scholarly journals Procedural Results and In-Hospital Adverse Outcomes Following Multivessel Percutaneous Coronary Intervention (PCI)

1970 ◽  
Vol 5 (2) ◽  
pp. 66-70
Author(s):  
Md Harisul Hoque ◽  
Sufia Rahman ◽  
Md Abu Siddique ◽  
Syed Ali Ahsan ◽  
CM Ahmed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Single Vessel ◽  
Increased Risk ◽  
Vessel Stenosis ◽  
Percutaneous Coronary ◽  
The Difference ◽  
Artery Disease ◽  
Procedural Success

Several Studies have reported specific factors associated with increased risk of adverse outcome following balloon angioplasty. These factors include advanced age, female Sex, unstable angina, congestive heart failure, diabetes and multivessel Coronary artery disease. By this time, Studies have been shown the remarkable procedural success & minimum adverse outcomes following multivessel stenting. This comparative observational study shows no death, procedural MI, tamponade, cerebrovascular accident, heart failure or cardiogenic shock, vascular access site complications like bleeding, A-V fistula in any group (single vessel stenting vs multivessel stenting). However, minor adverse events occurred at an overall rate of 6% in single vessel stenosis (SVS) group & 12% in multivessel stenosis (MVS) group. Procedural results were also similar in both groups. Angiographic success of 100% in the SVS group & 98% in the MVS group noted. The difference in the outcomes were between the two groups was not significant. Key Words: Adverse Outcomes; Multivessel Coronary Stenting; Procedural Results DOI: 10.3329/uhj.v5i2.4557 University Heart Journal Vol.5(2) July 2009 pp.66-70

scholarly journals Cost-effectiveness analysis of percutaneous coronary intervention for single-vessel coronary artery disease: an economic evaluation of the ORBITA trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044054
Author(s):  
Victoria McCreanor ◽  
Alexandra Nowbar ◽  
Christopher Rajkumar ◽  
Adrian G Barnett ◽  
Darrel Francis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Single Vessel ◽  
Vessel Coronary Artery Disease ◽  
Effectiveness Analysis ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Vessel Coronary Artery

ObjectiveTo evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.DesignA cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months.SettingFive UK NHS hospitals.Participants200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy.InterventionsAt recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure.Outcome measuresIncremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo.ResultsThe estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses.ConclusionsThe ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by the National Institute of Health and Care Excellence when undertaking health technology assessment for the NHS context.Trial registration: The ORBITA study is registered with ClinicalTrials.gov, number NCT02062593.

scholarly journals Case ReportsClinical effect of ivabradine in patient with congestive heart failure with cardiogenic shock condition: A case reportAcute mesenteric ischemia on extensive anterior STEMI with paroxysmal atrial fibrilation: A rare complicationAcute fulminant myocarditis mimicking ST-elevation myocardial infarctionFractional flow reserve: Nurturing a functional perspective in angioplasty (Case Report)The role of invasive fractional flow reserve (FFR) in multivessel diseaseFibrinolytic followed by early angiography in cardiac arrest survivor patients with ST elevation ACS: A pharmaco-invasive in non-primary PCI capable hospitalEarly accelerated idioventricular rhythm followed by premature ventricular complexes as a marker for successful reperfusion in ST-elevation myocardial infarct patientInferior ST-elevation myocardial infarction complicated by unstable total atrioventricular block and diabetic ketoacidosis in end stage renal failure patientOutlflow tract ventricular arrythmia 3D ablation in LV summit Area: A case reportIntravascular hemolysis complication after transcatheter PDA closure with ADO device: A case reportA very rare case: A patient with extreme levocardia without remarkable symptomTransradial primary percutaneous coronary intervention on a patient with ST-Elevation myocardial infarction with comorbid peripheral artery disease and severe partial obstruction in the abdominal aortaAcute coronary syndrome with ventricular stormCardio-cerebral infaction: A rare case of concomitant acute right ventricular infarction and ischemic strokeTypical ECG pattern of acute pulmonary embolism in a 45 years old dyspneic and chest pain male patient: A case reportPersistent high degree AV block after early invasive strategy in acute decompensated heart failure caused by NSTEMI: A case reportAdult patent ductus arteriosus complicated by pulmonary artery endarteritis and pneumoniaRoutine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary? (Case Report)Curable severe tachycardiomyopathy due to typical atrial flutter by radiofrequency catheter ablationSinus node dysfunction in right heart failure: A rare caseLipomatous hypertrophy of the interatrial expanding into left atrial appendage mimicking thrombus: A very rare case reportConservative approach for patient in acute heart failure with cor triatriatum dexter and atrial fibrillation: A rare case reportAcute rheumatic fever in juvenile complicated by complete heart block: A case reportA nineteen years old young woman with idiopathic hypertrophic subaortic stenosis: A case reportRecurrent acute coronary syndrome – a manifestation of clopidogrel resistance: A case reportSubarterial doubly committed ventricularseptal defectcomplicated with right-sided fungalinfective endocarditisCase report: The hemodynamic effect of non invasive ventilation in atrial septal defect with severe pulmonary hypertension and respiratory failureEchocardiography-guided percutaneus transvenous mitral commissurotomy in a pregnant woman with severe mitral stenosisThe correlation between endothelial function parameter flow mediated vasodilatation with the complexity of coronary artery disease based on Syntax ScoreRuptured sinuses of valsalva aneurysms: Report of five casesParacetamol as alternative for patent ductus arteriosus (PDA) management

