Percutaneous Intervention Patients Research Articles

Emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported percutaneous interventions in refractory cardiac arrest and profound cardiogenic shock

AimsWe investigated the spectrum of emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported interventions including percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI) and invasive electrophysiology (EP). Methods and resultsBetween June 2010 and February 2020, 52 consecutive patients underwent VA ECMO implantation for refractory cardiac arrest (E-CPR) and 78 for profound cardiogenic shock. Percutaneous interventions on VA ECMO included PCI (n = 29), TAVI (n = 4) and EP (n = 1). Surgical interventions were cardiac (n = 36) or non-cardiac (n = 5). During PCI, ECMO flow was maintained at 2.7 ± 1.0 L/min. Of the 40 treated lesions, 48% were located on left anterior descending and 20% on the left main artery. An average 2.0 ± 1.8 DES/patient with diameter 3.2 ± 0.5 mm and stented length 41 ± 35 mm were implanted. PCI success was 83%. TAVI was performed in 4 patients with left ventricular ejection fraction 21 ± 10% and mean aortic valve gradient 41 ± 5 mmHg. After successful valve implantation supported by 1.4 ± 0.1 L/min ECMO flow, mean gradient decreased to 11 ± 5 mmHg without significant aortic regurgitation. In one patient radiofrequency ablation of His bundle followed by permanent pacemaker implantation was performed under ECMO flow of 2.8 L/min. Overall survival to hospital discharge with good neurological recovery was 29% in E-CPR and 44% in profound cardiogenic shock. ConclusionsOur study showed feasibility and effectiveness of VA ECMO-supported percutaneous interventions in patients with profound hemodynamic collapse.

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience.

ResumoFundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional.Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal).Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05.Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias,50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; 115(3):515-524)

Percutaneous Coronary Intervention in an Octogenarian With Anomalous Origin Arising From Right Sinus: A Rare Case Report

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging. J Med Cases. 2020;11(2):41-43 doi: https://doi.org/10.14740/jmc3429

Association of serum bilirubin level with clinical outcomes after primary percutaneous intervention in patients with ST segment elevation myocardial infarction

Background Serum bilirubin (SB) increases acutely after ST segment elevation myocardial infarction (STEMI)/percutaneous coronary intervention (PCI), peaking at 21 h after the intervention. Aim The aim of this study is to investigate the association of SB levels with the prognosis of STEMI patients after 1ry PCI. Patients and methods This study was carried out on 90 patients admitted with STEMI and treated with 1ry PCI and were divided into three equal groups: group I included patients with high SB levels (≥0.7 mg/dl), group II included patients with intermediate SB levels (0.49–0.7 mg/dl) and group III included patients with low SB levels (≤0.49 mg/dl). Comparison of clinical results was performed in terms of major adverse cardiac events (MACE) during hospital admission. Results Patients with high SB had higher Killip class II–IV, higher hemoglobin and white blood cell count, lower HDL levels, lower ejection fraction (EF) and higher rate of death and congestive heart failure. No significant difference was found in age, sex, family history of coronary artery disease (CAD), history of HTN, diabetes mellitus or smoking, dyslipidemia, symptoms duration, time to reperfusion, random blood sugar on admission, STEMI location, infarction-related artery, number of diseased vessels, type of intervention, Thrombolysis in Myocardial Infarction (TIMI) flow, serum triglycerides and LDL level, serum creatinine and Creatinine Kinase - MB (CK-MB) level on admission, number of patients undergoing reinfection and target vessel revascularization. High SB levels predicted the overall MACE following STEMI. Conclusion High SB was accompanied by in-hospital cardiac mortality, advanced heart failure and MACE after 1ry PCI in STEMI patients.

Long-term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure.

