Long-term follow-up of therapeutic efficacy of everolimus-eluting bioresorbable vascular scaffold in comparison to everolimus-eluting stent in treatment of chronic total occlusion guided by intracoronary imaging.

BACKGROUND: We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period. RESULTS: At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES. CONCLUSION: This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology. TRIAL REGISTRATION: ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: IRB_123@medicine.zu.edu.eg.

Correction to: Rapid guide to the management of cardiac patients during the COVID-19 pandemic in Egypt: "a position statement of the Egyptian Society of Cardiology".

An amendment to this paper has been published and can be accessed via the original article.

Rapid guide to the management of cardiac patients during the COVID-19 pandemic in Egypt: "a position statement of the Egyptian Society of Cardiology".

COVID-19 pandemic poses an enormous challenge to healthcare system in Egypt. This document is a position statement from the Egyptian Society of Cardiology. It aims to provide information to cardiovascular healthcare providers in Egypt to guarantee delivery of quality patient care and ensure adequate levels of protection against infection during the COVID-19 pandemic. Older patients and those with cardiovascular disease are at higher risk of mortality. The current situation requires unusual allocation of resources which may negatively impact the care of patients with cardiovascular disease. Cardiologists should be prepared in the COVID-19 pandemic. The challenge is in providing the best quality of care despite limited resources while keeping all medical staff as safe as possible. Consider deferring elective procedures whenever possible. All medical staff should undergo rigorous training on infection control and the use of high-quality personal protection equipment. Cardiologists should promote telemedicine in the outpatient setting, prioritize outpatient contacts, and avoid nosocomial dissemination of the virus to patients and healthcare providers. A much conservative approach for emergent cardiac patients is recommended, and invasive interventions are reserved for high risk hemodynamically unstable patients. During the pandemic, the most important principles of treatment should be controlling the spread of infection as the first priority, prompt assessment of patient risk, recommending conservative medical therapy rather than invasive interventions, and strict infection control measures to limit infection spread within the hospital and to healthcare workers.

Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion.

We performed this study to compare the sensitivity and specificity of multi-slice computed tomography (MSCT) to coronary angiography (CA) in detecting coronary total occlusion (CTO) lesion characteristics. Moreover, we analyzed the association between these characteristics and the risk of revascularization failure. Fifty patients with confirmed CTO diagnosis were tried for revascularization using the antegrade (all 50) or retrograde (in failed nine antegrade interventions) approaches. Each patient underwent CA and MSCT before the intervention and data from both modalities were compared using the SPSS software. Successful revascularization occurred in 36 (72%) and 6 (66.7%) patients of the antegrade and retrograde groups, respectively. Compared to CA, MSCT exhibited high sensitivity in detecting CTO segment calcification (100%), size of the affected vessel (100%, area under the curve [AUC] = 0.82), distal filling of the affected segment (97.7%) and side-branching at the CTO segment (93.3%). However, it had lower sensitivity in detecting collaterals (75%) and the length of the affected segment (87.5%, AUC = 0.77). According to MSCT data, increased occlusion length > 18 mm (p = 0.01), atherosclerotic vessel wall (p = 0.02), small distal vessel size ≤ 2.75 mm (p = 0.002), proximal side-branching (p = 0.01) and calcification of the proximal cap (p = 0.007) or distal stump (p = 0.01) were associated with an increased risk of revascularization failure. MSCT exhibited high sensitivity in identifying several CTO lesion characteristics, such as lesional calcification and size of the affected vessel. However, further research is needed to improve the diagnostic accuracy of this modality and define the predictors of revascularization failure in CTO patients.