Performed Percutaneous Coronary Intervention Research Articles

The effect of treatment srategy for acute myocardial infarction complicated by cardiac shock using Impella in accordance with institutional protocol

Abstract Backgrounds Team-based care for cardiogenic shock (CS) using mechanical circulatory support (MCS) including Impella in accordance with standardized protocol was reported to improve the prognosis of patients with CS. Methods Between February 2018 and September 2022, we performed percutaneous coronary intervention (PCI) in 63 patients with acute myocardial infarction (AMI) complicated by CS using Impella. We introduced institutional protocol (Figure 1) to standardize the treatment strategy for CS from June 2019, in which early Impella implantation preceding PCI was recommended. We retrospectively examined the incidence of Impella implantation preceding PCI, in-hospital outcomes including the rates of survival to Impella weaning and to discharge, and the incidence of major cardiovascular events (MACE) including all death, MI, and hospitalization for heart failure at 1-year before and after protocol introduction. Results The patients have a mean age of 67.1±13.2 years and 53 patients (84.1%) were male. The patients in preceding period were 16 cases, while 47 in latter period. The rate of Impella implantation preceding PCI was significantly higher in latter period than that in preceding period (61.7% vs. 25%, p=0.027) (Figure 2A). The rate of survival to Impella weaning was significantly higher in latter period than that in preceding period (83% vs. 56.3%. p=0.043). There was no difference in the rate of survival to discharge between each period (50% in preceding period vs. 68.1% in latter period, p=0.236). However, the cumulative MACE free survival rate was significantly higher in latter period than that in preceding period (56.9% vs. 31.3%, Log-rank p=0.020) (Figure 2B). Conclusion The introduction of institutional standardized protocol of MCS use might improve 1-year outcomes of patients with AMI complicated by CS treated with Impella.Figure 1Figure 2

Importance of the Multimodality Evaluation of a Double-chambered Right Ventricle for Surgical Indications on Admission for Acute Myocardial Infarction.

We treated a female patient known to have a double-chambered right ventricle (DCRV) who presented with symptoms of an acute myocardial infarction (AMI). Emergent coronary artery catheterization revealed acute right coronary artery (RCA) occlusion and proximal left anterior descending (LAD) stenosis. We performed percutaneous coronary intervention (PCI) for the RCA occlusion. Right heart catheterization revealed a pressure gradient across the mid-RV of 58 mmHg. Computed tomography and magnetic resonance imaging revealed no other congenital cardiac abnormalities. She underwent surgical repair of the RV stenosis and coronary artery bypass surgery for LAD stenosis.

Abstract 12249: Optimal Timing of Extracorporeal Membrane Oxygenation (ECMO) Application for the Prognosis of Patients With Acute Coronary Syndrome (ACS) Accompanying Cardiogenic Shock

Introduction: Advances in mechanical circulatory support (MCS) devices and several studies showing that early application of MCS devices can improve survival rates in cardogenic shock (CS) patients are increasing interest in the usefulness of MCS devices in CS patients. However, studies on the optimal use and timing of application of MCS device in CS patients are still lacking. Methods: The RESCUE study is multicenter, retrospective, and prospective registry of patients that presented with CS. From January 2014 to December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. Among enrolled patients, ECMO was applied to 238 of 693 patients who performed percutaneous coronary intervention (PCI) with acute coronary syndrome. The primary endpoint was a composite of in-hospital, 30-day, 6-month and 12-month mortality according to ECMO application timing. Results: There was no difference in the 30-day mortality in ACS patients with CS according to ECMO application timing before and after PCI. However, when stratified by time from CS recognition to ECMO application (Shock to ECMO application time, ≤100 minute vs. >100 minute), 30-day Kaplan-Meier survival curve showed differences according to ECMO application timing. When the time from CS to ECMO application less than 100 minutes, patients who applied ECMO during or after PCI had a 34% reduction in 30-mortality compared to patients who applied ECMO before PCI (HR = 0.64, 95% CI: 0.39-1.03; P = 0.07). And, when the time from CS to ECMO application exceeded 100 minute, patients who applied ECMO during or after PCI had an approximately twice the 30-day mortality compared to patients who applied ECMO before PCI (HR = 2.03, 95% CI: 1.07-3.85; P = 0.03). Conclusions: According to ECMO application timing, prognosis of ACS patients with cardiogenic shock was different. In case of exceed 100 minute, early initiation of ECMO application was associated with improved prognosis in 30-day mortality.