2016 ◽  
Vol 18 (suppl B) ◽  
pp. B51-B57 ◽  
Author(s):  
A. Widya ◽  
A. Jalaludinsyah ◽  
D.G. Widyawati ◽  
E. Hindoro ◽  
E. Supriadi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Rare Case ◽  
Ductus Arteriosus ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Artery Disease ◽  
Patent Ductus

Abstract 2808: Combination of Adenosine Stress Perfusion and Late Enhancement Cardiac Magnetic Resonance Imaging in Patients with Suspected Coronary Artery Disease, Percutaneous Coronary Intervention and Coronary Bypass Graft -A Multi-Center Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Peter Bernhardt ◽  
Guenter Pilz ◽  
Jochen Spiess ◽  
Berthold Hoefling ◽  
Vinzenz Hombach ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Suspected Coronary Artery Disease ◽  
Stress Perfusion ◽  
Vessel Stenosis ◽  
Percutaneous Coronary ◽  
Adenosine Stress Perfusion ◽  
Artery Disease

The combination of stress perfusion and late Gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) has been established for diagnosis of myocardial ischemia. However, little is known about this helpful clinical examination tool in patients who were treated by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Aim of our study was to compare the diagnostic accuracy of stress perfusion and LGE in patients with suspected coronary artery disease (CAD), with PCI and with CABG in a multi-center trial. 477 patients with suspected CAD, 209 with PCI and 110 with CABG were included to the study and underwent adenosine stress perfusion and LGE 10 min. after a second bolus of contrast agent. CMR images were assessed visually using the 16-segments model. Myocardial ischemia was defined as resgional hypoenhancement in stress perfusion with absent LGE. All patients underwent coronary angiography. A significant stenosis was defined by QCA in case of ≥70% of coronary artery or bypass graft narrowing in vessels ≥2 mm diameter. A relevant vessel stenosis or occlusion was present in 173 (36%) patients with susptectd CAD, 69 (29%) PCI and 71 (65%) CABG patients. PCI was performed 314±231 and CABG 423±275 days before CMR examination. Sensitivity, specificity and overall accuracy per patient are given in table 1 CMR is feasible and suitable for detecting relevant vessel stenosis in patients who previously were treated by PCI or CABG. Diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Furthermore, presented evaluation method may be inadequate, since collaterals and different perfusion territories are not taken into consideration. CMR yields similar diagnostic accuracy in patients with suspected CAD and those who previously were treated by PCI.

Percutaneous (short-term) mechanical circulatory support

2021 ◽  
pp. 351-359
Author(s):  
Holger Thiele ◽  
Pascal Vranckx
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Mechanical Circulatory Support ◽  
Decompensated Heart Failure ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Acute Heart Failure Syndromes ◽  
Artery Disease ◽  
Invasive Management

Coronary artery disease (CAD) has emerged as the dominant aetiologic factor in acute heart failure syndromes (AHFS) and cardiogenic shock (CS). The invasive management of the complex cardiac patient with advanced (decompensated) heart failure, CS, and/or potential haemodynamic compromise during and/after percutaneous coronary intervention (PCI) has become the remit of specialty myocardial intervention centres. Such centres provide state-of the art facilities for PCI, including experienced senior operators and critical care physicians who are available 24 hours per day, 7 days per week, with immediate access to cardiac surgery and mechanical circulatory support (MCS) systems.

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Iosif Xenogiannis ◽  
Fotis Gkargkoulas ◽  
Dimitri Karmpaliotis ◽  
Khaldoon Alaswad ◽  
Oleg Krestyaninov ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Peripheral Artery ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
History Of ◽  
Artery Disease ◽  
Procedural Success ◽  
The Impact ◽  
Complex Lesions

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

scholarly journals Triglyceride to high-density lipoprotein cholesterol ratio as a predictor of long-term mortality in patients with coronary artery disease after undergoing percutaneous coronary intervention: a retrospective cohort study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Xin-Ya Dai ◽  
Ying-Ying Zheng ◽  
Jun-Nan Tang ◽  
Xu-Ming Yang ◽  
Qian-Qian Guo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Cholesterol Ratio ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Lower Group ◽  
Long Term Mortality

Abstract Background It has been confirmed that the triglyceride to high-density lipoprotein cholesterol ratio (THR) is associated with insulin resistance and metabolic syndrome. However, to the best of our knowledge, only a few studies with small sample sizes have investigated the relationship between THR and coronary artery disease (CAD). Therefore, we aimed to assess the correlation between the THR and long-term mortality in patients with CAD after undergoing percutaneous coronary intervention (PCI) in our study that enrolled a large number of patients. Methods A total of 3269 post-PCI patients with CAD were enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The mean follow-up time was 37.59 ± 22.24 months. Patients were divided into two groups according to their THR value: the lower group (THR < 2.84, n = 1232) and the higher group (THR ≥ 2.84, n = 2037). The primary endpoint was long-term mortality, including all-cause mortality (ACM) and cardiac mortality (CM). The secondary endpoints were major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). Results In our study, ACM occurred in 124 patients: 30 (2.4%) in the lower group and 94 (4.6%) in the higher group (P = 0.002). MACEs occurred in 362 patients: 111 (9.0%) in the lower group and 251 (12.3%) in the higher group (P = 0.003). The number of MACCEs was 482: 152 (12.3%) in the lower group and 320 (15.7%) in the higher group (P = 0.008). Heart failure occurred in 514 patients: 89 (7.2%) in the lower group and 425 (20.9%) in the higher group (P < 0.001). Kaplan–Meier analyses showed that elevated THR was significantly related to long-term ACM (log-rank, P = 0.044) and the occurrence of heart failure (log-rank, P < 0.001). Multivariate Cox regression analyses showed that the THR was an independent predictor of long-term ACM (adjusted HR = 2.042 [1.264–3.300], P = 0.004) and heart failure (adjusted HR = 1.700 [1.347–2.147], P < 0.001). Conclusions An increased THR is an independent predictor of long-term ACM and heart failure in post-PCI patients with CAD.

scholarly journals Prognostic Value of Residual Syntax Score after Percutaneous Coronary Intervention in Multivessel Coronary Artery Disease

2019 ◽  
Vol 04 (03) ◽  
pp. 133-141
Author(s):  
Sunitha Aramalla ◽  
Indrani Garre ◽  
Shabbir Ali Shaik ◽  
P. Hemanth Harish
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Coronary Atherosclerosis ◽  
Coronary Intervention ◽  
Multivessel Coronary Artery Disease ◽  
Percutaneous Coronary ◽  
The Difference ◽  
Artery Disease

Abstract Background Residual SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) Score (RSS) is an objective measure for the assessment of degree and complexity of residual stenosis after the percutaneous coronary intervention (PCI). Aim The study aimed at evaluating the role of angiographic complete (CR) and incomplete (ICR) revascularization on clinical outcomes in patients undergoing PCI for multivessel coronary artery disease (MVCAD). The study sought to investigate the role of initial and residual severity of coronary atherosclerosis in prognostication of patients with MVCAD who underwent PCI. Material and Methods We retrospectively recruited 135 patients having MVCAD who underwent PCI. Coronary angiogram was used to assess the severity of coronary atherosclerosis. From the angiographic data baseline (BSS) and RSS were calculated. Subjects having a RSS of 0 were defined as having CR, and those having RSS > 0 are defined as ICR group. The study population was subgrouped into two groups as follows: CR, 0 (n = 17, 23%); ICR, >0 to 4 (n = 89, 47.2%). Clinical outcomes were measured, which included major adverse cardiac and cerebrovascular events (MACE) at 1 year. Results Among the study subjects mean age was 57.25 ± 17.55. About 76.3% were males, and 23.7% were females. About 89.4% had diabetes, 88.6% had hypertension as risk factors, and 95.8% were smokers.The mean values of BSS and RSS were 20.2 ± 9.2 and 4.1 ± 7.0, respectively. Based on RSS the individuals were divided into two groups as follows: CR, 0 (n = 17, 23%); ICR, > 0 to 4 (n = 89, 47.2%), > 4 to 8 (n = 16, 21.6%), > 8 (n = 13, 17.55%). After 1 year, three patients lost the follow-up. Among the remaining 132 patients, those with higher BSS had more mortality and morbidity, and the difference is statistically significant (MACE in ≥23 vs. <23, p = 0.000755); 10 patients in the ICR group had MACE compared with 1 patient in CR group(5.8% in CR group vs. 8.6% in ICR group, p-value of 0.38); however, the difference was not statistically significant. However, higher RSS acts as an indirect marker of increasing morbidity and mortality when compared within the tertiles, and the difference was statistically significant (RSS 1–4 group vs. > 4 MACE, p = 0.0009559, RSS < 8 vs. >8 MACE, p = 0.00000172). Conclusions This study proved that both BSS and higher RSS help to foretell the risk of adverse clinical outcomes in individuals with MVCAD who underwent PCI. RSS, which is an indirect marker of residual atherosclerosis, that is, ICR, had a positive correlation MACE after PCI.

