P2814The long-term patterns of red blood cell transfusion and outcome in patients undergoing percutaneous coronary intervention - a Korean nationwide longitudinal cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J.-M Choi ◽  
J.-H Choi ◽  
Y.-J Jang ◽  
N.-R Song ◽  
S.-H Lee ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Critically Ill ◽  
Significant Risk ◽  
Coronary Intervention ◽  
Clinical Event ◽  
Red Blood Cell Transfusion ◽  
Incidence Density ◽  
Adverse Clinical Event ◽  
Percutaneous Coronary

Abstract Aims Transfusion long after percutaneous coronary intervention (PCI) may pose a significant risk but is not sufficiently understood. We investigated the long-term patterns and impact of transfusion on the clinical outcome of patients undergoing PCI. Methods and results Five-year clinical outcomes of all Korean undergoing PCI using stent in year 2011 (n=48786) were investigated. Primary outcome was the incidence density of transfusion. The association of transfusion with major adverse clinical event (MACE) consisting all-cause death, revascularization, critically ill cardiovascular status, or stroke was assessed after reflecting the propensity of each patient for transfusion and adjusting transfusion frequency and intervals. The 5-year incidence density of transfusion was 4.74 (95% confidence interval [CI] = 4.70–4.79) per 100 person-year. Patients who received transfusion were older, were more often women, and had overall higher frequency of clinical risk factors (p<0.001, all). Transfusion was associated with MACE (hazard ratio [HR] = 3.0, 95% CI = 2.9–3.1, p<0.001) and with death, revascularization, critically ill cardiovascular status, and stroke (HR from 1.6 to 6.5, p<0.001, all). The period of transfusion coincided with the period of highest MACE incidence density and all other clinical events. Subgroup analyses classified by clinical characteristics showed consistent results. Year of transfusion and outcome Conclusions One out of every 4 Koreans undergoing PCI received transfusion within 5 years, and had 3-fold higher risk of MACE compared to patients without transfusion. These observational findings may warrant the establishment of transfusion strategies for patients undergoing PCI.

Gender difference in long-term clinical outcomes after percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.H Choi ◽  
S.H Lee ◽  
J.M Choi ◽  
Y.J Jang ◽  
K.H Choi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Gender Difference ◽  
Cumulative Incidence ◽  
Coronary Intervention ◽  
Clinical Event ◽  
Adverse Clinical Event ◽  
Percutaneous Coronary ◽  
Specific Outcome ◽  
Gender Specific

Abstract Background The comparative gender-specific outcome after PCI in real-world practice is limited. We investigated the gender difference in the 5-year outcome after percutaneous coronary intervention (PCI). Methods A retrospective study. nationwide PCI registry. All PCI performed in Korea in year 2011 (N=48,783). Outcomes adjusted with age and propensity for clinical characteristics were compared. Primary outcome was 5-year cumulative incidence of major adverse clinical event (MACE) consisting of all-cause death, revascularization, shock, or stroke. Results In unadjusted analysis, women (N=15,710) were older (69.7±9.7 versus 62.0±11.1 year) and had higher frequency of comorbidities including hypertension, hyperlipidemia, and diabetes compared to men (N=33,073) (p&lt;0.001, all). Women had higher 5-year cumulative incidence of MACE than men (41.9% versus 37.2%; hazard ratio [HR] 1.16, 95% confidential interval [CI] 1.12–1.19; p&lt;0.001). In propensity score-matched 14,462 pairs, women had lower 5-year mortality risk (40.7% versus 46.0%, HR 0.85, 95% CI 0.82–0.88, p&lt;0.001). The lower 5-year MACE risk in women was consistent in subgroup analyses of age, risk factors, and clinical diagnosis including angina or acute myocardial infarction (p&lt;0.05, all). The risk of all-cause death, revascularization, and shock were also lower in women than men (p&lt;0.05, all) but the risk of stroke was not different between women and men. Conclusions The apparent worse outcome in women can be explained by older age and more common comorbidities in women. After adjusting these disadvantages, women had better outcome after PCI than men. Our result suggests presence of the reversal paradox in the gender-specific outcome following PCI. Women vs men, 5 year outcome Funding Acknowledgement Type of funding source: None

scholarly journals GPIIb/IIIa Receptor Antagonism Using Small Molecules Provides no Additive Long-Term Protection after Percutaneous Coronary Intervention as Compared to Clopidogrel Plus Aspirin

