Role Of PCI Research Articles

Unlocking the Secrets of Acute Coronary Syndromes Using Intravascular Imaging: From Pathophysiology to Improving Outcomes.

Acute coronary syndrome (ACS) represents the most severe manifestation of coronary artery disease. Intravascular imaging, both intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have played crucial roles for the impressive reduction in mortality of ACS. Intravascular imaging is useful for the detection of atherosclerotic mechanism (plaque rupture, calcified nodules, or plaque erosions) and for the evaluation of nonatherosclerotic and nonobstructive types of ACS. In addition, IVUS and OCT play a crucial role in the optimization of the PCI. The aim of the current review is to present the role of intravascular imaging in identifying the mechanisms of ACS and its prognostic role in future events, to review the current guidelines suggesting intravascular imaging use in ACS, to summarize its role in PCI in patients with ACS, and to compare IVUS and OCT.

Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry

BackgroundPercutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this...

Prophylactic cerebral irradiation or active brain magnetic resonance imaging surveillance in small-cell lung cancer patients (EORTC-1901: PRIMALung).

TPS8614 Background: PRIMALung is an EORTC-sponsored study. Primary objective is to show that overall survival with brain MRI surveillance alone is non-inferior to brain MRI surveillance combined with PCI in patients with SCLC. PCI is currently SOC in most institutions, but can be associated with neurocognitive toxicity and impact quality of life. 600 patients will be recruited from 50 EORTC centres in 10 countries. This study is currently recruiting and will play an important role in clarifying whether MRI surveillance is a viable strategy in SCLC. Furthermore, it will answer important questions about the role of PCI in the era of immunotherapy, particularly in ES-SCLC. Methods: Key eligibility: ECOG performance status ≤ 2 patients with SCLC (Limited or Extensive-Stage, stage I-IV) who did not progress after (≤ 16 weeks from day 1 of last cycle of chemotherapy to randomisation) completed standard therapy. Absence of progression, brain metastases or leptomeningeal disease after completing therapy. Trial Interventions: Patients will be randomised 1:1 to receive brain MRI surveillance with or without PCI (25Gy in 10 fractions). Primary objective - to show that overall survival with brain MRI surveillance alone is non-inferior to brain MRI surveillance combined with PCI. Secondary objectives - cognitive failure-free survival, quality of life and acute/late toxicities according to CTCAE v5.0. The trial was open to recruitment on 27/10/2022. Three countries open to date (Belgium, Switzerland, UK). Further sites in France, Poland and Austria will be open to recruitment Q1 2023. The first patient has been randomized on the 4th of January 2023. Further information: https://clinicaltrials.gov/ct2/show/NCT04790253 contact: 1901@EORTC.org. Clinical trial information: NCT04790253 .

The role of PCI in extensive stage small cell lung cancer treated with palliative chemotherapy and consolidative thoracic radiotherapy

The role of PCI in extensive stage small cell lung cancer treated with palliative chemotherapy and consolidative thoracic radiotherapy

TCT-746 Can Cardiac MRI Viability Assessment Guide Revascularization Decisions in Patients with Ischemic Cardiomyopathy?

CABG improves survival in CAD patients with severe LV dysfunction; trials comparing CABG with PCI have excluded these patients and the role of PCI has been unclear. The role of viability testing to guide revascularization is similarly unclear although Cardiac MRI (CMR) has not been well studied for

P2.05-025 9-Year Experience: Prophylactic Cranial Irradiation in Extensive Disease Small-Cell Lung Cancer: Topic: Clinical Outcome

In 2007, a EORTC study demonstrated a beneficial impact on overall survival with the use of prophylactic cranial irradiation in extensive disease small cell lung cancer. Nevertheless, there is ongoing debate over the role of PCI as patients in this trial did not undergo imaging of the brain prior to treatment, and a recent Japanese randomized trial showed a detrimental effect of PCI on OS in patients with a negative pre-treatment brain MRI. 87% of our patients received brain imaging prior to PCI. We examined the medical records of 137 patients with extensive disease small cell lung cancer who initially responded to chemotherapy and received PCI between 2007 and 2015. The outcomes, including the development of brain metastases and OS following PCI were analyzed. Survival and correlations were calculated using log-rank, univariate, and multivariate Cox proportional hazards-ratio analyses. Median OS after PCI was 12 months and the median nPFS after PCI was 19 months. There was no significant survival difference in patients who received an MRI prior to PCI compared to patients who received a contrast enhanced computer tomography (CT) (p=0.20). Univariate analysis for overall survival did not show a statistically significant effect for known cofactors. We present the 9-year clinical experience with PCI in ED SCLC patients from one of Europe’s largest Lung Cancer Centres. PCI leads to a nearly doubled median OS compared to the irradiation arm of the EORTC trial with a 2-months prolonged median OS compared to the irradiation arm of the Japanese trial. PCI should remain standard of care for all patients with SCLC who have a response to initial chemotherapy. Contrast enhanced brain MRI instead of CT for staging prior to PCI is recommended if possible.

