Uncomplicated Percutaneous Coronary Intervention Research Articles

Myocardial inflammation after elective percutaneous coronary intervention

ObjectiveIt is well established that inflammation plays a central role in the sequelae of percutaneous coronary intervention (PCI). Most of the studies to date have focused on the inflammatory reaction affecting the vessel wall after angioplasty. However, there are data to suggest that the main foci of inflammation are in fact in the myocardium beyond the vessel wall. The main aim of our study was to investigate the myocardial inflammation after elective, uncomplicated angioplasty with cardiovascular magnetic resonance (CMR) enhanced by ultrasmall superparamagnetic particles of iron oxide (USPIO) and also blood biomarkers. This is the first study to report such findings after elective angioplasty. MethodsWe assessed patients undergoing elective angioplasty for stable angina with USPIO-enhanced CMR two weeks after the procedure and compared the results with those of healthy volunteers who constituted the control group. We excluded patients with previous myocardial infarction, previous PCI, or any significant inflammatory condition. All patients also underwent blood biomarker testing at baseline (pre-PCI), 4 h, and two weeks later. ResultsA total of five patients and three controls were scanned. There was a small absolute increase, although statistically insignificant, in R2∗ values in the PCI area compared with either remote myocardium from the same patient (PCI area [left anterior descending artery (LAD)] vs remote myocardium [circumflex area]: 19.3 ± 10.8 vs 9.2 ± 7.9, p = 0.1) or healthy myocardium from healthy volunteers (PCI area [LAD] vs healthy myocardium [LAD]: 19.3 ± 10.8 vs 12.2 ± 4.0, p = 0.2). PTX3 and IL-6 were the only biomarkers that changed significantly from baseline to 4 h and 2 weeks. Both biomarkers peaked at 4 h. ConclusionWe used USPIO-enhanced CMR for the first time to assess myocardial inflammation after elective, uncomplicated PCI. We have demonstrated a small numerical increase in inflammation, which was not statistically significant. This study opens the way for future studies to use this method as a means to target inflammation.

Association between optical coherence tomography-defined culprit morphologies and changes in hyperemic coronary flow after elective stenting assessed by transthoracic Doppler echocardiography.

Stress-transthoracic Doppler echocardiography (S-TDE) provides a noninvasive assessment of coronary flow parameters in the left anterior descending artery (LAD). However, the association between morphological characteristics and coronary flow changes after elective percutaneous coronary intervention (PCI) remains unclear. We aimed to evaluate the relationships between periprocedural coronary flow changes observed on S-TDE and lesion-specific plaque characteristics obtained by optical coherence tomography (OCT) in the interrogated vessels in patients with chronic coronary syndrome (CCS). Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease. In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.

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.

Circulating intermediate monocytes increase after elective percutaneous coronary intervention

Abstract Introduction 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 study explores the changes in monocyte subset and humoral response after elective PCI. Methods In this prospective study we recruited patients undergoing elective PCI for stable angina due to de novo coronary artery disease, either with DES or DCB utilised at the discretion of the operator. We excluded patients with significant renal impairment or any significant inflammatory condition on immunosuppression. All patients provided written, informed consent. Patients had 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 Some 30 patients were recruited in the study; two patients were lost to follow-up and two patients were excluded as they had raised baseline (pre-PCI) troponin; therefore 26 patients were included in analysis. Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI (Fig 1). The classical monocytes appeared to follow the opposite pattern to intermediate monocytes while the non-classical monocytes did not change significantly, suggesting that there was a shift from classical to intermediate monocytes and vice versa. Subgroup analysis showed that the intermediate monocytes remained significantly elevated in the DES group but not in the DCB group (Fig 2). Gene expression analysis of CD14+ leucocytes showed that 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 remained elevated up to two weeks post PCI while IL6 and TNFα remained elevated till two months post PCI. Conclusion Intermediate monocytes, a highly proatherogenic monocyte subset, 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 and improve patient outcomes.Monocyte response after PCIMonocyte response after DCB(A) or DES(B)

