scholarly journals New era of education: mobile learning of coronary guidewires in cardiovascular medicine

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Kyaw ◽  
A Vengrenyuk ◽  
G Johal ◽  
S Goel ◽  
S Sharma ◽  
...  
Keyword(s):  
Online Education ◽  
Mobile Learning ◽  
Coronary Intervention ◽  
Early Career ◽  
Torque Control ◽  
Total Occlusion ◽  
Catheterization Laboratory ◽  
Funding Sources ◽  
Global Pandemic ◽  
Teaching Cases

Abstract Background Online education has transformed the way we teach and learn, especially in the midst of a global pandemic. Multiple devices, including coronary guidewires, are required to perform a successful coronary intervention, and understanding the engineering aspect of coronary guidewire technology is paramount. Purpose We aim to develop and evaluate a novel teaching tool/mobile learning app to understand a complex guidewire architecture and appropriate wire selection based on a lesion characteristics. Methods A guidewire is incredibly complex, consisting of a multitude of technologies allowing a range of tip softness, trackability around curves, and precise torque control. Despite operator preference, the process of choosing an appropriate coronary guidewire has gone mostly unchanged. We envisioned developing the GuidewireAID app with three main parts: 1) wire basics, 2) lesion-based guidewire selection, and 3) cased-based approach. Appropriate teaching cases were selected from a large-volume catheterization laboratory and divided into non-chronic total occlusion (non-CTO) and CTO. Non-CTO cases include simple, calcified, angulated, and bifurcation lesions, as well as thrombotic occlusion and tortuous vessels (Figure 1). Each case is described and analysis is offered on how to select an appropriate wire, followed by teaching points pertinent to the topic. Results Twenty-three detailed clinical cases and more than a hundred wires are illustrated in the GuidewireAID app. Case presentation, angiographic analysis, and a thorough understanding of wire characteristics allows the operator to know which wire to use and when it is time to switch, especially when dealing with complex coronary cases. Conclusion The GuidewireAID app will help fellows in training (FIT), early career interventionists, and practicing interventional cardiologists understand the complex aspects of a coronary guidewire and appreciate how their nuances could overcome real-world clinical challenging scenarios. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Prognostic impact of CTO lesion in NSE-ACS patients: three-year outcome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Boukerche ◽  
N Laredj
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Observational Study ◽  
Chronic Total Occlusion ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Total Occlusion ◽  
Funding Sources ◽  
Percutaneous Coronary

Abstract Introduction CTO represents the most advanced form of CAD and affects adverse clinical outcomes in patients with AMI due to several pathophysiological mechanisms Purpose The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on two-year outcome in a prospective cohort of NSTE-ACS patients. CTO is present in many patients with NSTE-ACS and is difficult to treat with percutaneous coronary intervention. Methods Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether CTO lesions were vs. were not present. Major outcomes were assessed at 3 years. Results A total of 296 patients were evaluated: mean age was 62±12 years and 58% were male. The three-year mortality was 12.2% (36 patients) and the three-year MACCE was 26.4% (78 patients). The CTO group included 38 patients (12.2%). The three-year mortality and MACCE in the patients of CTO group was significantly higher (26.3% vs. 10.1%; p=0.013) and (50.0% vs. 22.9%; p=0.001) respectively. Conclusion In this prospective observational study of patients with NSTE-ACS, CTO was associated with a worst three-year outcome. FUNDunding Acknowledgement Type of funding sources: None. MACCE: CTO Vs No CTO lesion

Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations—A 10-year Single-center Experience

2011 ◽  
Vol 9 (2) ◽  
pp. 87 ◽  
Author(s):  
Preeti Chandra ◽  
Saurav Chatterjee ◽  
Nishant Koradia ◽  
Deepak Thekkoott ◽  
Bilal Malik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Predisposing Factors ◽  
Covered Stents ◽  
Optimal Management ◽  
Balloon Inflation ◽  
Catheterization Laboratory ◽  
Cell Counts

Background:Coronary perforation during percutaneous coronary intervention is a rare but dreaded complication. The risk factors, optimal management, and outcome remain obscure.Objectives:To determine the predisposing factors, optimal management, and preventive strategies. We retrospectively looked at coronary perforations at our catheterization laboratory over the last 10 years. We reviewed patient charts and reports. Two independent operators, in a blinded approach, reviewed all procedural cineangiograms. Data were analyzed by simple statistical methodology.Results:Nine patients were treated conservatively and six patients were treated with prolonged balloon inflation. Six patients were treated with polytetrafluoroethylene (PTFE)-covered stents. One patient required emergency coronary artery bypass graft. No deaths were reported. Subjects with perforations also had a significantly higher total white blood cell count (means 12,134 versus 6,155, 95 % confidence interval [CI], p< 0.0001, n=22), total absolute neutrophil count (means 74.2 % versus 57.1 %, 95 % CI, p<0.0001, n=22), and neutrophil:lymphocyte ratio (means 3.65 versus 1.50, 95% CI, p<0.0001, n=22).Conclusions:Coronary perforations are rare but potentially fatal events. Hypertension, small vessel diameter, high balloon:artery ratio, use of hydrophilic wires, and presence of myocardial bridging appear to be possible risk factors. Most perforations can be treated conservatively or with prolonged balloon inflation using perfusion balloons. Use of PTFE-covered stents could be a life-saving measure in cases of large perforations. Subjects with perforations also had greater systemic inflammation as indicated by elevated white cell counts.

