scholarly journals 580 Percutaneous coronary intervention or medical therapy as initial management strategy of patients with spontaneous coronary artery dissections: insight from the multicentre, international dissezioni spontanee coronariche (disco) registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Stefano Benenati ◽  
Federico Giacobbe ◽  
Antonio Zingarelli ◽  
Truffa Giachet Alessandra ◽  
Primiano Lombardi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Medical Management ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Timi Flow Grade ◽  
Coronary Segment ◽  
Timi Flow ◽  
Percutaneous Coronary

Abstract Aims Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes of immediate PCI patients with those undergoing an initial strategy of medical management. Methods and results 369 patients enrolled in the multicentre international DIssezioni Spontanee COronariche (DISCO) registry between January 2009 and December 2020 were included. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI) and any PCI. 240 (65%) patients underwent initial medical management, whereas 129 (35%) had immediate PCI. PCI patients presented more frequently with ST segment-elevation myocardial infarction (STEMI) (68.2% vs. 35%, P < 0.001) and had higher frequency of proximal coronary segment SCAD (31.8% vs. 6.7%, P < 0.001), Thrombolysis in Myocardial infarction (TIMI) flow grade 0–1 (54.3% vs. 20.4%, P < 0.001) and multivessel SCAD (18.6% vs. 9.2%, P = 0.015), as well as a more severe diameter stenosis [99% (100–90) vs. 90% (99–75), P < 0.001]. At multivariate logistic regression, STEMI at presentation (vs. NSTE-ACS, OR: 3.30 95% CI: 1.56–7.12, P = 0.002), proximal coronary segment involvement (OR: 5.43, 95% CI: 1.98–16.45, P = 0.002), TIMI flow grade 0–1 and 2 (respectively, vs. grade 3: OR: 3.22 95% CI: 1.08–9.96, P = 0.038; and OR: 3.98; 95% CI: 1.38–11.80, P = 0.009) and diameter stenosis (per 5% increase, OR: 1.13; 95% CI: 1.01–1.28, P = 0.037) were predictors of immediate PCI, whereas the angiographic subtype 2B predicted a conservative approach (OR: 0.25; 95% CI: 0.07–0.83, P = 0.026). The frequency of in-hospital major adverse cardiac events did not differ between medically and PCI-treated patients. At 2-year follow-up, there were no differences with respect to the composite of MACE (11.7% vs. 13.9%, P = 0.47) and the individual components of cardiovascular death (0.4% vs. 0.7%, P = 0.65), non-fatal MI (8.3% vs. 9.3%, P = 0.92), and any PCI (8.7% vs. 12.4%, P = 0.23). Conclusions The choice between an immediate medical or PCI management of SCAD is mostly driven by clinical presentation and procedural aspects. In the DISCO cohort, the primary treatment approach was not associated with the risk of short-to-midterm adverse events.

scholarly journals Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318914
Author(s):  
Deevia Kotecha ◽  
Marcos Garcia-Guimaraes ◽  
Diluka Premawardhana ◽  
Dario Pellegrini ◽  
Clare Oliver-Williams ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Timi Flow ◽  
Percutaneous Coronary

