Predictors for Target Vessel Failure after Recanalization of Chronic Total Occlusions in Patients Undergoing Surveillance Coronary Angiography

(1) Background: Knowledge about predictors for the long-time patency of recanalized chronic total coronary occlusions (CTOs) is limited. Evidence from invasive follow-up in the absence of acute coronary syndrome (routine surveillance coronary angiography) is scarce. (2) Methods: In a monocentric-retrospective analysis, we obtained baseline as well as periprocedural data of patients undergoing routine invasive follow-up. We defined target vessel failure (TVF) as a combined primary endpoint, consisting of re-occlusion, restenosis, and target vessel revascularization (TVR). (3) Results: We included 93 consecutive patients (15.1% female) from October 2013 to May 2018. After a follow-up period of 206 ± 129 days (median 185 (IQR 127–237)), re-occlusion had occurred in 7.5%, restenosis in 11.8%, and TVR in 5.4%; the cumulative incidence of TVF was 15.1%. Reduced TIMI-flow immediately after recanalization (OR for TVR: 11.0 (95% CI: 2.7–45.5), p = 0.001) as well as female gender (OR for TVR: 11.0 (95% CI: 2.1–58.5), p = 0.005) were found to be predictive for pathological angiographic findings at follow-up. Furthermore, higher blood values of high-sensitive troponin after successful revascularization were associated with all endpoints. Interestingly, neither the J-CTO score nor the presence of symptoms at the follow-up visit could be correlated to adverse angiographic results. (4) Conclusions: In this medium-sized cohort of patients with surveillance coronary angiography, we were able to identify reduced TIMI flow and female gender as the strongest predictors for future TVF.

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Treatment of De Novo Chronic Total Occlusions with Drug-Coated Balloon-Only

10.21203/rs.3.rs-620404/v1 ◽

2021 ◽

Author(s):

Eun-Seok Shin ◽

Eun Jung jun ◽

Eu-Vin Teoh ◽

Youngjune Bhak ◽

Song Lin Yuan ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Angiography ◽

De Novo ◽

Target Vessel ◽

Timi Flow Grade ◽

Timi Flow ◽

Grade 3 ◽

Drug Coated Balloon ◽

Vessel Thrombosis

Abstract The study aimed to investigate the impact of angiographic and clinical outcomes of the drug-coated balloon (DCB)-only treatment for de novo coronary chronic total occlusion (CTO). One hundred one vessels with de novo CTO lesions dilated by balloon angioplasty with thrombolysis in myocardial infarction (TIMI) flow-grade 3 were assigned. Among them, we analyzed 93-vessel treated using DCB-only treatment. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and target vessel thrombosis. The secondary endpoint was late lumen loss (LLL) on follow-up coronary angiography. All 84-patient were followed up clinically, and 67-vessel underwent scheduled coronary angiography after 6-month. There were no procedural complications, and three vessels required bailout-stenting. MACE occurred in 14 patients, including 2 cardiac deaths, 3 non-fatal MIs, and 11 TVRs. There was no target vessel thrombosis. The mean LLL was 0.03 ± 0.53mm. Binary restenosis occurred in 10 and re-occlusion in 2 vessels. The results from a 2-year follow-up with DCB-only treatment are encouraging, with a low rate of hard endpoints and acceptable MACE rates. It may offer an alternative to the implantation of a drug-eluting stent if the CTO lesions have TIMI flow-grade 3 after pre-dilation.

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First Bioresorbable Vascular Scaffold Implantation in Patients with Acute Coronary Syndrome in the Republic of Macedonia

PRILOZI ◽

10.1515/prilozi-2015-0063 ◽

2015 ◽

Vol 36 (2) ◽

pp. 147-155

Author(s):