Abstract 15431: Barriers to Percutaneous Coronary Intervention in Sub Saharan Africa: A Call to Action

Introduction: Myocardial infarction incidence is rising in Sub-Saharan Africa (SSA). Currently, 80% of the world cardiovascular disease mortality burden is by low- and middle-income countries. SSA countries have limited access to trained interventional cardiologists and medical centers where Percutaneous Coronary Intervention (PCI) is performed. Methods: In this review, Google Scholar and PubMed were used to search literature on PCI in SSA. Selection criteria were manuscripts published between 2013-2023, written in English language, and addressed the hurdles with PCI. Results: Between April 2010 and March 2019, patients presenting to a PCI-capable center in Abidjan, Côte d’Ivoire had a median delay of 20 hours from onset of symptoms to admission. This was 53.2 hours in Senegal, 4.35 days in Burkina-Faso, and 6.6 days in Tanzania, while it was between 2.3 to 3.6 hours in South Africa. In terms of availability of PCI-capable centers in East and Central Africa; Kenya, Ethiopia Tanzania, and Uganda 5, 3, 2, and 1 center (s) respectively. In West Africa; Nigeria, Senegal, Ghana, Côte d’Ivoire and Cameroon had 6, 4, 2, 1, and 1 center(s), respectively. The average cost of an uncomplicated PCI of a single vessel occlusion costs up to $3500 (R65,000/1,612,000). In SSA, due to limited access to medical insurance, the proportion of direct out-of-pocket payments in total health expenditure remains above 40%. Conclusions: Minimizing ST-elevation Myocardial Infarction care and PCI delay should be a public health priority, as it a matter of public health interest and global health equity. There is a need for research into understanding better ways to improve access to STEMI care in Africa.

Prognostic role of hs-CRP before and after Percutaneous Coronary Intervention in Patients with Stable Angina Pectoris

Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury.&#x0D; Subjects and Methods: This prospective observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period between July’2012 to June’2013. A total of 200 patients studied who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hs-CRP level and the preprocedural hs-CRP level . We divided the patients according to the median value of hs- CRP: Group I &lt;3 mg/L and Group II &gt;3 mg/L.&#x0D; Results: Postprocedural TnI elevation was were observed in 72 (36%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnI elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p&lt;0.001). The incidences of TnI levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnI level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnI level 5 times the upper normal limit. Multivariate analysis revealed that postprocedural hs- CRP elevation in high risk group were the significant independent predictors of postprocedural TnI elevation.&#x0D; Conclusion: Elevated hs-CRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury. Measuring of hs-CRP either preprocedural or postprocedural in high risk patients is useful for predicting early cardiovascular events.&#x0D; University Heart Journal 2022; 18(2): 87-92

Prognostic implications of unrecognized myocardial infarction before elective percutaneous coronary intervention

Abstract Background A non-negligible proportion of myocardial infarction (MI) is not clinically recognized and unrecognized myocardial infarction (UMI) is associated with adverse outcomes. Purpose To determine the prevalence and prognostic significance of UMI by delayed-enhancement cardiac magnetic resonance (DE-CMR) before elective percutaneous coronary intervention (PCI). Methods In this prospective, single-center study, 236 patients with stable coronary artery disease undergoing elective and uncomplicated PCI were studied. All patients underwent DE-CMR before PCI. The prevalence of UMI was evaluated and the association of clinical and CMR-derived variables with primary MACE, defined as cardiovascular death, nonfatal MI, hospitalization for heart failure, unplanned late revascularization, and ischemic stroke was investigated. Results In the final analysis of 213 patients, 63 patients (29.6%) showed UMI. Target territory UMI was observed in 38 (17.8% of total, 60.3% of patients with UMI). UMI was significantly associated with sex, diabetes mellitus, left ventricular ejection fraction, SYNTAX score and fractional flow reserve in target vessels. During follow-up periods (median, 23 months), MACE was observed in 17 (27.0%) of patients with UMI, and 17 (11.3%) without (P=0.001). In a multivariable model, UMI (hazard ratio [HR] 2.18, 95% confidential interval, 1.10–4.33, P=0.001) remained as an independent predictor of MACE. Kaplan–Meier analysis indicated that the presence of UMI was significantly associated with higher incidence of MACE. Conclusions The prevalence of UMI in patients undergoing elective PCI was 29.6%. UMI was independently associated with an increased risk of MACE after successful PCI. Given the non-negligible prevalence and potential clinical significance of UMI, clinical studies comparing PCI and guideline directed medical therapy (GDMT) versus GDMT only strategy might have to take the presence of UMI into consideration. Funding Acknowledgement Type of funding sources: None.