Prevalence of premature coronary artery disease (CAD) according to genetic familial hypercholesterolaemia (FH) diagnosis in Lithuania

Background and Aims : FH is known to be a predisposing cause of premature CAD. We aimed to determine the distribution of premature CAD according to genetic diagnosis of FH in Lithuania.Methods: Prospective observational cohort study enrolled patients with clinically diagnosed FH according to Dutch Lipid Clinic Network (DLCN) criteria treated in Vilnius University Hospital Santaros Klinikos during the period of 2016-2021. Premature CAD was defined as occuring in men younger than 55 years and women younger than 60 years. Data of 60 study patients were included in the analysis. Obstructive Atherosclerotic CAD was defined as the presence of stenosis ≥50% in at least one coronary vessel in Coronary Computed Tomography Angiography (CCTA) or coronary angiography, as well as performed percutaneous coronary intervention (PCI) or coronary arteries bypass grafting (CABG). Genetic testing was performed using genomic DNA, which was enzymatically fragmented, and regions of interest were enriched using DNA capture probes. The final indexed libraries were sequenced on an Illumina platform. The prevalence of CAD according to genetic diagnosis of FH was analysed. Statistical analysis was performed using R (v. 4.0.4) program package.Results: Of 60 examined patients 28,3% (n=17) had the genetic diagnosis of FH and 71,7% (n=43) had no FH mutation. Premature CAD was found in 47% (n=8) patients with genetic diagnosis of FH and in 19% (n=8) with no mutations determined (p=0,049).Conclusions: Premature CAD was more prevalent among patients with genetically confirmed FH. Background and Aims : FH is known to be a predisposing cause of premature CAD. We aimed to determine the distribution of premature CAD according to genetic diagnosis of FH in Lithuania. Methods: Prospective observational cohort study enrolled patients with clinically diagnosed FH according to Dutch Lipid Clinic Network (DLCN) criteria treated in Vilnius University Hospital Santaros Klinikos during the period of 2016-2021. Premature CAD was defined as occuring in men younger than 55 years and women younger than 60 years. Data of 60 study patients were included in the analysis. Obstructive Atherosclerotic CAD was defined as the presence of stenosis ≥50% in at least one coronary vessel in Coronary Computed Tomography Angiography (CCTA) or coronary angiography, as well as performed percutaneous coronary intervention (PCI) or coronary arteries bypass grafting (CABG). Genetic testing was performed using genomic DNA, which was enzymatically fragmented, and regions of interest were enriched using DNA capture probes. The final indexed libraries were sequenced on an Illumina platform. The prevalence of CAD according to genetic diagnosis of FH was analysed. Statistical analysis was performed using R (v. 4.0.4) program package. Results: Of 60 examined patients 28,3% (n=17) had the genetic diagnosis of FH and 71,7% (n=43) had no FH mutation. Premature CAD was found in 47% (n=8) patients with genetic diagnosis of FH and in 19% (n=8) with no mutations determined (p=0,049). Conclusions: Premature CAD was more prevalent among patients with genetically confirmed FH.

Prevalence of premature coronary artery disease (CAD) according to clinical familial hypercholesterolaemia (FH) diagnosis in Lithuania

