Post-percutaneous Coronary Intervention Research Articles

Microvascular resistance reserve before and after PCI: A serial FFR and [15O] H2O PET study

Background and aimsMicrovascular Resistance Reserve (MRR) has recently been introduced as a microvasculature-specific index and hypothesized to be independent of coronary stenosis. The aim of this study was to investigate the change of MRR after percutaneous coronary intervention (PCI). MethodsIn this post-hoc analysis from the PACIFC trials, symptomatic patients underwent [15O]H2O positron emission tomography (PET) and invasive fractional flow reserve (FFR) before and after revascularization. Coronary flow reserve (CFR) from PET and invasive FFR were used to calculate MRR. ResultsAmong 52 patients (87 % male, age 59.4 ± 9.4 years), 61 vessels with a median FFR of 0.71 (95 % confidence interval: 0.55 to 0.74) and a mean MRR of 3.80 ± 1.23 were included. Following PCI, FFR, hyperemic myocardial blood flow (hMBF) and CFR increased significantly (all p-values ≤0.001). MRR remained unchanged after PCI (3.80 ± 1.23 before PCI versus 3.60 ± 0.97 after PCI; p=0.23). In vessels with a pre-PCI, FFR ≤0.70 pre- and post-PCI MRR were 3.90 ± 1.30 and 3.73 ± 1.14 (p=0.56), respectively. Similar findings were observed for vessels with a FFR between 0.71 and 0.80 (pre-PCI MRR 3.70 ± 1.17 vs. post PCI MRR 3.48 ± 0.76, p=0.19). ConclusionsOur study indicates that MRR, assessed using a hybrid approach of PET and invasive FFR, is independent of the severity of epicardial stenosis. These findings suggest that MRR is a microvasculature-specific parameter.

The Use of Quantitative Flow Ratio for Decisions and Outcomes in Percutaneous Coronary Intervention Study

Background: This pilot study explores the impact of quantitative flow ratio (QFR) guidance on decision-making for angioplasty and post-intervention procedures in stable coronary artery disease. Aim: The primary aim was to evaluate the vessel-oriented composite endpoint (VOCE) at 6 months, encompassing cardiac death, vessel-related MI and ischaemia-driven target vessel revascularisation. Secondary objectives included assessing individual components of VOCE and the influence that the QFR had on decision-making before and after interventions. Methods: The pilot study was conducted from 1 January to 31 July 2023 and included all angiogram patients. Cardiologists used QFR readings for decision-making, with QFR >0.80 indicating non-significance and <0.80 denoting significant stenosis, prompting angioplasty. The lesions were re-evaluated post-angioplasty and QFR >0.90 indicated that no further intervention was necessary. Results: A total of 770 subjects were screened. Most of the patients in the post-percutaneous coronary intervention (PCI) without QFR group were Malaysian (36.1%), while there were more Chinese patients in the PCI with QFR group (49.2%). Hypertension was the primary risk factor for both groups (79.5% and 73%, respectively). Decision changes were more common in pre-intervention assessments (39%), with 34% of these opted not to proceed whereas 66% agreed to proceed. Post-PCI decision changes were less common (22%); 19% of these opted for further intervention and 81% accepted the angiographic results before the QFR reading. VOCE at 6-month follow-up showed one cardiac death in the PCI without QFR group and none in the PCI with QFR group (p=0.316). Conclusion: QFR readings demonstrated significant value in guiding pre-PCI decisions. This study underscores the potential for enhanced decision-making and improved patient outcomes by using QFR-guided interventions.

Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia.

Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the "P2Y12 inhibition gap". Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32-34 °C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow® and Multiplate® ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow® showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p < 0.001) and 3 h (24 vs. 180 PRU; p < 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p < 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate® ADP was also decreased at 1 h (14 vs. 48 U; p < 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug-drug interaction with ticagrelor.

New Indices to Detect Acute Kidney Injury in Coronary Artery Disease Patients

Objectives: Pre-procedure liver impairment has been revealed as a poor prognostic factor post-percutaneous coronary intervention (PCI). Recent investigations discovered that the aspartate aminotransferase-to-alanine aminotransferase ratio (De-Ritis ratio) indicates the severity of liver impairment and was related to adverse outcomes. We aimed to evaluate the predictive value of the De-Ritis ratio for contrast-associated acute kidney injury (CA-AKI). Materials and Methods: We prospectively enrolled 150 patients undergoing elective PCI between June 2022 and August 2022. Contrast-induced AKI: It is defined as an acute decline in renal function, defined as an increase in creatinine of ≥0.5 mg/dL or ≥25% compared to baseline. It usually develops 24–72 h post administration of an IV contrast agent in the absence of other identifiable causes. Results: The incidence of CA-AKI was 8% (n = 12). The De-Ritis ratio &gt;1.30 was identified as the best cutoff value for CA-AKI prediction. Conclusion: The De-Ritis ratio was an independent risk factor for CA-AKI in patients undergoing elective PCI.

