Safety and feasibility of same-day early discharge after endovascular revascularization of lower extremities in elderly. SENIOR-ER registry.

OBJECTIVE: The aim of the study was to assess safety and feasibility of one-day early discharge (ODD) after endovascular revascularization (ER) of lower extremities in elderly. BACKGROUND: Safety and feasibility of ODD after ER have never been investigated in the elderly, despite the PAD rate has been rising in well-developed countries as their populations are getting older. METHODS: The consecutive data of 477 patients after ER who were intended to ODD were reviewed. The ER procedure (balloon angioplasty, atherectomy, stenting) was performed due to significant, angiographically confirmed arterial stenosis with at least Rutheford III claudication. The population was divided into two groups: ≥70 years old (y. o.) in which were 235 patients and 220 patients <70 y. o., the younger control cohort. The follow-up was performed 24 hr after (24FU) the procedure and 30 days (30FU) after discharge. RESULTS: There were no differences between the groups in the ratio of same-day discharge (99% vs 99.5%, P = 0.6) and the mean time to ambulation was 287.4 ± 43.4 min versus 285.8 ± 45.7 min (P = 0.603). The ODD was not applied in 2 patients ≥70 y. o. due to two pseudoaneurysms requiring surgical repairs and in one from the control group due to retroperitoneal bleeding. There was no MACE or creatinine increase at 24 hr in both groups. At 30 days, there was no incidence of MACE in the ≥70 y. o. group while 3 MACE occurred in the control. The ratio of access site complications was comparable between the groups. CONCLUSION: The study allows for a hypothesis that the advantages of ODD could be safely extended to the patients ≥70 y. o.

Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization.

OBJECTIVES: The purpose of this study was to compare the early and late results of percutaneous and surgical revascularization of left main coronary artery stenosis. BACKGROUND: Unprotected left main coronary artery (ULMCA) stenting is being investigated as an alternative to bypass surgery. METHODS: We randomly assigned 105 patients with ULMCA stenosis to percutaneous coronary intervention (PCI; 52 patients) or coronary artery bypass grafting (CABG; 53 patients). The primary end point was the change in left ventricular ejection fraction (LVEF) 12 months after the intervention. Secondary end points included 30-day major adverse events (MAE), major adverse cardiac and cerebrovascular events (MACCE), length of hospitalization, target vessel failure (TVF), angina severity and exercise tolerance after 1 year, and total and MACCE-free survival. RESULTS: A significant increase in LVEF at the 12-month follow-up was noted only in the PCI group (3.3 +/- 6.7% after PCI vs. 0.5 +/- 0.8% after CABG; p = 0.047). Patients performed equally well on stress tests, and angina status improved similarly in the 2 groups. PCI was associated with a lower 30-day risk of MAE (p < 0.006) and MACCE (p = 0.03) and shorter hospitalizations (p = 0.0007). Total and MACCE-free 1-year survival was comparable. Left main TVF was similar in the 2 groups. During the 28.0 +/- 9.9-month follow-up, there were 3 deaths in the PCI group and 7 deaths in the CABG group (p = 0.08). CONCLUSIONS: Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.

Early and late results of percutaneous revascularization in patients with ischemic cardiomyopathy and decreased left ventricular ejection fraction. (Revascularisation in Heart Failure Trial, REHEAT Registry).

AIMS: REvascularization in Ischaemic HEart Failure Trial (REHEAT) is a registry prospectively evaluating the outcomes of percutaneous myocardial revascularization in postinfarction patients with ischemic cardiomyopathy and various categories of surgical risk. METHODS AND RESULTS: One hundred seventy consecutive postinfarction patients with LVEF <40% and angiographically documented coronary stenoses eligible for PCI were enrolled to the study. The study end-points included: angiographic success of PCI, major adverse events at 30 days and 1 year after procedure, long-term survival, functional status (CCS and NYHA class) and LVEF 12 months after the intervention. Angiographic success rate was 98,8% and complete revascularization was achieved in 38.8% cases. No periprocedural deaths were registered. Thirtieth-days survival was 97% and was better in comparison to calculated survival for CABG patients; 1-year survival was 94.4% and was not inferior to predicted survival after CABG. In the general study population a significant improvement of LVEF (27,8+/-7,0 to 35,9+/-9,4%) was shown (absolute change mean 6.45+/-10%). In low/intermediate risk group the LVEF increase was lower (6.5+/-10,9) in comparison to high risk group (10,3+/-9,6%)(p=0,042). In both groups a significant and comparable reduction of angina and heart failure severity was shown in 1-year follow-up. CONCLUSION: PCI in postinfarction patients with markedly reduced LVEF is associated with a significant increase of LVEF and favorable clinical outcome (CCS and NYHA class). PCI is safe, feasible and can be an alternative approach to CABG both in low/intermediate and high surgical risk patients.