Successful Percutaneous Revascularization Research Articles

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

Successful Percutaneous Revascularization for Femoral Artery Occlusion After Catheter Intervention: Serial Case Report

The usefulness of tumor necrosis factor-like weak inducer of apoptosis in patients with acute ST-elevation myocardial infarction.

We aimed to determine the utility of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) for the early diagnosis and prognosis of acute ST-elevation myocardial infarction (STEMI). Patients presented with STEMI arrived at the hospital within 45 minutes after the onset of chest pain were included in this study. Blood samples for TWEAK, high-sensitivity C-reactive protein (hs-CRP), creatine kinase MB isoenzyme (CK-MB), and high-sensitivity cardiac troponin T (hs-TnT) levels were obtained at the time of arrival at the hospital. Subsequent samples were drawn at 4 h after primary percutaneous coronary intervention. The study cohort comprised patients with confirmed STEMI between January 2022 and September 2022, for a total of 45 enrolled STEMI patients. Plasma TWEAK levels were markedly elevated at hospital arrival, followed by a decrease at 4 hours after successful primary percutaneous coronary revascularization (PPCI). High-sensitive troponin T (Hs-TropT), CK-MB, and CRP were found within normal limits at the hospital arrival. Conversely, increased levels of CRP, CKMB, and hs-TropT were observed at 4 hours after PPCI. Plasma TWEAK levels were elevated earlier in the acute phase and decreased earlier after PPCI than other classic myocardial biomarkers.

Combined Right and Left Ventricular Reperfusion Injury following Percutaneous Coronary Intervention: Role of Myocardial Contrast Echocardiography

Right ventricular myocardial infarction (RVMI) occurs in up to half of the patients of inferior wall myocardial infarction. RVMI results in edema and increased right ventricular (RV) mass, and hence, it should be possible to visualize microvascular obstruction as a manifestation of reperfusion injury. Reperfusion injury of the RV myocardium following primary percutaneous coronary intervention has been rarely reported. This report describes a patient with the left ventricular inferior and RVMI who showed echocardiographically detected reperfusion injury of the RV-free wall and left ventricular basal inferolateral wall and conformed by myocardial contrast perfusion study despite successful percutaneous revascularization of the right coronary artery.

Association of Successful Percutaneous Revascularization of Chronic Total Occlusions With Quality of Life

Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is not usually offered because of skepticism about long-term clinical benefits. To assess the association of successful CTO-PCI with quality of life by analyzing the relevant domains of the Seattle Angina Questionnaire (SAQ). PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane databases were searched to identify randomized trials and observational studies specifically addressing quality of life domains of SAQ from January 2010 to June 2022. Studies included reporting SAQ metrics such as angina frequency, physical limitation, and quality of life, before and after CTO-PCI. The present study was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, in which fixed-effect or random-effect models with generic inverse-variance weighting depending on statistical homogeneity were applied. Data were extracted by 3 independent reviewers. The primary outcome was angina frequency; physical limitation and quality of life were assessed as secondary outcomes. Seven prospective randomized or observational studies (2500 patients) were included, with a mean (SD) participant age of 61.2 (2.1) years. CTO-PCI was associated with significantly improved quality-of-life metrics during a mean (SD) follow-up of 14.8 (16.3) months. In patients with successful procedures, angina episodes became less frequent (mean [SD] difference for SAQ angina frequency of 12.9 [3.1] survey points [95% CI, 7.1-19.8 survey points]; standardized mean difference was 0.54 [95% CI, 0.21-0.92]; P = .002; I2 = 86.4%) and they experienced less physical activity limitation (mean [SD] difference for SAQ physical limitation of 9.7 [6.2] survey points [95% CI, 3.5-16.2 survey points]; standardized mean difference was 0.42 [95% CI, 0.24-0.55]; P < .001; I2 = 20.9%), and greater quality-of-life domain (mean [SD] difference for SAQ quality of life of 14.9 [3.5] survey points [95% CI, 7.7-22.5 survey points]; standardized mean difference was 0.41 [95% CI, 0.25-0.61]; P < .001; I2 = 58.8%) compared with patients with optimal medical therapy or failed procedure. Furthermore, follow-up duration (point estimate, 0.03; 95% CI, 0.01-0.04; P = .01) was associated with a significant decrease in angina frequency in meta-regression analysis. In this systematic review and meta-analysis examining quality of life following CTO-PCI, successful procedures were associated with improved quality-of-life parameters compared with patients on optimal medical therapy or after failed CTO-PCI. These findings suggest support for using PCI to treat CTOs in symptomatic patients unresponsive to medical treatment.