Background and Aims : We aimed to determine the prevalence of CAD according to clinical diagnosis of Familial Hypercholesterolemia(FH) in Lithuania.Methods: Prospective observational cohort study enrolled patients with clinically diagnosed FH treated in Vilnius University Hospital Santaros Klinikos during the period of 2016-2021. According to Dutch Lipid Clinic Network (DLCN) diagnostic criteria for FH, definite FH was diagnosed when a total point score was>8, probable–6-8, possible-3-5,unlikely<3 points. Premature CAD was defined as occuring in men <55 years and women <60 years. Obstructive Atherosclerotic CAD was defined as the presence of stenosis ≥50% in at least one coronary vessel in Coronary Computed Tomography Angiography(CCTA) or coronary angiography, as well as performed percutaneous coronary intervention(PCI) or coronary arteries bypass grafting(CABG). Data of 119 study patients were included in the analysis. The prevalence of premature CAD was compared in different groups according to FH diagnosis. Statistical analysis was performed using R(v. 4.0.4) program package.Results: Of 119 examined patients 52,1%(n=62) were women and47,9%(n=57) were men.In the study population, premature CAD was diagnosed for 26%(n=31) patients. 21,8%(n=26) of study patients had definite FH diagnosis, 37,8%(n=45) had probable FH, 28,6%(n=34) - possible FH and11,8% (n=14) had unlikely FH diagnosis. Premature CAD was diagnosed to 38,5%(n=10) patients with definite FH, 33,3%(n=15) with probable FH, 14,7%(n=5) with possible FH and 7,1%(n=1) among people with unlikely FH.Conclusions: Our findings indicate that among individuals with premature CAD there is an opportunity to detect an index case for initiation of cascade FH screening, especially in definite and probable FH cases. Background and Aims : We aimed to determine the prevalence of CAD according to clinical diagnosis of Familial Hypercholesterolemia(FH) in Lithuania. Methods: Prospective observational cohort study enrolled patients with clinically diagnosed FH treated in Vilnius University Hospital Santaros Klinikos during the period of 2016-2021. According to Dutch Lipid Clinic Network (DLCN) diagnostic criteria for FH, definite FH was diagnosed when a total point score was>8, probable–6-8, possible-3-5,unlikely<3 points. Premature CAD was defined as occuring in men <55 years and women <60 years. Obstructive Atherosclerotic CAD was defined as the presence of stenosis ≥50% in at least one coronary vessel in Coronary Computed Tomography Angiography(CCTA) or coronary angiography, as well as performed percutaneous coronary intervention(PCI) or coronary arteries bypass grafting(CABG). Data of 119 study patients were included in the analysis. The prevalence of premature CAD was compared in different groups according to FH diagnosis. Statistical analysis was performed using R(v. 4.0.4) program package. Results: Of 119 examined patients 52,1%(n=62) were women and47,9%(n=57) were men.In the study population, premature CAD was diagnosed for 26%(n=31) patients. 21,8%(n=26) of study patients had definite FH diagnosis, 37,8%(n=45) had probable FH, 28,6%(n=34) - possible FH and11,8% (n=14) had unlikely FH diagnosis. Premature CAD was diagnosed to 38,5%(n=10) patients with definite FH, 33,3%(n=15) with probable FH, 14,7%(n=5) with possible FH and 7,1%(n=1) among people with unlikely FH. Conclusions: Our findings indicate that among individuals with premature CAD there is an opportunity to detect an index case for initiation of cascade FH screening, especially in definite and probable FH cases.

Differential Prognostic Value of Revascularization for Coronary Stenosis With Intermediate FFR by Coronary FlowReserve.

The authors sought to evaluate comparative prognosis between deferred versus performed percutaneous coronary intervention (PCI) according to coronary flow reserve (CFR) values of patients with intermediate fractional flow reserve (FFR). For coronary stenosis with intermediate FFR, the prognostic value of PCI remains controversial. The prognostic impact of PCI may be different according to CFR in patients with intermediate FFR. From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry, N=2,322), 400 patients (412 vessels) with intermediate FFR (0.75-0.80) were selected. Patients were stratified into preserved CFR (>2.0, n=253) and depressed CFR (≤2.0, n=147) cohorts. Per-vessel clinical outcomes during 5 years of follow-up were compared between deferred versus performed PCI groups in both cohorts. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. Among the study population, PCI was deferred for 210 patients (219 vessels, 53.2%) (deferred group) and performed for 190 patients (193 vessels, 46.8%) (performed group). The risk of TVF was comparable between the deferred and performed groups (12.8% vs 14.2%; adjusted HR: 1.403; 95%CI: 0.584-3.369; P=0.448). When stratified by CFR, PCI was performed in 39.1% (100/261 vessels) of the preserved CFR cohort and 61.9% (93/151 vessels) of the depressed CFR cohort. Within the preserved CFR cohort, the risk of TVF did not differ significantly between the deferred and performed groups (11.0% vs 13.9%; adjusted HR: 0.770; 95%CI: 0.262-2.266; P=0.635). However, in the depressed CFR cohort, the deferred group had a significantly higher risk of TVF than the performed group (17.2% vs 14.2%; adjusted HR: 4.932; 95%CI: 1.312-18.53; P=0.018). A significant interaction was observed between CFR and the treatment decision (interaction P =0.049). Results were consistent after inverse probability weighting adjustment. In patients with intermediate FFR of 0.75 to 0.80, the prognostic value of PCI differed according to CFR, with a significant interaction. PCI was associated with a lower risk of TVF compared with the deferral strategy when CFR was depressed (≤2.0), but there was no difference when CFR was preserved (>2.0). CFR could be used as an additional risk stratification tool to determine treatment strategies in patients with intermediate FFR. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234).

