Clinical Outcomes following Large Vessel Coronary Artery Perforation Treated with Covered Stent Implantation: Comparison between Polytetrafluoroethylene- and Polyurethane-Covered Stents (CRACK-II Registry).

Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up.

Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry.

BACKGROUND: Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. METHODS: This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). RESULTS: The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. CONCLUSIONS: The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.

The relationship between increased air pollution expressed as PM10 concentration and the frequency of percutaneous coronary interventions in patients with acute coronary syndromes-a seasonal differences.

The aim of the presented study was to assess the relationship between air pollution expressed as particulate air matters less than 10 µm (PM10) and acute coronary syndromes (ACSs). In this observational study, we selected regions with low pollution according to PM10 (non-polluted) and with the highest pollution (polluted). The occurrence of percutaneous coronary interventions (PCIs) in patients with ACSs was matched according to the location. The current study included 7678 patients in polluted areas and 4327 patients from non-polluted regions. Analysing the period from January to December 2017, the number of patients undergoing angioplasty in monitored catheterization laboratories and the mean daily concentration of PM10 in all selected cities were calculated for each day. The annual average concentration of PM10 amounts to 50.95 µg/m3 in polluted and 26.62 µg/m3 in non-polluted cities (P < 0.01). The rise in PM10 pollution levels was related with the increased frequency of PCIs in patients with ACSs in polluted (P < 0.01) and non-polluted (P < 0.01) areas. In the non-polluted regions, the increase in PM10 concentration by every 1 µg/m3 causes 0.22 additional ACS angioplasties per week. In polluted regions, the same increase in PM10 concentration causes 0.18 additional ACS angioplasties per week. In non-winter weeks, the mean number of ACS PCIs expressed in promiles was lower than in winter weeks in polluted (P = 0.03) and non-polluted cities (P = 0.02). The study shows that the increase in air pollution expressed as PM10 concentration and winter time influences the frequency of ACS-related PCIs.

Effect of day- and night-time admissions on long-term clinical outcomes of patients with acute myocardial infarction treated with percutaneous coronary intervention.

INTRODUCTION: It has been suggested that the time of admission during the day and night may influence the clinical outcomes of patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI). OBJECTIVES: The aim of this study was to assess the impact of day- and night­time admissions on the clinical outcomes of patients with AMI undergoing PCI. PATIENTS AND METHODS: This retrospective cohort study was based on the data on PCIs performed in Poland from January 2014 to December 2017, prospectively collected in the National Registry of Invasive Cardiology Procedures (ORPKI). Day hours were defined as the time interval between 7:00 am and 10:59 pm. The study endpoints included the all­cause in­hospital mortality rate and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30­day,12­month, and 36­month follow­up. RESULTS: A total of 2919 patients were included in the study (2462 [84.3%] treated during the day hours). ST­segment elevation myocardial infarction (1993 [68.3%]) was the main indication for PCI. We demonstrated that the 30­day mortality rate was significantly higher in patients treated during the night hours than during the day hours (P = 0.01). Night hours were also among the independent predictors of increased 30­day mortality (hazard ratio, 1.54; 95% CI, 1.11-2.16; P = 0.01). No significant differences were observed in in­hospital, 12­month, and 36­month mortality rates between patients treated during the night and day hours. There were no significant differences in the MACCE rates at the follow­up timepoints. CONCLUSIONS: Primary PCI for AMI is associated with increased 30­day mortality among patients treated during the night hours compared with those managed during the day hours.

Age and gender differences in clinical outcomes of patients with heavy-calcified coronary artery lesions treated percutaneously with rotational atherectomy.

BACKGROUND: Rotational atherectomy (RA) used in elderly patients treated with percutaneous coronary interventions (PCI) could enable revascularization or the omission of cardiac surgery. Knowledge about factors affecting the prognosis may improve the results of treatment. OBJECTIVES: We aimed to assess the relationship of gender and age with long-term clinical outcomes expressed as major adverse cardiac and cerebrovascular events (MACCEs). MATERIAL AND METHODS: The study included 97 consecutive patients treated with PCI and RA at the mean age of 71. The study group contained 73.2% men and 26.8% women, 36.1% of patients older than 75 and 63.9% younger than 75. The mean time of follow-up was 695.3 ±560.9 days. The rate of MACCEs (deaths, myocardial infarctions (MIs), reinterventions, coronary artery by-pass surgeries, or cerebral strokes (CSs)/transient ischemic attacks (TIAs)) in the overall group of patients was calculated at 33.7%. RESULTS: The comparison of Kaplan-Meier survival curves did not depict significant differences in the frequency of MACCEs for age (p = 0.36) and gender (p = 0.07). We noticed that the death rate was higher in females than in males and in patients older than 75 compared to those younger, and was statistically significant for age (p = 0.04). The rate of periprocedural complications was significantly higher among women than among men (p = 0.005) and in patients older than 75 compared to the younger ones (p = 0.003). CONCLUSIONS: Age and gender are not significantly associated with an increased rate of MACCEs during follow-up in elderly patients treated with PCI and RA.

Mortality and chronic obstructive pulmonary disease in patients treated with endovascular revascularization of the infra-inguinal lower limb arteries from retrograde access.

BACKGROUND: In this trial, our objective was to evaluate the relationship between long-term clinical outcomes in patients with peripheral arterial disease (PAD) treated with retrograde endovascular recanalization (ER) of chronic total occlusions (CTOs) regarding the infra-inguinal lower limb arteries and chronic obstructive pulmonary disease (COPD). METHODS: A total of 834 consecutive subjects were enrolled in the study. The mean age was 67.8±10.6 years (62.6% males). COPD was diagnosed in 98 patients (11.7%). The infra-inguinal location included the deep, superficial and common femoral artery, popliteal artery or below the knee arteries. During follow-up, we evaluated major adverse cardiac and cerebrovascular events (MACCE) and major adverse limb events (MALE). MACCE was considered as death, stroke/transient ischemic attack, myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting operation, while MALE regarded amputation, target lesion re-intervention, target vessel re-intervention and surgical action. RESULTS: The mean follow-up was 1,144.9±664.3 days and the interquartile range was 1,110.5 (504.5-1,734.7). Data were collected between 2006 and 2016. We noticed significant differences in death rates among the COPD and non-COPD groups. The cumulative number of events (deaths) was 12.2%, 17.3%, 18.4%, 22.4%, 23.5%, 23.5% and 23.5% in the COPD group and 6.1%, 7.5%, 10.5%, 11.3%, 11.4% 11.5% and 11.5% in the non-COPD group after 1, 2, 3, 4, 5, 6 and 7 years of follow-up, and was notably greater for COPD (P=0.0007). CONCLUSIONS: Patients with COPD and PAD treated with the ER and retrograde approach due to CTOs are related to higher mortality than non-COPD patients.