Report long-term outcomes of percutaneous intervention in patients with pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) from a single center over 16 years. Outcome reports of percutaneous intervention for PVS resulting from PVI are limited. Retrospective review of all patients with PVS after PVI who underwent percutaneous intervention at the Cleveland Clinic Foundation between January 2000 and December 2016. A total of 205 patients underwent cardiac catheterization for PVS during the study period. Completely occluded veins which could not be recanalized occurred in six patients. Of the remaining 199 patients, 27 (14%) were lost to follow-up, leaving 172 patients with 276 veins for analysis. Balloon angioplasty was performed in 62 veins and stent implantation in 250 (primary in 214, to treat postdilation restenosis in 36). Re-intervention occurred in 45/62 (73%) balloon-dilated veins and 45/250 (18%) stented veins. Freedom from re-intervention at 1 and 5 years was 90 and 73% following stenting versus 40 and 23% following balloon dilation (p < .001, Hazard ratio (HR) = 5.7). Veins with stent diameter ≥7 mm (n = 231) had greater freedom from re-intervention (95% at 1 year, 79% at 5 years) than veins with stents <7 mm (43% at 1 year, 9% at 5 years), p < .001. There was clear symptomatic improvement after intervention and no procedural mortality. Stent implantation at ≥7 mm for PVS after PVI is associated with low rates of re-intervention, in contrast to balloon dilation and stenting with small conventional stents.

P3589New generation stents for primary percutaneous coronary intervention in patients with acute myocardial infarction: evidence from an individual patient data network meta-analysis of randomized clinical

Abstract Background Drug-eluting stents have shown their superiority in primary percutaneous intervention in patients with ST-segment elevation myocardial infarction (STEMI). No specific stent type has fully proven its superiority over others. Purpose We sought to compare the safety and efficacy of coronary artery stents in STEMI patients undergoing primary PCI through comprehensive network meta-analysis (NMA). Methods We performed an individual patient data (IPD) NMA of dedicated randomized trials in STEMI patients treated with coronary stents. The primary endpoint of interest was the composite outcome of cardiac death, any myocardial infarction (MI) or target lesion revascularization (TLR). Secondary outcomes were the individual component of the primary endpoint and definite or probable stent thrombosis. Outcomes were analyzed at the longest available follow-up. The primary analysis was performed using a one-stage random-effects meta-analysis. Results IPD from 15 randomized trials in STEMI patients were obtained including a total of 10,979 patients. Six different stent types were studied including bare metal stents (BMS), durable-polymer paclitaxel-eluting stents (DP-PES), durable-polymer sirolimus-eluting stents (DP-SES), durable-polymer zotarolimus-eluting stents (DP-ZES), durable-polymer everolimus-eluting stents (DP-EES) and biodegradable-polymer biolimus-eluting stent (BP-BES). Mean patient age was 60.7±11.9 years; 22.7% were female and 16.1% were diabetic. Median symptom onset to balloon time was 210 min. At a median follow-up of 3 years (interquartile range 2–4.9 years), patients treated with second-generation (DP-EES and BP-BES) or first-generation DES (DP-PES, DP-SES and DP-ZES) had significantly lower risk of the primary endpoint than patients treated with BMS (BMS vs. second-generation DES; HR 0.69, 95% CI 0.57–0.82, BMS vs. first-generation DES; HR 0.70, 95% CI 0.61–0.80). The differences were driven by the significant reduction of TLR associated with first- and second-generation DES compared with BMS. A trend towards lower risk of MI with second-generation DES compared with BMS or first-generation DES was observed (BMS vs. second-generation DES; HR 0.79, 95% CI 0.58–1.06, first- vs. second-generation DES; HR 0.75, 95% CI 0.54–1.03). Second-generation DES was associated with a significantly lower risk of definite or probable stent thrombosis compared with BMS (HR 0.62, 95% 0.40–0.97) and first-generation DES (HR 0.55, 95% CI 0.34–0.91). DP-EES and BP-BES had a similar risk of the primary endpoint, individual components of the primary endpoint, and definite or probable stent thrombosis. Conclusions In this larger-scale IPD NMA in STEMI patients, second-generation DES were superior to BMS with respect to long-term efficacy and safety outcomes. Second-generation DES were associated with a significant reduction of stent thrombosis compared with BMS and first-generation DES. Similar long-term outcomes were observed between DP-EES and BP-BES. Acknowledgement/Funding This study was funded by Biosensors International