Analysis of clinical features and coronary angiography in 10 patients with de winter syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Guohua Ni Objective To investigate the clinical characteristics and electrocardiogram (ECG) changes of patients with de winter syndrome, so as to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients. Methods The clinical data of 10 cases of patients with de winter syndrome admitted to a Medical University Hospital from January 2015 to May 2019 were retrospectively analyzed, to summarize the clinical characteristics, de Winter ECG pattern, timing of emergency interventional therapy, prognosis and other factors. Results Among the 10 patients with de winter syndrome, 9 males and 1 female, 3 cases of acute extensive anterior wall myocardial infarction (MI), 3 cases of non-ST -segment elevation MI (NSTEMI), 2 cases of acute anterior wall MI, and 2 cases of acute anterior septal MI. All the cases were in line with de winter ECG pattern, and they all had dynamic evolution characteristics. Of these, 7 patients developed ST-segment elevation MI (STEMI) and 3 patients developed NSTEMI. All cases were performed coronary angiography (CAG) and 9 patients were performed percutaneous coronary intervention(PCI). CAG showed that there were 6 cases of multi-vessel coronary disease, 4 cases of proximal occlusion of left anterior descending artery, 2 cases of subtotal occlusion, 1 case of 95% stenosis in proximal middle segment of stent. There was 1 case of middle occlusion of anterior descending branch and 1 case of subtotal occlusion, all the above 9 cases were performed PCI. One case had 95% stenosis in the middle segment of anterior descending branch, and no interventional therapy was performed due to hematuria. Conclusion de winter ECG pattern should be regarded as an STEMI equivalent, prompt recognition of the de winter ECG pattern and a timely diagnosis is of the utmost importance, in order to perform early emergency medical and interventional therapy. Clinical Implications * My study will enable cardiovascular clinicians to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients, so as to improve the outcome and prognosis of the de winter syndrome. Abstract Figure.

Successful double-layer metal stents rotational ablation under 2-dimensional and 3-dimensional optical coherence tomography guidance: a case report

BackgroundStent ablation with rotational atherectomy has been considered a bail-out strategy for the treatment of severe stent underexpansion. Only a few reports have yet shown rotational ablation for double-layer metal struts.Case presentationWe present a case of 80-year-old female patient presented to our hospital because of worsening effort angina. Coronary angiography revealed severe in-stent restenosis in the proximal left anterior descending artery. Optical coherence tomography (OCT) examinations found that severe stenosis occurred at the overlap region with 2-layer underexpanded stents and circumferential calcification beneath them. Under the guidance of 2-dimensional (2D) and 3-dimensional (3D) OCT, we successfully performed percutaneous coronary intervention (PCI) of this lesion after adequate stent ablation, high-pressure balloon dilatation, and subsequent everolimus-eluting stent implantation. The patient recovered well uneventfully and discharged from hospital 7 days later. No restenosis occurred after 12 months.ConclusionsWe report a very rare case of in-stent restenosis due to double-layer underexpanded stents. The entire percutaneous coronary intervention procedure was performed step by step under the guidance of high-resolution OCT. Our findings highlight the specific value of 2D and 3D OCT guidance in double-layer stents rotational ablation.

Comparison of the effects of ticagrelor and clopidogrel on heart rate variability and heart rate turbulence in patients with percutaneous coronary interventions.