Native coronary artery or bypass graft percutaneous coronary intervention in patients after previous coronary artery bypass surgery: A large nationwide analysis from the Netherlands Heart Registration

BackgroundPatients with previous coronary artery bypass surgery (CABG) who require repeat revascularization frequently undergo percutaneous coronary intervention (PCI). We sought to identify factors associated with the decision to intervene on the native vessel versus a bypass graft and investigate their outcomes in a large nationwide prospective registry. MethodsWe identified patients who underwent PCI with a history of prior CABG from the Netherlands Heart Registration between 2017 and 2021 and stratified them by isolated native vessel PCI versus PCI including at least one venous- or arterial graft. The primary endpoint of major adverse cardiac events (MACE) was a composite of all-cause death and target vessel revascularization (TVR) at one-year post PCI. The key secondary endpoint was a composite of all-cause death, myocardial infarction (MI), and TVR at 30 days. ResultsOut of 154,146 patients who underwent PCI, 12,822 (8.3%) had a prior CABG. Isolated native vessel PCI was most frequently performed (75.2%), while an acute coronary syndrome (ACS) presentation was most strongly associated with graft interventions. The primary outcome of MACE at one-year post PCI occurred more frequently in interventions including grafts compared with native vessels alone (19.7% vs. 14.3%; adjOR 1.267; 95% CI 1.101–1.457); p < 0.001) driven by TVR. There was however no difference in mortality or the key secondary endpoint between the two groups. ConclusionIn this nationwide prospective registry, ACS presentation was strongly associated with bypass graft PCI. At one year after PCI, interventions including bypass grafts had a higher composite of MACE compared with isolated native vessel interventions.

A biomarker for estimating no-reflow phenomenon in PCI-treated non-ST-segment elevation myocardial infarction patients: serum Cystatin C

Aims: Cystatin C (Cys-C) is a biochemical marker associated not only with renal function but also with inflammatory processes. We aimed to investigate the relationship between the post-percutaneous coronary intervention (PCI) no-reflow phenomenon (NRP) and Cys-C in patients with non-ST-segment elevation acute coronary syndrome (NST-ACS).&#x0D; Methods: This retrospective, single-center observational study consecutively enrolled patients who were hospitalized with a diagnosis of NST-ACS and underwent PCI between October 2021 and February 2022. Baseline characteristics, medications, admission laboratory parameters, and angiographic features were recorded. Logistic regression and sensitivity analyses were performed to identify parameters associated with NRP.&#x0D; Results: Out of 199 patients (mean age: 62.0±10.3, 59.8% male), 36 (18.1%) developed NRP. Patients who developed NRP had a lower ejection fraction (49.7±10.3% vs. 53.5±7.1%, p=0.046) and were less likely to be male (36.1% vs. 65.0%, p=0.001). Additionally, individuals with NRP exhibited higher blood urea and C-reactive protein levels than those without NRP (p1.1 mg/L for Cys-C determined NRP with 72.2% sensitivity and 66.9% specificity (area under the curve=0.711, p

Knowledge, attitude, and practice toward postoperative self-management among patients after percutaneous coronary intervention: A structural equation modeling analysis.