ObjectiveTo investigate percutaneous coronary intervention (PCI) practice in an international cohort of patients with spontaneous coronary artery dissection (SCAD). To explore factors associated with complications and study angiographic and longer term outcomes.MethodsSCAD patients (n=215, 94% female) who underwent PCI from three national cohort studies were investigated and compared with a matched cohort of conservatively managed SCAD patients (n=221).ResultsSCAD-PCI patients were high risk at presentation with only 8.8% undergoing PCI outside the context of ST-elevation myocardial infarction/cardiac arrest, thrombolysis in myocardial infarction (TIMI) 0/1 flow or proximal dissections. PCI complications occurred in 38.6% (83/215), with 13.0% (28/215) serious complications. PCI-related complications were associated with more extensive dissections (multiple vs single American Heart Association coronary segments, OR 1.9 (95% CI: 1.06–3.39),p=0.030), more proximal dissections (proximal diameter per mm, OR 2.25 (1.38–3.67), p=0.001) and dissections with no contrast penetration of the false lumen (Yip-Saw 2 versus 1, OR 2.89 (1.12–7.43), p=0.028). SCAD-PCI involved long lengths of stent (median 46mm, IQR: 29–61mm). Despite these risks, SCAD-PCI led to angiographic improvements in those with reduced TIMI flow in 84.3% (118/140). Worsening TIMI flow was only seen in 7.0% (15/215) of SCAD-PCI patients. Post-PCI major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular function outcomes were favourable.ConclusionWhile a conservative approach to revascularisation is favoured, SCAD cases with higher risk presentations may require PCI. SCAD-PCI is associated with longer stent lengths and a higher risk of complications but leads to overall improvements in coronary flow and good medium-term outcomes in patients.

Vitamin D level predicts angiographic no-reflow phenomenon after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

2021 ◽  
Vol 15 (15) ◽  
pp. 1357-1366
Author(s):  
Ömer Şen ◽  
Sıdıka B Şen ◽  
Ayşe N Topuz ◽  
Mustafa Topuz
Keyword(s):  
Myocardial Infarction ◽  
Vitamin D ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Normal Flow ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p < 0.001). 25(OH)D3 level was significantly negatively correlated with Neutrophil/lymphocyte (N/L) ratio. In multivariate analysis, 25(OH)D3 level on admission (OR: 0.738; 95% CI: 0.584–0.878; p = 0.001) was found an independent predictor of NRP together with N/L ratio, N-Terminal-proBNP, balloon pre dilatation and syntax score I. On receiver operating curve analysis (ROC), the cut-off value of admission 25(OH)D3 level was 10.5 ng/ml for the prediction of NRP with a sensitivity of 93% and specificity of 68%. The area under the ROC curve (AUC) was 0.772 (95% CI: 0.697–0.846; p < 0.001). Conclusion: We have shown that lower 25(OH)D3 level on admission is associated with higher NRP frequency and may be used as a predictor for NRP in STEMI patients undergoing PPCI.

Abstract 225: Impact of Revascularization Strategy on Risk of Readmission After Non-ST Elevation Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Moses Anabila ◽  
Jeevanantham Rajeswaran ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Medical Management ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation

Background: It is unclear how revascularization strategy (medical management vs percutaneous coronary intervention vs coronary artery bypass surgery), affects 90-day readmissions after Non-ST Elevation Myocardial Infarction (NSTEMI). Methods: We identified cases of NSTEMI at a single quaternary care medical center between January 1 st , 2010 to January 1 st , 2017 and readmissions within 90 days. Cases were categorized based on revascularization strategy into medical management, PCI (percutaneous coronary intervention) or CABG (coronary artery bypass surgery). The readmissions were categorized according to the time of readmission into early (0-30 days) and late (31-90 days) after discharge. The instantaneous risk of readmission following each treatment option was calculated using the parametric method. Results: We identified 6626 patients with index MI, of which 4692 patients had NSTEMI. There were a total of 2051 readmissions within 90 days. The risk of readmission for CABG and PCI treatment groups yielded an early peaking phase followed by a constant risk whereas the risk of readmission in the medically managed group showed an early decreasing phase followed by a constant risk. An unadjusted comparison of the risk of readmission between the three groups showed that the PCI group had the lowest early risk of readmission (P=0.03). The medically managed group had the highest risk of readmission. Conclusion: Patients with NSTEMI who are medically managed appear to be at higher risk for readmission than revascularized patients. Understanding the care processes for these patients may serve as a future opportunity to improve outcomes in these high-risk patients.

scholarly journals One-Year Outcome of Patients with Coronary Artery Ectasia Undergoing Percutaneous Coronary Intervention: Clinical Implications and Question Marks

