Does Chronic Total Occlusion Percutaneous Coronary Intervention Improve Survival

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Ultra-low contrast percutaneous coronary intervention in patients with severe chronic kidney disease

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Características y factores pronósticos de los pacientes ingresados por síndrome coronario agudo sin elevación del ST en un hospital de tercer nivel

Registre per a estudiar l'impacte clínic de l'SCASEST a un hospital de tercer nivell. En un any van ingressar 310 pacients (54% Cardiologia, 46% Semicrítics/Unitat d'Estada Curta). La mortalitat hospitalaria va ser de l'1%; a 6 mesos va haver un 4,6% de morts i un 16% de reingressos. Edat, filtrat glomerular i FE van ser predictors de mortalitat; una troponina positiva i l'ingres a Cardiologia es van associar amb un menor risc de reingrés. Ingressar a Cardiologia es va associar a ser tributari de coronariografia i revascularització quirúrgica. El tipus de Servei pot tenir un impacte adicional en la història de l'SCASEST.Registro para estudiar el impacto clínico del SCASEST en un hospital de tercer nivel. En un año ingresaron 310 pacientes (54% Cardiología, 46% Semicríticos/Unidad de Estancia Corta). La mortalidad hospitalaria fue del 1%; a 6 meses hubo un 4,6% de muertes y un 16% de reingresos. Edad, filtrado glomerular y FE fueron predictores de mortalidad; una troponina positiva y el ingreso en Cardiología se asociaron con un menor riesgo de reingreso. Ingresar en Cardiología se asoció a ser tributario de coronariografía y revascularización quirúrgica. El tipo de Servicio puede tener un impacto adicional en la historia del SCASEST

TCT-121 Extraplaque Versus Intraplaque Tracking in Chronic Total Occlusion Percutaneous Coronary Intervention

Background: The impact of modern extraplaque (EP) tracking techniques on long-term outcomes remains controversial. Methods: We performed a systematic review and meta-analysis of studies that compared EP vs intraplaque (IP) tracking in CTO PCI. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Der-Simonian and Laird random-effects method. Results: Our meta-analysis included seven observational studies with 2,982 patients. Patients who underwent EP tracking had significantly more complex CTOs with higher J-CTO scores (2.9 ± 1.2 vs 1.6 ± 1.1, P \u3c 0.001), longer lesion length, more severe calcification, and significantly longer stented segments. During a median follow-up of 12 months (range 9-12 months), EP tracking was associated with a higher risk of major adverse cardiovascular events (MACE) (OR 1.50, 95% CI 1.10-2.06, P = 0.01) and target vessel revascularization (TVR) (OR 1.69, 95% CI 1.15-2.48, P = 0.01) compared with IP tracking. There was no difference in the incidence of all-cause death (OR 1.37, 95% CI 0.67-2.78, P = 0.39), myocardial infarction (MI) (OR 1.48, 95% CI 0.82-2.69, P = 0.20), or stent thrombosis (OR 2.09, 95% CI 0.69-6.33, P = 0.19) between EP and IP tracking. Conclusion: Compared with IP tracking, EP tracking was utilized in more complex and longer CTOs, required more stents, and was associated with a higher risk of MACE at 12 months, driven by a higher risk of TVR, but without an increased risk of death or MI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP

contrast enhanced echocardiography to rule out active intrapericardial bleeding following coronary artery perforation

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Subadventitial stenting around occluded stents: A bailout technique to recanalize in-stent chronic total occlusions

To evaluate the outcomes of subadventitial stenting (SS) around occluded stents for recanalizing in-stent chronic total occlusions (IS-CTOs).There is little evidence on the outcomes of SS for IS-CTO.We examined the outcomes of SS for IS-CTO PCI at 14 centers between July 2011 and June 2017, and compared them to historical controls recanalized using within-stent stenting (WSS). Target-vessel failure (TVF) on follow-up was the endpoint of this study, and was defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.During study period, 422 IS-CTO PCIs were performed, of which 32 (7.6%) were recanalized with SS, usually when conventional approaches failed. The most frequent CTO vessel was the right coronary artery (72%). Mean J-CTO score was 3.1 ± 0.9. SS was antegrade in 53%, and retrograde in 47%. Part of the occluded stent was crushed in 37%, while the whole stent was crushed in 63%. Intravascular imaging was used in 59%. One patient (3.1%) suffered tamponade. Angiographic follow-up was performed in 10/32 patients: stents were patent in six cases, one had mild neointimal hyperplasia, and three had severe restenosis at the SS site. Clinical follow-up was available for 29/32 patients for a mean of 388 ± 303 days. The 24-month incidence of TVF was 13.8%, which was similar to historical controls treated with WSS (19.5%, P = 0.49).SS is rarely performed, usually as last resort, to recanalize complex IS-CTOs. It is associated with favorable acute and mid-term outcomes, but given the small sample size of our study additional research is warranted

The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access The Campeau Radial Paradox

AbstractObjectivesThe purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.BackgroundThe recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.MethodsLogistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.ResultsA total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.ConclusionsIn a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators