial Infarction major and minor bleeding (6.2% vs. 2.3%, odds ratio 2.79, 95% confidence interval 1.86-4.2; P<0.0001). Except for previous coronary artery bypass grafting, multivariable analysis did not identify preprocedural clinical predictors of complications. In a contemporary NSTE ACS population, procedural complications with PCI remain frequent, are difficult to predict based on clinical characteristics, and are associated with worse ischaemic and haemorrhagic outcomes.

Unexpected Coronary Perforation Complicated by Cardiac Tamponade: A Case Report and How to Treat It

Coronary artery perforation is a rare but fatal complication of percutaneous coronary intervention. Cardiac tamponade constitutes the most severe clinical consequence. If not properly and promptly treated, it is burdened by a high mortality rate. This article report the case of an intra-stent coronary perforation after simple revascularization, followed by an immediate impairment of hemodynamic compensation, due to significant pericardial effusion and sub-sequent cardiac tamponade. While prompt surgical intervention may be lifesaving, expertise in the use of stent graft may provide a valuable rescue option for this serious complication. Interventional cardiologists should be able to recognize and know available treatment options of this serious complication.

Elevation of preoperative cystatin C as an early predictor of contrast-induced nephropathy in patients receiving percutaneous coronary intervention.

Introduction:Contrast-induced nephropathy (CIN) is a serious complication of percutaneous coronary intervention (PCI). The most important predictor of CIN is renal function before PCI. Serum creatinine (SCr) is a commonly used biomarker of renal function, but an elevation in SCr lags behind the onset of kidney injury and is not viable for early detection of CIN after PCI. Our primary objective was to investigate whether preoperative cystatin C (CysC) before PCI was an early predictor of postoperative CIN. The secondary objective was to evaluate associations between preoperative CysC and renal biomarkers.Methods:From December 2014 to December 2015, 341 patients with normal renal function were enrolled into the study at our medical centre. All patients were apportioned to normal CysC (≤1.03 mg/L) or high CysC (>1.03 mg/L) groups before PCI and were hydrated from four hours prior to PCI to 24 hours after it. Renal function was monitored at 48 hours after PCI. Clinical parameters were recorded before and after PCI.Results:There was no significant difference in preoperative SCr between the CIN and non-CIN groups. However, preoperative CysC demonstrated significant difference between the two groups (p <0.01). Logistic regression analysis showed that elevated CysC before PCI was a risk factor for CIN (p = 0.013). Furthermore, the linear regression models identified an association between CysC before PCI and renal function after PCI.Conclusion:CysC before PCI was viable as a biomarker of renal function after PCI and high preoperative CysC was able to predict CIN earlier than SCr.

The prevalence, management and outcomes of coronary artery perforations during percutaneous coronary intervention in patients with or without acute coronary syndromes.

Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention (PCI). The aim of this study was to compare early and late clinical outcomes of CAP in patients with or without acute coronary syndromes (ACS). A retrospective review was made of the procedural records of 15 878 patients who underwent PCI at two large tertiary centers between January 2012 and December 2018. A total of 51 (0.32 %) CAP cases were identified. Of the 51 CAP cases, 26 (51.0%) patients had ACS and 25 (49%) patients had stable coronary artery disease (CAD). The major cause of perforation was stenting (43%). Cardiac tamponade was more frequent in the ACS group than stable CAD group (34.6 vs. 8%; P = 0.024). Kaplan-Meier analysis showed that the overall 30-day cardiovascular mortality rate was higher in patients with ACS than stable CAD (23.1 vs. 0%; P = 0.011). At the 3-year follow-up examination, no statistically significant difference was determined between the two groups in respect of all-cause mortality (36.1 vs. 28.4%; P = 0.262). Multivariable Cox regression analysis demonstrated left ventricular ejection fraction (hazard ratio, 0.94; 95% CI, 0.89-0.99; P = 0.033) but not ACS at presentation (hazard ratio, 1.39; 95% CI, 0.37-5.20; P = 0.628) as a predictor of mortality at 3 years. Early clinical outcomes following CAP, including cardiac tamponade and 30-day cardiovascular mortality, were significantly worse in patients with ACS compared to stable CAD.

Practical utilization of cardiac computed tomography for the success in complex coronary intervention.

Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.