Relationship between NT-proBNP and myocardial deformation in obese patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania, grant number 1529/66/18.01.2019. Introduction In addition to promoting coronary artery disease, obesity increases the risk of cardiovascular complications. The obesity paradox, however, refers to the observation that a high body mass index (BMI) may be protective of outcomes following an acute myocardial infarction (AMI). In patients with AMI, both NT-proBNP and novel echocardiographic markers (global longitudinal strain - GLS) provide additional information; nevertheless, there is limited research on the association between these parameters and obesity in this clinical setting. Material and methods This was a prospective study that included 55 patients admitted with AMI and preserved or mildly reduced LVEF (&amp;gt;40%), which all underwent successful percutaneous revascularization. At 48 hours after PCI, echocardiography was performed using a Vivid E95 scanner and the automated function-imaging (AFI) tool was used to determine GLS. NT-proBNP was measured using ELISA. All patients were divided into two groups according to their BMI (group 1 included 18 patients with normal BMI&amp;lt;25 kg/m2, and group 2 included 37 obese patients, with a BMI&amp;gt;30 kg/m2). Results The mean age of the patients was of 66±14 years, 58% were male and 65.5% had STEMI. Other than obesity, there was no difference between groups in the other cardiovascular risk factors (smoking, dyslipidemia, arterial hypertension, diabetes, age, gender). In both groups, the anterior descending coronary artery was the most frequent culprit vessel (44% vs. 40%, p=0.9). The majority of the patients had single- or two- vessel coronary artery disease (72% vs. 73%), but there were no differences between groups (p=0.74). The values of NT-proBNP were significantly lower in the obese group (300 [117-713] vs. 756 [450-1800] pg/mL, p=0.02). However, regarding the echocardiographic evaluation of myocardial function, there was no difference between the values of GLS (-10.5% vs. -10.8%, p=0.77) or LVEF (56.7% vs. 49.2%, p=0.27) among groups. GLS showed a stronger correlation to NT-proBNP values in the normal weight group (r=0.63) than in the obese group (r=0.27). Conclusion Despite the fact that increased BMI is linked to lower values of NT-proBNP following AMI, non-obese patients do not demonstrate more impaired myocardial longitudinal function. These findings might offer more insights on the perspectives of obese AMI patients.

The effect of successful lower extremity revascularization on aortic stiffness in patients with peripheral arterial disease.

Peripheral arterial disease (PAD) is a global health problem and associated with poor outcomes. It causes increased arterial stiffness. The association of PAD with aortic arterial stiffness was investigated in previous studies. However, there is limited data regarding the effect of peripheral revascularization on arterial stiffness. The aim of our study is to investigate the effect of peripheral revascularization on aortic stiffness parameters in patients with symptomatic PAD. A total of 48 patients with PAD who underwent peripheral revascularization were included in the study. Echocardiography was performed before and after the procedure, and aortic stiffness parameters were obtained by using aortic diameters and arterial blood pressure measurements. Post-procedural aortic strain (5.1 [1.3-14] vs. 6.3 [2.8-6.3], p = 0.009) and aortic distensibility (0.2 [0.0-0.9] vs. 0.3 [0.1-1.1], p = 0.001) measurements were significantly increased compared to pre-procedural values. Patients were also compared according to the lesion laterality, site and treatment methods. It was found that the change in aortic strain (p = 0.031) and distensibility (p = 0.043) were significantly higher in unilateral lesion compared to bilateral lesion. Also, the change in aortic strain (p = 0.042) and distensibility (p = 0.033) were significantly higher in iliac site lesion compared to superficial femoral artery (SFA) site lesion. Moreover, the change in aortic strain was significantly higher (p = 0.013) in patients treated with stent compared to only balloon angioplasty. Our study showed that successful percutaneous revascularization significantly reduced aortic stiffness in PAD. The change in aortic stiffness was significantly higher in unilateral lesions, iliac site lesions and stent-treated lesions.