2010 ◽  
Vol 4 (1) ◽  
pp. 151-156 ◽  
Author(s):  
Michele Schiariti ◽  
Angela Saladini ◽  
Francesco Papalia ◽  
Placido Grillo ◽  
Cristina Nesta ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Small Molecules ◽  
Significant Risk ◽  
Coronary Intervention ◽  
Rank Test ◽  
High Dose ◽  
Percutaneous Coronary ◽  
One Year ◽  
Ischemic Events

Background: There is some controversy as to whether tirofiban or eptifibatide, two small anti-aggregating drugs (AAD), may reduce the incidence of composite ischemic events within one year in patients undergoing percutaneous coronary intervention (PCI) in the real clinical world. Methods: We compared consecutive patients on oral double AAD (with clopidogrel and aspirin) who underwent PCI (n=207) and patients who were on single AAD and received a second AAD, just prior to PCI, and either high-dose tirofiban or double-bolus eptifibatide (double AAD plus small molecules group, n=666). The primary end point (incidence of composite ischemic events within one year) included death, acute myocardial infarction, unstable angina, stent thrombosis or repeat PCI or coronary bypass surgery (related to the target vessel PCI failure) and was modelled by Cox’s regression. Results: There were 89 composite ischemic events: 24 (11.6%) in double AAD alone and 65 (9.8%) in double AAD plus small molecules groups (log-rank test: p=0.36). Incidences by type of ischemic events were similar between the 2 groups. Based on 21 potential covariates fitted simultaneously, adjusted hazard ratios (HR and 95% confidence intervals) showed that age (HR 1.03, 1.01-1.06, p=0.01), diabetes (HR 1.68, 1.01-2.79, p=0.05) and intra aortic balloon pump (HR 5.12, 2.36-11.10, p=0.0001) were significant risk factors whereas thrombolysis by tenecteplase (HR 0.35, 0.13-0.98, p=0.05) and having had hypertension or anti-hypertensive treatment (HR 0.58, 0.36-0.93, p=0.03) were significant protectors for events. Whether small molecules were present provided a non significant additional benefit as compared to double AAD alone (HR 0.83, 0.51-1.36, p=0.46). Pre-PCI CK-MB were not useful to predict events (HR 1.01, 0.99-1.01, p=0.17). Conclusions: In clinical world patients undergoing PCI (rescue plus primary <13%) while on double AAD, based on clopidogrel plus aspirin, small molecules (tirofiban or eptifibatide) provided no additive long-term protection against the occurrence of composite ischemic events whereas thrombolysis by tenecteplase did.

Percutaneous coronary intervention and carotidal endarterectomy: hospital and long-term outcomes of hybrid interventions and predictors of complications

2021 ◽  
pp. 33-44
Author(s):  
Anton Nikolaevich Kazantsev ◽  
Viacheslav Nikolaevich Kravchuk ◽  
Roman Aleksandrovich Vinogradov ◽  
Olga Yaroslavna Porembskaya ◽  
Mikhail Alexandrovich Chernyavsky ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Coronary Arteries ◽  
Significant Risk ◽  
Coronary Intervention ◽  
Long Term Results ◽  
Percutaneous Coronary ◽  
Hybrid Revascularization

