Coronary Angiography Percutaneous Coronary Intervention Research Articles

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

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

FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH IHD

The aim of the study: to study the functional state of the kidneys in patients with ischemic heart disease (IHD) in the long-term period after myocardial revascularization. Material and research methods. The study included 160 patients with ischemic heart disease (IHD), hospitalized for coronary angiography and decisions on the appropriateness and choice of revascularization technique. The study did not include patients with eGFR less than 60 ml/min. All patients were prescribed standard IHD therapy. On the second day after the endovascular procedure, coronary angiography/percutaneous coronary intervention (CAG/PCI), all patients underwent determination of the blood creatinine concentration to identify patients who developed contrast-induced nephropathy (CIN). In dynamics, three months later, at the end of the first and second years of observation after revascularization, all patients underwent determination of the functional state of the kidneys: the concentration of blood creatinine, with the calculation of GFR, the concentration of parathyroid hormone, phosphorus, uric acid in the peripheral blood. According to the results of coronary angiography, 21 patients underwent surgical revascularization (coronary artery bypass grafting CABG) within a month after CAG. Endovascular revascularization (stenting of the coronary arteries) was performed in 139 patients. CIN in the early period after endovascular intervention was observed in 37 patients. The study showed that during 2 years of follow-up after coronary revascularization, there was a progressive decrease in eGFR: by the 3rd month, eGFR decreased by -17.39 ± 1.17%, by the end of the 1st year - by -43.62 ± 1.28%, by the end of the second year of follow-up - by -46.50 ± 1.79% The decrease in eGFR was significantly more pronounced in the group of patients who had CIN in the early period after endovascular intervention (37 patients): (-39 , 82 ± 2.02% by the end of the 3rd month, -54.61 ± 2.94% by the end of the 1st year and -60.10 ± 3.99% by the end of the 2nd year of follow-up versus -10, 65 ± 0.57%, -40.32 ± 1.27% and -42.41 ± 1.85% in patients with CIN, respectively, p <0.001). By the third month of follow-up, the dynamics of eGFR in the groups, depending on the revascularization method, did not differ (-16.36 ± 3.30% and -17.55 ± 1.25%, respectively). By the end of the 1st year of follow-up, in patients who underwent surgical revascularization, the decrease in eGFR was significantly more pronounced than in patients who underwent coronary artery stenting (-51.80 ± 3.51% versus -42.39 ± 1.35%, p <0.05), and the differences increased even more during the second year of observation (-57.99 ± 4.75% versus -44.76 ± 1.89%, p <0.05). Violation of the functional state of the kidneys was manifested by an increase in the concentration of blood phosphorus, parathyroid hormone and uric acid. The concentration of these markers increased during observation in parallel with a decrease in eGFR. The concentration of these substances was higher in patients after CIN. compared with patients with an uncomplicated postprocedural period. The concentration of uric acid was initially higher in the group of patients who underwent CABG compared with patients who underwent percutaneous coronary intervention PTCI. Conclusion. In patients with IHD after revascularization, there is a significant decrease in the glomerular filtration function of the kidneys by the 3rd month after the endovascular procedure and lasts at least 2 years. The most significant decrease was observed in patients with diabetes mellitus, as well as in patients who underwent CIN in the early period after endovascular intervention. The progression of CKD continues to be accompanied by an increase in the concentration of parathyroid hormone, uric acid and blood phosphates.

Remote Ischemic Preconditioning Reduces the Risk of Contrast-Induced Nephropathy in Patients with Moderate Renal Impairment Undergoing Percutaneous Coronary Angiography: A Meta-Analysis

Background/Aims: This meta-analysis evaluated the effects of remote ischemic preconditioning (RIPC) on the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention/coronary angiography (PCI/CA). Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that assessed the effect of RIPC on CIN in patients undergoing PCI/CA. The main outcomes of interest were the incidence of CIN 48–72 h after CA, the levels of serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and estimated glomerular filtration rate (eGFR), mortality, and requirement of hemodialysis and rehospitalization. The analysis was conducted using the random-effect model due to the expected heterogeneity among different studies. Results: In total, 16 trials covering 2,048 patients were identified. By assessing the methodological quality of the included studies through the Coch­rane risk of bias, we found that of the 16 RCTs, 3 had a low risk of bias, 6 a high, and 7 an unclear risk. The application of RIPC decreased the incidence of CIN (relative risk, RR, 0.50, 95% confidence interval, CI, 0.39–0.65; p < 0.001). Subgroup analyses showed that RIPC decreased the incidence of CIN in patients with eGFR <60 mL/min/1.73 m² (RR 0.53, 95% CI 0.38–0.75; p < 0.001) but not in patients with eGRF ≥60 mL/min/1.73 m² (RR 0.82, 95% CI 0.35–1.94; p = 0.66) at baseline. Furthermore, the increase in serum creatinine was significantly lower in patients with RIPC compared to control patients (standardized mean difference –1.41, 95% CI –2.46 to –0.35; p = 0.009). Conclusions: Based on 16 RCTs, this meta-analysis shows that RIPC can reduce the risk of CIN in patients with moderate renal impairment undergoing PCI/CA. However, this needs to be confirmed by further high-quality evidence.