2021 ◽  
Author(s):  
Alireza Amirzadegan ◽  
Seyed-Ali Sadre-Bafghi ◽  
Saeed Ghodsi ◽  
Hamidreza Soleimani ◽  
Mehrnaz Mohebi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Cox Regression ◽  
Coronary Intervention ◽  
The Body ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Artery Ectasia ◽  
Timi Flow ◽  
Percutaneous Coronary

Background: Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty. Methods: We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were considered to consist of mortality, nonfatal myocardial infarction (MI), repeated revascularization, and stroke. Results: The mean age of the participants was 57.31±6.70 years. Multivariate regression analysis revealed that patients with diabetes, ST-segment–elevation MI at presentation, and high thrombus grades were more likely to have suboptimal postPCI thrombolysis in myocardial infarction (TIMI) flow. However, CAE was not a predictor of a decreased TIMI flow (OR: 1.46, 95% CI: 0.78–8.32; P=0.391). The Cox-regression model showed that CAE, the body mass index, and a family history of MI were risk factors for MACE, while short lesion lengths (<20 vs >20 mm) had an inverse relationship. The adjusted hazard ratio (HR) for the prediction of MACE in the presence of CAE was 1.65 (95% CI: 1.08–4.78; P=0.391). All-cause mortality (HR: 1.69, 95% CI: 0.12–3.81; P=0.830) and nonfatal MI (HR: 1.03, 95% CI: 0.72–4.21; P=0.341) occurred similarly in the CAE and non-CAE groups. Conversely, CAE increased urgent repeat revascularization (HR: 2.40; 95% CI: 1.13–5.86; P=0.013) Conclusion: Although CAE had no substantial short-term prognostic effects on post-PCI TIMI flow, considerable concerns regarding adverse outcomes emerged during our extended follow-up. Stringent follow-ups of these patients should be underscored due to the high likelihood of urgent revascularization.

scholarly journals А САSЕ OF SPONTANEOUS CORONARY ARTERY DISSECTION (REVIEW AND CASE REPORT)

2019 ◽  
Vol 9 (1) ◽  
pp. 23-30
Author(s):  
N. T. Vatutin ◽  
G. G. Taradin ◽  
D. V. Bort ◽  
A. V. Dmitriev ◽  
I. V. Kanisheva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Clinical Manifestations ◽  
Intramural Hematoma ◽  
Coronary Intervention ◽  
Stress Factors ◽  
Artery Dissection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The article presents a literature review on the problem of spontaneous dissection of the coronary artery (SCAD) — tearing of its wall, not associated with atherosclerosis, trauma or iatrogenic effects leading to blood penetration between vessel layers of the artery. The consequence of this dissection is obstruction of the coronary artery due to the formation of intramural hematoma or intima damage, and myocardial ischemia with development of acute coronary syndrome, myocardial infarction or sudden cardiac death. Information on the epidemiology, pathophysiology andetiology of the disease is presented here. It was highlighted a role of arteriopathies, inflammatory diseases, pregnancy and female sex hormones, genetic causes as well as initiating and stress factors in its development. The clinic picture and diagnosis of the disease is described. It was emphasized that in addition to clinical manifestations, the traditional electrocardiogram and coronary angiography remain the standard for diagnostics of the dissection. In the treatment of SCAD, percutaneous coronary intervention with stenting of the affected artery is used, coronary artery bypass surgery and medications with regard to preference of conservative drug therapy. A special attention is paid to the features of diagnostic and therapeutic measures in pregnant and breast-feeding patients. The article also presents a clinical case of development of large-focal myocardial infarction complicated by cardiogenic shock in a young woman without risk factors for coronary heart disease in the postpartum period caused by SCAD. Diagnosis of the disease was accompanied by certain difficulties. An urgent percutaneous coronary intervention with stenting of the infarct-related coronary artery allowed rapidlyimproving and stabilizing the patient’s condition.