TCT-489 Complete percutaneous revascularization in ischemic heart failure improves survival – report from the COMMIT-HF registry

Heart failure (HF) is the major cause of death in cardiovascular disease. In a post-STICH environment, we lack data on the role of PCI in systolic HF patients. Complete revascularization of myocardium remains one of the key unanswered questions in ischemic HF. The COMMIT-HF is an ongoing single-

SYNTAX–SCORE BASED ASSESSMENT FOR IDENTIFYING APPROPRIATE CANDIDATE OF PCI AMONG PATIENTS WITH CHRONIC TOTAL OCCLUSION

In this study, we assessed efficacy of CTO–PCI among patients divided by severity of syntax score to establish role of PCI among patients with CTO. We investigated consecutive 245 patients who underwent CTO–PCI adjunctive to medical therapy. All those patients were assessed by syntax score

P-0134 Small Cell Carcinoma of the Gastrointestinal Tract: A Single Institution Experience

ABSTRACT Introduction Small cell carcinoma (SCC) of the gastrointestinal tract (GI) tract is rare and there is no standard treatment strategy for managing these patients. The objective of this study is to report the clinical experience and management of patients with SCC of the GI tract, treated in the Cross Cancer Institute, Edmonton, AB, Canada from 1992 to 2009. Methods A retrospective chart review of all patients diagnosed with SCC of the GU tract between 1992 and 2009 was undertaken. Data was collected on demographics, clinical and pathological characteristics, and patient outcomes. Results Forty-seven patients were identified with primary sites as follows: esophagus 12 (26%), stomach 3 (6%), small bowel 3 (6%), colorectal 17 (36%), pancreas 5 (11%), liver 3 (6%) and gallbladder 2 (5%). Mean age for the entire group was 63 years (range 31 - 85yrs); 22/47 (47%) were females and 25/47 (53%) were males. Eighty-five percent (40/47) had pure SCC; the rest had mixed histology. Forty-five percent (21/47) were positive for at least one neuroendocrine marker. Overall, 11/47 had limited-stage disease, 33/47 had extensive-stage disease, and three were unknown. Treatment of limited-stage patients was 7/11 (64%) surgery with or without adjuvant chemotherapy, 2/11 (18%) concurrent chemotherapy with radiation, 1/11 (9%) chemotherapy alone, and 1/11 (9%) radiation alone. For extensive-stage patients, 8/33 (24%) received chemotherapy alone, 3/33 (9%) received RT and chemotherapy, 6/33 (18%) surgery alone, and 16/33 (48%) supportive care only. No one with limited-stage disease received prophylactic cranial irradiation. Despite this, only two patients in the entire cohort presented with brain metastases as the site of initial relapse. Median overall survival for the entire cohort was 6.1 months (95% CI: 1.7-8.5) (17.6 months for limited-stage disease and 5.1 months for extensive-stage disease). Conclusion SCC of the GI tract is aggressive with a poor overall prognosis. As there is no standard of care for these patients, they are treated according to local protocols. Further efforts should be made to develop more effective treatments and the role of PCI should be investigated in the setting of a clinical trial, in conjunction with other extrapulmonary SCCs.

Small cell carcinoma of the genitourinary tract: A 10-year single institution experience.

312 Background: Small cell carcinoma (SCC) of the genitourinary (GU) tract is rare and there is no standard treatment strategy for managing these patients. The objective of this study is to report the clinical experience and management of patients with SCC of the GU tract, treated in the Cross Cancer Institute, Edmonton, AB, Canada from 1999 to 2009. Methods: A retrospective chart review of all patients diagnosed with SCC of the GU tract between 1999 to 2009 was undertaken. Data was collected on demographics, clinical and pathological characteristics, and patient outcomes. Results: Fifty-eight patients were identified with primary sites as follows: urinary bladder (UB) 35 (60%), prostate 17 (29%) and upper urinary tract (UUT) 6 (11%). Mean age for the entire group was 68 years; 12/58 were female and 46/58 were male. Sixty-six percent (37/58) had pure SCC; the rest had mixed histology. Seventy percent (41/58) were positive for at least one neuroendocrine marker. Overall, 27/58 had limited stage disease, 25/58 had extensive disease and six were unknown. Treatment of limited stage patients was 10/27 (37%) concurrent chemotherapy with radiation, 5/27 (19%) surgery +/- adjuvant chemotherapy, 5/27 (19%) chemotherapy alone, 2/27 (7%) radiation alone and 5/27 (19%) supportive care only. For extensive stage patients, 5/25 (20%) received chemotherapy alone, 3/25 (12%) received radiation alone, 4/25 (16%) received RT and chemotherapy, 4/25 (16%) surgery alone and 9/25 (36%) supportive care only. One patient with limited stage disease received prophylactic cranial irradiation. Despite this, only one patient in the entire cohort presented with brain metastases as the site of initial relapse. Median survival for the entire cohort was 24 months (28 months for limited stage disease and 7 months for extensive). Prostate patients tended to do worse, with a survival of only eight months. Conclusions: SCC of the GU tract is aggressive with an overall poor prognosis. As there is no standard of care for these patients, they are treated according to local protocols. Further efforts should be made to develop more effective treatments and the role of PCI should be investigated in the setting of a clinical trial, in conjunction with other extrapulmonary SCCs.