Jorgo Kostov ◽

Jelka Davceva-Pavlovska ◽

Sasko Kedev

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Symptoms ◽

High Rate ◽

Target Vessel ◽

Lumen Area ◽

Bioresorbable Vascular Scaffold ◽

Coronary Syndrome ◽

Timi Flow ◽

Scaffold Thrombosis

Abstract Background: The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia. These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization. We evaluated the feasibility and the acute performance of the everolimus-eluting bioresorbable vascular scaffolds (BVS) for the treatment of patients presenting with ACS. Methods and results: The present investigation was a prospective, single-centre study. Clinical outcomes were reported at the 30-day, 6-month, 1 year and 2 years follow-up. The procedural success was 100.0%. After the BVS implantation a TIMI flow 3 was achieved in all 15 patients and the postprocedure percentage diameter stenosis was 16.4 ± 8.6%. No patients had angiographically visible residual thrombus at the end of the procedure. Optical coherence tomography (OCT) analysis was performed in 8 patients (53.3%) and showed that the post-procedure mean lumen area was 7.86 ± 1.81 mm2, minimum lumen area 5.51 ± 1.58 mm2. At the 30-day, 6-month, 1 year (15 patients) and 2 years follow-up (5 patients) target-lesion failure rate was 0%. Non-target vessel revascularization and target vessel myocardial infarction were not reported. No cases of cardiac death or scaffold thrombosis were observed. Conclusion: BVS implantation in patients presenting with ACS appeared feasible, with high rate of final TIMI-flow 3 and good scaffold apposition.

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MID TERM OUTCOMES IN WELLENS SYNDROME

Romanian Medical Journal ◽

10.37897/rmj.2021.2.15 ◽

2021 ◽

Vol 68 (2) ◽

pp. 225-231

Author(s):

Anamaria Avram ◽

◽

Valentin Chioncel ◽

Cătălina Liliana Andrei ◽

Crina Sinescu ◽

...

Keyword(s):

Coronary Angiography ◽

Cardiac Biomarkers ◽

Risk Scores ◽

Control Group ◽

Matched Cohort ◽

Target Vessel ◽

Large Area ◽

Target Vessel Revascularization ◽

Age And Sex

Background. Wellens syndrome (WS) has been described as a clinical and electrocardiographic (ECG) complex that identifies a subset of patients with unstable angina (UA) at an impending risk of myocardial infarction (MI) and death in studies published almost 4 decades ago, before the wide use of cardiac biomarkers such as troponins. The mid and long term outcomes of patients with Wellens syndrome have never been compared with a contemporary cohort of patients with non-ST elevation acute coronary syndromes (NSTEACS). Objectives. The primary endpoints of our study were the rate of cardiovascular rehospitalizations, the rate of ischaemic reccurences, the rate of subsequent or reccurent revascularization and the rate of mortality at six months from the index event. Materials and methods. We performed a prospective analysis of 64 consecutive patients with WS who underwent coronary angiography and we compared them with an age and sex matched cohort of patients with NSTEACS who underwent coronary angiography. The study took place at Bagsadar-Arseni Emergency Clinical Hospital and included a total of 127 patients recruited within 2 years (from January 2018 until December 2019), who were followed for a period of 6 months. Results. Within 6 months of follow-up, patients in the control group had a significantly higher rate of cardiovascular rehospitalizations (41.9% vs. 21.9%, p = 0.016), although the rate of ischaemic recurrences was similar between the 2 groups. Other interventional end-points, such as subsequent interventional revascularization, repeat interventional revascularization and repeat target vessel revascularization (TVR) were comparable between the 2 groups at 6 months follow-up. There was no significantly difference with respect to global mortality (6.3% in WS group vs. 7.9% in the control group, p = 0.74). Discussions. To our knowledge, this is the first prospective study with mid term follow up that compared a consecutive cohort of patients with WS who underwent coronary angiography with an age and sex matched cohort of patients with NSTEACS. Patients with WS had similar event rates with respect to ischaemic recurrences, subsequent or repeat interventional revascularization and repeat target vessel revascularization (TVR) and mortality rate at 6 months, although significantly more patients in WS group were considered at low risk. Conclusions. Wellens sign is frequently overlooked in the emergency department and risk assessment based on risk scores is frequently misleading. Prompt recognition of subtle ECG ischaemic changes, such as WS, in patients with chest pain is crucial, as it reflects a large area of myocardium at risk and identifies a subgroup of patients who can benefit from early invasive management.

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Efficacy and safety of bioresorbable vascular scaffold Absorb: 6-month outcomes of GABI-R: Russia registry

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2019-1s-s26-s33 ◽

2019 ◽

Vol 23 (1S) ◽

pp. 26

Author(s):

A. A. Prokhorikhin ◽

E. I. Fartakov ◽

D. U. Malaev ◽

A. A. Boykov ◽

S. V. Oidup-Ool ◽

...