Evaluating the occurrence of increased postoperative cardiac enzymes in patients with coronary atherosclerotic obstruction.

Percutaneous transluminal coronary angioplasty (PTCA) has been accepted as the elective treatment in many patients with coronary atherosclerotic obstruction. A slight increase in cardiac markers after the percutaneous coronary intervention (PCI) has been commonly reported. Some researchers have suggested that it predicts mortality and long-term complications. This study aimed to evaluate the occurrence of increased postoperative cardiac enzymes and determine the relationship between such an increase and clinical angiographic and technical variables. For this purpose, the descriptive study was performed in Hospital's cardiac ward from 2020-to 2021. One hundred twenty-two patients with stable coronary artery disease were studied for elective PTCA implanted with successful and uncomplicated stenting. Blood samples were taken from all patients to measure cardiac markers 20 hours after surgery. The normal range was CTnI ≤ 2ng/ml and CKMB ≤ 24 IU/L. Plasma levels of myocardial infarction and their relationship with clinical variables (including age, sex, risk factors for coronary artery disease, the severity of symptoms based on ccs class and previous history of acute coronary syndromes), angiographic including (lesion type, severity of stenosis) or related to the operation (operation on one or two vessels and direct stenting versus PTCA + stenting) were recorded in a questionnaire and observation sheets. The collected data were processed using descriptive statistics, frequency distribution tables, Chi-square, and student t-tests. Abnormal values of myocardial infarction were observed in 46.72% (57 patients). An increase in CTnI was observed in 39 patients (31.96%) and an increase in CKMB was seen in 31 patients (25.40%). Although the rise in CTnI exceeded the CKMB, the difference between the two was not statistically significant. The increased CTnI was significantly higher in older people, and the increase in CKMB was significantly higher in hypertensive individuals (p = 0.01). Based on the findings of this study, there is an increase in enzymes after successful and uncomplicated PCI selection. Increased CTnI occurs more frequently than CKMB. There is no relationship between enzyme enhancement and other clinical, angiographic, and technical variables.

Effect of percutaneous coronary intervention on global hemodynamics and the prevalence of residual microvascular dysfunction

AbstractObjectivesWe aimed to examine the changes in hyperemic coronary sinus flow (CSF) and global coronary flow reserve (g‐CFR) after percutaneous coronary intervention (PCI) and investigate the predictors to improve these metrics and the prevalence of residual coronary microvascular dysfunction (CMD).MethodsThis prospective, single‐center study included 118 patients with stable coronary artery disease undergoing PCI for a single proximal lesion. Phase‐contrast cine‐cardiac magnetic resonance (PC‐CMR) was used to assess hyperemic CSF (HCSF) and g‐CFR, before and after PCI. Residual CMD was defined as concordantly impaired post‐PCI HCSF (&lt;2.3 ml/min/g) and g‐CFR (&lt;2.0).ResultsHCSF significantly increased, although 38 (32.2%) patients showed a decrease. There was no significant change in g‐CFR despite fractional flow reserve (FFR) improvement in all target territories. Concordantly increased HCSF and g‐CFR were effectively discriminated by adding PC‐CMR‐derived information to pre‐PCI FFR. Residual CMD was observed in 30 (25.4%) patients and was associated with pre‐PCI renal dysfunction and lower pre‐PCI rest and hyperemic CSF, but not with pre‐PCI regional physiological indices.ConclusionsFFR‐guided PCI was associated with increased HCSF, but not with increased g‐CFR. After uncomplicated PCI, one‐quarter of patients showed residual CMD. Our approach may help identify patients who may benefit from increased coronary perfusion or show residual CMD.