The knowledge, attitude, and practice (KAP) toward post-percutaneous coronary intervention (PCI) self-management among Chinese patients remains unknown. This study investigated the KAP toward postoperative self-management among patients after PCI. Patients exhibit poor knowledge, attitudes, and practices regarding post-PCI self-management, requiring enhanced education strategies. This cross-sectional study recruited patients after PCI at Jishuitan Hospital, Beijing, between November 2022 and May 2023. Inclusion criteria comprised patients 1-3 months post-PCI, those capable of self-care, and those willingly participating. The questionnaire (49 items) was designed with reference to current guidelines (the Cronbach α = .829). The final questionnaire included four dimensions with 49 items. The Pearson correlation analysis and structural equation modeling (SEM) were used to determine the relationship among knowledge, attitude, and practice. A total of 476 valid questionnaires were included. The knowledge, attitude, and practice scores were 8.24 ± 2.78 (possible range: 0-12), 21.61 ± 3.15 (possible range: 9-45), and 32.62 ± 3.75 (possible range: 10-50). The Pearson correlation analysis showed only knowledge scores were correlated with the attitude scores (r = .446, p < .001). The SEM showed that knowledge directly affects attitude (β = .616, p < .001) but had no influence on practice (β = .119, p = .155); attitude had no influence on practice (β = .015, p = .809). This study indicated that patients had poor knowledge, unfavorable attitudes, and unsatisfied practice toward post-PCI self-management. Strengthening patient health education through diverse approaches is imperative.

The nursing strategies for preventing post-percutaneous coronary intervention hematomas: a review

Post-percutaneous coronary intervention (PCI) hematomas pose significant risks for patients and can lead to severe morbidity and mortality if left unaddressed. Nurses play a vital role in preventing these complications, emphasizing the importance of their understanding and implementation of nursing strategies and interventions. This comprehensive review investigates the various nursing strategies and interventions aimed at mitigating the risk of post-PCI hematomas and improving patient outcomes. A systematic search across multiple medical databases and scholarly sources yielded data on preventive measures and treatment options for post-PCI hematomas. The review underscores the significance of nursing interventions, including patient education, pressure dressings, careful hemostasis, and medication management, in reducing the occurrence of hematomas. It also highlights the potential complications associated with post-PCI hematomas, emphasizing the necessity of timely intervention and patient education to minimize the risk. The review emphasizes the critical role of nurses in the prevention and management of post-PCI hematomas and provides insights for future research and quality improvement initiatives. Overall, the review serves as a valuable resource for healthcare professionals, offering a comprehensive understanding of nursing interventions and guidelines to enhance patient safety and minimize the incidence of post-PCI hematomas.

Implementation of a Multidimensional Strategy to Reduce Post-PCI Bleeding Risk.

The American College of Cardiology Reduce the Risk: PCI Bleed Campaign was a hospital-based quality improvement campaign designed to reduce post-percutaneous coronary intervention (PCI) bleeding events. The aim of the campaign was to provide actionable evidence-based tools for participants to review, adapt, and adopt, depending upon hospital resources and engagement. We used data from 8 757 737 procedures in the National Cardiovascular Data Registry between 2015 and 2021 to compare patient and hospital characteristics and bleeding outcomes among campaign participants (n=195 hospitals) and noncampaign participants (n=1384). Post-PCI bleeding risk was compared before and after campaign participation. Multivariable hierarchical logistic regression was used to determine the adjusted association between campaign participation and post-PCI bleeding events. Prespecified subgroups were examined. Campaign hospitals were more often higher volume teaching facilities located in urban or suburban locations. After adjustment, campaign participation was associated with a significant reduction in the rate of bleeding (bleeding: adjusted odds ratio, 0.61 [95% CI, 0.53-0.71]). Campaign hospitals had a greater decrease in bleeding events than noncampaign hospitals. In a subgroup analysis, the reduction in bleeding was noted in non-ST-segment-elevation acute coronary syndrome and ST-segment-elevation myocardial infarction patients, but no significant reduction was seen in patients without acute coronary syndrome. Participation in the American College of Cardiology Reduce the Risk: PCI Bleed Campaign was associated with a significant reduction in post-PCI bleeding. Our results underscore that national quality improvement efforts can be associated with a significant impact on PCI outcomes.

Culprit Lesion Vessel Size and Risk of Reperfusion Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study.

Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well-established imaging biomarkers of failed myocardial tissue reperfusion in patients with ST-segment elevation-myocardial infarction treated with percutaneous coronary intervention. MVO and IMH are associated with an increased risk of adverse outcome independent of infarct size, but whether the size of the culprit lesion vessel plays a role in the occurrence and severity of reperfusion injury is currently unknown. This study aimed to evaluate the association between culprit lesion vessel size and the occurrence and severity of reperfusion injury as determined by cardiac magnetic resonance imaging. Patients (n=516) with first-time ST-segment-elevation myocardial infarction underwent evaluation with cardiac magnetic resonance at 4 (3-5) days after infarction. MVO was assessed with late gadolinium enhancement imaging and IMH with T2* mapping. Vessel dimensions were determined using catheter-based reference. Median culprit lesion vessel size was 3.1 (2.7-3.6) mm. MVO and IMH were found in 299 (58%) and 182 (35%) patients. Culprit lesion vessel size was associated with body surface area, diabetes, total ischemic time, postinterventional thrombolysis in myocardial infarction flow, and infarct size. There was no association between vessel size and MVO or IMH in univariable and multivariable analysis (P>0.05). These findings were consistent across patient subgroups with left anterior descending artery and non-left anterior descending artery infarctions and those with thrombolysis in myocardial infarction 3 flow post-percutaneous coronary intervention. Comprehensive characterization of myocardial tissue reperfusion injury by cardiac magnetic resonance revealed no association between culprit lesion vessel size and the occurrence of MVO and IMH in patients treated with primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.