Keyword(s):

Coronary Artery ◽

Conflict Of Interest ◽

Target Vessel ◽

Efficacy And Safety ◽

Bioresorbable Vascular Scaffold ◽

Target Vessel Revascularization ◽

Coronary Syndrome ◽

Scaffold Thrombosis ◽

Artery Disease

Aim. The paper demonstrates the interim analysis of efficacy and safety after everolimus-eluting bioresorbable vascular scaffold (BVS) Absorb implantation in “real-world patients” with coronary artery disease.Methods. A cohort of 500 consecutive patients who underwent percutaneous coronary intervention for stable chest pain or acute coronary syndrome with implantation of at least one BVS (Absorb, Abbott Vascular) and followed up by telephone interview and review of medical charts were included in a singlecenter, prospective, all-comers, first in Russia registry. The primary endpoint, target vessel failure, defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization and secondary endpoints, MACCE (composite of cardiovascular death, myocardial infarction, coronary artery bypass surgery, target vessel revascularization, stroke) and stent thrombosis, were assessed during 6-month follow-up.Results. A total of 500 patients with coronary artery disease (CAD) (stable CAD 54.4%, acute coronary syndrome 45.6%) and different amount of affected vessels (1 vessel CAD 40.8%, n = 204; 2-vessel CAD 32.8%, n = 164; 3-vessel CAD 26.4%, n = 132) received 664 scaffolds and 55 stents in 603 stenoses. Procedure success, defined as a residual stenosis less than 30% and TIMI 3 flow in target vessel at the end of procedure, was observed in 98.51% (n = 594). At the moment of 6-month follow-up 4.2% (n = 24) of patients were lost to contact. After 6 months, incidence of target vessel failure and MACCE was 4.2% (n = 21) and 5% (n = 25). The cumulative rate of definite/probable scaffold thrombosis was 1.6% (n = 8).Conclusion. The interim analysis of Gabi-R: Russia registry, the largest trial of BVS Absorb implantation in routine clinical practice, showed high procedural success and low incidence of adverse events during follow-up. However, a tendency to high incidence of scaffold thrombosis compared to drug-eluting stents can be observed. Considering the long-term results of randomized trials retrospective registries, safety in terms of BVS routine use is of big concern. Longterm 24-month data regarding safety endpoints are required to test the afore-mentioned suggestion. Received 5 January 2019. Revised 28 March 2019. Accepted 29 March 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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Role of BMS in Des ERA

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1656473 ◽

2016 ◽

Vol 01 (01) ◽

pp. 028-032

Author(s):

Guru Kumar C ◽

Phani kotewsar Rao

Keyword(s):

Stent Thrombosis ◽

Chronic Stable Angina ◽

Target Vessel ◽

Cobalt Chromium ◽

Cardiac Events ◽

Target Vessel Revascularization ◽

Coronary Syndrome ◽

The Common

AbstractBACKGROUND: DES has gained significant importance in coronary interventions due to its superiority of decrease in target vessel revascularization when compared to BMS. In this DES era, we want to study the role of BMS as it is more economical.MATERIAL AND METHODS: We have analyzed acute coronary syndrome (ACS) and chronic stable angina patients who underwent BMS implantation between January 2011 to March 2011 under government health scheme of Andhra Pradesh.RESULTS: We retrospectively analyzed the cardiac events in 4181 BMS implanted patients. 1938 (46.4%) patients were followed for 365 days. More men than women with 40 to 69 years were there. ST elevation MI was the common presenting symptom in 1902patients (45.49%). 1881 patients (44.98%) were diabetic. Single vessel disease was more common 2522(60.32%), Multivessel disease was seen in 210 patients (5.02%). LAD being the common vessel involved followed by RCA. Primary PCI was done in 320 patients(7.65%).Out of 4181 patients, 9366 lesions were stented with BMS, stainless steel BMS was used in 4988(53.26%) and cobalt chromium BMS was used in 4378 (46.74%) patients.Out of 4181 patients, 1938 patients (46.4%) were followed up of 1yr, post PCI 686 (35.4%) patients had worsening angina, 226(11.66%) patients had worsening heart failure, 17 (0.88%) patients had repeat STEMI, 11(0.56%) patients had repeat NSTEMI, 16(0.82%) patients had subacute stent thrombosis, 27(1.39%) patients developed late stent thrombosis, 51 patients (2.63%) underwent repeat target vessel revascularization(TVR). 52 (2.68%) patients died due to cardiac cause with in one year of follow up.CONCLUSIONS: Our study show that even in present era of DES, BMS implantation is effective and associated with less mortality and less stent thrombosis and less chances of target vessel revascularization with the limitations (as it was telephonic follow up).

