scholarly journals High Risk Percutaneous Coronary Intervention of Left Main Bifurcation Stenosis in a Peritoneal Dialysis Patient

PRILOZI ◽  
2021 ◽  
Vol 42 (2) ◽  
pp. 71-78
Author(s):  
Oliver Bushljetikj ◽  
Biljana Zafirovska Taleska ◽  
Zhan Zimbakov ◽  
Frosina Arnaudova Dezulovic ◽  
Irena Rambabova-Bushljetik ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Peritoneal Dialysis ◽  
High Risk ◽  
Peritoneal Dialysis Patient ◽  
Coronary Intervention ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Abstract Complex coronary artery disease is the leading cause of death in patients with end-stage renal disease. We report a case of a patient on peritoneal dialysis, preloaded with Prasugrel and acetylsalicylic acid as а potent dual antiplatelet therapy (DAPT). The patient underwent a high-risk percutaneous coronary intervention (PCI) due to bifurcation stenosis of the left main stem branch. A “double kiss crush” bifurcation stenting technique was performed. This case provides additional data about the treatment of this group of patients, a group that is often excluded from randomized control trials, but is frequently encountered in cardiovascular practice. Furthermore, it helps to advance PCI treatment along with exploring the safety of potent DAPT in a group that is susceptible to both ischemia and bleeding, thus presenting a great challenge in the decision for treatment.

P1577Incidence, etiologies and predictors of 30-day readmission after percutaneous coronary intervention in end-stage renal disease patients; Analysis from national readmission database

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Hassan ◽  
C Krittanawong ◽  
S Jazner ◽  
J Rangaswami ◽  
B Bozorgnia ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
End Stage Renal Disease ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
National Readmission Database

Abstract Background End stage renal disease (ESRD) is a known risk factor for coronary artery disease (CAD). The association of ESRD with short-term readmissions after percutaneous coronary intervention (PCI) has not been well studied. Purpose This study aims to examine he 30-day readmission rate, predictors of readmission and etiologies of readmission in ESRD patients after PCI. Methods and results The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in ESRD patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. Results We evaluated 96,869 hospitalized patients who survived to discharge after PCI from January through November 2014 and analyzed unplanned readmissions over 30 days after discharge. A total of 11,624 patients (12%) were readmitted within 30 days. Among the readmitted patients, majority of readmissions were due to non-cardiac causes. Nineteen percent had congestive heart failure (HF), 11% had PCI, 2% had coronary artery bypass surgery, and 1.5% died during the readmission. Acute respiratory failure (21%) and infections (14%) compromised majority of non-cardiac causes. Predictors of increased readmissions were female sex (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01- 1.0, p<0.001), infections (OR 2.06, 95% CI 1.44–2.4, p<0.001), diabetes (OR 1.91, 95% CI 1.07–2.63, P<0.001), chronic lung disease (OR 3.16, 95% CI 2.11–4.2, p<0.001), chronic liver disease (OR 1.96, 95% CI 1.1–2.23, p<0.001), acute HF (OR 1.17, 95% CI 1.12–1.22, p<0.001) and anemia (OR 1.09, 95% CI 1.06–1.13, p<0.001). Conclusion ESRD patients are at high risk of 30-day readmissions after PCI. Although majority of patients are readmitted with non-cardiac causes, HF and repeat PCI were the most common cardiac etiologies of readmissions. Female sex, infections, chronic liver and lung diseases are independently associated with high risk of 30-day readmission in ESRD patients after PCI. Acknowledgement/Funding None

Abstract 4460: Supported High-Risk Percutaneous Coronary Intervention Using The Impella LP2.5 Device. The Europella Registry

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Krischan D Sjauw ◽  
Christian Hassager ◽  
Paolo L Danna ◽  
Thomas Konorza ◽  
Annemarie E Engström ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Coronary Intervention ◽  
Lv Function ◽  
Left Main ◽  
Hemodynamic Compromise ◽  
Percutaneous Coronary ◽  
Artery Disease

Background Patients with complex or high risk coronary lesions, due to extensive and diffuse multivessel, left main or last remaining coronary artery disease are increasingly being treated with percutaneous coronary intervention (PCI). As peri-procedural hemodynamic compromise and complications may occur rapidly, many of these high-risk procedures are being performed with mechanical cardiac assistance, particularly in patients with poor left ventricular (LV) function. The Impella LP2.5, a novel percutaneous implantable LVAD able to provide flow up to 2.5 L/min, may be a superior alternative to the traditionally used IABP. Methods We studied safety and feasibility of LV support with the Impella LP2.5 in 144 high-risk PCI patients. All patients were enrolled in the Europella registry, a prospective multicenter registry comprising 10 high volume tertiary PCI centers in Europe. Results Patients were old (62% >70 years), 53% had previous myocardial infarction, 54% had a LV ejection fraction ≤30% and the prevalence of co-morbid conditions was high. Mean EuroSCORE was 8.2 (SD 3.4) and 43% of the patients were refused for CABG. PCI was considered high risk due to left main, last remaining and multivessel coronary artery disease, and low LV function respectively in 53%, 17%, 81% and 35% of the cases. The mean assist time was 1 hour and 28 minutes (SD 51min). There were no intra-procedural major adverse cardiac and cerebral events. In-hospital and 30-day mortality were 4.7% and 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery and vascular complications at 30 days were respectively 0%, 0.7%, 1.4% and 4.0% Conclusions The safety and feasibility findings of Impella LP2.5 are encouraging. Our study, supports the potential usefulness of hemodynamic support with Impella LP2.5 to prevent intra-procedural major adverse events and hemodynamic compromise in high-risk PCI.

scholarly journals Underweight and low waist circumference prior to percutaneous coronary intervention increase the risk for end-stage renal disease: A Nationwide Population Based-cohort Study

2020 ◽  
Author(s):  
Eun Hui Bae ◽  
Sang Yeob Lim ◽  
Tae Ryom Oh ◽  
Hong Sang Choi ◽  
Chang Seong Kim ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Waist Circumference ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Coronary Intervention ◽  
Baseline Body Mass Index ◽  
National Health Insurance System ◽  
Percutaneous Coronary ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background The effect of obesity prior to percutaneous coronary intervention (PCI) on the development of end-stage renal disease (ESRD) is not clear. Methods Using nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without renal disease at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline body mass index (BMI) and six levels based on their waist circumference (WC; 5-cm increments). BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD. Results During a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (HR 1.331, 95%CI: 0.955–1.856) and low WC (< 80/<75) (HR 1.589, 95%CI: 1.379–1.831) showed the highest ESRD risk and the BMI 25 ~ 30 group showed the lowest ESRD risk (HR 0.604, 95%CI: 0542-0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM), BMI showed a U-shape relationship with ESRD risk at a baseline of 28.8 for BMI in the none-DM group and a reverse linear relationship in the DM group. However, low WC prior to PCI was risk factor in only DM group. Conclusions Underweight and low WC prior to PCI, which showed the increased ESRD risk in patients undergoing PCI, especially in those with DM. Trial Registration: Retrospectively registered

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