Desfechos clínicos de pacientes submetidos à intervenção coronária percutânea eletiva com alta hospitalar no mesmo dia. Evolução em 10 anos

Background Same-day discharge for percutaneous coronary interventions is an attractive and safe strategy. Observational and randomized data show equivalent results as compared to overnight observation. In addition, it ensues great savings for the healthcare system. Nevertheless, in Brazil, this approach is underused. The objective of this study was to describe the characteristics and outcomes of patients undergoing percutaneous coronary intervention with same-day discharge. Methods A single-center study with patients who underwent selected procedures, uneventful, discharged on the same day. Clinical and angiographic characteristics were described. Major cardiovascular events and complications were analyzed, reported, and compared to a historical cohort. Results A total of 413 patients were included, mean age of 64±10 years. After a 30-day follow-up, no major cardiovascular event was observed in selected patients submitted to the same-day discharge strategy. In addition, we found an increase in clinical and angiographic complexity as compared to the previous series, which did not translate to rise in adverse outcomes. Conclusion Uncomplicated percutaneous coronary interventions, with same-day discharge, are safe among appropriately selected patients, encouraging further adoption of this approach.

Antithrombotic therapy in patients with atrial fibrillation and percutaneous coronary intervention: what has changed in the guidelines in 2020?

The article presents an analytical review of the studies aimed at determining the optimal antithrombotic therapy in patients with atrial fibrillation undergoing elective or emergency percutaneous coronary intervention (PCI) due to the development of acute coronary syndrome (ACS). The results of the WOEST study are analysed. This study was the first to demonstrate an opportunity to safely discontinue administration of aspirin as part of the multicomponent antithrombotic therapy that included warfarin as an anticoagulant. Three studies were analysed - PIONEER AF-PCI, RE-DUAL-PCI and AUGUSTUS, where direct oral anticoagulants (DOACs) - rivaroxaban, dabigatran and apixaban were used as anticoagulants as part of the multicomponent therapy. The results of these studies formed the backbone of the updated European guidelines for the diagnosis and treatment of atrial fibrillation, 2020. The guidelines offer to divide patients with AF and ACS, who require multicomponent antithrombotic therapy, into two categories. The first group includes AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as patients with a risk of bleeding that prevails over the risk of stent thrombosis. The second category of patients, in contrast, is characterized by a high risk of stent thrombosis, which prevails over the risk of bleeding. In the absence of contraindications, the patients of both categories should choose DOAC as an anticoagulant and be prescribed clopidogrel as a P2Y12 inhibitor for 12 months. In AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as in patients with a risk of bleeding, which prevails over the risk of stent thrombosis, the period of treatment with the second antiplatelet drug (aspirin) should belimited to the hospital stay. Patients at increased risk of stent thrombosis and reduced risk of bleeding can extend the aspirin therapy for 1 month. The approaches to the choice of the duration and composition of the multicomponent antithrombotic therapy in AF patients taking oral anticoagulants after elective PCI are similar to those in ACS patients, except for the duration of clopidogrel therapy, which is reduced to 6 months in all patients.

Same day discharge after chronic total occlusion interventions: A single center experience.