Double Trouble: A Case Of Combined Amyloid And Ischemic Cardiomyopathy

Background The management of concurrent cardiac amyloidosis (CA) and ischemic cardiomyopathy (ICM) is not well established due to the rarity of this phenomenon. We present a case of mixed cardiomyopathy with challenging clinical decision-making. Case A 76-year-old African American woman with hypertension, diabetes, and longstanding carpal tunnel syndrome presented with progressive dyspnea and was found to have decompensated heart failure attributable to a new cardiomyopathy. Initial workup revealed left ventricular ejection fraction (LVEF) of 20% and severe triple vessel coronary artery disease. Echocardiogram also demonstrated an apical-sparing strain pattern (Figure 1A) prompted concern for coexisting CA given her demographic and carpal tunnel history. A cardiac magnetic resonance (CMR) raised further concern for CA given restrictive cardiomyopathy, pericardial effusion, and characteristic late gadolinium enhancement (Figure 1B and 1C). Ultimately, transthyretin CA (ATTR) was confirmed with a positive technetium-99m-Pyrophosphate Scintigraphy (PYP) scan (Figure 1D) paired with normal serum immunofixation electrophoresis. She was evaluated by cardiothoracic surgery but deemed a prohibitively high-risk candidate for CABG due to her advanced age, ATTR diagnosis, and significant systolic dysfunction. Instead, she was diuresed and started on guideline-directed medical therapy, which she tolerated unusually well despite her diagnosis of ATTR. Using Impella CP for temporary mechanical circulatory support, she underwent high-risk percutaneous coronary intervention to the distal left main artery extending into the proximal left circumflex. She was discharged on dual antiplatelet therapy. During outpatient follow-up in the Multidisciplinary CA Clinic, genetic testing revealed a pathogenic V122I mutation indicative of hereditary ATTR. She was started on tafamidis after nerve conduction studies did not demonstrate neuropathy. The combination of guideline-directed medical therapy, successful percutaneous revascularization, and ATTR-directed treatment resulted in remarkable improvement (NYHA Class II, LVEF 50% from NYHA IV, LVEF 20%). Conclusion Further investigation is needed to define optimal treatment strategies in patients with coexisting ischemic and amyloid cardiomyopathy. Until then, a multidisciplinary approach must be utilized to individualize the care of such patients. The management of concurrent cardiac amyloidosis (CA) and ischemic cardiomyopathy (ICM) is not well established due to the rarity of this phenomenon. We present a case of mixed cardiomyopathy with challenging clinical decision-making. A 76-year-old African American woman with hypertension, diabetes, and longstanding carpal tunnel syndrome presented with progressive dyspnea and was found to have decompensated heart failure attributable to a new cardiomyopathy. Initial workup revealed left ventricular ejection fraction (LVEF) of 20% and severe triple vessel coronary artery disease. Echocardiogram also demonstrated an apical-sparing strain pattern (Figure 1A) prompted concern for coexisting CA given her demographic and carpal tunnel history. A cardiac magnetic resonance (CMR) raised further concern for CA given restrictive cardiomyopathy, pericardial effusion, and characteristic late gadolinium enhancement (Figure 1B and 1C). Ultimately, transthyretin CA (ATTR) was confirmed with a positive technetium-99m-Pyrophosphate Scintigraphy (PYP) scan (Figure 1D) paired with normal serum immunofixation electrophoresis. She was evaluated by cardiothoracic surgery but deemed a prohibitively high-risk candidate for CABG due to her advanced age, ATTR diagnosis, and significant systolic dysfunction. Instead, she was diuresed and started on guideline-directed medical therapy, which she tolerated unusually well despite her diagnosis of ATTR. Using Impella CP for temporary mechanical circulatory support, she underwent high-risk percutaneous coronary intervention to the distal left main artery extending into the proximal left circumflex. She was discharged on dual antiplatelet therapy. During outpatient follow-up in the Multidisciplinary CA Clinic, genetic testing revealed a pathogenic V122I mutation indicative of hereditary ATTR. She was started on tafamidis after nerve conduction studies did not demonstrate neuropathy. The combination of guideline-directed medical therapy, successful percutaneous revascularization, and ATTR-directed treatment resulted in remarkable improvement (NYHA Class II, LVEF 50% from NYHA IV, LVEF 20%). Further investigation is needed to define optimal treatment strategies in patients with coexisting ischemic and amyloid cardiomyopathy. Until then, a multidisciplinary approach must be utilized to individualize the care of such patients.