Goal. Analysis of hospital and long-term results with the identification of predictors of complications after combined interventions on the coronary and carotid arteries in the volume of percutaneous coronary intervention + carotid endarterectomy (PCI + CEE). Materials and methods. From 2010 to 2016, 64 patients underwent hybrid revascularization of the brain and myocardium in the volume of PCI + CEE. Initially, PCI was performed, then the patient was transported to the vascular operating room, where he underwent CEE was performed according to the classical technique with modeling the reconstruction zone with a patch made of diepoxy-treated xenopericardium. Brain protection was achieved by invasive measurement of retrograde pressure. After CEE, the patient received a loading dose of clopidogrel 600 mg. The average follow-up period in the long-term period was 53.04 ± 17.1 months. Results. In the hospital period, only hemorrhagic complications were noted (n = 3; 4.68 %) while taking double antiplatelet therapy (acetylsalicylic acid + clopidogrel) and intraoperative heparin. In the long-term period, the leading position was occupied by a lethal outcome (n = 9; 16.6 %). Despite taking double antiplatelet therapy, in 6 (11.1 %) cases, stroke development was noted, in 1 (1.8 %) — MI. In 3 (5.5 %) patients, repeated unplanned revascularization was performed — CABG as a result of restenosis in the stent. The combined endpoint (death + stroke + myocardial infarction) was 29.6 % (n = 16). Significant risk factors for the development of complications in the hospital postoperative period were chronic renal failure (OR 3.7165; 95 % CI 1.2032–11.4800), III–IV functional class of angina (OR 21.9; 95 % CI 2.29–208, 8), a history of stroke (OR 6.82; 95 % CI 1.04–44.7). In the long term, the predictors of adverse events were bleeding (OR 2.02; 95 % CI 1.15–3.55), ejection fraction less than 50 % (OR 2.9; 95 % CI 1.47–5.7) and lesion trunk of the left coronary artery and more than three additional coronary arteries (OR 2.67; 95 % CI 1.27–5.59), and two or less affected coronary arteries (OR 0.34; 95 % CI 0.19–0.62). Conclusion. The efficiency and safety of hybrid revascularization in the volume of PCI + CEE has been proven in view of the minimum number of complications at different stages of follow-up.

scholarly journals Long-term Outcomes of contemporary Percutaneous Coronary Intervention with the Xience Drug-Eluting Stent: Results from a Multicentre Australian Registry

2020 ◽  
Author(s):  
David Eccleston ◽  
Enayet Chowdhury ◽  
Sinny Delacroix ◽  
Mark Horrigan ◽  
Tony Rafter ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Clinical Event ◽  
Drug Eluting Stents ◽  
Study Cohort ◽  
Long Term Outcomes ◽  
Adverse Clinical Event ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Event Rates

Abstract BackgroundSeveral 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 in Australia, and little information comparing new second generation drug-eluting stents (DES) with earlier DES. Also, approval of new-generation drug-eluting stents (DES) is almost exclusively based on non-inferiority trials comparing outcomes with first generation DES, and there are limited data comparing safety and efficacy outcomes of new second generation DES with bare metal stents (BMS). This study long-term outcomes after PCI with the Xience DES from a large national multicentre registry, the GenesisCare Outcomes Registry (GCOR).MethodsThe study population comprised the first 1500 patients consecutively enrolled from January 2015 to January 2019 who were treated exclusively with either Xience DES or BMS and were eligible for 1-year follow-up, from a total group of 4,765 PCI patients enrolled during that period. Baseline patient and procedural data, medications and major adverse cardiovascular events (MACE) in-hospital, at 30-days and 1-year were reported and analysed with respect to the type of stent used (Xience DES n = 1000, BMS n = 500).ResultsOf the 4,765 patients enrolled in GCOR during this period, DES were exclusively used in 3621 (76.0%), BMS were exclusively used in 596 (12.5%) with the remainder receiving a combination of DES and BMS. In the study cohort of 1,500 Xience and BMS patients 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. Adverse clinical event rates In the study cohort were low in comparison to international reports at 30-days in terms of mortality (0.20%), target lesion revascularisation (TLR, 0.27%) and MACE (0.47%). Similarly, adverse clinical event rates at 12 months were low in terms of mortality (1.26%), TLR (1.16%) and MACE (1.78%).ConclusionsClinical 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.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000899943This trial was registered retrospectively on 11/09/2020.

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

2016 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Yohei Sotomi ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Percutaneous Coronary ◽  
Orbital Atherectomy ◽  
Long Term Follow Up ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (&gt;50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF&lt;40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF&lt;40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p&lt;0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p&lt;0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p&lt;0.001) and median age (61 vs. 59 vs. 64 years, p&lt;0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p&lt;0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p&lt;0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p&lt;0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (&lt;40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

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