To assess the feasibility and safety of same day discharge (SDD) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). CTO PCI has been associated with higher complication rates and procedural and hospitalization costs. Shortening post-PCI hospitalization length not only increases the patients' comfort but at the same time it consists an important part of cost reduction policies. We retrospectively compared the 30-day outcomes of patients who underwent CTO PCI at the Red Cross Hospital, Greece between January 2016 and June 2019 and underwent SDD versus non-SDD. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction, urgent repeat target vessel revascularization, tamponade, and stroke. A total of 173 patients (mean age 63.7 ± 8.9 years) were included, of whom 51 (30%) underwent SDD. SDD patients were less likely to have diabetes mellitus (51 vs. 31%, p=.015), arterial hypertension (89 vs. 67%, p < .001), and acute coronary syndrome presentation (39.7 vs. 21.6%, p=.022), compared with non-SDD patients. Forearm access was used in all SDD patients and in 83% of the non-SDD patients. The 30-day incidence of MACE was 0% in the SDD group and 1.6% in the non-SDD group. Multivariable analysis showed that diabetes mellitus and longer procedural time were associated with lower probability of SDD (OR: 0.34, 95% CI: 0.15, 0.73 and OR: 0.29, 95% CI: 0.12, 0.71, respectively). SDD appears to be feasible and safe in selected patients undergoing an uncomplicated CTO PCI through forearm approach.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Early discharge of patients (within 24 h) after percutaneous coronary intervention is feasible and safe in Indian setup

Percutaneous coronary intervention (PCI) is the commonest cardiac procedure in most centres in India. Unlike in most western countries, patients who undergo PCI in India are discharged after a few days. We undertook an observational study of 100 consecutive patients to evaluate the outcome of early discharge (within 24 h) after uncomplicated elective PCI. This showed that early discharge is feasible and safe; and most patients felt comfortable with early discharge. It is the responsibility of the interventional cardiologist to educate and reassure these uncomplicated PCI patients about the safety of this approach.

Intolerance to aspirin in patients undergoing percutaneous coronary intervention in the setting of chronic coronary syndromes: perspectives from the ESC 2019 Chronic Coronary Syndromes guidelines.

Bianco et al draw attention to the therapeutic challenge that aspirin intolerance not uncommonly presents to interventional cardiologists. In the ESC 2019 Guidelines on Chronic Coronary Syndromes, we describe several relevant points in this regard.[1] Firstly, we state that other nonselective non-steroidal antiinflammatory drugs are not suitable as an alternative to aspirin in view of their adverse cardiovascular risk profile. Secondly, we provide a class IIb recommendation for using prasugrel or ticagrelor in patients who cannot tolerate aspirin. We don't suggest an alternative to aspirin as part of a dual therapy strategy with prasugrel or ticagrelor but do describe the results of the GEMINI ACS study in which rivaroxaban 2.5 mg b.i.d. in combination with an oral P2Y12 inhibitor was compared with standard DAPT and shown to have similar efficacy, albeit in stabilized patients after uncomplicated percutaneous coronary intervention (PCI) in the presence of aspirin.[2] This presents the possibility of using such a regimen in patients where there are concerns about the risk of stent thrombosis with prasugrel or ticagrelor monotherapy. However, currently there is insufficient evidence on which to base any recommendations for such a strategy, particularly since, as we indicate, the safety of performing PCI without aspirin pre-treatment is uncertain.

P6527Patients discharged on the same day following elective PCI report equal satisfaction using health related quality of life instruments as compared to usual care: results from a randomized trial

