Intravascular Ultrasound Guided Intervention in Calcified Coronary Lesions Showed Good Clinical Outcomes during One Year Follow-Up.

BACKGROUND: Calcified coronary lesions can cause stent under-expansion, malapposition, and polymer degradation, hence increasing the risk of adverse clinical outcomes. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) has been used regularly to improve outcomes. Our primary aim was to evaluate the clinical efficacy of IVUS-guided PCI in calcified coronary lesions. METHODS: From August 2018 to December 2021, we prospectively included 300 patients in the CAPIRO study (CAlcified plaque in patients receiving Resolute Onyx®) at three educational hospitals in Jeonbuk Province. We studied 243 patients (265 lesions) who were followed up for over a year. Based on coronary calcification by IVUS analysis, the patient population was categorized into two groups (Group I: non/mild calcification; Group II: moderate/severe calcification (maximum calcium arc >180° and calcium length > 5 mm)). One-to-one Propensity Score Matching was used to match the baseline characteristics. The stent expansion rate was analyzed by recent criteria. The primary clinical outcome was Major Adverse Cardiac Events (MACE), which included Cardiac death, Myocardial Infarction (MI), and Target Lesion Revascularization (TLR). RESULTS: After follow-up time, the MACE rate in Group I was 1.99%, comparable to Group II's 1.09% (p = 0.594). The components of MACE did not significantly differ between the two groups. Based on absolute MSA or MSA/MVA at MSA site criteria, the stent expansion rate in Group II was lower than that of Group I. Nevertheless, based on recent relative criteria, the stent expansion rate in both groups was comparable. CONCLUSIONS: After more than a year of follow-up, IVUS-guided PCI in moderate/severe calcification lesions was associated with good clinical outcomes, which was comparable with non/mild calcification lesions. Future studies with a larger sample size and a more extended follow-up period are required to clarify our findings.

Determinants of health-related quality of life among outpatients with acute coronary artery disease after percutaneous coronary intervention.

AIM: This study aimed to identify health-related quality of life (HRQoL) and its determinants in outpatients with acute coronary syndrome (ACS) after percutaneous coronary intervention. METHODS: A cross-sectional design was used and a total of 124 Korean participants was enrolled. The HRQoL (physical limitations, treatment satisfaction, and disease perception), symptom experience (frequency, severity, and distress), physiological (left ventricular ejection fraction and lipids), psychological (depression and anxiety), and situational (social support) factors were measured, selected on the basis of the theory of unpleasant symptoms. The HRQoL was assessed by using the Seattle Angina Questionnaire-Korean, designed to evaluate disease-specific health outcomes in patients with coronary artery disease. Descriptive statistics and multiple linear regression analyses were conducted. RESULTS: The mean age of the participants was 61.73 years. The HRQoL was moderate. Among the HRQoL domains, disease perception showed the lowest level. The most intense symptoms that were experienced by the participants were fatigue, shortness of breath, and chest discomfort. More than half of the participants had depression and anxiety. The determinants of worse HRQoL were severe symptom experience, higher depression, higher low-density lipoprotein cholesterol, a lower educational level, and lower social support. CONCLUSION: This study proposes a comprehensive approach to health care that incorporates symptom experience, as well as the physiological, psychological, and situational aspects based on the theory of unpleasant symptoms, to improve the HRQoL among outpatients with ACS. Nurses should play a key role to help patients with ACS to deal with the symptoms, low-density lipoprotein cholesterol, and depression and to promote social support, particularly in less-educated patients, in order to improve their HRQoL.

Successful Prasugrel Therapy for Recurrent Left Main Stent Thrombosis in a Clopidogrel Hyporesponder.

Stent thrombosis is a life-threatening sequela of drug-eluting stent implantation. Dual antiplatelet therapy with aspirin and thienopyridine is typically used to prevent this catastrophic event. In terms of stent thrombosis, the major concern is the variable response of patients to clopidogrel, and this has raised interest in new antiplatelet agents. We present the case of a 64-year-old woman whom we successfully treated with prasugrel after she had repeated episodes of stent thrombosis caused by a poor response to clopidogrel. This case highlights the potential role of new antiplatelet agents for patients who are undergoing drug-eluting stent implantation.

Percutaneous Forceps Retrieval of an Embolized Amplatzer Duct Occluder.

Transcatheter closure of patent ductus arteriosus with the Amplatzer duct occluder shows excellent results. However, there is a risk of device embolization after deployment. We report the case of a 33-year-old man in whom an embolized Amplatzer device was retrieved from the right pulmonary artery by a percutaneous method. We also review this uncommon severe complication and offer technical tips for percutaneous removal.