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Clinical Research of Percutaneous Coronary Intervention

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 41032

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Special Issue Editor

Dr. Shun Kohsaka

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Guest Editor

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
Interests: general cardiology; heart failure; coronary artery disease; atiral fibrillation; observational studies; statistical analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are very fortunate to practice interventional cardiology during an era of rapid clinical and technological evolution that allows us to offer potentially life-saving options to challenging cardiac conditions. The development of coronary stents, imaging techniques to better visualize lesions and repairs, and new adjunctive antithrombotic agents and regimens are very active areas of research. In addition, the development of risk scores and models has led to improved accuracy in the prediction of procedure-related mortality and complications such as bleeding or acute kidney injury.

Despite these advances, the burden of the coronary artery disease, both in chronic and acute phases, remains high. In stable ischemic heart disease (SIHD), diagnosis is more difficult compared to the standardized algorithms available for acute patients. The classic risk prediction model has been repeatedly debated, and the value of percutaneous coronary intervention (PCI) is often questioned in low- to moderate-risk patients. In the management of acute coronary syndrome (ACS), particularly in ST-elevation myocardial infarction (STEMI), the time to coronary flow restoration is vital for survival and overall outcome. However, there exists a significant variation in reported cases and the application of PCI by operators, institutions, and regions. Furthermore, the procedural complication rate is high in these patients, and the implementation of complication (e.g., bleeding) avoidance strategies remains suboptimal. Public reporting of PCI has recently undergone significant refinements considering a large body of evidence suggesting that mandated reporting of outcomes is associated with the aversion of high-risk patients and may worsen overall outcomes.

In this Special Issue dedicated to recent advances in PCI, we are interested in original and review articles that (1) assess short- and long-term clinical outcomes as a consequence of various advances in this area, (2) highlight unmet needs, and (3) discuss future research directions. We must also reconsider how to compromise between identifying metrics that are simple and convenient and those that more clearly capture overall procedural quality. The editors hope that this issue will be of interest to not just interventional cardiologists that perform PCI but also to a broader range of clinicians that encounter coronary artery disease.

Thank you,

Dr. Shun Kohsaka
Guest Editor

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Keywords

coronary revascularization
acute coronary syndrome
stable ischemic heart disease
outcomes
public reporting

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Published Papers (13 papers)

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Editorial

Jump to: Research, Review

4 pages, 177 KiB

Open AccessEditorial

To the Future and Beyond: Recent Advances in the Application of Percutaneous Coronary Intervention

by Shun Kohsaka

J. Clin. Med. 2021, 10(2), 177; https://doi.org/10.3390/jcm10020177 - 6 Jan 2021

Viewed by 1576

Abstract

We are very fortunate to be practicing interventional cardiology during an era of rapid clinical and technological evolution, which allows us to offer potentially life-saving options for challenging cardiac conditions [...] Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

Research

Jump to: Editorial, Review

14 pages, 2853 KiB

Open AccessArticle

Applicability and Eligibility of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) for Patients who Underwent Revascularization with Percutaneous Coronary Intervention

by Nozomi Niimi, Mitsuaki Sawano, Nobuhiro Ikemura, Toshiyuki Nagai, Shintaro Nakano, Satoshi Shoji, Yasuyuki Shiraishi, Ikuko Ueda, Yohei Numasawa, Masahiro Suzuki, Shigetaka Noma, Keiichi Fukuda and Shun Kohsaka

J. Clin. Med. 2020, 9(9), 2889; https://doi.org/10.3390/jcm9092889 - 7 Sep 2020

Cited by 10 | Viewed by 3151

Abstract

In the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial, an early invasive strategy did not decrease mortality compared to a conservative strategy for stable ischemic heart disease (SIHD) patients with moderate-to-severe ischemia, and the role of revascularization would be revised. However, the applicability and potential influence of this trial in daily practice remains unclear. Our objective was to assess the eligibility and representativeness of the ISCHEMIA trial on the patients with percutaneous coronary intervention (PCI). From a multicenter registry, we extracted a consecutive 13,223 SIHD patients with PCI (baseline cohort). We applied ISCHEMIA eligibility criteria and compared the baseline characteristics between the eligible patients and the actual study participants (randomized controlled trial (RCT) patients). In 3463 patients with follow-up information (follow-up cohort), the 2 year composite of major adverse cardiac events was evaluated between the eligible patients and RCT patients, as well as eligible and non-eligible patients in the registry. In the baseline cohort, 77.3% of SIHD patients with moderate-to-severe ischemia were eligible for the ISCHEMIA. They were comparable with RCT patients for baseline characteristics and outcomes unlike the non-eligible patients. In conclusion, the trial results seem applicable for the majority of PCI patients with moderate-to-severe ischemia except for the non-eligible patients. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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12 pages, 496 KiB