Abstract Background Earlier observations in the era of femoral procedures using warfarin as the anticoagulant agent have shown safety following same day discharge after elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). Procedures have evolved with most European centres adopting radial procedures with corresponding improvement in technique and equipment. Adoption of “radial lounges” has improved and simplified the observation routines with early ambulation. Antiplatelet therapy has also become more efficacious. The safety of same day discharge has been demonstrated. The economic benefit of such a strategy is significant with reported cost reductions of approximately 50%. Patient reported satisfaction is also shown to be comparable to standard care. The current bed availability in health care facilities has made it a necessity to explore measures to reduce bed occupancy rates. Reduction in bed occupancy can further permit health personell to focus on other duties and obligations in wards with patients requiring hospitalization. Early discharge may cause anxiety and dissatisfaction among patients. Purpose The aim of our study was to evaluate safety and patient satisfaction of same discharge following uncomplicated elective radial access PCI. Methods Randomized controlled single center study. Eligible patients scheduled for elective PCI with radial access were prescreened following predefined inclusion and exclusion criteria. Health related quality of life instruments (HRQOL), Seattle Angina Questionnaire (SAQ), Short form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were completed by the patients and received at base line and at 30 days post-procedure. All same day discharged patients were contacted by phone by a specialized study nurse the day after the procedure. Results 517 patients were screened between November 2015 and November 2018 and 82 patients with mean age of 65 years were block randomized post-procedure. 38 patients were randomized to same day discharge after 6 hours of observation and 44 patients to standard care group which necessitated an overnight hospitalization. 11 female patients and 71 male patients were included. No adverse events were registered in either group. No significant difference between groups were observed in the SAQ (treatment satisfaction score p=0.48, angina frequency scale p=0.58), SF-36 (SF vitality p=0.93) or HADS (HADS anxiety + depression p=0.15). Changes of HADS score Conclusions Discharge on the same day following uncomplicated PCI for stable angina is safe and patient health related quality of life instruments confirm that patients are equally satisfied with this new care strategy when compared to usual care. Acknowledgement/Funding Stavanger University Hospital

P2239The association between global coronary flow reserve and coronary inflammation assessed by fat attenuation index on computed tomography in patients with acute coronary syndrome

Abstract Background Impaired global coronary flow reserve (G-CFR) is known to predict worse outcomes in patients with coronary artery disease. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying coronary sinus flow (CSF) and global coronary flow reserve (G-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Although G-CFR impairment has been previously reported to be linked with endothelium dysfunction and subsequent atherosclerosis, the relationship between coronary inflammation and absolute coronary blood flow volume or coronary flow reserve remains elusive. Purpose We evaluated the association between G-CFR by quantifying CSF using PC-CMR and the extent of coronary inflammation in patients with ACS treated with emergent percutaneous coronary intervention (PCI). Methods The study enrolled 107 ACS patients who underwent uncomplicated emergent PCI within 48 hours of symptom onset and coronary CT angiography were performed before PCI. Proximal 40-mm segments of all three major epicardial coronary vessels were examined. Coronary inflammation was assessed by the CT fat attenuation index of perivascular adipose tissue (FAI−PVAT) defined as the mean attenuation of the perivascular adipose tissue (−190 to −30 Hounsfield units (HU)) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel, as previously reported. CMR images were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after emergent PCI and revascularization of non-culprit significant lesions. The patients were divided into 4 groups according to the number of inflamed vessels (defined as 0, 1, 2, 3 vessels with FAI ≥−70.1 HU). Results In the final analysis of 102 patients (mean age 64, Male 65 (63.7%)) including 77 patients with non-ST-segment elevation myocardial infarction (NSTEMI) (75.5%) and 25 patients with unstable angina pectoris (UAP), 25, 30, 26, 21 patients exhibited none, 1, 2, 3 inflamed vessels with FAI ≥−70.1 HU, respectively. Rest and maximal hyperemic CSF and corrected G-CFR were 1.17 [0.63, 1.71] vs 1.36 [1.05, 1.67] vs 1.21 [0.83, 1.94] vs 1.35 [0.96, 1.67] ml/min/g; P=0.61, 3.26 [2.62, 2.99] vs 3.50 [2.60, 4.03] vs 3.34 [1.78, 4.20] vs 2.48 [1.54, 3.43]; P=0.061, 2.95 [2.05, 4.30] vs 2.63 [1.80, 3.56] vs 2.15 [1.37, 2.91] vs 2.18 [1.46, 2.42]; P=0.018, respectively. G-CFR was significantly lower in group with increased number of inflamed vessels. Conclusions In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR significantly associated with the prevalence of inflamed vessels detected by coronary CT. Further large population study is warranted to test the hypothesis that the extent of coronary inflammation before coronary revascularization in patients with ACS might provide prognostic information.