scholarly journals Prognostic Value of VEGF in Patients Submitted to Percutaneous Coronary Intervention

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Catarina Ramos ◽  
Patrícia Napoleão ◽  
Mafalda Selas ◽  
Cláudia Freixo ◽  
Ana Maria Viegas Crespo ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Cardiac Events ◽  
Positive Role ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Previous Medication ◽  
Drug Eluting ◽  
Artery Disease

We examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients’ serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0–264 pg/mL versus 419, 212–758 pg/mL;P<0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167–498 pg/mL;P<0.001) and remained steady to 1-year (median, IQ: 320, 173–497 pg/mL;P<0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P<0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.

scholarly journals The Placebo-Controlled Effect of Percutaneous Coronary Intervention on Exercise Induced Changes in Anti-Malondialdehyde-LDL Antibody Levels in Stable Coronary Artery Disease: A Substudy of the ORBITA Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Adam Hartley ◽  
Matthew Shun-Shin ◽  
Mikhail Caga-Anan ◽  
Christopher Rajkumar ◽  
Alexandra N. Nowbar ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Randomised Trial ◽  
Coronary Intervention ◽  
Single Vessel ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Exercise Induced ◽  
Induced Changes

Aim: Malondialdehyde-modified low-density lipoprotein (MDA-LDL) forms a significant component of oxidised LDL. The effects of exercise on levels of MDA-LDL and anti-MDA-LDL antibodies are not well-understood. Furthermore, it is not known whether these can be modified in patients with coronary artery disease by percutaneous coronary intervention (PCI).Methods: The Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA) trial was the first blinded, multi-centre randomised trial of PCI vs. placebo procedure for angina relief. Serum samples were available at four time-points: pre-randomisation pre- (P1) and post- (P2) exercise and post-randomisation (6-weeks following the PCI or placebo procedure), pre- (P3) and post- (P4) exercise. ELISAs were performed using laboratory-developed assays for MDA-LDL (adjusted for Apolipoprotein B) and anti-MDA-LDL antibodies.Results: One hundred ninety-six of the 200 patients (age 66.1 [SD 8.99] years, 28% female) with severe single vessel coronary artery disease suitable for PCI enrolled in the ORBITA trial had blood available for analysis. With exercise at pre-randomisation (P2–P1) there was no significant change in adjusted MDA-LDL (−0.001, 95% CI −0.004 to 0.001; p = 0.287); however, IgG and IgM anti-MDA-LDL significantly declined (−0.022, 95% CI −0.029 to −0.014, p &lt; 0.0001; −0.016, 95% CI −0.024 to −0.008, p = 0.0002, respectively). PCI did not have a significant impact on either the pre-exercise values (P3 controlling for P1) of MDA-LDL (p = 0.102), IgG (p = 0.444) or IgM anti-MDA-LDL (p = 0.909). Nor did PCI impact the exercise induced changes in these markers (P4 controlling for P1, P2, and P3) for MDA-LDL (p = 0.605), IgG (p = 0.725) or IgM anti-MDA-LDL (p = 0.171). Pre-randomisation ischaemia on stress echo did not impact these interactions.Conclusions: Exercise results in an acute reduction in anti-oxLDL antibodies in patients with severe single vessel coronary disease, possibly indicating an induction in homoeostatic clearance via the innate immune system. However, PCI did not ameliorate this effect.

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