Enhancing Postoperative Recovery and Nutritional Status in Acute Myocardial Infarction Patients: The Impact of Early Rehabilitation Nursing and Enteral Nutrition Post-Percutaneous Coronary Intervention

Enhancing Postoperative Recovery and Nutritional Status in Acute Myocardial Infarction Patients: The Impact of Early Rehabilitation Nursing and Enteral Nutrition Post-Percutaneous Coronary Intervention

Hypertension Management in Pre- and Post Percutaneous Coronary Intervention Patients: An Expert Opinion of Cardiologists from India

Introduction: Despite recent advancements in hypertension management, a significant portion of the population in India still has uncontrolled blood pressure (BP), particularly post percutaneous coronary intervention (PCI). This paper fulfils the gap between post-PCI and hypertension management, ensuring hypertension is well-controlled before, during, and after PCI. Methods: Cardiologists (interventional, n = 256; noninterventional, n = 336) throughout India who treated hypertensive patients, post PCI were invited to participate in a survey and virtual meetings. The perception and practices in managing these patients and strategies to improve BP control were captured. Results: Out of 593 cardiologists, 57.5% opined that heart failure (HF) was more common in patients with hypertension indicated for PCI. The target BP after PCI for patients aged &lt;65 years and &gt;65 years was recommended to be 121–130/80 mmHg by 39% of experts while 131–140/90 mmHg by 33.2% of experts, respectively, with a target heart rate of 60–80 bpm. Angiotensin II receptor blockers (ARBs) were considered the most effective antihypertensive agent in different comorbid conditions. Metoprolol and bisoprolol were the most preferred cardio-selective beta-blockers for both post-PCI and HF. A combination of ARBs and beta-blockers after the intervention was suggested in hypertensive patients with coronary artery disease and diabetes mellitus (57.0%), stroke (41.1%), and HF (44.9%). Conclusions: Managing BP and heart rate in patients with hypertension post-PCI is important. In monotherapy, ARBs followed by beta-blockers and angiotensin-converting enzyme inhibitors, were the most preferred antihypertensive agents in these patients with different comorbid conditions. While a combination of ARB and beta-blocker was preferred in patients with PCI and multiple comorbidities.

Predictive value of the inconsistency between the residual and post-PCI QFR for prognosis in PCI patients.

To investigate the prognostic value of the consistency between the residual quantitative flow ratio (QFR) and postpercutaneous coronary intervention (PCI) QFR in patients undergoing revascularization. This was a single-center, retrospective, observational study. All enrolled patients were divided into five groups according to the ΔQFR (defined as the value of the post-PCI QFR minus the residual QFR): (1) Overanticipated group; (2) Slightly overanticipated group; (3) Consistent group; (4) Slightly underanticipated group; and (5) Underanticipated group. The primary outcome was the 5-year target vessel failure (TVF). A total of 1373 patients were included in the final analysis. The pre-PCI QFR and post-PCI QFR were significantly different among the five groups. TVF within 5 years occurred in 189 patients in all the groups. The incidence of TVF was significantly greater in the underanticipated group than in the consistent group (P = 0.008), whereas no significant differences were found when comparing the underanticipated group with the other three groups. Restricted cubic spline regression analysis showed that the risk of TVF was nonlinearly related to the ΔQFR. A multivariate Cox regression model revealed that a ΔQFR≤ -0.1 was an independent risk factor for TVF. The consistency between the residual QFR and post-PCI QFR may be associated with the long-term prognosis of patients. Patients whose post-PCI QFR is significantly lower than the residual QFR may be at greater risk of TVF. An aggressive PCI strategy for lesions is anticipated to have less functional benefit and may not result in a better clinical outcome.