P3585Prognostic value of the assessment of coronary sinus flow by phase contrast cine-magnetic resonance imaging in patients with acute coronary syndrome

Abstract Background Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying global coronary sinus flow (CSF) and global coronary flow reserve (G-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Purpose We evaluated the prognostic value of G-CFR by quantifying CSF using PC-CMR in patients with ACS treated with primary or emergent percutaneous coronary intervention (PCI). Methods The study prospectively enrolled 387 ACS patients who underwent uncomplicated primary or emergent PCI within 48 hours of symptom onset. Breath-hold PC-CMR images of CS were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after primary PCI and revascularization of functionally significant non-culprit lesions of ACS. The association of G-CFR and baseline clinical characteristics with major adverse cardiac events (cardiac death, nonfatal myocardial infarction, late revascularization, or hospitalization for congestive heart failure) was investigated. Results In the final analysis of 366 patients (Male 294 (80.3%), mean age 65) including 233 patients (63.7%) with ST-segment elevation myocardial infarction (STEMI) and 133 patients (36.3%) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), rest and maximal hyperemic CSF and corrected G-CFR were 1.24 [0.83, 1.71] ml/min/g, 2.56 [1.87, 3.66] ml/min/g, and 2.20 [1.53, 3.17], respectively. During a median follow-up of 16 months, MACE occurred in 84 patients (cardiac death: 9, nonfatal myocardial infarction: 11, late revascularization: 59, hospitalization for congestive heart failure: 5). Cardiac event-free survival was significantly worse in patients with a corrected G-CFR &lt;2.00 (log-rank χ2=20.2, P&lt;0.001). Cox proportional hazards analysis showed that corrected G-CFR were independent predictors of adverse cardiac events during follow-up in patients with STEMI (hazard ratio, 0.66, 95% confidence interval, 0.51–0.85, p=0.001) and NSTE-ACS (hazard ratio, 0.64, 95% confidence interval, 0.43–0.95, p=0.026), respectively. Conclusions In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR provided significant prognostic information independent of infarction size and conventional risk scores.

Comparison short time discharge with long time discharge following uncomplicated percutaneous coronary intervention for Non-ST elevation myocardial infarction patients

BackgroundThe rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients.MethodsThis retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias.ResultsThe incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups.ConclusionsIf an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.

Same-day discharge after elective percutaneous coronary intervention: A single-center experience

Advances in vascular access techniques, stent technology, and anti-platelet therapy have facilitated changes in discharge patterns following percutaneous coronary intervention (PCI). Overnight stay strategy remains the reference attitude although no recommendation has been published regarding the optimal duration of surveillance after uncomplicated PCI. To assess the feasibility and safety of same-day discharge (SDD) after elective PCI in Rouen University Hospital. All consecutive patients with stable coronary artery disease (CAD) scheduled for elective PCI in Rouen University Hospital between October 2017 and May 2018 were prospectively enrolled in our study. The eligibility criteria of same-day discharge (after 4 to 6 hours of surveillance) have been defined a priori . We evaluated the feasibility of same-day discharge and its safety by a combined endpoint including 30-day mortality, myocardial infarction, stent thrombosis, stroke, vascular complication, and readmission. From October 2017 and May 2018, 246 patients were included and 52 (21%) were discharged the same day (SDD patients). SDD patients were significantly younger than patients with overnight hospitalization (66.5 ± 11.4 vs. 70.3 ± 11.2 years, P = 0.03). A radial approach was more frequent in the SDD group (88.4% vs. 63.9%, P = 0.001). No major complications occurred during hospital surveillance in both groups and no events occurred within 30 days in SDD patients. Same-day discharge after elective PCI is feasible and safe in patients with stable CAD. Further studies are required to confirm our results and to evaluate the medico-economic impact of this strategy.