Relationship between 3D and 2D global longitudinal strain in patients with acute myocardial infarction after percutaneous revascularization

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania. This paper was published under the frame of European Social Found, Human Capital Operational Programme 2014-2020, project no. POCU/380/6/13/125171 Introduction Impaired longitudinal strain (GLS) is associated with increased wall stress following acute myocardial infarction (MI). However, little is known about the relationship between three-dimensional (3D)-GLS and two-dimensional (2D)-GLS. The aim of this study was to evaluate the relationship between 3D-GLS and 2D-GLS and also the association of 3D-GLS with specific biomarkers (NT-proBNP and Troponin) in patients with acute MI following percutaneous revascularization (PCI). Methods We included 100 patients with acute MI after successful PCI with a left ventricular ejection fraction (LVEF) &amp;gt;40%. 2D-GLS and 3D-GLS were assessed using speckle-tracking echocardiography and plasma concentrations of NT-proBNP and high sensitive troponin were analyzed. Results The patients had a mean age of 67.1 ± 13.1 years. 69 patients were diagnosed with ST-elevation MI (STEMI). Mean 3D-GLS was of -9.44 ± 4.35% and mean 2D-GLSwas of -10.1 ± 3.9%. 3D-GLS showed a strong correlation with 2D-GLS (r=-0.57, p &amp;lt; 0.001) and LVEF (r=-0.58,p &amp;lt; 0.001), a moderate correlation with NT-proBNP (r = 0.22), but no correlation with Troponin (r = 0.19). There was no difference (paired t-test) between 3D-GLS and 2D-GLS (p = 0.56, mean of differences of 0.65), but the limits of agreement were wide (-6.8% and 8.11%). Conclusion 3D-GLS showed small bias compared to 2D-GLS, but wide limits of agreement. The correlation between 3D-GLS and NT-proBNP was only moderate in acute MI. 3D-GLS might offer additional advantages in patients with complex geometry after acute MI due to faster data acquisition and lack of geometric assumption,but future studies are needed to confirm its role. Abstract Figure. Relationship between 3D and 2D GLS Abstract Figure. Corresponding Bland-Altman plots

Prognostic value of baseline versus 6-month follow infarct size in patients with reperfused STEMI

Abstract Background Acute infarct size is a predictor of clinical outcomes in acute ST segment elevation myocardial infarction (STEMI) patients, although its prognostic value has differed between studies. In acute STEMI, infarct size is often overestimated due to the presence of extensive myocardial oedema, a confounder that is no longer present at a 6-month follow-up study. It was our purpose to assess whether infarct size in the acute phase or at 6-months follow-up provided superior prognostic information in STEMI patients. Methods STEMI patients who underwent successful primary percutaneous revascularization were included and a cardiac magnetic resonance (CMR) was performed between 5–7 days after STEMI and at 6 months to study infarct size (as a % of myocardial mass). The primary endpoint was a composite of cardiovascular mortality, hospitalization for heart failure and ventricular arrhythmia. Results A total of 796 patients were included (mean age 58.3±11.5 years, 82.4% male, 52.3% anterior infarction). During a mean follow-up of 59 months, 59 patients (7.4%) presented with the primary end-point (cardiovascular death n=7, hospitalization for heart failure n=52, ventricular arrhythmia n=1). ROC curve analysis (figure 1) showed a non-significant difference between baseline and 6-month infarct size for the prediction of the primary endpoint (baseline AUC 0.685 95% CI 0.610–0.760, 6-month AUC 0.713 95% CI 0.643–0.782, p=0.60). Optimal cut-off values for baseline and 6-months follow-up infarct size for prediction of outcomes, respectively 22% and 17.5%, were used for Kaplan-Meier curve analysis (figure 2). Conclusion Infarct size estimated during the first week after STEMI and at 6-months follow-up showed similar predictive value and with similar cut-off values. Therefore, the prognostic information provided by infarct size can be obtained during initial STEMI admission and does not require a waiting period for infarct size stabilization. Funding Acknowledgement Type of funding sources: None. ROC curve analysisKaplan-Meier analysis

Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease.

The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4-6weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.

Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion.