Significance of Multiple Lymphocyte-to-C-Reactive Protein Ratios in Predicting Long-Term Major Cardiovascular Adverse Events in Emergency Percutaneous Coronary Intervention Patients with ST-Segment Elevation Myocardial Infarction.

The high morbidity and mortality associated with ST-segment elevation myocardial infarction (STEMI) are an urgent concern. This study aimed to investigate the ratio of lymphocyte count to C-reactive protein ratio (LCR) in multiple measurements in the perioperative period, exploring dynamic changes as the best predictor of major adverse cardiovascular events (MACE) in STEMI patients. We enrolled 205 STEMI patients, conducting blood counts at admission, 24 hours post-percutaneous coronary intervention (PCI), and at discharge. Cox proportional risk models evaluated factors independently associated with STEMI prognosis. The receiver operating characteristic (ROC) curve and the De-Long test determined the best predictor. Kaplan-Meier analysis assessed the prognostic value of LCR for STEMI patients. Statistical differences and correlations between LCR at 24 hours post-PCI and cardiovascular disease risk factors were also analyzed. Gensini score (HR, 1.015; 95% CI, 1.007-1.022; P < 0.001), total stent length (HR, 1.015; 95% CI, 1.002-1.029; P=0.025), lipoprotein (a) (HR, 1.001; 95% CI, 1.000-1.002; P=0.043), LCR at admission (HR, 0.995; 95% CI, 0.989-1.000; P=0.002), and LCR at 24 hours post-PCI (HR, 0.587; 95% CI, 0.486-0.708; P < 0.001) were independent risk factors for long-term STEMI prognosis after PCI. LCR at admission (cut-off value, 2.252; 95% CI, 0.040-0.768; P < 0.001) and LCR at 24 hours post-PCI (cut-off value, 2.252; 95% CI, 0.831-0.924; P < 0.001) effectively predicted MACEs occurrence, with the latter exhibiting a superior predictive effect (P<0.001). Kaplan-Meier analysis revealed that patients with LCR at admission ≤ 50.29 and LCR at 24 hours post-PCI ≤ 2.25 had significantly higher risks of developing MACEs (Log-rank P < 0.0001). LCR at 24 hours post-PCI may be a superior marker for long-term MACE prediction in STEMI patients, serving as the best predictor for distant MACE occurrence.

Potential roles of IL-38, among other inflammation-related biomarkers, in predicting post-percutaneous coronary intervention cardiovascular events.

Percutaneous coronary intervention (PCI), as a relatively rapid and effective minimally invasive treatment for coronary heart disease (CHD), can effectively relieve coronary artery stenosis and restore myocardial perfusion. However, the occurrence of major adverse cardiovascular events (MACE) is a significant challenge for post PCI care. To better understand risk/benefit indicators and provide post PCI MACE prediction, 408 patients with CHD who had undergone PCI treatment from 2018 to 2021 in Tianjin Chest hospital were retrospectively studied for their clinical characteristics in relation with the MACE occurrence during a 12-month follow-up. In the study, 194 patients had MACE and 214 patients remained MACE-free. Using uni- and multivariate regression analyses, we have shown that smoking history, elevated serum C-reactive protein levels (hs-CRP), and high haemoglobin levels A1c (HbA1c) are all independent risk factors for MACE after PCI. Furthermore, we have discovered that the serum level of IL-38, one of the latest members identified in the IL-1 cytokine family, is another predictive factor and is reversely related to the occurrence of MACE. The serum level of IL-38 alone is capable of predicting non-MACE occurrence in subcategorized patients with abnormal levels of hs-CRP and/or HbA1c.

Genotype-guided prescribing predictors in CYP2C19 intermediate metabolizers receiving percutaneous coronary intervention.

Background: Previous differences in guideline recommendation strength for CYP2C19 intermediate metabolizers may have limited genotype (PGx)-optimal post-percutaneous coronary intervention antiplatelet prescribing.Results: In this single-center retrospective observational cohort study of CYP2C19 intermediate metabolizers, patients prescribed PGx-optimal therapy were younger and less likely on anticoagulation (2 vs12%; p=0.006). More patients prescribed PGx-optimal therapy possessed commercial insurance (36vs 7%; p<0.001), which was a predictor for PGx-optimal selection (OR: 6.464; 95% CI: 2.386-17.516; p<0.001).Conclusion: Anticoagulation use was significantly associated with clopidogrel use (OR: 0.138; 95% CI: 0.026-0.730; p=0.020). No statistical difference in composite major adverse cardiovascular events (5 vs 14%; p=0.173) or bleeding (8 vs6%; Not significant) was observed between PGx-optimal and PGx-suboptimal therapy.