scholarly journals Surgical Management of Type A Aortic Dissection After Percutaneous Coronary Intervention in a Patient with Acute Myocardial Infarction Due to a Spontaneous Coronary Artery Dissection

2021 ◽  
Author(s):  
Athanasia Makrygianni ◽  
Filippos - Paschalis Rorris ◽  
Lydia Kokotsaki ◽  
Konstantinos Velissarios ◽  
Mohammad Salmasi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Type A Aortic Dissection ◽  
Percutaneous Coronary

Type A aortic dissection after percutaneous coronary intervention is a rare and life-threatening situation. The reported incidence ranges from 0,02% to 0,6% of all diagnostic and interventional percutaneous procedures. We describe a case of aortic dissection after percutaneous coronary intervention in a patient with acute myocardial infarction from spontaneous coronary artery dissection. The patient was initially treated with primary percutaneous coronary intervention of the affected left coronary artery branches and left main coronary artery. Conservative management for the aortic dissection proved inadequate due to increasing diameter of the false lumen and the patient was referred to our cardiovascular unit for definite surgical management.

P4611Colchicine before percutaneous coronary intervention in acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A H Talasaz ◽  
Y Jenab ◽  
S H Hosseini
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion ◽  
Coronary Intervention ◽  
Control Group ◽  
Timi Flow Grade ◽  
Timi Myocardial Perfusion Grade ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Aims Myocardial perfusion could determine the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the impact of colchicine on myocardial perfusion in this population. Methods In a double-blind, randomized trial, we assigned 196 patients with STEMI undergoing PCI to two groups: the colchicine group (N=95) and the control group (N=101). The primary endpoints were the thrombolysis in myocardial infarction (TIMI) score; TIMI myocardial perfusion grade (TMPG), and TIMI frame count (TFC). The major adverse cardiovascular events (MACEs) were recorded after one month of PPCI. Results The Final TIMI flow grade, TMPG and TFC were not significantly different between the 2 groups (p=0.75, p=0.533, p=0.161; respectively). MACE include Mortality, Non-fatal myocardial infarction, target lesion/vessel revascularization were similar between the 2 groups (p=0.058). Study outcomes Characteristics Colchicine Group (n=95) Control Group (n=101) P value Discharge status   Deceased 2 (2.1%) 2 (2%) 1   Alive 93 (97.9%) 99 (98%) TIMI flow grade after PCI   0 2 (2.1%) 1 (1%) 0.747   1 2 (2.1%) 4 (4%)   2 17 (17.9%) 21 (20.8%)   3 74 (77.9%) 75 (74.3%) TIMI myocardial perfusion grade 2.39±0.89 2.31±0.95 0.533 ST segment resolution   Below 50 Percentage 23 (27.1%) 27 (32.1%) 0.71   Between 50 to 70 Percentage 8 (9.4%) 6 (7.1%)   Above 70 Percentage 54 (63.5%) 51 (60.7%)   MACE.1.Month 10 (9.9%) 3 (3.2%) 0.058   MACE.1.Month(Mortality) 4 (4.0%) 2 (2.1%) 0.451   MACE.1.Month(Non.Fatal.MI) 2 (2.0%) 0 (0%) 0.168   MACE.1.Month(TLR) 2 (2.0%) 1 (1.1%) 0.597   MACE.1.Month(TVR) 5 (5.0%) 1 (1.1%) 0.113 Conclusion In STEMI patients treated by PPCI, the effect of colchicine before PPCI was not revealed on myocardial perfusion markers.

scholarly journals Isolated right ventricular myocardial infarction: a case report

2020 ◽  
Author(s):  
Adeogo Akinwale Olusan ◽  
Paul Francis Brennan ◽  
Paul Weir Johnston
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Ventricular ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Right Ventricular Myocardial Infarction ◽  
Percutaneous Coronary

Abstract Background Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway. Case summary A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. Discussion This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.

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