Cardiovascular Disease Continuum

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.

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

Angiology ◽

10.1177/0003319719895178 ◽

2019 ◽

Vol 71 (3) ◽

pp. 274-280 ◽

Cited By ~ 3

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.

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Are There Gender Differences in Coronary Artery Disease? The Malaysian National Cardiovascular Disease Database – Percutaneous Coronary Intervention (NCVD-PCI) Registry

PLoS ONE ◽

10.1371/journal.pone.0072382 ◽

2013 ◽

Vol 8 (8) ◽

pp. e72382 ◽

Cited By ~ 12

Author(s):

Chuey Yan Lee ◽

Noran N. Hairi ◽

Wan Azman Wan Ahmad ◽

Omar Ismail ◽

Houng Bang Liew ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Gender Differences ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Artery Disease ◽

National Cardiovascular

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Overview of Technical and Cost Considerations in Complex Percutaneous Coronary Intervention

Interventional Cardiology Review ◽

10.15420/icr.2011.9.1.17 ◽

2011 ◽

Vol 9 (1) ◽

pp. 17 ◽

Cited By ~ 2

Author(s):

J Raider Estrada ◽

Jonathan D Paul ◽

Atman P Shah ◽

Sandeep Nathan ◽

◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Saphenous Vein Graft ◽

Significant Proportion ◽

Coronary Intervention ◽

Cardiac Events ◽

Chronic Total Occlusions ◽

Percutaneous Coronary ◽

Complex Percutaneous Coronary Intervention ◽

Artery Disease ◽

Procedural Success

Complex percutaneous coronary intervention (PCI), encompassing an ever-expanding range of challenging lesion sets and patient populations, accounts for a significant proportion of PCI procedures being performed currently. Specific lesion types associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (MACE) include multivessel disease, unprotected left main coronary artery disease, fibrocalcific or undilatable lesions, chronic total occlusions, degenerated saphenous vein graft lesions, thrombotic lesions, and bifurcation disease. Validated tools and technical strategies currently exist to address most procedural scenarios encountered and should be familiar to the complex PCI operator. Anticipated clinical outcomes, projected resource utilization, and cost considerations should all factor into the decisions of when, how, and in whom to intervene.

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High Bleeding Risk (HBR) patients Percutaneous Coronary Intervention-a Challenge to Deal with

Bangladesh Heart Journal ◽

10.3329/bhj.v36i2.56039 ◽

2021 ◽

Vol 36 (2) ◽

pp. 133-138

Author(s):

AHM Waliul Islam ◽

AQM Reza ◽

Sham Munwar ◽

Shahabuddin Talukder

Keyword(s):

Percutaneous Coronary Intervention ◽

Bleeding Risk ◽

Coronary Intervention ◽

Mortality And Morbidity ◽

St Segment ◽

Percutaneous Coronary ◽

Procedural Complication ◽

Artery Disease ◽

Procedural Success ◽

High Bleeding Risk

Coronary artery disease (CAD) is one of the leading causes of death in our patient population. In the era of cardiovascular intervention, Percutaneous coronary intervention (PCI) is one of the most important modalities in treating these group of patients. Several CAD risks factors and co-morbid conditions are key responsible factor of procedural success. High bleeding risk (HBR) patients undergoing PCI is not an uncommon phenomenon. Incidences and prevalence of HBR patients with CAD and their management by PCI is not well addressed in our literature. PCI in HBR patients carries potential risk of intracranial hemorrhage (ICH) and lifethreatening bleeding. Therefore, careful pre-PCI assessment of possible risk or threats of post-PCI complications in patients with HBR are deem necessitate to understand. We recommend forming multicenter common consensus and to form a guideline in treating HBR patient by PCI. Thus, to reduce post procedural complication and subsequent improvement of mortality and morbidity in HBR patients undergoing PCI in both ST segment elevated myocardial infarction (STEMI) and as well as non-STEMI. Bangladesh Heart Journal 2021; 36(2): 133-138

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

University Heart Journal ◽

10.3329/uhj.v5i2.4557 ◽

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

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Treatment of Bifurcation Coronary Artery Disease with the Dedicated Cappella Sideguard® Stent