Circulating intermediate monocytes CD14++CD16+ are increased after elective percutaneous coronary intervention

Aim Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This article explores the changes in monocyte subset and humoral response after elective PCI. Methods This prospective study included 30 patients without inflammatory diseases being referred for elective PCI. We included patients treated with drug coated balloons or 2nd generation drug eluting stents. Patients underwent blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers. Results Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group. Gene expression analysis of CD14+ leucocytes showed IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remains elevated up to two weeks post PCI while IL6 and TNFα remain elevated till two months post PCI. Conclusion Intermediate monocytes increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI.

Coldpack Intervention to Alleviate Hematoma in Post-Percutaneous Coronary Intervention Patient: A Case Study

Introduction: Interventions necessary for patients experiencing Coronary Artery Disease (CAD) include revascularization through Coronary Artery Bypass or Percutaneous Coronary Intervention (PCI). Vascular complications resulting from PCI procedures include hematoma, microvascular aneurysm, bleeding, edema, incision site pain, ecchymosis, embolism, arterial occlusion, arterial spasm, arteriovenous fistula, and retroperitoneal hematoma. Objective: To describe the nursing intervention outcomes using cold packs to address hematoma in post-PCI patients with femoral sheath access. Method: A qualitative study employing a case study approach conducted from March 23-25, 2023, at the Heart and Vascular Hospital Tasikmalaya. Inclusion criteria for participants include a diagnosis of Coronary Artery Disease (CAD), prior PCI intervention, PCI access via femoral sheath, and willingness to provide informed consent. The intervention involves the application of a cold pack. Research instruments utilized in this study include semi-structured interviews (in-depth interviews) and observations using The Femoral Scale. Result: The use of cold packs to address hematoma in post-PCI patients with femoral sheath access is effective. This is evidenced by the absence of hematoma in post-PCI patients with femoral access after applying mechanical pressure with a cold pack. During the observation, patients did not express significant complaints; they reported greater comfort using a cold pack compared to the conventional sandbag approach. Conclusion: The utilization of cold packs in this case can be considered an alternative to sandbags to enhance patient comfort. However, it is imperative to conduct additional monitoring when removing the cold pack, especially during the 6-hour immobilization period, to ensure patient awareness and compliance with immobilization protocols.

Colchicine Leads the Charge in Post-percutaneous Coronary Intervention Anti-inflammatory Defense.

Colchicine Leads the Charge in Post-percutaneous Coronary Intervention Anti-inflammatory Defense.

Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI.

Even with intracoronary imaging-guided stent optimisation, suboptimal haemodynamic outcomes post-percutaneous coronary intervention (PCI) can be related to residual lesions in non-stented segments. Preprocedural assessment of pathophysiological coronary artery disease (CAD) patterns could help predict the physiological response to PCI. The aim of this study was to assess the relationship between preprocedural pathophysiological haemodynamic patterns and intracoronary imaging findings, as well as their association with physiological outcomes immediately post-PCI. Data from 206 patients with chronic coronary syndrome enrolled in the ASET-JAPAN study were analysed. Pathophysiological CAD patterns were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the pullback pressure gradient (PPG) index. Intracoronary imaging in stented segments after stent optimisation was also analysed. In the multivariable analysis, diffuse disease - defined by the pre-PCI μQFR-PPG index - was an independent factor for predicting a post-PCI μQFR <0.91 (per 0.1 decrease of PPG index, odds ratio 1.57, 95% confidence interval: 1.07-2.34; p=0.022), whereas the stent expansion index (EI) was not associated with a suboptimal post-PCI μQFR. Among vessels with an EI ≥80% and post-PCI μQFR <0.91, 84.0% of those vessels had a diffuse pattern preprocedure. There was no significant difference in EI between vessels with diffuse disease and those with focal disease. The average plaque burden in the stented segment was significantly larger in vessels with a preprocedural diffuse CAD pattern. A physiological diffuse pattern preprocedure was an independent factor in predicting unfavourable immediate haemodynamic outcomes post-PCI, even after stent optimisation using intracoronary imaging. Preprocedural assessment of CAD patterns could identify patients who are likely to exhibit superior immediate haemodynamic outcomes following PCI.