Open AccessArticle

Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography

by Caroline Birgy, Antonin Trimaille, Nathan Messas, Jessica Ristorto, Anas Kayali, Benjamin Marchandot, Thomas Cardi, Sébastien Hess, Marion Kibler, Laurence Jesel, Patrick Ohlmann and Olivier Morel

J. Clin. Med. 2020, 9(9), 2747; https://doi.org/10.3390/jcm9092747 - 25 Aug 2020

Cited by 4 | Viewed by 2170

Abstract

With respect to the transfemoral approach, transradial procedures enable a drastic reduction of bleeding events and are associated with a reduction of mortality. Radial artery spasm (RAS) is one of the most common complications and may lead to patient discomfort and procedural failure. Currently, there is no consensus on the optimal sedation protocol to avoid RAS. The aim of this study was to investigate the respective impact of opioids analgesia and inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox) on pain and occurrence of RAS during transradial coronary procedures. Consecutive patients undergoing transradial coronary angiography were prospectively enrolled in one, single center observational study (Nouvel Hôpital Civil, Strasbourg, France). Patients received opioids analgesia or inhalation sedation with Kalinox. The primary endpoints of the study were the incidence of a pain scale ≥5/10 and the occurrence of RAS. The secondary endpoints were the incidence of side effects. A total of 325 patients were enrolled (185 in the opioids analgesia group, 140 in the Kalinox group). RAS and pain scale ≥5 rates were not significantly different in the opioids analgesia and Kalinox groups (respectively 13.5% vs. 10.0% and 16.2% vs. 11.4%). Headache was more frequently observed in the Kalinox group (6.4% vs. 0.0%; p = 0.002). By multivariate analysis, female gender, BMI <25 kg/m², puncture difficulty, the use of plastic needle and 6F sheath were identified as independent predictors of RAS. Procedural inhalation sedation by Kalinox is as safe as opioids analgesia during transradial coronary angiography. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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15 pages, 1140 KiB

Open AccessArticle

Long-Term Prognosis of Patients with Myocardial Infarction Type 1 and Type 2 with and without Involvement of Coronary Vasospasm

by Ryota Sato, Kenji Sakamoto, Koichi Kaikita, Kenichi Tsujita, Koichi Nakao, Yukio Ozaki, Kazuo Kimura, Junya Ako, Teruo Noguchi, Satoshi Yasuda, Satoru Suwa, Kazuteru Fujimoto, Yasuharu Nakama, Takashi Morita, Wataru Shimizu, Yoshihiko Saito, Atsushi Hirohata, Yasuhiro Morita, Teruo Inoue, Atsunori Okamura, Toshiaki Mano, Kazuhito Hirata, Kengo Tanabe, Yoshisato Shibata, Mafumi Owa, Hiroshi Funayama, Nobuaki Kokubu, Ken Kozuma, Shirou Uemura, Tetsuya Toubaru, Keijirou Saku, Shigeru Ohshima, Kunihiro Nishimura, Yoshihiro Miyamoto, Hisao Ogawa and Masaharu Ishihara Show full author list Hide full author list

J. Clin. Med. 2020, 9(6), 1686; https://doi.org/10.3390/jcm9061686 - 2 Jun 2020

Cited by 10 | Viewed by 2673

Abstract

While prognoses in relation to myocardial infarction (MI) type have been elucidated in past reports, the results were not consistent, perhaps due to occurrence of Type 2 MI with CVS and its mortality. The Japanese registry of acute Myocardial Infarction diagnosed by Universal Definition (J-MINUET) is a prospective multicenter registry in Japan. In contrast to thromboembolic event-related Type 1 myocardial infarction (MI), clinical features of Type 2 MI, including coronary vasospasm (CVS), are varied due to the heterogeneous nature of its development. To elucidate the MI type-related all-cause mortality, 2989 consecutive patients with AMI were stratified as Type 1 MI, Type 2 MI with CVS, and Type 2 MI with non-CVS. Most patients (n = 2834; 94.8%) were classified as Type 1 MI and 155 patients (5.2%) were classified as Type 2 MI. Of the Type 2 MI patients, 87 (56% of Type 2 MI) were diagnosed as MI with CVS. Although the 3-year mortality was comparable between Type 1 and Type 2 MI patients, significant differences were observed between Type 2 MI with CVS and with non-CVS (3.4% and 22.1%, p < 0.001). Among Japanese patients with AMI, mortality rates between Type 1 MI and Type 2 MI are comparable, but further stratification of Type 2 MI (with or without CVS) may be useful in predicting the prognosis of patients with Type 2 MI. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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17 pages, 6864 KiB