Prediction of a common structural scaffold for proteasome lid, COP9-signalosome and eIF3 complexes

BackgroundThe 'lid' subcomplex of the 26S proteasome and the COP9 signalosome (CSN complex) share a common architecture consisting of six subunits harbouring a so-called PCI domain (proteasome, CSN, eIF3) at their C-terminus, plus two subunits containing MPN domains (Mpr1/Pad1 N-terminal). The translation initiation complex eIF3 also contains PCI- and MPN-domain proteins, but seems to deviate from the 6+2 stoichiometry. Initially, the PCI domain was defined as the region of detectable sequence similarity between the components mentioned above.ResultsDuring an exhaustive bioinformatical analysis of proteasome components, we detected multiple instances of tetratrico-peptide repeats (TPR) in the N-terminal region of most PCI proteins, suggesting that their homology is not restricted to the PCI domain. We also detected a previously unrecognized PCI domain in the eIF3 component eIF3k, a protein whose 3D-structure has been determined recently. By using profile-guided alignment techniques, we show that the structural elements found in eIF3k are most likely conserved in all PCI proteins, resulting in a structural model for the canonical PCI domain.ConclusionOur model predicts that the homology domain PCI is not a true domain in the structural sense but rather consists of two subdomains: a C-terminal 'winged helix' domain with a key role in PCI:PCI interaction, preceded by a helical repeat region. The TPR-like repeats detected in the N-terminal region of PCI proteins most likely form an uninterrupted extension of the repeats found within the PCI domain boundaries. This model allows an interpretation of several puzzling experimental results.

More debate on role of PCI in multivessel CAD

More debate on role of PCI in multivessel CAD

Protein C Inhibitor Acts as a Procoagulant by Inhibiting the Thrombomodulin-Induced Activation of Protein C in Human Plasma

AbstractProtein C inhibitor (PCI), which was originally identified as an inhibitor of activated protein C, also efficiently inhibits coagulation factors such as factor Xa and thrombin. Recently it was found, using purified proteins, that the anticoagulant thrombin-thrombomodulin complex was also inhibited by PCI. The paradoxical inhibitory effect of PCI on both coagulant and anticoagulant proteases raised questions about the role of PCI in plasma. We studied the role of thrombomodulin (TM)-dependent inhibition of thrombin by PCI in a plasma system. Clotting was induced by addition of tissue factor to recalcified plasma in the absence or presence of TM, and clot formation was monitored using turbidimetry. In the absence of TM, PCI-deficient plasma showed a slightly shorter coagulation time compared with normal plasma. Reconstitution with a physiologic amount of PCI gave normal clotting times. Addition of PCI to normal plasma and protein C–deficient plasma resulted in a minor prolongation of the clotting time. This suggested that PCI can act as a weak coagulation inhibitor in the absence of TM. TM caused a strong anticoagulant effect in normal plasma due to thrombin scavenging and activation of the protein C anticoagulant pathway. This effect was less pronounced when protein C–deficient plasma was used, but could be restored by reconstitution with protein C. When PCI was added to protein C–deficient plasma in the presence of TM, a strong anticoagulant effect of PCI was observed. This anticoagulant effect was most likely caused by the TM-dependent thrombin inhibition by PCI. However, when PCI was added to normal plasma containing TM, a strong procoagulant effect of PCI was observed, due to the inhibition of protein C activation. PCI-deficient plasma was less coagulant in the presence of TM. A concentration-dependent increase in clotting time was observed when PCI-deficient plasma was reconstituted with PCI. The combination of these results suggest that the major function of PCI in plasma during coagulation is the inhibition of thrombin. A decreased generation of activated protein C is a procoagulant consequence of the TM-dependent thrombin inhibition by PCI. We conclude that TM alters PCI from an anticoagulant into a procoagulant during tissue factor-induced coagulation.