Long-term Clinical Outcomes of intraVascular Ultrasound-guided vs Angiography-guided Primary pErcutaneous Intervention in Patients With Acute ST Segment Elevated Myocardial Infarction

Long-term Clinical Outcomes of intraVascular Ultrasound-guided vs Angiography-guided Primary pErcutaneous Intervention in Patients With Acute ST Segment Elevated Myocardial Infarction

Sex Difference and Outcome after Percutaneous Intervention in Patients with Chronic Total Occlusion: A Systematic Review and Meta-Analysis

Recent studies suggest that sex difference is an outcome predictor in chronic total occlusion (CTO) patients who are undergoing percutaneous intervention (PCI). However, a systematic review and meta-analysis of the literature have not been done. We assessed the outcome of PCI in CTO between male and female. We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) and case control studies of CTO patients who underwent PCI that compared successful procedure and major cardiac event (MACE), including cardiac death, target vessel revascularization, myocardial infarction, and stroke, between male and female. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Nine studies were included in this meta-analysis involving 30,830 CTO subjects (8350 female and 22,480 male) who underwent PCI. Females were not significantly associated with reduced risk of MACE (pooled risk ratio = 0.86, 95% confidence interval: 0.66-1.12, p = 0.262, I2 = 47.0%) as well as successful rate of PCI (pooled risk ratio = 1.04, 95% confidence interval: 0.99-1.10, p = 0.161, I2 = 76.6%) in CTO patients who underwent PCI. Our study suggests that sex is not an independent risk factor of MACE or successful procedure in CTO patients who underwent PCI.

A Pathognomonic Electrocardiogram That Requires Urgent Percutaneous Intervention: A Case of Wellens Syndrome in a Previously Healthy 55-Year-Old Male

Patient: Male, 55Final Diagnosis: Wellens’ syndromeSymptoms: Chest painMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. Wellens syndrome is characterized by a history of chest pain, normal or minimally elevated biomarkers, no STEMI/Q-waves, and specific ECG changes. These changes consist of biphasic T waves in lead V2 and V3 or deep symmetrically inverted T waves in leads V1–V4.Case Report:A 55-year-old male presented to the emergency department with acute chest pain in a background of active smoking, hypertension, and hyperlipidemia. His ECG was characteristic of Wellens syndrome type 1 and negative cardiac biomarkers. His TIMI (thrombolysis in myocardial infarction) score was 2, however, he failed conservative management necessitating urgent coronary angiogram. Critical stenosis of the proximal left anterior descending (LAD) coronary artery was found which required 2 drug eluting stents. He was discharged home asymptomatic on optimal medical therapy.Conclusions:Conventional management of patients with NSTEMI (non-ST-elevation myocardial infarction) and unstable angina with risk stratification utilizing TIMI score may not be appropriate in patient with Wellens syndrome. This highlights the importance of ECG recognition and urgent percutaneous intervention in patients with Wellens syndrome. Failure to identify this clinical syndrome could result in significant morbidity and mortality because it relates to critical stenosis and imminent large myocardial infarction.

Assessment of impact of chronic kidney disease on platelet inhibition among post percutaneous intervention patients on antiplatelet therapy

Assessment of impact of chronic kidney disease on platelet inhibition among post percutaneous intervention patients on antiplatelet therapy

Comparision between clopidogrel and prasugrel on hsCRP levels in post percutaneous intervention patients

Comparision between clopidogrel and prasugrel on hsCRP levels in post percutaneous intervention patients

Transradial PCI and Same Day Discharge.

The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD). This literature review was performed to evaluate the studies that were published over the last 17years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: "same day," "same day discharge," "outpatient," and "ambulatory radial PCI." Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals. The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.