Open AccessArticle

Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

by Tatsuya Nakachi, Shun Kohsaka, Masahisa Yamane, Toshiya Muramatsu, Atsunori Okamura, Yoshifumi Kashima, Shunsuke Matsuno, Masami Sakurada, Yoshitane Seino and Maoto Habara

J. Clin. Med. 2020, 9(5), 1319; https://doi.org/10.3390/jcm9051319 - 2 May 2020

Cited by 5 | Viewed by 3928

Abstract

Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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12 pages, 786 KiB

Open AccessArticle

Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery

by Shun Kohsaka, Hiraku Kumamaru, Taku Inohara, Tetsuya Amano, Takashi Akasaka, Hiroaki Miyata, Noboru Motomura and Masato Nakamura

J. Clin. Med. 2020, 9(5), 1267; https://doi.org/10.3390/jcm9051267 - 27 Apr 2020

Cited by 4 | Viewed by 2740

Abstract

Background: Percutaneous coronary intervention (PCI) is performed in a wide range of institutions. We sought to assess the relationship between coronary artery bypass grafting (CABG) volume relative to PCI volume and clinical outcome using nationally representative PCI and CABG registries in Japan. Methods: This was a collaborative, registry-based cohort study enrolling patients undergoing percutaneous coronary intervention in 2013–2014 using Japanese nationwide registry (J-PCI) with follow up until discharge. The absolute volume of CABG for each hospital was calculated using additional data from Japan CardioVascular Surgery Database (JCVSD). Patients undergoing their first PCI registered in the registry (N = 220,934), at 943 facilities were studied. Main outcomes were in-hospital mortality, and incidence of composite of in-hospital death and postprocedural complications. Results: Among the 220,934 patients, 162,411 were men, with a mean age of 69.7 (SD 11.6) years. Patients underwent PCI at hospitals with varying CABG volume: The overall in-hospital mortality and composite event rate for PCI patients was 0.9% and 2.4%, respectively. CABG volume was associated with the in-hospital mortality of PCI at facilities performing less than 200 PCIs per year, but not at facilities performing 200 or more. Similarly, in-hospital mortality or complication was associated with PCI volume <200 only if no CABG is done at the facility. The result remained largely consistent in subgroup of patients presenting with acute coronary syndrome or even after excluding these institutions with extremely low number of PCI (<50 cases/year) or CABG (<15 cases / year). Conclusions: In a nationwide registry-based analysis, the surgical volume was associated with patients’ clinical outcome after PCI, when limited number of PCIs were performed at the facility. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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Graphical abstract

13 pages, 1137 KiB

Open AccessArticle

Exploring Triaging and Short-Term Outcomes of Early Invasive Strategy in Non-ST Segment Elevation Acute Coronary Syndrome: A Report from Japanese Multicenter Registry

by Nobuhiro Ikemura, Yasuyuki Shiraishi, Mitsuaki Sawano, Ikuko Ueda, Yohei Numasawa, Shigetaka Noma, Masahiro Suzuki, Yukihiko Momiyama, Kentaro Hayashida, Shinsuke Yuasa, Hiroaki Miyata, Keiichi Fukuda and Shun Kohsaka

J. Clin. Med. 2020, 9(4), 1106; https://doi.org/10.3390/jcm9041106 - 13 Apr 2020

Cited by 3 | Viewed by 2834

Abstract

This observational study aimed to examine the extent of early invasive strategy (EIS) utilization in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) according to the National Cardiovascular Data Registry (NCDR) CathPCI risk score, and its association with clinical outcomes. Using a prospective multicenter Japanese registry, 2968 patients with NSTE-ACS undergoing percutaneous coronary intervention within 72 hours of hospital arrival were analyzed. Multivariable logistic regression analyses were performed to determine predictors of EIS utilization. Additionally, adverse outcomes were compared between patients treated with and without EIS. Overall, 82.1% of the cohort (n = 2436) were treated with EIS, and the median NCDR CathPCI risk score was 22 (interquartile range: 14–32) with an expected 0.3–0.6% in-hospital mortality. Advanced age, peripheral artery disease, chronic kidney disease or patients without elevation of cardiac biomarkers were less likely to be treated with EIS. EIS utilization was not associated with a risk of in-hospital mortality; yet, it was associated with an increased risk of acute kidney injury (AKI) (adjusted odds ratio: 1.42; 95% confidence interval: 1.02–2.01) regardless of patients’ in-hospital mortality risk. Broader use of EIS utilization comes at the cost of increased AKI development risk; thus, the pre-procedural risk-benefit profile of EIS should be reassessed appropriately in patients with lower mortality risk. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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Graphical abstract

17 pages, 2835 KiB

Open AccessArticle

Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

by Pei-Hsun Sung, Yi-Chen Li, Mel S. Lee, Hao-Yi Hsiao, Ming-Chun Ma, Sung-Nan Pei, Hsin-Ju Chiang, Fan-Yen Lee and Hon-Kan Yip

J. Clin. Med. 2020, 9(4), 1043; https://doi.org/10.3390/jcm9041043 - 7 Apr 2020

Cited by 7 | Viewed by 2971

Abstract

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 10⁷/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry). Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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10 pages, 882 KiB

Open AccessArticle

Residual Inflammation Indicated by High-Sensitivity C-Reactive Protein Predicts Worse Long-Term Clinical Outcomes in Japanese Patients after Percutaneous Coronary Intervention

by Norihito Takahashi, Tomotaka Dohi, Hirohisa Endo, Takehiro Funamizu, Hideki Wada, Shinichiro Doi, Yoshiteru Kato, Manabu Ogita, Iwao Okai, Hiroshi Iwata, Shinya Okazaki, Kikuo Isoda, Katsumi Miyauchi and Kazunori Shimada

J. Clin. Med. 2020, 9(4), 1033; https://doi.org/10.3390/jcm9041033 - 6 Apr 2020

Cited by 6 | Viewed by 2616

Abstract

The aim of this study was to investigate the long-term clinical impact of residual inflammatory risk (RIR) by evaluating serial high-sensitivity C-reactive protein (hs-CRP) in Asian patients with coronary artery disease (CAD). We evaluated 2032 patients with stable CAD undergoing percutaneous coronary intervention (PCI) with serial hs-CRP measurements (2 measurements, 6–9 months apart) from the period 2000 to 2016. A high-RIR was defined as hs-CRP > 0.9 mg/L according to the median value. Patients were assigned to four groups: persistent-high-RIR, increased-RIR, attenuated-RIR, or persistent-low-RIR. Major adverse cardiac events (MACE) and all-cause death were evaluated. MACE rates in patients with persistent high, increased and attenuated RIR were significantly higher than in patients with persistent low RIR (p < 0.001). Moreover, the rate of all-cause death was significantly higher among patients with persistent high and increased RIR than among patients with attenuated and persistent low RIR (p < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37–3.67, p = 0.001), increased RIR (HR 2.25, 95%CI 1.09–4.37, p = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14–3.32, p = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41–3.08, p < 0.001) and increased RIR (HR 1.94, 95%CI 1.07–3.36, p = 0.029) were predictive for all-cause death. A high RIR was significantly associated with MACE and all-cause death among Japanese CAD patients. An evaluation of changes in inflammation may carry important prognostic information and may guide the therapeutic approach. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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9 pages, 416 KiB

Open AccessArticle

Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions

by Max-Paul Winter, Georg Goliasch, Philipp Bartko, Jolanta Siller-Matula, Mohamed Ayoub, Stefan Aschauer, Klaus Distelmaier, Catherine Gebhard, Kambis Mashayekhi, Miroslaw Ferenc, Christian Hengstenberg and Aurel Toma

J. Clin. Med. 2020, 9(4), 938; https://doi.org/10.3390/jcm9040938 - 30 Mar 2020

Cited by 5 | Viewed by 2339

Abstract

Background: Concomitant left main coronary artery (LMCA) disease in patients with chronic total occlusions (CTO) commonly results in referral for coronary artery bypass grafting, although the impact of LMCA in CTO patients remains largely unknown. Nevertheless, patient selection for percutaneous coronary intervention of CTOs (CTO-PCI) or alternative revascularization strategies should be based on precise evaluation of the coronary anatomy to anticipate those patients that most likely benefit from a procedure and not on strict adherence to perpetual clinical practice. Therefore, the aim of this study was to assess the impact of LMCA disease on long-term outcomes in patients undergoing percutaneous coronary intervention for CTO. Methods: We enrolled 3860 consecutive patients undergoing PCI for at least one CTO lesion and investigated the predictive value of concomitant LMCA disease. All-cause mortality was defined as the primary study endpoint. Results: We observed that LMCA disease is significantly associated with mortality. In the Cox regression analysis, we observed a crude hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.23–2.04, p < 0.001) for patients with LMCA disease as compared to patients without. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion: LMCA disease is associated with excess mortality in CTO patients. Specifically, anatomical features such as CTO of the circumflex artery represent a high risk patient population. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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13 pages, 2674 KiB