scholarly journals Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.K Park ◽  
S.H Choi ◽  
J.M Lee ◽  
J.H Yang ◽  
Y.B Song ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT). Purpose To compare 10-year clinical outcomes between OMT and PCI in CTO patients. Methods Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death. Results In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p&lt;0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant). Conclusions As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients. Cardiac death in matched population Funding Acknowledgement Type of funding source: None

scholarly journals Mobile application to optimize care for STEMI patients in a large healthcare system, STEMIcathAID. Rationale and design

2021 ◽  
Author(s):  
Parasuram Krishnamoorthy ◽  
Andriy Vengrenyuk ◽  
Brian Wasielewski ◽  
Nitin Barman ◽  
Jeffrey Bander ◽  
...  
Keyword(s):  
Healthcare System ◽  
Mobile Application ◽  
Performance Metrics ◽  
Clinical Status ◽  
Coronary Intervention ◽  
Mobile App ◽  
Gps Tracking ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory

Abstract Technological advancements have transformed healthcare. System delays in transferring patients with ST- segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) center are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication and coordination between the STEMI care teams to reduce ischemia time and improve patient outcomes. The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the EKG and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer center. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPPA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge important data elements have to be entered to close the case. In conclusion, we developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

Implementation and clinical outcomes of pharmacogenetic CYP2C19 testing for clopidogrel therapy in real-world clinical practice.

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
POD O"drisceoil ◽  
TK Kiernan ◽  
SA Arnous
Keyword(s):  
Real World ◽  
Point Of Care ◽  
Coronary Intervention ◽  
Buccal Swab ◽  
Loss Of Function ◽  
Gain Of Function ◽  
Funding Sources ◽  
Patients At Risk ◽  
Clopidogrel Therapy ◽  
Stable Cad

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUNDCYP2C19 loss-of-function (LOF) polymorphisms are associated with adverse ischaemic events after PCI. The use of a point-of-care assay (POC) to routinely genotype patients immediately post PCI could rapidly identify patients at risk of adverse cardiac outcomes. PURPOSE To investigate the incidence of CYP2C19 polymorphisms (*2, *17) and 30-day MACE in patients presenting to catheter laboratory for PCI (See table 1).METHODS We performed a single centre prospective analysis of patients presenting to a cardiac catheterisation laboratory for percutaneous coronary intervention. Participants underwent prospective rapid point-of-care genotyping of CYP2C19 major alleles (2*,17*), using the SpartanRx PCR device via buccal swab sample. All patients provided written consent. RESULTS:A total of 120 tests were performed, 51 patients were normal allele carriers (*1), 31 patients were carriers of LOF alleles (*2) and 38 patients were carriers of gain of function alleles (*17). All tests results returned in one hour. Rate of dyslipidaemia was significantly different between three groups (55% vs. 63% vs. 36%; p = 0.050). A numerically higher proportion of LOF allele carriers received clopidogrel prior to undergoing pharmacogenetic testing but this was not statistically significant (52% vs. 35% vs. 34%; p = 0.09). Two cases of MACE at 30 day follow up occurred in the loss-of-function group. Both cases received clopidogrel.CONCLUSIONSWe have demonstrated that a rapid POC of CYP2C19 testing can take place in a real-world setting. Our incidence rate of LOF carriers is concordant with international published literature. We found 52% of LOF carriers were commenced on clopidogrel therapy prior to genetic analysis. Comparison of CPY2C19 Metabolisers genotype Loss of function normal Gain of function p values baseline characteristics age in years, median (range) 65 (43-82) 64 (43-85) 65 (42-89) 0.717 Male, N (%) 21 (68%) 43 (64%) 27 (71%) 0.198 Hypertensive, N (%) 16 (52%) 29 (57%) 24 (50%) 0.623 Dyslipidaemia. N (%) 17 (55%) 32 (63%) 14 (36%) 0.050 Indication, N (%) St-Elevation MI 12 (39%) 18 (35%) 11 (29%) 0.558 NSTEMI 5 (16%) 15 (29%) 14 (37%) 0.142 Unstable Angina 5 (16%) 7 (14%) 3 (8%) 0.518 Stable CAD 9 (29%) 11 (22%) 10 (26%) 0.731 Antiplatelet, N (%) Ticagrelor 15 (48%) 33 (65%) 25 (66%) 0.09 Clopidogrel 16 (52%) 18 (35%) 13 (34%) Complication, N (%) 30-day MACE 2 (6.5%) 0 0 0.01

scholarly journals Antegrade Approach of Percutaneous Coronary Intervention for Chronic Total Occlusion

2021 ◽  
Author(s):  
C. Raghu ◽  
Rahul K. Ghogre ◽  
Alekhya Mandepudi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Chronic Total Occlusion ◽  
Bypass Surgery ◽  
Coronary Intervention ◽  
Technical Expertise ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Percutaneous Coronary ◽  
Coronary Lesions

AbstractChronic total occlusion (CTO) is a common challenge accounting for 10% of coronary lesions found on coronary angiography. Patients are frequently referred for bypass surgery because percutaneous coronary intervention is challenging in this subset. Recent advances in the hardware as well as the technical expertise and an algorithm approach have improved the success to more than 90%.Antegrade approach is the cornerstone for managing CTO and has two distinct strategies: antegrade wire escalation, and antegrade dissection and reentry strategy. Step-wise approach to perform these procedures and the use of adjunct imaging are discussed.

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