Abstract 16040: High-risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support in Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nauman Khalid ◽  
Hasan Javed ◽  
Cheng Zhang ◽  
Corey Shea ◽  
Evan Shlofmitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (HRPCI) remains controversial with lack of randomized evidence and associated complication risks from these devices. We investigated whether performing HRPCI without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. Methods: A single-center, retrospective analysis was done for patients presenting with ACS meeting HRPCI criteria (defined by Interventional Council of American College of Cardiology) including unprotected left main disease, last remaining conduit, left ventricular ejection fraction<35%, 3-vessel coronary artery disease, severe aortic stenosis or severe mitral regurgitation. Clinical, procedural, major in-hospital and 30-days cardiovascular outcomes were assessed. Results: From 2003-2018, 1992 patients (2887 lesions) with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) and 920 patients (1328 lesions) with ST-segment elevation myocardial infarction (STEMI) underwent HRPCI. The study population had 64.8% men and 52.9% Caucasians in UA/NSTEMI-group and 64.3% men and 53.7% Caucasians in STEMI-group. Mean age for UA/NSTEMI and STEMI patients were 68.6+/-12.69 and 64.52+/-13.54 years respectively. Procedural success was achieved in 96.5% of UA/NSTEMI and 97.9% of STEMI patients. In-hospital and 30-day all-cause mortality was 2.1% for UA/NSTEMI and 4.7% for STEMI patients. Bailout MCS was required in 2.4% of UA/NSTEMI and 9.9% of STEMI patients. Rates of major complications for UA/NSTEMI and STEMI were low, except for renal failure (Panel A). Panel B provides HRPCI criteria distribution. Conclusions: HRPCI without elective MCS is safe and feasible in majority of ACS patients challenging the current practices of professional societies. A randomized trial comparing unprotected vs. protected HRPCI for ACS patients is warranted to identify patients that would benefit from MCS.

scholarly journals Organoprotective Effects of Extracorporeal Membrane Oxygenation and Intra-Aortic Balloon Pump in High-Risk Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 16 (1) ◽  
pp. 16-26
Author(s):  
R. A. Kornelyuk ◽  
D. L. Shukevich ◽  
I. E. Vereshchagin ◽  
V. I. Ganyukov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Intra Aortic Balloon Pump ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary

Purpose of the study: to evaluate the organoprotective effects of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump during high-risk percutaneous coronary intervention in acute coronary syndrome.Materials and methods. Patients required mechanical circulatory support (n=51) were divided into two study groups: patients who received mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation (ECMO) (Group 1, n=29) during high-risk percutaneous coronary intervention, and Group 2 patients who received mechanical circulatory support by intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention (Group 2, n=22). The dynamics of instrumental parameters and laboratory markers of organ damage were evaluated by electrocardiography, echocardiography, determining troponin I, creatine phosphokinases and creatinine levels, NGAL, venous blood saturation to compare the organoprotective properties of mechanical circulation support in the intra- and postoperative period.Results. The following values of the parameters were found the next day after the intervention: troponin I — 0.18 (0.1; 2.3) ng/ml in the ECMO group and 1.64 (0.92; 2.36) ng/ml in the IABP group (P=0.045); serum NGAL —139.4 (88.1; 166.7) ng/ml in the ECMO group and 212.3 (102; 279) in the IABP group (P=0.027); renal dysfunction (stages R, I, F according to RIFLE) — 2 (6.8%) observations in the ECMO group and 7 (31.8%) in the IABP group (P=0.021); multiple organ failure (2 or more points according to SOFA) — 3 (10.3%) cases in the ECMO group and 12 (54.5%) in the IABP group (P=0.001).Conclusion. Veno-arterial ECMO in comparison with IABP has a more pronounced organoprotective effect by achieving better hemodynamic stability, which, in turn, prevents hypoxia and the subsequent development of organ dysfunction. In addition, in conditions of veno-arterial ECMO, better completeness and quality of revascularization is ensured, and hospital mortality is also reduced.

scholarly journals Case series of high-risk percutaneous coronary intervention with rotational atherectomy under short-term mechanical circulatory support with TandemHeart in the setting of acute myocardial infarction

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Leonie Großekettler ◽  
Bastian Schmack ◽  
Hugo A Katus ◽  
Raffi Bekeredjian ◽  
Philip Raake
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Case Series ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Percutaneous Coronary

Abstract Background  TandemHeart is a percutaneous Ventricular Assist Device, most commonly used to provide mechanical circulatory support during high-risk percutaneous coronary intervention and postcardiotomy cardiac failure. However, TandemHeart has not been applied in patients with severe heart failure due to myocardial infarction during high-risk percutaneous coronary intervention with the need for rotational artherectomy (RA) before, so we present a first-in-man case series. Case summary  Three patients with severe HF[Please spell out HF, LA and MI (if necessary).] due to acute myocardial infarction revealed severely calcified lesions of the unprotected left main artery. We successfully used the TandemHeart as percutaneous Ventricular Assist Device during high-risk percutaneous coronary intervention with RA. Discussion  We here report our experience and show that RA under TandemHeart mechanical circulatory support is feasible and safe in case of acute MI.