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Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1508 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Balcer ◽

I Dykun ◽

S Hendricks ◽

F Al-Rashid ◽

M Totzeck ◽

...

Keyword(s):

Coronary Artery Disease ◽

Regression Analysis ◽

Coronary Artery ◽

Coronary Angiography ◽

Conventional Coronary Angiography ◽

Term Survival ◽

Coronary Syndrome ◽

Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of <13.0g/dl for male and <12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age <50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p<0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p<0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p<0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p<0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p<0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p<0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p<0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p<0.0001; IAP: 2.67 [2.06–3.47], p<0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

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Target Vessel Revascularization and Territory of Myocardial Ischemia in Patients With Chronic Total Occlusions

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.07.713 ◽

2017 ◽

Vol 70 (9) ◽

pp. 1196-1197 ◽

Cited By ~ 4

Author(s):

Eric A. Secemsky ◽

Robert Gallagher ◽

James Harkness ◽

Eugene Pomerantsev ◽

Henry Gewirtz ◽

...

Keyword(s):

Myocardial Ischemia ◽

Target Vessel ◽

Chronic Total Occlusions ◽

Target Vessel Revascularization

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Abstract 509: Comparison of Drug Elluting Stent and Per Cutenaeous Transluminal Angioplasty in Patients With Infra-Popliteal Peripheral Arterial Disease

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.509 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Rahul Vasudev ◽

MeetKumar Sheth ◽

Priyank Shah ◽

Upamanyu Rampal ◽

Hiten Patel ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Transluminal Angioplasty ◽

Limb Amputation ◽

Categorical Variables ◽

Target Vessel ◽

Target Vessel Revascularization ◽

All Cause Mortality ◽

Vessel Patency

Introduction: Drug-eluting Stent(DESs) have demonstrated improved patency and freedom from target lesion revascularization compared with Bare-Metal stents or Percutaneous Transluminal Angioplasty(PTA); however, the effect on clinical outcome parameters, such as limb salvage and wound healing, remains unidentified. We present a direct comparison of clinical outcomes in patients who underwent DES vs PTA. Methods: We collected data of patients who underwent infra-popliteal arterial interventions at our institution. Clinical end points analyzed were all cause mortality, target vessel revascularization, primary vessel patency, and target limb major and minor amputations. Differences between two groups were analyzed by chi square for categorical variables and t test for continuous variables. Statistical significance was considered for P values less than .05 in a 2-sided test. Results: Total of 83 cases, n=42 in DES group and n=41 in PTA group were analyzed. Mean age was 71.6 years (range 49-95). Out of the total 83 patients in the study 45 had a history of diabetes (54%) and 51 (61%) were current /past smokers. Average follow up period of 14 months for both the groups. Primary vessel patency was defined as absence of ≥50% restenosis on follow up. During the follow up period vessel patency in DES group [69% (n=29/42)] was significantly higher as compared to 36% (15/41) in PTA group (P=0.04, odds ratio 3.867, 95% Confidence interval: 1.5 - 9.6). Target vessel revascularization in DES group was 24% (10/42) as compared to 32% (13/28) in PTA group (P=0.47, odds ratio 0.67, 95% confidence interval: 0.26 - 1.77). Target limb amputation was 10% (4/42) in DES group as compared to 24% (10/41) in PTA group (P = 0.085), odds ratio 0.33, 95% confidence interval: 0.09 - 1.14). All cause mortality in both the groups were at 10%, 4/42 in DES group and 4/41 in PTA group (P=1, odds ratio 0.97, 95% confidence interval: 0.23 - 4.19). Conclusion: To conclude primary vessel patency was superior in DES group as compared to PTA group. Target limb amputation rates were higher in PTA group but not statistically significant. Target vessel revascularization and all cause mortality were similar in both the groups. Thus primary treatment with DES should be considered in patients with infra-popliteal PAD.

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Spontaneous coronary artery dissection: Rare but challenging

Vojnosanitetski pregled ◽

10.2298/vsp120819055p ◽

2014 ◽

Vol 71 (3) ◽

pp. 311-316

Author(s):

Biljana Putnikovic ◽

Ivan Ilic ◽

Milos Panic ◽

Aleksandar Aleksic ◽

Radosav Vidakovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Flow ◽

Coronary Artery ◽

Coronary Angiography ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

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