Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention

<b><i>Objective:</i></b> We aimed to investigate the relation between CHA₂DS₂-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). <b><i>Subjects and Methods:</i></b> The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA₂DS₂-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA₂DS₂-VASc score. <b><i>Results:</i></b> Subjects were stratified into 2 groups based on IMR &#x3c;/≥ 40 U; 72 patients (62.6) with IMR &#x3c;40 U and 43 patients (37.4) with IMR ≥40 U. Patients with IMR ≥40 U had higher CHA₂DS₂-VASc score (<i>p</i> &#x3c; 0.001). CHA₂DS₂-VASc score was significantly correlated with increased left atrial volume index, diastolic dysfunction, wall motion score index, and inversely correlated left ventricular ejection. Moreover, CHA₂DS₂-VASc score was strongly correlated with IMR (<i>p</i> &#x3c; 0.001). At multivariate analysis, low systolic blood pressure, stent diameter, and CHA₂DS₂-VASc score were associated with MVD. Besides, CHA₂DS₂-VASc score ≥4 was the optimal value in predicting MVD (IMR ≥40) in STEMI patients. <b><i>Conclusions:</i></b> The data of the current study point out that increased CHA₂DS₂-VASc score, lower systolic blood pressure &#x3c;90 mm Hg, and stent diameter are associated with increased incidence of MVD (increased IMR) after PPCI of STEMI. We suggest that the CHA₂DS₂-VASc score may be a simple, inexpensive useful risk score for the prediction of MVD risk after PPCI for STEMI patients.

Impact of anemia on in-stent restenosis after percutaneous coronary intervention

Background Anemia is a common risk factor for post-percutaneous coronary intervention (PCI) adverse events; however, data on its association with in-stent restenosis (ISR) is limited. Methods 538 patients who underwent PCI between January 2017 and September 2019 and follow-up angiography 9–12 months after the initial PCI were enrolled in this study. Baseline clinical and procedural characteristics were compared between the ISR and non-ISR groups, and independent predictors of ISR were determined using propensity score matching. Results The incidence of anemia was 53.5% in patients with ISR and 19.0% in those without ISR. Univariable logistic regression analyses showed that anemia (OR, 4.283; 95% CI, 1.949–9.410; P < 0.001), diabetes mellitus (OR, 2.588; 95% CI, 1.176–5.696; P = 0.018), chronic kidney disease (OR, 3.058; 95% CI, 1.289–7.252; P = 0.011), multiple stenting (OR, 2.592; 95% CI, 1.205–5.573; P = 0.015), bifurcation lesion (OR, 2.669; 95% CI, 1.236–5.763; P = 0.012), and calcification (OR, 3.529; 95% CI, 1.131–11.014; P = 0.030) were closely associated with ISR. Low-density lipoprotein cholesterol (LDL-c) levels and stent diameter were also significantly linked to ISR, as was anemia (P = 0.009) after propensity score matching. Conclusion Anemia is closely associated with post-PCI ISR, and patients with lower hemoglobin levels are at a higher risk of ISR.

Subjective approach to optimal cross-sectional design of biodegradable magnesium alloy stent undergoing heterogeneous corrosion

Existing biodegradable Magnesium Alloy Stents (MAS) have several drawbacks, such as high restenosis, hasty degradation, and bulky cross-section, that limit their widespread application in a current clinical practice. To find the optimum stent with the smallest possible cross-section and adequate scaffolding ability, a 3D finite element model of 25 MAS stents of different cross-sectional dimensions were analysed while localized corrosion was underway. For the stent geometric design, a generic sine-wave ring of biodegradable magnesium alloy (AZ31) was selected. Previous studies have shown that the long-term performance of MAS was characterized by two key features: Stent Recoil Percent (SRP) and Stent Radial Stiffness (SRS). In this research, the variation with time of these two features during the corrosion phase was monitored for the 25 stents. To find the optimum profile design of the stent subjectively (without using optimization codes and with much less computational costs), radial recoil was limited to 27 % (corresponding to about 10 % probability of in-stent diameter stenosis after an almost complete degradation) and the stent with the highest radial stiffness was selected.The comparison of the recoil performance of 25 stents during the heterogeneous corrosion phase showed that four stents would satisfy the recoil criterion and among these four, the one having a width of 0.161 mm and a thickness of 0.110 mm, showed a 24 % – 49 % higher radial stiffness at the end of the corrosion phase. Accordingly, this stent, which also showed a 23.28 % mass loss, was selected as the optimum choice and it has a thinner cross-sectional profile than commercially available MAS, which leads to a greater deliverability and lower rates of restenosis.