In hospital outcomes of primary percutaneous intervention in patients presenting with acute myocardial infarction in Saudi Arabia – A single center study

OBJECTIVE: To study the presentation, response to treatment, complication and prognosis of patients with acute ST-Elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PPCI) at King Faisal Cardiac Center (KFCC) in the period from January 2015 till December 2016. METHODS: Data of 77 patients with STEMI who were treated with primary PCI as a mode of reperfusion who presented to KFCC were collected retrospectively from January 2015 till December 2016. The primary end point was in hospital mortality. RESULTS: 77 patients with STEMI received PPCI. These were predominantly male (86%, no=66). The mean age was 57.9 (SD ± 11.8). History of Diabetes was present in (64.7%, no=49), hypertension (49% no=38) dyslipidemia (51% no=39) and smoking (41.6%, no=32). Chest pain was the most common presenting symptoms (97%, no=75). Only 5 patients (6%) presented to emergency department within 1 hour from chest pain onset. While 7 (8%) of patients presented beyond 12 hours the majority of patients arrived within 6 hours 29 patients (38%) and 37 patients (48%) arrived after 6 hours but within 12 hours from pain onset. The median door to balloon time was 84 minutes (IQR: 63.5- 111.5 minutes). Door to balloon time of less than 90 minutes was achieved in (62%, no=46) while D2B time of more than 90 minutes but within 120 minutes was seen in (22 %,) while (16%) had D2B time of more than 120 minutes. The left anterior descending artery was the culprit in 37 patients (48%) Femoral artery access was used in 48 patients (62%).The success of delivering the stent was 97% (no =75). The Median length of hospital stay was 3 days (IQR: 2-4). The primary endpoint of inhospital death was 5.1%. CONCLUSION: Our findings suggest favorable outcomes of STEMI patients treated with PPCI, matching the international data. D2B time remains below acceptable standers. Regardless of logistic limitations Primary PCI should be the preferred method of reperfusion. Strategies towards increasing patient’s access and improving D2B time should be adopted.

The Impact of Red Cell Distribution Width on the Development of Contrast-Induced Nephropathy in Patients with Stable Coronary Artery Disease who Underwent Coronary Angiography.

Objectives:Contrast-induced nephropathy (CIN) accounts for 10% of all causes of hospital-acquired renal failure. The pathophysiological cellular mechanism of the CIN development remains unclear and seems to be multifactorial. Herein, we aimed to determine the role of red cell distribution width (RDW) in the development of CIN after elective percutaneous intervention in patients with stable coronary artery disease, which in our opinion has not been researched enough.Methods:Between October 2009 and October 2011, a total of 211 patients with stable coronary artery disease who had undergone a coronary intervention procedure were evaluated prospectively. The patients were classified according to the development of CIN, and both groups were compared statistically according to clinical, laboratory, and demographic features, including the serum RDW level.Results:In 18.8% of the patients, CIN was observed. The mean age was 64±10.5, and 59% of the study group was male. An advanced age, male gender, hypertension, the serum total protein level, high density lipoprotein, and albumin levels were correlated with the development of CIN. The mean RDW level was 13.7±1.4%, and the mean creatinine level was 1.0±0.2 mg/dL. There was not any correlation between RDW and the presence of CIN (CIN[−]=13.8±1.5, CIN[+]=13.6±1.0, p>0.05), and also a multivariate regression analysis proved this non-correlation (OR : 0.92, 95% confidence interval [CI]=0.62–1.34; p: 0.67 ). There was only a correlation between hypertension and male gender with CIN that was proved with a multivariate regression analysis (OR=5.74, 95% CI: 1.96–16.79, p<0.01 vs OR=5.34, 95% CI=1.22–23.3, p: 0.02, respectively).Conclusion:Our outcomes indicate that the RDW has a limited use as a CIN predictor in patients with stable coronary artery disease.

