Procedural Results and Long-term Outcome of Chronic Total Occlusion Percutaneous Coronary Intervention in a UK Non-surgical Centre.

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved a great deal over recent years, with increased procedural success and lower complication rates being reported. This study aims to evaluate the feasibility, safety and success of a dedicated CTO programme in a large UK PCI centre without on-site cardiothoracic surgery facilities. Methods: Clinical and procedural data were retrospectively collected for consecutive unselected patients undergoing CTO PCI between 2015 and 2019 from the local database and regional electronic patient records. In-hospital outcomes and long-term major adverse cardiovascular events (all-cause mortality, MI, stroke and target vessel revascularisation) were recorded. Results: A total of 170 patients underwent 191 CTO procedures during the study period. The mean age was 63 ± 10 years and 80.6% of patients were male (n=137). The clinical indications were: stable chronic coronary syndromes in 88.5% (n=169) of patients; staged procedures in the context of acute coronary syndromes in 1.6% (n=3); and presentation with acute coronary syndrome in 9.9% (n=19). The procedural success rate was 50.0% (n=25) for general interventional cardiologists and 90.1% (n=127) for dedicated CTO operators. In-hospital major adverse cardiovascular events occurred once (0.5%) and interhospital transfer for emergency salvage cardiac surgery was not required. Long-term follow-up data at a median duration of 3.8 years revealed 4 (2.4%) cardiac deaths, 14 (8.3%) spontaneous MI events and 10 (5.9%) target vessel revascularisations. Conclusion: These data suggest CTO PCI using contemporary techniques is both safe and effective when undertaken in a high-volume non-surgical centre by experienced operators.

Assessing the impact of university students' involvement in the first year of Nurture-U: a national student wellbeing research project.

BACKGROUND: Students experience lower levels of wellbeing than the general, age-matched population. A whole-university approach to mental health is encouraged, which must work for individuals from all backgrounds and experiences. Student input is vital in researching and designing these solutions. Nurture-U is a national, large-scale research project exploring better ways to support student wellbeing, with a Student Advisory Group (SAG) that feeds into project decision making. With the first year of the project now completed, we now critically review the processes and effectiveness of the SAG and how well the project is engaging and working with students. METHODS: Assessment of the SAG's impact on the project, the student advisors, and the researchers was undertaken through a content analysis of team meetings and collection of advisor and researcher feedback using the Patient Engagement Quality Guidance Tool. RESULTS: 142 students worked on different tasks in the first year of the Nurture-U project. The SAG was involved in the project branding and marketing, and in the development and co-design of interventions and tools. They reported a positive experience, with involvement boosting confidence. They felt valued but reported not always knowing whether their input was implemented in final decisions. They also recommended different methods of providing feedback. Researchers found student input beneficial to communicate the viewpoint of a different generation and increase the relevance of the study, but also suggested improvements for communication between the research team and the student group. CONCLUSIONS: This critical reflection of the SAG's public advisor role in this large-scale research project was important in highlighting what worked well and areas to improve. As the project unfolds, we aim to adapt our methods of student input, increase the transparency of decision-making processes, and in turn increase student-led decision making within the project.

University students face many challenges to their wellbeing, including academic stress, frequent changes of location, distancing of support systems, and new social and cultural surroundings. The Nurture-U research project is looking at how universities can support student wellbeing. It is supported by a Student Advisory Group (SAG) that is helping us design the research. The aim of this paper is to reflect on the input of the SAG in the first year of the 4-year Nurture-U project. 142 students worked on different tasks in the first year of the Nurture-U project, including marketing and designing therapeutic apps. The SAG described feeling valued, gaining confidence and an understanding of mental health and research. Researchers felt the SAG improved Nurture-U, making it more relevant to students. However, all were concerned that final decisions were researcher-led, not student-led. There was also a lack of diversity, with most of the SAG being female. The SAG advised different ways for researchers and students to work together. This included having different ways for student advisors to voice their opinions, for example in smaller or face-to-face groups, or on online boards. Also, researchers could engage with the SAG differently, through newsletters or videos, to make it clearer how final decisions are made. This formal reflection activity has helped the Nurture-U team consider ways to improve working with the SAG for the rest of the project, which we hope will ensure that student voices guide how the project unfolds.

Fractional flow reserve derived from coronary computed tomography: where are we now and where are we heading?

Computed tomography coronary angiography is emerging as the preferred diagnostic tool for patients with chest pain. Additional knowledge of the extent and distribution of myocardial ischemia enables tailored patient management. Computed tomography-derived fractional flow reserve (FFRCT) employs computed tomography coronary angiography raw data processed via complex computational fluid dynamics and produces a surrogate of the invasive fractional flow reserve (FFR) thus delivering anatomical and physiological assessment in a single test. FFRCT has been extensively validated against invasive FFR and observational clinical studies have consistently demonstrated its utility as gatekeeper to invasive angiography while also reducing downstream clinical events and costs. Novel workstation-based models of estimating FFR are now being tested. Ongoing and future research results will define their role in clinical practice.

Does specialist review for patients with suspected heart failure predict better outcomes? An observational study on the utility of compliance with NICE guidelines.

OBJECTIVES: Compare outcomes in patients with suspected heart failure (HF) and raised natriuretic peptides who are reviewed in a specialist HF clinic in line with National Institute for Health and Care Excellence (NICE) guidelines (compliant group) versus patients who are not reviewed in the clinic (non-compliant group). DESIGN: Retrospective observational study. SETTING: Single large UK district general hospital. PARTICIPANTS: 567 consecutive patients in primary care with raised N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels (>400 pg/mL) from February to September 2014. INTERVENTIONS: 161 (28%) patients were referred to the specialist HF clinic and 406 (72%) were not. Outcomes were compared between the two groups. OUTCOME MEASURES: All-cause and cardiovascular (CV) hospitalisations and all-cause mortality. RESULTS: The compliant group were slightly younger than the non-compliant group (78±9 vs 80±9; p=0.019) but had much higher NT-pro-BNP (3108±4526 vs 2271±3637 pg/mL; p<0.0001). Despite this, over a mean follow-up period of 9±2 months, rates of all-cause hospitalisation (24% vs 44%; p<0.0001) and CV hospitalisation (3% vs 15%, p<0.0001) were significantly lower in the compliant group versus the non-compliant group, respectively. There was no significant difference in mortality rates (6% compliant group vs 8% non-compliant group; p=0.487). CONCLUSIONS: Hospitalisation rates in patients with suspected HF and raised NT-pro-BNP were extremely high over a relatively short follow-up period. Patients reviewed in a specialist HF clinic had much higher NT-pro-BNP levels, suggesting they were at higher risk of adverse outcomes, yet also had significantly lower rates of all-cause and CV hospitalisation. Our findings support implementation of the relevant NICE guidelines for patients with suspected HF.