Association of stent diameter and target vessel revascularization in patients undergoing percutaneous coronary intervention: a secondary retrospective analysis based on a Chinese cohort study

Background In the treatment of coronary heart disease, target vessel revascularization (TVR) has attracted increasing attention as an efficient means of percutaneous coronary intervention (PCI). The purpose of this study was to explore the association between stent diameter and TVR in patients undergoing PCI. Methods This was a secondary retrospective analysis involving patients with PCI with at least one stent implanted. Information was obtained from the Dryad Digital Repository. Multivariable logistic regression models, interaction analyses, subgroup analyses and piecewise linear regression models were used to evaluate the association between stent diameter and TVR. Results A total of 2522 patients were eventually enrolled in this study, of which 122 (4.8%) had undergone TVR. Significant positive associations were observed between stent diameter and TVR (continuous: odds ratio [OR] 0.485, 95% confidence interval [CI] 0.305–0.773, P = 0.002; categorical variable: T2 vs. T1, OR 0.541, 95% CI 0.348–0.843; T3 vs. T1, OR 0.520, 95% CI 0.334–0.809; P for trend = 0.005). The association remained stable in the fully adjusted model (continuous: OR 0.526, 95% CI 0.306–0.902, P = 0.020; categorical variable: T2 vs. T1, OR 0.510, 95% CI 0.310–0.839; T3 vs. T1, OR 0.585, 95% CI 0.352–0.973; P for trend = 0.042). Among the subgroups of differing clinical presentations, stent diameter was a powerful protective factor for TVR, especially in the delayed PCI group (P for interaction = 0.002). The association was highly consistent across all the other subgroups studied (all P for interaction > 0.05). In the piecewise linear regression model, the need for TVR decreased with an increase in stent diameter when this ranged between 2.5 and 2.9 mm (OR 0.01, 95% CI: 0.01–0.13, P < 0.001). Conclusions A large stent diameter is a powerful protective factor for TVR in PCI patients, especially in the delayed PCI group. This “bigger-is-better” protective effect is remarkable in stents with diameter 2.5–2.9 mm.

Predictors of 10-Year Stent-Related Adverse Outcomes after Coronary Drug-Eluting Stent Implantation: The Importance of Stent Size

