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Clinical Frontiers in Percutaneous Coronary Intervention
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Clinical Frontiers in Percutaneous Coronary Intervention

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

Deadline for manuscript submissions: closed (25 June 2023) | Viewed by 10072

Special Issue Editor

Dr. Marcel A. M. Beijk

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Guest Editor
Department of cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Interests: complex PCI; structural interventions; TAVI; mitraclip; percutaneous interventions in ACHD; ANOCA; MINOCA

Special Issue Information

Dear Colleagues,

In recent years, the field of percutaneous coronary interventions (PCI) has made significant progress, mainly attributed to the development of newer devices, drugs, and the applications of technology. Although clinical outcomes after PCI have improved dramatically, the need for continuous progress remains. As the life expectancy of the general population grows, patients will have more high-risk comorbidities and more complex coronary anatomies. Moreover, the availability of intracoronary physiology and imaging has a significant impact on the percutaneous treatment of coronary artery disease.

This Special Issue of the Journal of Clinical Medicine aims to present cutting-edge research dedicated to clinical frontiers in percutaneous coronary intervention. I would like to invite state-of-the-art reviews, as well as original research, in this area to be considered for inclusion in this issue. (Case reports and short reviews are not accepted.) Examples include developments of percutaneous coronary intervention-guided coronary physiology or intravascular imaging (optical coherence tomography, intravascular ultrasound), medical therapy (i.e., anti-platelet and anticoagulation therapy during and after procedure), management of challenging coronary anatomy (chronic total occlusions, bifurcations, restenotic lesions), management of complex higher-risk (and clinically indicated) patients, specific clinical problems (e.g., risk/benefit of revascularization in chronic coronary syndromes), and management of patients diagnosed with angina and ischemia and no obstructive coronary artery disease.

Dr. Marcel A. M. Beijk
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • intracoronary physiology
  • intracoronary imaging
  • medical therapy
  • challenging coronary anatomy
  • complex high-risk patients
  • ANOCA
  • INOCA

Published Papers (7 papers)

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Editorial

Jump to: Research

3 pages, 166 KiB  
Editorial
Special Issue “Clinical Frontiers in Percutaneous Coronary Intervention”
by Marcel A. M. Beijk
J. Clin. Med. 2023, 12(18), 5969; https://doi.org/10.3390/jcm12185969 - 14 Sep 2023
Viewed by 599
Abstract
In the last decade, significant advancements have been made in the field of percutaneous coronary interventions (PCIs) with the development of new devices and drugs, the application of new technology and the utilization of artificial intelligence/machine learning, and new indications for revascularization [...] [...] Read more.
In the last decade, significant advancements have been made in the field of percutaneous coronary interventions (PCIs) with the development of new devices and drugs, the application of new technology and the utilization of artificial intelligence/machine learning, and new indications for revascularization [...] Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)

Research

Jump to: Editorial

12 pages, 2090 KiB  
Article
Machine Learning for Prediction of Technical Results of Percutaneous Coronary Intervention for Chronic Total Occlusion
by Tatsuya Nakachi, Masahisa Yamane, Koichi Kishi, Toshiya Muramatsu, Hisayuki Okada, Yuji Oikawa, Ryohei Yoshikawa, Tomohiro Kawasaki, Hiroyuki Tanaka and Osamu Katoh
J. Clin. Med. 2023, 12(10), 3354; https://doi.org/10.3390/jcm12103354 - 9 May 2023
Cited by 2 | Viewed by 1551
Abstract
(1) Background: The probability of technical success in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) represents essential information for specifying the priority of PCI for treatment selection in patients with CTO. However, the predictabilities of existing scores based on conventional regression [...] Read more.
(1) Background: The probability of technical success in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) represents essential information for specifying the priority of PCI for treatment selection in patients with CTO. However, the predictabilities of existing scores based on conventional regression analysis remain modest, leaving room for improvements in model discrimination. Recently, machine learning (ML) techniques have emerged as highly effective methods for prediction and decision-making in various disciplines. We therefore investigated the predictability of ML models for technical results of CTO-PCI and compared their performances to the results from existing scores, including J-CTO, CL, and CASTLE scores. (2) Methods: This analysis used data from the Japanese CTO-PCI expert registry, which enrolled 8760 consecutive patients undergoing CTO-PCI. The performance of prediction models was assessed using the area under the receiver operating curve (ROC-AUC). (3) Results: Technical success was achieved in 7990 procedures, accounting for an overall success rate of 91.2%. The best ML model, extreme gradient boosting (XGBoost), outperformed the conventional prediction scores with ROC-AUC (XGBoost 0.760 [95% confidence interval {CI}: 0.740–0.780] vs. J-CTO 0.697 [95%CI: 0.675–0.719], CL 0.662 [95%CI: 0.639–0.684], CASTLE 0.659 [95%CI: 0.636–0.681]; p < 0.005 for all). The XGBoost model demonstrated acceptable concordance between the observed and predicted probabilities of CTO-PCI failure. Calcification was the leading predictor. (4) Conclusions: ML techniques provide accurate, specific information regarding the likelihood of success in CTO-PCI, which would help select the best treatment for individual patients with CTO. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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17 pages, 956 KiB  
Article
Clinical Outcomes after Percutaneous Coronary Intervention for Cardiogenic Shock Secondary to Total Occlusive Unprotected Left Main Coronary Artery Lesion-Related Acute Myocardial Infarction
by Marcel A. M. Beijk, Julián Palacios-Rubio, Maik J. D. Grundeken, Debbie N. Kalkman and Robbert J. De Winter
J. Clin. Med. 2023, 12(4), 1311; https://doi.org/10.3390/jcm12041311 - 7 Feb 2023
Cited by 3 | Viewed by 1240
Abstract
Background: Acute myocardial infarction (AMI) with occlusion of an unprotected left main coronary artery (ULMCA) is a rare condition with a high mortality. The literature on clinical outcomes after percutaneous coronary intervention (PCI) for cardiogenic shock secondary to ULMCA-related AMI is scarce. Methods: [...] Read more.
Background: Acute myocardial infarction (AMI) with occlusion of an unprotected left main coronary artery (ULMCA) is a rare condition with a high mortality. The literature on clinical outcomes after percutaneous coronary intervention (PCI) for cardiogenic shock secondary to ULMCA-related AMI is scarce. Methods: In this retrospective analysis, all consecutive patients undergoing PCI for cardiogenic shock secondary to total occlusive ULMCA-related AMI were included between January 1998 and January 2017. The primary endpoint was 30-day mortality. The secondary endpoints were long-term mortality and 30-day and long-term major adverse cardiovascular and cerebrovascular events. The differences in clinical and procedural variables were assessed. A multivariable model was created to search for independent predictors of survival. Results: Forty-nine patients were included, and the mean age was 62 ± 11 years. The majority of patients suffered cardiac arrest prior or during PCI (51%). Thirty-day mortality was 78%, of which 55% died within 24 h. The median follow-up of patients who survived 30 days (n = 11) was 9.9 years (interquartile range 4.7–13.6), and long-term mortality was 84%. Long-term all-cause mortality was independently associated with cardiac arrest prior or during PCI (hazard ratio [HR] 2.02, 95% confidence interval 1.02–4.01, p = 0.043). Patients who survived to the 30-day follow-up with severe left ventricular dysfunction had a significantly higher risk of mortality compared to patients with moderate to mild dysfunction (p = 0.007). Conclusions: Cardiogenic shock secondary to total occlusive ULMCA-related AMI carries a very high 30-day all-cause mortality. Thirty-day survivors with a severe left ventricular dysfunction have a poor long-term prognosis. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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10 pages, 262 KiB  
Article
Long-Term Outcomes of Contemporary Percutaneous Coronary Intervention with the Xience Drug-Eluting Stent: Results from a Multicentre Australian Registry
by David S. Eccleston, Enayet Chowdhury, Tony Rafter, Peter Sage, Alan Whelan, Christopher Reid, Danny Liew, MyNgan Duong, Nisha Schwarz and Stephen G. Worthley
J. Clin. Med. 2023, 12(1), 280; https://doi.org/10.3390/jcm12010280 - 29 Dec 2022
Cited by 2 | Viewed by 1512
Abstract
Introduction: Several large registries have evaluated outcomes after percutaneous coronary intervention (PCI) in the USA, however there are no contemporary data regarding long-term outcomes after PCI, particularly comparing new generation drug-eluting stents (DES) with other stents in Australia. Additionally, approval of new-generation drug-eluting [...] Read more.
Introduction: Several large registries have evaluated outcomes after percutaneous coronary intervention (PCI) in the USA, however there are no contemporary data regarding long-term outcomes after PCI, particularly comparing new generation drug-eluting stents (DES) with other stents in Australia. Additionally, approval of new-generation drug-eluting stents (DES) is almost exclusively based on non-inferiority trials comparing outcomes with early generation DES, and there are limited data comparing safety and efficacy outcomes of new-generation DES with bare metal stents (BMS). This study reports in-hospital and long-term outcomes after PCI with the Xience DES from a large national registry, the GenesisCare Outcomes Registry (GCOR). Methods: The first 1500 patients consecutively enrolled from January 2015 to January 2019 and treated exclusively with either Xience DES or BMS and eligible for 1-year follow-up were included. Baseline patient and procedural data, major adverse cardiovascular events (MACE) in-hospital, at 30 days and 1-year, and medications were reported and analysed with respect to Xience DES (n = 1000) or BMS (n = 500) use. Results: In this cohort the mean age was 68.4 ± 10.7 years, 76.9% were male, 24.6% had diabetes mellitus and 45.9% presented with acute coronary syndromes. Of the overall cohort of 4765 patients from this period including all DES types, and patients who received multiple DES or a combination of DES and BMS, DES were exclusively used in 3621 (76.0%) patients, and BMS were exclusively used in 596 (12.5%). In comparison to international cohorts, adverse clinical event rates were low at 30 days in terms of mortality (0.20%), target lesion revascularisation (TLR, 0.27%) and MACE (0.47%), and at 12 months for mortality (1.26%) TLR (1.16%) and MACE (1.78%). Conclusions: Clinical practice and long-term outcomes of PCI with the Xience DES in Australia are consistent with international series. Recent trends indicate DES use has increased in parallel with good outcomes despite an increasingly complex patient and lesion cohort. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
20 pages, 1906 KiB  
Article
The Association of Sex with Unplanned Cardiac Readmissions following Percutaneous Coronary Intervention in Australia: Results from a Multicentre Outcomes Registry (GenesisCare Cardiovascular Outcomes Registry)
by Andre Conradie, John Atherton, Enayet Chowdhury, MyNgan Duong, Nisha Schwarz, Stephen Worthley and David Eccleston
J. Clin. Med. 2022, 11(22), 6866; https://doi.org/10.3390/jcm11226866 - 21 Nov 2022
Cited by 2 | Viewed by 1245
Abstract
Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year [...] Read more.
Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year readmission rates and their association with mortality. The aim of this study was to investigate the impact of biological sex at 1-year post-PCI on unplanned cardiac readmissions. Methods and results: Patients enrolled into the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from December 2008 to December 2020 were included in the study. A total of 13,996 patients completed 12 months of follow-up and were assessed for unplanned cardiac readmissions. All patients with unplanned cardiac readmissions in the first year of post-PCI were followed in year 2 (post-PCI) for survival status. The rate of unplanned cardiac readmissions was 10.1%. Women had a 29% higher risk of unplanned cardiac readmission (HR 1.29, 95% CI 1.11 to 1.48; p = 0.001), and female sex was identified as an independent predictor of unplanned cardiac readmissions. Any unplanned cardiac readmission in the first year was associated with a 2.5-fold higher risk of mortality (HR 2.50, 95% CI 1.67 to 3.75; p < 0.001), which was similar for men and women. Conclusion: Unplanned cardiac readmissions in the first year post-PCI was strongly associated with increased all-cause mortality. Whilst the incidence of all-cause mortality was similar between women and men, a higher incidence of unplanned cardiac readmissions was observed for women, suggesting distinct predictors of unplanned cardiac readmissions exist between women and men. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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10 pages, 1010 KiB  