IntroductionClopidogrel and ticagrelor are commonly used, antiplatelet agents. Ticagrelor has an effect of enhancing the plasma level of adenosine that may alter the autonomic function. The aim of this study is to compare the effects of ticagrelor and clopidogrel on heart rate variability (HRV) and heart rate turbulence (HRT).MethodsThirty subjects who performed percutaneous coronary intervention (PCI) were included in the randomized, crossover study. These patients were divided into two groups. Clopidogrel or ticagrelor was administered in two different testing sessions (1-month treatment for each session). In group 1, clopidogrel and ticagrelor treatment were used while in group 2, ticagrelor and clopidogrel treatment were used respectively. Three times rhythm Holter recording (baseline, 1st and 2nd month) was performed. The HRV (time domain and frequency domain) and HRT (turbulence onset (TO) and turbulence slope (TS)) parameters were analyzed from the Holter recordings.ResultsAccording to baseline Holter recording, pNN50 (5.82 ± 5.83 vs 10.56 ± 8.28; p = 0.03) and HF(nu) (6.85 ± 9.33 vs 9.53 ± 7.41; p = 0.04) parameters were higher in group 2 than in group 1, while TO(0.004 ± 0.02 vs −0.01 ± 0.02; p = 0.01) parameter was positive and higher in group 1 than in group 2. In the second month, the LF/HF ratio (4.47 ± 2.43 vs 3.18 ± 2.45; p = 0.04) was higher in group 1 than in group 2. However, when the evaluation was done within the groups themselves, there were no statistically significant differences in HRV and HRT parameters obtained before and after clopidogrel and ticagrelor administration in group 1 and group 2.ConclusionTicagrelor and clopidogrel treatments did not have a significant effect on HRV and HRT parameters.

E0639 Clinical study of Endeavour stent in patients with coronary heart disease and diabetes

ObjectiveTo evaluated the safety and efficacy of Endeavor Stent in patients with coronary heart disease (CHD) and diabetes performed percutaneous coronary intervention (PCI) via trans-radial artery approach for de novo...

Combined Assessment of Myocardial Perfusion and Late Gadolinium Enhancement in Patients After Percutaneous Coronary Intervention or Bypass Grafts: A Multicenter Study of an Integrated Cardiovascular Magnetic Resonance Protocol

We sought to assess the accuracy of an integrated cardiac magnetic resonance (CMR) protocol for the diagnosis of relevant coronary artery or bypass graft stenosis in patients with suspected coronary artery disease (CAD) or with previously performed percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG). CMR is suitable for diagnosing inducible myocardial ischemia in patients with suspected CAD and has been proven to be a helpful diagnostic tool for decision of further treatment. However, little is known about its diagnostic accuracy in patients with known CAD who previously were treated by PCI or CABG. A total of 477 patients with suspected CAD, 236 with previous PCI, and 110 after CABG referred for coronary X-ray angiography (CXA) underwent an integrated CMR examination before CXA. Myocardial ischemia was assessed using first-pass perfusion after vasodilator stress with adenosine (140 microg/kg/min for 3 min) using gadolinium-based contrast agents (0.1 mmol/kg). Late gadolinium enhancement (LGE) was assessed 10 min after a second contrast bolus. CXA demonstrated a relevant coronary vessel stenosis (> or =70% luminal reduction) in 313 (38%) patients using quantitative coronary analysis. The combination of CMR perfusion and LGE assessment for detecting a relevant coronary stenosis in patients with suspected CAD yielded sensitivity and specificity of 0.94 and 0.87, in PCI patients 0.91 and 0.90, and in CABG patients 0.79 and 0.77, respectively. A combined CMR protocol for the assessment of myocardial perfusion and LGE is feasible for the detection of relevant coronary vessel stenosis even in patients who previously were treated by PCI or CAG in a routine clinical setting. However, diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Further studies are needed to optimize the clinical protocols especially in post-surgical patients.

The History of Suzuka General Hospital and The Results of Treatment for Coronary Artery Disease in Suzuka District.

We held the 49th meeting of The Japanese Association of Rural Medicine in Mie Prefecture in November, 2000. The main theme of this meeting was “Future Aspect of Health, Medicine and Welfare in the next Century, with special reference to the medical service in local community”.Firstly, I introduced the history of our hospital, that wasestablished in 1938, named Chusei Hospital with 30 beds. In 1993, our hospital was transferred in present place, and renamed Suzuka General Hospital, with 500 beds. Since, our hospital has been recognized as the Suzuka city hospital.Secondly, I mentioned my career as a cardiologist. My lifelong teacher, Professor Hideo TAKEZAWA, led me a clinician and researcher by bedside teaching, with intense passion and research mind.Finally, I described a clinical results in the diagnosis and treatment for coronary artery disease in our cardiology division with my colleagues. Especially, focusing in recent one year, we performed percutaneous coronary intervention (PCI) to both native and in-stent restenosis lesions using cutting balloon TM. Initial success rate, rate of restenosis and complication rate were favorable results.