Feasibility and Safety of High-Risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support

2021 ◽  
Author(s):  
Nauman Khalid ◽  
Toby Rogers ◽  
Rebecca Torguson ◽  
Cheng Zhang ◽  
Corey Shea ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: Recommendations to broaden the use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) remain controversial with the absence of robust evidence from randomized clinical trials and the risk of device-related complications. This investigation examined whether performing high-risk PCI without elective MCS is feasible and safe. Methods: We performed a single-center, retrospective analysis for patients meeting contemporary high-risk PCI criteria as defined by the Interventional Council of the American College of Cardiology. These criteria include unprotected left main disease, last remaining conduit, left ventricular ejection fraction <35%, three-vessel coronary artery disease, severe aortic stenosis, or severe mitral regurgitation. Clinical, procedural, and major in-hospital and 30-day cardiovascular outcomes were assessed. Results: The analysis included a cohort of 1680 patients (2887 lesions) with stable coronary artery disease who met high-risk PCI criteria and were treated from 2003 to 2018. The study population comprised 75% men and 68% whites. Mean age was 69.16±11.19 years. Conventional cardiovascular risk factors among our cohort were as follows: hypertension, 91%; hypercholesterolemia, 91%; diabetes, 44%; and cigarette smoking, 14%. Intravascular ultrasound was performed on 53% of the lesions. Rescue MCS was required in 0.8% of the patients. Procedural success was observed in 98.2% of the patients, while the 30-day mortality rate was 1.6%. The incidence of major complications was as follows: all-cause mortality, 1.6%; cardiac death, 0.8%; acute renal failure, 4.6%; stroke, 0.2%; and major bleeding, 1.1%. Conclusions: High-risk PCI as defined by the professional societies without elective MCS is feasible and safe in the majority of patients, challenging the current recommendations and practice. A randomized trial comparing unprotected versus protected high-risk PCI for these broad recommendations is warranted to best ascertain which patients would benefit from MCS.

scholarly journals Ischemic ST‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)

2021 ◽  
Author(s):  
H. Pendell Meyers ◽  
Alexander Bracey ◽  
Daniel Lee ◽  
Andrew Lichtenheld ◽  
Wei J. Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Coronary Intervention ◽  
High Risk Population ◽  
Culprit Lesion ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary

Background Occlusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST‐segment–elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST‐segment depression maximal in leads V1–V4 (STDmaxV1–4) has been suggested as an indicator of posterior OMI. Methods and Results We retrospectively reviewed a high‐risk population with acute coronary syndrome. OMI was defined from prior studies as a culprit lesion with TIMI (Thrombolysis in Myocardial Infarction) 0 to 2 flow or TIMI 3 flow plus peak troponin T >1.0 ng/mL or troponin I >10 ng/mL. STEMI was defined by the Fourth Universal Definition of Myocardial Infarction. ECGs were interpreted blinded to outcomes. Among 808 patients, there were 265 OMIs, 108 (41%) meeting STEMI criteria. A total of 118 (15%) patients had “suspected ischemic” STDmaxV1–4, of whom 106 (90%) had an acute culprit lesion, 99 (84%) had OMI, and 95 (81%) underwent percutaneous coronary intervention. Suspected ischemic STDmaxV1–4 had 97% specificity and 37% sensitivity for OMI. Of the 99 OMIs detected by STDmaxV1–4, 34% had <1 mm ST‐segment depression, and only 47 (47%) had accompanying STEMI criteria, of which 17 (36%) were identified a median 1.00 hour earlier by STDmaxV1–4 than STEMI criteria. Despite similar infarct size, TIMI flow, and coronary interventions, patients with STEMI(−) OMI and STDmaxV1–4 were less likely than STEMI(+) patients to undergo catheterization within 90 minutes (46% versus 68%; P =0.028). Conclusions Among patients with high‐risk acute coronary syndrome, the specificity of ischemic STDmaxV1–4 was 97% for OMI and 96% for OMI requiring emergent percutaneous coronary intervention. STEMI criteria missed half of OMIs detected by STDmaxV1–4. Ischemic STDmaxV1–V4 in acute coronary syndrome should be considered OMI until proven otherwise.

IMMEDIATE AND 4-YEAR OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE

2021 ◽  
pp. 8-11
Author(s):  
Saroj Mandal ◽  
Sidnath Singh ◽  
Kaushik Banerjee ◽  
Aditya Verma ◽  
Vignesh R.
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Mean

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality

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