Article
Quantitative Flow Ratio Is Related to Anatomic Left Main Stem Lesion Parameters as Assessed by Intravascular Imaging
by Andrea Milzi, Rosalia Dettori, Richard Karl Lubberich, Kathrin Burgmaier, Nikolaus Marx, Sebastian Reith and Mathias Burgmaier
J. Clin. Med. 2022, 11(20), 6024; https://doi.org/10.3390/jcm11206024 - 12 Oct 2022
Cited by 3 | Viewed by 1376
Abstract
Introduction: Previously, an association between anatomic left main stem (LMS) lesion parameters, as described by intravascular ultrasound (IVUS) and fractional flow reserve (FFR), was shown. Quantitative flow ratio (QFR) is a novel, promising technique which can assess functional stenosis relevance based only on [...] Read more.
Introduction: Previously, an association between anatomic left main stem (LMS) lesion parameters, as described by intravascular ultrasound (IVUS) and fractional flow reserve (FFR), was shown. Quantitative flow ratio (QFR) is a novel, promising technique which can assess functional stenosis relevance based only on angiography. However, as little is known about the relationship between anatomic LMS parameters and QFR, it was thus investigated in this study. Methods: In 53 patients with LMS disease, we tested the association between anatomic assessment using OCT (n = 28) or IVUS (n = 25) on the one hand and functional assessment as determined by QFR on the other hand. LMS-QFR was measured using a dedicated approach, averaging QFR over left anterior descending (LAD) and circumflex (LCX) and manually limiting segment of interest to LMS. Results: The minimal luminal area of the LMS (LMS-MLA) as measured by intravascular imaging showed a consistent correlation with QFR (R = 0.61, p < 0.001). QFR could predict a LMS-MLA < 6 mm2 with very good diagnostic accuracy (AUC 0.919) and a LMS-MLA < 4.5 mm2 with good accuracy (AUC 0.798). Similar results were obtained for other stenosis parameters. Conclusions: QFR might be a valuable tool to assess LMS disease. Further studies focusing on patient outcomes are needed to further validate the effectiveness of this approach. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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16 pages, 567 KiB  
Article
Health-Related Quality of Life (HRQoL) and the Effect on Outcome in Patients Presenting with Coronary Artery Disease and Treated with Percutaneous Coronary Intervention (PCI): Differences Noted by Sex and Age
by Andre Conradie, John Atherton, Enayet Chowdhury, MyNgan Duong, Nisha Schwarz, Stephen Worthley and David Eccleston
J. Clin. Med. 2022, 11(17), 5231; https://doi.org/10.3390/jcm11175231 - 5 Sep 2022
Cited by 5 | Viewed by 1716
Abstract
Background and aim: poor quality of life (QoL) has been identified as an independent risk factor for mortality and major cardiac events (MACE) in patients with cardiovascular disease (CVD). The aim of this study was to assess health-related quality of life (HRQoL) at [...] Read more.
Background and aim: poor quality of life (QoL) has been identified as an independent risk factor for mortality and major cardiac events (MACE) in patients with cardiovascular disease (CVD). The aim of this study was to assess health-related quality of life (HRQoL) at baseline and its association with outcome in patients with coronary artery disease presenting for percutaneous coronary intervention (PCI). The outcome was measured by mortality and MACE at 1-year, and whether there was any difference for sex and different age groups. Methods and results: all patients prospectively enrolled into the GenesisCare Outcome Registry (GCOR) over a 11-year period were included in the study. The EQ-5D-5L and VAS patient survey were used for assessment of baseline HRQoL. Of the 15,198 patients, only 6591 (43.4%) completed the self-assessment. Women had significantly more impairment of all five dimensions of the EQ-5D-5L survey, and their self-reported QoL was significantly lower than men (68.3 in women vs. 71.9 in men, p < 0.001). Poor QoL was strongly associated with increased mortality (HR 2.85; 95% CI 1.76 to 4.62, p < 0.001) and MACE (HR 1.40; 95% CI 1.10 to 1.79, p = 0.01). A similar trend was noted for women and men, but did not reach significance in women due to the smaller number of female patients. Conclusion: poor HRQoL is associated with subsequent mortality and MACE in patients undergoing PCI. By not assessing quality of life as a standard of care, an opportunity is lost to identify high-risk patients who may benefit from targeted interventions to improve health outcomes. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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