Clinical and angiographic profile and in-hospital outcomes of elective percutaneous interventions in patients with Diabetes mellitus in a tertiary care centre

Clinical and angiographic profile and in-hospital outcomes of elective percutaneous interventions in patients with Diabetes mellitus in a tertiary care centre

COOL AMI EU pilot trial: a multicentre, prospective, randomised controlled trial to assess cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction.

We aimed to investigate the rapid induction of therapeutic hypothermia using the ZOLL Proteus Intravascular Temperature Management System in patients with anterior ST-elevation myocardial infarction (STEMI) without cardiac arrest. A total of 50 patients were randomised; 22 patients (88%; 95% confidence interval [CI]: 69-97%) in the hypothermia group and 23 patients (92%; 95% CI: 74-99) in the control group completed cardiac magnetic resonance imaging at four to six days and 30-day follow-up. Intravascular temperature at coronary guidewire crossing after 20.5 minutes of endovascular cooling decreased to 33.6°C (range 31.9-35.5°C). There was a 17-minute (95% CI: 4.6-29.8 min) cooling-related delay to reperfusion. In "per protocol" analysis, median infarct size/left ventricular mass was 16.7% in the hypothermia group versus 23.8% in the control group (absolute reduction 7.1%, relative reduction 30%; p=0.31) and median left ventricular ejection fraction (LVEF) was 42% in the hypothermia group and 40% in the control group (absolute reduction 2.4%, relative reduction 6%; p=0.36). Except for self-terminating paroxysmal atrial fibrillation (32% versus 8%; p=0.074), there was no excess of adverse events in the hypothermia group. We rapidly and safely cooled patients with anterior STEMI to 33.6°C at the time of coronary guidewire crossing. This is ≥1.1°C lower than in previous cooling studies. Except for self-terminating atrial fibrillation, there was no excess of adverse events and no clinically important cooling-related delay to reperfusion. A statistically non-significant numerical 7.1% absolute and 30% relative reduction in infarct size warrants a pivotal trial powered for efficacy.

Safety of Radial Access for Primary Percutaneous Intervention in Patients With ST-Elevation Acute Myocardial Infarction: Results From a Low-Volume Center.

Radial access for primary percutaneous coronary intervention (pPCI) in patients with ST-elevation acute myocardial infarction (STEMI) is recommended in high-volume experienced centers. This study investigated whether radial access for pPCI is safe even in a low-volume center. We performed radial access for pPCI in 171 patients. Major adverse cardiac events (total death, myocardial infarction, stroke) rate was 1.2%. The overall incidence of bleeding complications was 2.4%; there was no vascular complication at the access site. In patients with STEMI undergoing pPCI, the results of radial access in a low-volume center were acceptable. These findings support the safety of radial access in patients with STEMI.

The management of patients with stable coronary syndromes

In coronary artery disease, symptoms and prognosis are not closely linked and sudden unexpected death or devastating acute myocardial infarction may be the first manifestation. In treating patients with stable coronary disease, we wish to both relieve symptoms and prevent adverse outcomes. Percutaneous revascularization provides excellent symptom relief but has no positive prognostic benefit in patients with stable coronary disease. The lesion causing the angina, treated by a stent, is not necessarily the lesion determining prognosis. Simple lifestyle modification and drug therapy are important determinants of prognosis. Coronary bypass graft surgery improves prognosis in well-defined subsets of patients and the application of percutaneous interventions in patients who might be better served by surgery can be questioned. It can be argued that the emphasis placed on percutaneous intervention in patients with stable disease may have adverse consequences.

TCTAP A-157 Short Term Outcomes After Percutaneous Interventions in Patients with Metabolic Syndrome

TCTAP A-157 Short Term Outcomes After Percutaneous Interventions in Patients with Metabolic Syndrome

Percutaneous interventions in patients with anomalous origin of coronary arteries presenting with acute coronary syndromes

Percutaneous interventions in patients with anomalous origin of coronary arteries presenting with acute coronary syndromes