<b><i>Introduction:</i></b> The predictors of stent treatment failure and their importance 10 years after treatment with drug-eluting stents (DESs) have not been reported in detail. <b><i>Methods:</i></b> Data were retrieved from the SORT-OUT II database encompassing 2,849 non-left main coronary lesions in 2,073 unselected all-comer patients treated with first-generation DES and followed clinically for 10 years. Stent treatment failure (STF) was defined as definite or probable stent thrombosis, target lesion revascularization (TLR), or &#x3e;70% restenosis left untreated. Target lesion failure (TLF) was defined as cardiac death, target vessel myocardial infarction, or TLR. Characteristics predicting higher hazard ratios (HRs) were identified by the multivariate Cox regression analysis. <b><i>Results:</i></b> A stent diameter ≤2.5 versus ≥3.5 mm had STF 23.3 versus 11.8% and TLF 27.9 versus 18.8%. Stent length &#x3c;20 versus &#x3e;40 mm had STF 13.0 versus 29.0% and TLF 18.7 versus 34.6%. In multivariate analysis, decreasing stent diameter (HR: 1.24 [3.0 mm] to 2.12 [2.25 mm], reference ≥3.5 mm) and increasing stent length (HR: 1.15 [20–30 mm] to 2.07 [&#x3e;40 mm], reference &#x3c;20 mm) predicted STF together with diabetes (HR: 1.31), previous revascularization (HR: 1.31), restenotic (HR: 2.25), bifurcation (HR: 1.45), and chronically occluded lesions (HR: 1.54). A predictive score (PS) was calculated for each lesion from the HRs for the predictors present. The 10-year rates of STF were 10% in lesions with a PS ≤ 1.5 and 37% in those with PS ≥ 3.5. <b><i>Conclusions:</i></b> Ten-year outcomes show large variations depending on the stent size and a few patient and lesion characteristics. The calculation of a PS from these unambiguous variables may be used to improve the risk estimate in individual lesions and patients.

The Effect of Clinical Characteristics and Stent Parameters on Left Ventricular Mechanical Dyssynchrony

Aim. To study short term effect of stent size and number on left ventricular mechanical dyssynchrony after elective percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery.Materials and methods. the study included 150 adult patients with LAD lesion treated with PCI using drug-eluting stent. Patients were evaluated pre PCI then 1 month and 3 months post PCI for evaluation of mechanical dyssynchrony using tissue synchronization image (TSI).Results. Before revascularization mean left ventricular ejection fraction was 51.2±5.7 %, mean time to peak TSI was 213.6±10.9 ms; 1 month after PCI TSI improved significantly to 163.7±17.6 ms (p<0.001), 3 months after PCI showed more improvement to 120.7±26.9 ms (p<0.001). After 3m; 61 patients (40.7%) showed recovery to normal TSI value. The predictors of non-improvement of time to peak TSI after 3 months were diabetes mellitus (p=0.007), dyslipidemia (p=0.001) and stent length (p=0.001), number of stents (p=0.004). There were strong negative correlation between stent length and improvement of the time to peak TSI at 1 month (r=-0.352, p<0.001) and at 3 months (r=-0.509, p<0.001),and also with number of stent at 1 month (r= -0.173, p=0.034) and at 3 months (r=-0.499, p<0.001), but the correlation between stent diameter and improvement of the TSI wasn’t significant neither at 1 month nor at 3 months (r=0.055, p=0.504 and r= -0.018, p=0.827) respectively.Conclusion. Increased number and length of the implanted stents were predictors to non-improvement of mechanical dyssynchrony, while stent diameter didn’t affects the recovery.

Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent

Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.

Endovascular treatment of aortic coarctation with a novel BeGraft aortic stent in children and young adults: a single-centre experience with short-term follow-up results

Objectives: We present our experience and outcomes with the BeGraft in the treatment of aortic coarctation in a predominantly paediatric population. Methods: This study includes a retrospective analysis of patients who had Begraft aortic stent implantation between 2018 and 2020 from a single centre. Results: The BeGraft aortic stent was used in 11 patients (7 males, 4 females) with a median age of 14 (13–21) years and a median weight of 65 (46–103) kg. Coarctation was native in five patients and recurrent in six patients. Median stent diameter and length were 16 mm and 38 mm, respectively. The median peak-to-peak pressure was 30 (12–55) mmHg before the procedure and 5 (0–17) mmHg after the procedure. The stenting procedure was successful in 10 of the 11 patients. Stent migration to the abdominal aorta occurred on post-procedure day 1 in the 21-year-old patient, who had previously undergone surgical closure of the ventricular septal defect and balloon angioplasty for coarctation. After repositioning failed, the stent was safely fixed in the abdominal aorta. Strut distortion also occurred during balloon retrieval in one patient, but no aneurysm or in-stent restenosis was observed at 1-year follow-up. The patients were followed for a median of 14 (4–25) months and none required redilation. Conclusions: Our initial results demonstrated that the BeGraft aortic stent effectively reduced the pressure gradient in selected native and recurrent cases. Despite advantages such as a smaller sheath and low profile, more experience and medium- to long-term results are needed.

