Left ventricular support during complex transradial percutaneous coronary intervention for complete revascularization

Abstract Background Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle. Case summary We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary–left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD–LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up. Discussion Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization.

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Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x19666181120161810 ◽

2019 ◽

Vol 19 (2) ◽

pp. 160-168 ◽

Cited By ~ 2

Author(s):

Habib Haybar ◽

Saeed Alipour Parsa ◽

Isa Khaheshi ◽

Zeinab Deris Zayeri

Keyword(s):

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Left Ventricular ◽

Relative Advantage ◽

Left Ventricular Ejection ◽

Percutaneous Coronary ◽

Ptx3 Level ◽

Tertiary Center ◽

Functional Advantage

Aims: To examine if pentraxin can help identify patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis. Methods: Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities. Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 days after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3). Results: The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF was attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 ng.ml-1 PTX3 level, achieved a clinically significant increase in the LVEF as compared to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing an LVEF <40%. Conclusion: We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevance to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75% of patients with STEMI who have PTX3 levels ≤7 ng.ml-1 imply the need of PCI.

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Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Left Ventricular Systolic Dysfunction: Insights from the VA CART Program

American Heart Journal ◽

10.1016/j.ahj.2021.02.002 ◽

2021 ◽

Author(s):

Todd J. Brophy ◽

Theodore J. Warsavage ◽

Annika L. Hebbe ◽

Mary E. Plomondon ◽

Stephen W. Waldo ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Left Ventricular Systolic Dysfunction ◽

Stable Coronary Artery Disease ◽

Systolic Dysfunction ◽

Coronary Intervention ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Percutaneous Coronary ◽

Artery Disease

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Differing effects of beta-blockers on long-term clinical outcomes following percutaneous coronary intervention between patients with mid-range and reduced left ventricular ejection fraction

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01850-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jun Shitara ◽

Ryo Naito ◽

Takatoshi Kasai ◽

Hirohisa Endo ◽

Hideki Wada ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Ejection Fraction ◽

Clinical Outcomes ◽

Beta Blockers ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Syndrome ◽

Percutaneous Coronary

Abstract Background The aim of this study was to determine the difference in effects of beta-blockers on long-term clinical outcomes between ischemic heart disease (IHD) patients with mid-range ejection fraction (mrEF) and those with reduced ejection fraction (rEF). Methods Data were assessed of 3508 consecutive IHD patients who underwent percutaneous coronary intervention (PCI) between 1997 and 2011. Among them, 316 patients with mrEF (EF = 40–49%) and 201 patients with rEF (EF < 40%) were identified. They were assigned to groups according to users and non-users of beta-blockers and effects of beta-blockers were assessed between mrEF and rEF patients, separately. The primary outcome was a composite of all-cause death and non-fatal acute coronary syndrome. Results The median follow-up period was 5.5 years in mrEF patients and 4.3 years in rEF patients. Cumulative event-free survival was significantly lower in the group with beta-blockers than in the group without beta-blockers in rEF (p = 0.003), whereas no difference was observed in mrEF (p = 0.137) between those with and without beta-blockers. In the multivariate analysis, use of beta-blockers was associated with reduction in clinical outcomes in patients with rEF (hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.36–0.97; p = 0.036), whereas no association was observed among those with mrEF (HR 0.74; 95% CI 0.49–1.10; p = 0.137). Conclusions Our observational study showed that use of beta-blockers was not associated with long-term clinical outcomes in IHD patients with mrEF, whereas a significant association was observed in those with rEF.

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