Predictors Of Percutaneous Coronary Intervention Research Articles

Predictors of percutaneous coronary intervention derived from CCTA in patients with chronic coronary syndrome

Abstract Background To identify anatomical and morphological plaque features predictors of percutaneous coronary intervention (PCI) and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFRCT (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFRCT) when integrated into the score. Methods Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFRCT available, referred to invasive coronary angiogram and assessment of fractional flow reserve. Plaque analysis was performed using validated semi-automated software. Logistic regression was performed to identify anatomical and morphological plaque features predictive of PCI. Optimal thresholds were defined by area under the receiver-operating characteristics curve (AUC) analysis. A scoring system was developed in a derivation cohort (70% of the study population) and tested in a validation cohort (30% of patients). Results The overall study population included 340 patients (455 vessels), among which 238 patients (320 vessels) were included in the derivation cohort. At multivariate logistic regression analysis, absence of left main disease, diameter stenosis (DS), non-calcified plaque (NCP) volume, and percent atheroma volume (PAV) were independent predictors of PCI. Optimal thresholds were: DS³50%, volume of NCP>113 mm3 and PAV>17%. A weighted score (CT-PCI Score) ranging from 0 to 11 was obtained. The AUC of the score was 0.80 (95%CI 0.74-0.86). The integration of ΔFFRCT in the CT-PCI score led to a mild albeit not significant increase in the AUC (0.82, 95%CI 0.77-0.87, p=0.328). Conclusions Plaque anatomy and morphology derived from CCTA could aid in identifying patients amenable to PCI.Central IllustrationPredictive accuracy of the CT-PCI score

Predictors Of Percutaneous Coronary Intervention Derived From Coronary Ct Angiography In Patients With Chronic Coronary Syndromes

Predictors Of Percutaneous Coronary Intervention Derived From Coronary Ct Angiography In Patients With Chronic Coronary Syndromes

Predictors Of Percutaneous Coronary Intervention Derived From Coronary Ct Angiography In Patients With Chronic Coronary Syndromes

Predictors Of Percutaneous Coronary Intervention Derived From Coronary Ct Angiography In Patients With Chronic Coronary Syndromes

P70 ESPERIENZA CLINICA DELLE PRIME 41 PROCEDURE DI LITOTRISSIA INTRACORONARICA IN UN CATH–LAB ITALIANO

Abstract Introduction Stent under expansion is one of the main predictors of percutaneous coronary intervention (PCI) failure, being a trigger for both in–stent restenosis and stent thrombosis, with their obvious clinical impact. Among the main causes of stent failure, the presence of a severely calcified lesion is the most frequent and dangerous. Correct recognition and preparation of target lesion are therefore mandatory before stenting. Methods We enrolled all the patients treated with angioplasty and IVL (Shockwave Medical Inc, Santa Clara, USA) from October 2020 to October 2021 in our cath lab. Each patient signed informed consent. Results We enrolled 35 patients (with 41 lesions treated with IVL). Mean age was 73 years old, 29 were males (82%). Clinical characteristics are shown in the table. Twenty–one lesions (50%) were treated up–stream before stenting, 6 (16%) were bail–out IVL for inadequate stent expansion after post–dilation and 14 (37%) were in–stent restenosis with evidence of stent under–expansion because of the high burden of calcium. Fifty–four per cent of patients were treated in the context of Acute Coronary Syndrome (ACS). Seventy–three per cent of patient had three–vessel disease. The majority of procedure were done through radial access (74%) and 79% of the stenosis was prepared with NC balloons (at least 2.5 mm diameter) before deployment of the IVL balloon; in 2 case IVL was done after rotational atherectomy. Intravascular ultrasound (IVUS) guidance was used in in 15 pts. Two balloon were broken during lithotripsy. In 26 of 41 stenosis (63%) IVL delivery was obtained on a single wire, while 11 required buddy–wire (of whom 8 required child–in–mother technique to obtain adequate support for delivery). We had two major complications: 1 case of ventricular fibrillation (in a patients with recent myocardial infarction and severe reduction of ejection fraction, and 1 case of perforation at the time of inflation of the NC balloon after IVL easily treated with positioning of a covered stent which was easily delivered thanks to the previous IVL treatment). Conclusion IVL is a safe and all–around technique for treatment of severely calcified lesion in different clinical contexts from stable coronary artery disease to ACS, useful for upstream calcium treatment as well as bail–out stent optimization and correction of under expansion in calcified in–stent restenosis.

Prediction Score of Antegrade Chronic Total Occlusion Percutaneous Coronary Intervention Success in Dr. Kariadi Central General Hospital Semarang

Background: 
 Lesion characteristics of chronic total occlusion (CTO) are predictors of percutaneous coronary intervention (PCI) success. A prediction score consist of these predictors can help CTO-PCI operators. Various prediction score had been established but none had been established in Indonesian population.
 Methods:
 This observational cohort study was performed in patients underwent native vessel CTO-PCI in Dr.Kariadi Hospital during 2018. Target vessels, ostial lesion, blunt stump, calcification, long lesion, bending, side branch, bridging collateral, and retrograde collateral were angiographic variables proposed to be predictors of CTO-PCI success. All of the variables were quantitatively assessed by two observers. Bivariate and multivariate analysis used to identify independent predictors of CTO-PCI success and to establish a scoring model.
 Results:
 A total 200 patients underwent CTO-PCI procedures were included to this study. All of the procedures used antegrade approach. The prediction score established as follows: bending (1 point), calcification (2 point), blunt stump (3 point), long lesion (1 point), and poor retrograde collateral filling (2 point). Total score ranged from 0 to 9 with decreased probability of success from 92.3% to 0.5%. Score value ? 3 categorized as difficult lesion with higher risk to failure compared to score value <3 (OR 15.4; p<0.001). The score model had good calibration and discrimination in predict CTO-PCI success (AUC 0.88; p<0.001).
 Conclusion: 
 Bending, calcification, blunt stump, long lesion, and poor retrograde collateral were predictors of CTO-PCI success. The score consist of these variables could predict antegrade CTO-PCI success.
 Keywords: chronic total occlusion; percutaneous coronary intervention; success; prediction score.

Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Aged Patients With Unprotected Left Main Artery Lesions

There is still much debate about revascularization strategies in aged patients with unprotected left main coronary artery (UPLM) lesions. This study compared the outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in this population.A total of 126 patients older than 60 years of age with LM lesions who underwent revascularization in our hospital from January 2012 to December 2013 were followed up for an average of 15.2 months. The cumulative incidence of major adverse cardiac and cerebral events (MACCE) was estimated by Kaplan-Meier plots. During follow-up, the CABG group had higher proportions of cardiac death, stroke, and worsening of heart failure while the PCI group had a higher proportion of recurrence of angina (P = 0.04). The MACCE incidence was lower in the PCI group than that in the CABG group (28.9% versus 35.6%, P = 0.04). Multivariate regression identified left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) as predictors of PCI, while age, LVEF, EuroScore, and diabetes were the predictors of CABG. PCI maintained its superiority over CABG after adjustment for risk factors (Hazard ratio: 0.28, P = 0.004). The CABG group included a higher proportion of severe hemorrhagic complications than the PCI group (P = 0.04).In terms of efficacy and safety, PCI had an advantage over CABG in aged patients with UPLM lesions. Thus, PCI was a reasonable alternative to CABG for this population.