Interventional Cardiology Review ◽

10.15420/ecr.2012.6.1.25 ◽

2011 ◽

Vol 6 (1) ◽

pp. 25

Author(s):

Mamas A Mamas ◽

Farzin Fath-Ordoubadi ◽

◽

Keyword(s):

Significant Proportion ◽

Coronary Intervention ◽

Success Rates ◽

Low Profile ◽

Percutaneous Coronary ◽

Bifurcation Lesions ◽

Artery Disease ◽

Procedural Success ◽

Provisional Stenting ◽

Event Rates

Bifurcation coronary lesions represent a significant proportion of percutaneous coronary intervention (PCI) procedures and are often technically challenging with both lower procedural success rates and higher adverse event rates than those observed in non-bifurcation lesions. Conventional techniques used to treat bifurcation lesions, including provisional stenting and various two-stent approaches, have several shortcomings. Dedicated bifurcation stents such as the Cappella Sideguard® have been developed to overcome the problems associated with the current available techniques. This review focuses on the utility of the nitinol Sideguard stent in the treatment of bifurcation lesions and discusses the benefits of its trumpet-shaped design, self-expanding properties and low-profile delivery system. Treatment of bifurcation lesions using the Sideguard stent is straightforward and not subject to some of the limitations associated with conventional PCI techniques. Several trials are currently on the way to assess the safety and clinical efficacy of this very promising stent platform.

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Impact of hostility on mortality of patients with coronary artery disease after percutaneous coronary intervention

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2018-2-39-46 ◽

2018 ◽

Vol 22 (2) ◽

pp. 39

Author(s):

Georgiy S. Pushkarev ◽

Vadim A. Kuznetsov

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Reference Group ◽

Coronary Intervention ◽

Risk Of Death ◽

Percutaneous Coronary ◽

Artery Disease ◽

High Level

Aim. The study focuses on the assessment of associations of hostility with clinical and instrumental variables in patients with coronary artery disease after percutaneous coronary intervention, as well as on its effect on the risk of death for the patients in one year after surgery. Methods. The prospective study included 1,018 patients with coronary artery disease (764 men and 254 women, mean age 58.9±9.7 years) who had undergone percutaneous coronary intervention. Mean duration of follow-up was 12.0±1.8 months. Hostility was assessed by Russian version of Cook and Medley hostility scale. To investigate the relative risk (RR) of death from all causes and cardiovascular disease was used Cox's multivariate regression model of proportional risk. Results. The mean score on the Cook-Medley hostility scale was 15.1±3.9. A high level of hostility was observed in 189 patients (20.0%). There was no difference in age, gender and main clinical and instrumental variables between reference group and group of patients with a high level of hostility. No difference was found in echocardiographic parameters and coronary angiographic data between the groups. At admission, acute coronary syndrome was more often observed in patients with a high level of hostility as compared to those in the reference group (39.2% vs. 31.0%, p = 0.03). During the follow-up, 24 patients (2.4%) died from all causes and 21 patients (2.2%) died from cardiovascular disease. Depending on the level of hostility, RR of death from all causes was 1.10 (95% confidence interval [CI] 0.99–1.22, p = 0.09) and 1.12 (95% CI 1.01–1.27, p = 0.04) from cardiac causes. When analyzing categorical indicators, in patients with a high level of hostility, the relative risk of death, both for all causes (RR = 2.65, 95% CI 1.09–6.45, p = 0.03) and cardiovascular disease (RR = 3.38, 95% CI 1.29–8.82, p = 0.01), was significantly higher in comparison with patients in the reference group. Conclusion. PAcute coronary syndrome was more frequently diagnosed in patients with a high level of hostility. The hostility was significantly and independently associated with the risk of death from cardiovascular disease in patients with coronary artery disease after percutaneous coronary interventions. In patients with high levels of hostility, the risk of all-cause and cardiovascular mortality was significantly higher.Received 30 May 2018. Revised 5 July 2018. Accepted 9 July 2018.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

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