Open AccessArticle

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

by Jeehoon Kang, Chengbin Zheng, Kyung Woo Park, Jiesuck Park, Taemin Rhee, Hak Seung Lee, Jung-Kyu Han, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo and Hyo-Soo Kim

J. Clin. Med. 2020, 9(1), 232; https://doi.org/10.3390/jcm9010232 - 15 Jan 2020

Cited by 6 | Viewed by 2931

Abstract

The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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13 pages, 2730 KiB

Open AccessArticle

Preparation of PCI Balloons: What Is the Best Method to Avoid Air in the Balloon? A Comparison of Different Methods of Connecting PCI Balloons and the Inflation Syringe while Removing Air from the Balloon

by Laura Kreuser, Karl-Ludwig Laugwitz, Klaus Tiemann, Thorsten Lewalter and Clemens Jilek

J. Clin. Med. 2020, 9(1), 172; https://doi.org/10.3390/jcm9010172 - 8 Jan 2020

Cited by 1 | Viewed by 5478

Abstract

As the techniques to connect percutaneous coronary intervention (PCI) balloons and the inflation syringe vary in the instructions for use and in practice, we measured the amount of air in PCI balloons after testing three connection methods to an inflation syringe. Following the preparation using one of the three methods, 114 balloons and stent balloons were tested four times. Method 1 connected the syringe and the balloon catheter directly after purging and filling the lumen, while method 3 omitted the purging and filling process. With method 2, the catheter lumen was purged, filled and fully vented via a three-way valve. The primary endpoint answered whether air remained in the balloon, and if so, the secondary endpoint indicated the total volume of remaining air. The connection with a three-way valve achieved significantly less air in the inflated balloon as compared with either direct connection approach (27% vs. 44% and 51%; p = 0.015). For the direct connection, no significant difference between purging and filling the lumen prior to making the connection or not existed. According to these findings, the best method to connect a PCI balloon to the inflation syringe while removing air involves using a three-way valve. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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Review

Jump to: Editorial, Research

14 pages, 3088 KiB

Open AccessReview

Early Aspirin Discontinuation Following Acute Coronary Syndrome or Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Paul Guedeney, Jules Mesnier, Sabato Sorrentino, Farouk Abcha, Michel Zeitouni, Benoit Lattuca, Johanne Silvain, Salvatore De Rosa, Ciro Indolfi, Jean-Philippe Collet, Mathieu Kerneis and Gilles Montalescot

J. Clin. Med. 2020, 9(3), 680; https://doi.org/10.3390/jcm9030680 - 3 Mar 2020

Cited by 13 | Viewed by 4418

Abstract

The respective ischemic and bleeding risks of early aspirin discontinuation following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remain uncertain. We performed a prospero-registered review of randomized controlled trials (RCTs) comparing a P2Y₁₂ inhibitor-based single antiplatelet strategy following early aspirin discontinuation to a strategy of sustained dual antiplatelet therapy (DAPT) in ACS or PCI patients requiring, or not, anticoagulation for another indication (CRD42019139576). We estimated risk ratios (RR) and 95% confidence intervals (CI) using random effect models. We included nine RCTs comprising 40,621 patients. Compared to prolonged DAPT, major bleeding (2.2% vs. 2.8%; RR 0.68; 95% CI: 0.54 to 0.87; p = 0.002; I²: 63%), non-major bleeding (5.0 % vs. 6.1 %; RR: 0.66; 95% CI: 0.47 to 0.94; p = 0.02; I²: 87%) and all bleeding (7.4% vs. 9.9%; RR: 0.65; 95% CI: 0.53 to 0.79; p < 0.0001; I²: 88%) were significantly reduced with early aspirin discontinuation without significant difference for all-cause death (p = 0.60), major adverse cardiac and cerebrovascular events (MACE) (p = 0.60), myocardial infarction (MI) (p = 0.77), definite stent thrombosis (ST) (p = 0.63), and any stroke (p = 0.59). In patients on DAPT after an ACS or a PCI, early aspirin discontinuation prevents bleeding events with no significant adverse effect on the ischemic risk or mortality. Full article

(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)

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