Long-Term Outcomes of the Coarctation of the Aorta Stent Trials

Background: Long-term outcome data of stent-implantation for coarctation of the aorta are limited. We report up to 5 years of postimplant follow-up in patients enrolled into the COAST (Coarctation of the Aorta Stent Trial) and the COAST II trial (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta), evaluating the bare and Covered Cheatham-Platinum Stents for the treatment of coarctation of the aorta and associated aortic wall injury. Methods: Data was prospectively collected during the 2 multi-center studies, enrolling 248 patients (COAST: n=121, COAST II: n=127). Late follow-up data (48–60 month) was compared with immediate (1 month) and early (12 months) follow-up. Results: There was a notable decrease in the use of antihypertensive medication, from 53% at immediate, to 42% at early, and 29% at late follow-up. The cumulative incidence of stent fractures was 0% immediately, 2.9% at early, and 24.4% at late follow-up. Independent predictors for stent fractures at late follow-up were age <18 years, male sex, minimum stent diameter ≥12 mm, and use of bare metal stent. The cumulative incidence of reintervention was 1.6% at immediate, 5.1% at early, and 21.3% at late follow-up. Independent predictors for reinterventions at late follow-up were age <18 years, post implantation systolic arm-leg blood pressure gradient ≥10 mm Hg, minimum stent diameter at implantation <12 mm, and initial coarctation minimum diameter <6 mm. There were 13 patients with aortic aneurysms, with a cumulative incidence of 6.3% at late follow-up. Conclusions: Coarctation stenting is effective at maintaining obstruction relief up to 60 months postimplant with reduction in the number of patients requiring antihypertensive medication. However, an increase in-stent fractures and reinterventions were observed between medium and long-term follow-up. Covered stents appear to confer some protection from the development of stent fractures but do not provide complete protection from late aneurysm formation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT00552812 and NCT01278303.

Impact of anemia on in-stent restenosis after percutaneous coronary intervention

Background Anemia is a well-recognized risk factor for adverse events after percutaneous coronary intervention (PCI), but data regarding the association between anemia and in-stent restenosis (ISR) remain limited.Methods A total of 538 patients who underwent PCI between January 2018 and September 2019 and performed follow-up angiography 9–12 months after the initial PCI was enrolled in the study. Baseline clinical and procedural characteristics were compared between ISR and non-ISR group. Multivariate logistic regression analysis was employed to determine the independent predictors of ISR.Results The incidence of anemia in patients with ISR was 53.5% and 19.0% in the non-ISR group, which was significantly different (P ༜0.001). The rate of diabetes, chronic kidney disease (CKD), bifurcation lesion and calcification was significantly higher in ISR group. In addition, low-density lipoprotein cholesterol (LDL-c), multiple stenting and stent diameter were also significantly related with ISR. After multivariate logistic analysis, anemia (odds ratio [OR], 2.786; 95% confidence interval [CI], 1.091 to 7.115; P = 0.032) together with LDL-c (OR, 1.682; 95% CI, 1.145 to 2.469; P = 0.008), diabetes (OR, 3.582; 95% CI, 1.406 to 9.125; P = 0.007), CKD (OR, 2.841; 95% CI, 1.006 to 8.027; P = 0.049), multiple stenting (OR, 2.823; 95% CI, 1.184 to 6.731; P = 0.019), and stent diameter (OR, 2.778; 95% CI, 1.069 to 7.194; P = 0.036) were closely associated with ISR.Conclusion Anemia is closely associated with ISR after PCI, patients with lower hemoglobin have a higher risk of ISR.