The QRS-T angle (QRS-Ta) is a novel marker of myocardial repolarization heterogeneity which is related to adverse cardiovascular events. Our aim in this study was to investigate the effect of successful percutaneous coronary intervention (PCI) on frontal QRS-Ta in patients with chronic total occlusion (CTO). A total of 132 patients undergoing PCI for CTO were included in this study. Successful PCI of CTO segment was performed in 84 patients (group 2) while 48 who failed CTO were observed (group 1). Baseline demographic and clinical variables were evaluated and, 12-lead surface ECGs of all subjects were recorded before performing coronary angiography and 1-month and 6-month after the index procedure. QRS-Ta values significantly decreased during follow-up visits compared to baseline values [92.5 (63.25-110.75); 85.0 (59.0-101.0); 80.0 (53.0-99.0), P < 0.001] in group 2 patients. Moreover, there was no significant difference in frontal QRS-Ta measurements in group 1 patients in their clinical 6-month follow-up [87.0 (48.25-103.0); 86.5 (46.0-101.75); 84.0 (49.0-103.75); P = 0.320]. First month frontal QRS-Ta values [92.5 (63.25-110.75); 85.0 (59.0-101.0), P = 0.002] and sixth month frontal QRS-Ta values [92.5 (63.25-110.75); 80.0 (53.0-99.0), P < 0.001] were lower than baseline values while sixth month values [85.0 (59.0-101.0); 80.0 (53.0-99.0), P = 0.002] was lower compared to first month values. Additionally, a decrease in frontal QRS-Ta was observed regardless of target vessel or Rentrop classification. Successful percutaneous revascularization of CTO was effective in ventricular repolarization. Frontal QRS-Ta significantly decreased after successful PCI on CTO patients at a 6-month follow-up.

Intermittent Claudication – Functional Status Assessment in Patient Follow-up after Successful Percutaneous Revascularization

Intermittent Claudication – Functional Status Assessment in Patient Follow-up after Successful Percutaneous Revascularization

Single Coronary Artery Anomaly in a Woman With Acute ST-Segment Elevation Myocardial Infarction

A 65-year-old woman presented with an acute inferior ST-segment elevation myocardial infarction and was found to have a rare single coronary artery anomaly on coronary angiography. A complete occlusion at the mid right coronary artery was identified as the culprit lesion and underwent successful percutaneous revascularization with stenting. (Level of Difficulty: Beginner.)

4936Cardiac magnetic resonance strain analysis predicts functional recovery following acute ST-segment elevation myocardial infarction

Abstract Background Late gadolinium enhancement (LGE) is the clinical reference standard for estimation of infarct extension and prediction of functional recovery following reperfused acute ST-segment elevation myocardial infarction (STEMI). Nevertheless, myocardial edema, microvascular obstruction and intramyocardial hemorrhage as well as the timing of image acquisition after contrast administration may influence the extent of LGE and underestimate the potential for recovery. Dobutamine stress testing has been recommended to more accurately predict functional recovery when infarct transmurality is between 25 to 75%. We hypothesized that cardiac magnetic resonance (CMR) tissue tracking strain analysis may provide additional value to LGE for the prediction of functional recovery. Methods In 370 patients with STEMI who underwent successful primary percutaneous revascularization and were studied with CMR within 3–5 days of the event, peak systolic longitudinal (LS), circumferential (CS) and radial (RS) strain were analyzed with routine SSFP images of 3 long-axis and a stack of short-axis slices (Tissue Tracking, CVI42®, Figure panel A and B). Inversion-recovery echogradient sequences were analyzed 20 minutes after contrast administration for LGE transmurality (Panel C). All per-segment analysis was performed according to the AHA 16-segment model. CMR was repeated at 6 months and functional recovery was defined as persistent normokinesia or improvement of wall motion score from baseline to 6-month CMR. Results At baseline CMR, of a total of 5920 segments 70.4% were normokinetic, 7.2% were hypokinetic, 21.9% were akinetic and 0.6% were dyskinetic. All strain parameters decreased significantly with worsening wall motion. At follow-up, 81.5% of the segments showed functional recovery. All strain parameters were significantly associated with functional recovery (p&lt;0.001) and showed higher predictive value for improvement of wall motion than LGE transmurality (ROC AUC 0.713 LS, 0.710 CS, 0.683 RS and 0.660 LGE). For basal CMR dysfunctional segments, a CS &lt;−10.7% showed the highest accuracy (66%) to predict wall motion improvement, with 58% sensitivity, 76% specificity, 75% positive predictive value (PPV) and 59% negative predictive value (NPV). These results were comparable to LGE transmurality &lt;50% (65% accuracy, 59% sensitivity, 73% specificity, 74% positive predictive value and 58% negative predictive value). Nevertheless, adding CS analysis to a 50% LGE transmurality cutoff was the best combination for prediction of functional recovery and increased the overall accuracy to 70%, with 76% sensitivity, 64% specificity, 65% PPV and 75% NPV. CS analysis in an inferior STEMI Conclusions Acute CMR tissue tracking strain analysis complements LGE assessment for prediction of functional recovery following an STEMI. The combination of LGE infarct transmurality under 50% and a CS strain higher than −10.7% showed the highest accuracy for prediction of recovery of function.

