RESUMO
OBJECTIVES: We sought to assess if ineligibility to coronary artery bypass grafting (CABG) constitutes a risk factor in patients who underwent a nonemergent unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with prophylactic Impella® heart pump support. BACKGROUND: ULMCA PCI in patients not deemed eligible for CABG is associated with significantly worse outcomes compared to ULMCA PCI in eligible patients. METHODS: Patients from the cVAD Registry and the PROTECT II trial who underwent a nonemergent ULMCA PCI were identified. We compared in-hospital mortality and major adverse cardiac and cerebrovascular event (MACCE) rates as well as 30-day survival and MACCE rates between CABG ineligible and CABG eligible patients. RESULTS: A total of 331 patients were included (293 Impella 2.5®, 38 Impella CP®); 227 were ineligible for CABG and 104 were eligible. Baseline characteristics were remarkable for a trend toward higher rate of chronic obstructive pulmonary disease in the ineligible patients. In-hospital mortality (3.52% vs. 5.77%; p=0.383) and MACCE (6.61% vs. 7.69%; p=0.816) rates as well as 30-day survival (92.0% vs. 93.4%; Log-Rank p-value =0.781) and MACCE (88.1% vs. 90.1%; Log-Rank p-value=0.648) rates were not different between the two groups. CONCLUSIONS: The results of our study suggest that prophylactic Impella support appears to mitigate the risks inherent to surgical ineligibility in patients undergoing a nonemergent ULMCA PCI. Our results require further investigation.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Coração Auxiliar , Intervenção Coronária Percutânea , Idoso , Contraindicações de Procedimentos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Definição da Elegibilidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. METHODS: In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6â¯months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. RESULTS: Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1â¯month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6â¯months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, Pâ¯=â¯.43; any dyspnea: 51.8% vs 50.1%, Pâ¯=â¯.40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1â¯month was not associated with an increased risk of angina, dyspnea, or worse health status at 6â¯months. CONCLUSIONS: Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1â¯month and was not associated with worse long-term health status.
Assuntos
Angina Pectoris/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Oclusão Coronária/cirurgia , Nível de Saúde , Intervenção Coronária Percutânea , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/cirurgia , Bloqueadores dos Canais de Cálcio/administração & dosagem , Distribuição de Qui-Quadrado , Doença Crônica , Oclusão Coronária/complicações , Dispneia/diagnóstico , Dispneia/terapia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Isquemia Miocárdica/complicações , Nitrocompostos/administração & dosagem , Estudos Prospectivos , Qualidade de Vida , Ranolazina/administração & dosagem , Sistema de Registros , Fatores de TempoAssuntos
Cateterismo Cardíaco , Ensaios Clínicos como Assunto/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Projetos de Pesquisa , Adenosina/administração & dosagem , Consenso , Doença da Artéria Coronariana/fisiopatologia , Humanos , Hiperemia/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Vasodilatadores/administração & dosagemRESUMO
Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed "Bifurcation and Ostial OCT Mapping" (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.
Assuntos
Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/métodos , Stents , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/métodos , Angiografia Coronária , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. OBJECTIVE: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiography and/or intervention and to determine the relationship between presence of PAD and severity of CAD. METHODS: The Peripheral Arterial Disease in Interventional Patients Study (PIPS) is a prospective cohort study conducted at an inpatient service of a tertiary referral center. A total of 800 patients referred for coronary angiography without prior diagnosis of PAD aged 70 years or older or aged 50-69 years with a history of tobacco use and/or diabetes mellitus were included. Evaluation involved a medical history, a questionnaire to assess symptoms and functional status, and measurement of the ankle-brachial index (ABI). PAD was considered present if the ABI was 0.90 or less. RESULTS: The prevalence of previously unrecognized PAD was 15%, 95% CI (12.6-17.7) and was highest among patients over 70 years of age (25.2%) and in women (23.3%). Among patients with CAD, those with PAD had higher prevalence of left main and multivessel coronary artery disease (87.2% vs. 75.5%, P = 0.006). Alternatively, patients with multivessel CAD had a twofold higher risk of being diagnosed with previously unrecognized PAD compared with those with single vessel CAD [adjusted OR = 2.02, (95% CI 1.03-3.98)]. CONCLUSIONS: PAD is often overlooked even in patients with known ischemic heart disease under specialist cardiovascular care. Overlooked PAD in this population increases in frequency with advanced age, in women, and in the presence of other traditional cardiovascular risk factors. Furthermore, the presence of PAD in this population identifies a subgroup with more severe form of CAD.
Assuntos
Angioplastia Coronária com Balão , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doenças Vasculares Periféricas/complicações , Fatores Etários , Idoso , Tornozelo/irrigação sanguínea , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/epidemiologia , Doenças Vasculares Periféricas/fisiopatologia , Prevalência , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , CaminhadaRESUMO
OBJECTIVES: This study was designed to investigate the impact of percutaneous coronary interventions (PCIs) in degenerated saphenous vein grafts (SVGs) without distal embolic protection. BACKGROUND: Distal embolic protection devices have been shown to reduce the incidence of no reflow/slow flow during PCI of de novo lesions in degenerated SVGs. It is unclear whether PCI of in-stent restenosis (ISR) lesions in degenerated SVGs is associated with no reflow/slow flow and whether distal embolic protection is beneficial in these cases as well. METHODS: We studied 54 consecutive patients with treated ISR lesions in degenerated SVGs who underwent PCI without distal embolic protection in a single center. Procedural and in-hospital outcomes were examined. The average age was 71 +/- 8 years; 32% of the patients had diabetes. The mean lesion length was 13 +/- 6 mm and the procedural success rate was 98% (53/54). Cutting balloon angioplasty was used in 46% (25/54) of cases, and a new stent was inserted in 46% (25/54) of patients. Gamma brachytherapy was performed in 19% (10/54) of patients. During the procedure there were no episodes of no reflow/slow flow, and there were no patients with in-hospital Q-wave or non-Q-wave myocardial infarction. There was one in-hospital noncardiac death. CONCLUSIONS: In this consecutive series of patients with ISR of degenerated SVGs undergoing PCI without distal protection, there were no episodes of slow flow/no reflow and no procedure-related myocardial infarctions. It appears that distal embolic protection may not be necessary during PCI of ISR lesions in degenerated SVGs.