P4352Usefulness of speckle tracking echocardiography in the detection of ventricular mechanics changes after percutaneous intervention of coronary chronic total occlusions

Abstract Background Previous studies show contradictory results of the effect of chronic total occlusions (CTO) revascularization on LVEF. Deformation parameters based on speckle tracking (2D-ST) echo allows the evaluation of the systolic regional function. Purpose To examine the usefulness of 2D-ST to detect changes in regional ventricular mechanics in a consecutive cohort of patients with successful CTO percutaneous revascularization. Methods Prospective study that included 13 consecutive patients (72±8 y, 85% men). Revascularization was justified based on the evidence of viability of the underlying territory. 2D-ST was performed before, one and three months after of the procedure. Based on 16 segments model (n: 208), these were classified in two groups (dependent/non-dependent) according to their relationship with the treated CTO. Strain rate (Sr) and Strain (S) of the three myocardial layers were measured. Results 208 segments analyzed. 62 (30%) perfusion dependent, (mean 5 segments/patient), non-dependent: 146 (70%). During follow-up (median: 3.3 m), there were no significant differences with respect to LVEF (56±6 vs. 59±6, p: 0.2). Although non-dependent segments showed no significant changes of deformation parameters after the procedure, dependent segments showed an increase (Δ) of both the S and Sr, being statistically significant the Δ of the three layers S at 3 months vs. non-dependent. Table 1 PRE POST p Δ Non-Dependent segments (N: 146) S-epicardial −16.6±4.9 −16.0±4.0 0.06 0.6±4.0 S-mesocardiac −17.4±4.8 −16.8±4.2 0.08 0.6±3.9 S-endocardial −18.1±5.1 −17.7±4.9 0.337 0.4±4.5 Sr −1.15±0.4 −1.09±0.4 0.080 0.07±0.47 Dependent segments (N: 62) S-epicardial −13.7±5.8 −16.3±4.5 &lt;0.001 −2.6±5.2* S-mesocardiac −14.7±6.1 −17.0±4.5 &lt;0.05 −2.3±5.2* S-endocardial −15.8±6.7 −17.9±4.9 &lt;0.05 −2.1±5.6* Sr −0.98±0.4 −1.03±0.4 0.353 −0.05±0.42 *p&lt;0.05 ΔNon-dependents vs. ΔDependents. S (%) improvement post RCA CTO treatment Conclusions This study shows that CTO treatment improves regional myocardial function in LV segments dependent on CTO at three months of follow-up, without changes in LVEF. 2D-ST allows to examine the effect of flow restoration, providing new information on the potential short-term benefits of this strategy

Short-term clinical outcomes in patients with acute myocardial infarction after successful percutaneous coronary revascularization: the role of promoter polymorphism of the endothelial nitric oxide synthase gene

Background: The purpose of this study was to investigate the associations between variants of a promoter polymorphism of the endothelial nitric oxide synthase (eNOS) gene and clinical outcomes in acute ST-segment elevation myocardial infarction (STEMI) patients after a successful primary percutaneous coronary artery intervention (PCI).&#x0D; Methods: 177 patients with acute STEMI, 82 patients with angiographically proven stable coronary artery disease, and healthy volunteers were included in the study. The primary end-point was a combined event (follow-up major adverse cardiac events –MACEs and hospitalization) that occurred within 6-month of the discharge from the hospital.&#x0D; Results: The combined end-point was determined in 72 patients from the entire acute STEMI population (40.6%), including 24 events for 786TT genotype, 23 events for 786TC genotype and 25 events for 786CC genotype. Kaplan-Meier curves demonstrated that acute STEMI patients with 786CC eNOs genotype had lower MACEs free accumulation when compared to those with 786TC and 786TT eNOs genotypes at 6-month follow up period (Log-rank p &lt; 0.001). Multivariate Cox regression analyses identified 786CC in eNOs gene as an independent predictor of clinical outcomes in STEMI after PCI.&#x0D; Conclusions: the 786CC polymorphism in eNOs gene is an independent predictor for clinical outcomes after a successful primary PCI in acute STEMI.&#x0D;

Early silent graft failure in off-pump coronary artery bypass grafting: a computed tomography analysis†.

The purpose was to assess predictors of early silent graft failure prior to discharge by multislice computed tomography in patients after off-pump coronary artery bypass grafting. From January 2017 until April 2018, 192 computed tomographic scans of consecutive asymptomatic patients were performed (seventh postoperative day ± 4 days) and analysed retrospectively. In total, 359 arterial and 278 venous anastomoses were evaluated. Two patient groups (overall patent anastomoses versus at least 1 occluded anastomosis) were compared. Cardiovascular risk factors, collateralization according to Rentrop, grade of native vessel stenosis and intraoperative flow measurements were analysed. Inferential statistics were performed with the Mann-Whitney U-test. Nominal and categorical variables were tested with the Fisher-Freeman-Halton exact test. In 33 patients, at least 1 occluded anastomosis could be identified, predominantly in women (P = 0.04). The patency of the arterial anastomoses was 96.4% and 88.9% for the venous anastomoses. In 14 patients with occluded anastomoses, a successful interventional revascularization was performed before discharge. There were significant differences in lower bypass flow [P = 0.02, odds ratio 3.2, 95% confidence interval (CI) 1.7-6.0] and higher pulsatility index (P < 0.001, odds ratio 4.5, 95% CI 2.4-8.5) in the occluded group. A calculated cut-off value identified an increased probability for graft occlusion at a flow under 23 ml/min and a pulsatility index greater than 2.3. Early silent graft failure occurred predominantly in venous grafts, with a tendency to female gender. A lower flow rate and a higher pulsatility index were significantly associated with graft occlusion, whereas collateralization and the degree of native vessel stenosis seem to play a tangential role. Fourteen patients had a successful percutaneous revascularization before discharge. NCT03657199.

TCTAP C-046 Acute Total Left Main Stem Occlusion with Cardiogenic Shock After Cardiac Arrest with Return of Spontaneous Circulation: Successful Percutaneous Revascularization Without Mechanical Hemodynamic Support

### Patient Initials or Identifier Number C.K.Y, male, 58 years-old ### Relevant Clinical History and Physical Exam He was referred to our hospital for primary percutaneous intervention, 70 minutes after the onset of acute chest pain. His cardiovascular risk factors were smoking and hypertension

Multisystem vascular disease with successful multisystem percutaneous transcatheter revascularization: Total body stenting

Patients with diabetes mellitus along other risk factors are vulnerable to develop micro and macro vascular disease including coronary artery, carotid, upper and lower extremities peripheral vascular disease. Physicians dealing with patients with coronary artery disease should at least suspect a disease(s) within other vascular territory or system and vies a versa for this at risk patients. We report a case of 74 year old male patient with history of heavy smoking, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, dyslipidemia, old stroke, chronic renal impairment and chronic anemia. He was referred from another hospital, with history of recurrent, transient ischemic attacks (TIAs), right upper limb and bilateral lower limb claudication, chest pain and three episodes of Non ST elevation Myocardial infarction within the last 2 months. Cardiac catheterization showed multivessel Coronary Artery Disease (CAD), severe occlusive peripheral arterial vascular disease (PAD), in addition to occluded right subclavian and critical bilateral internal carotid artery subtotal stenosis were found and managed successfully with multisystem Percutaneous Transcatheter intervention with near total body stenting.

3121Outcomes of patients with coronary CTOs up to 15 years follow-up: insights from the CLOSE study (coronary chronic total occlusions long term outcomes after successful percutaneous revascularization)

3121Outcomes of patients with coronary CTOs up to 15 years follow-up: insights from the CLOSE study (coronary chronic total occlusions long term outcomes after successful percutaneous revascularization)