Short-term outcomes of bioresorbable scaffold (BRS) implantation in patients with non-ST segment elevation myocardial infarction (NSTEMI)

Amaç: Günlük pratiğimizde perkütan koroner girişim (PKG) uyguladığımız hasta grubunu Akut Koroner Sendrom (AKS) veya stabil anjina pektoris (SAP) tablosuyla başvuran hastalar oluşturmaktadır. AKS tanısı ile hastanemize başvuran hastalar SAP tanısı ile başvuran hastalara göre erken dönem major kardiyak olaylar açısından daha riskli grubu oluşturmaktadır. Biyorezorbe stentler (BRS), stent teknolojisinin son gelinen aşamasında kullanıma girmiş olup, ilaç kaplı stentlere (DES) göre daha az bilgi sahibi olunan materyallerdir. BRS'ler ile ilgili SAP tanılı hastalarda çalışılmış olan ve sonuçları yüz güldürücü olan birçok yayın mevcuttur. Biz de çalışmamızda AKS'lerin bir çeşidi olan ST yükselmesiz miyokard enfarktüsü (NSTEMI) ile başvuran hasta gruplarında BRS'lerin erken dönem klinik sonlanımlarının değerlendirmesi amaçladık. Yöntem: İstanbul Medipol Üniversitesi Tıp Fakültesi Hastanesi'ne Haziran 2015- Nisan 2016 tarihleri arasında NSTEMI tanısı ile başvurup; tedavilerinde BRS kullanılan 39 hasta ve 53 lezyon çalışmaya dahil edildi. Sonlanım noktaları; cihaz başarısı, işlem başarısı, stent trombozu ve majör kardiyak olaylar (MACE) olarak kabul edildi. Bulgular: İşlemler, cihaz başarısı %98,1 ve işlem başarısı %98,1 oranlarında olacak şekilde gerçekleşti. Hiçbir hastada ölüm veya stent trombozu saptanmazken 1(bir) hastada hedef lezyon revaskularizasyonu (TLR) gerçekleştirildi. Toplam MACE %1,9 saptandı. İşlem sırasında ve yatış süresince, toplam 2(iki) hastada komplikasyon gelişti. Sonuç: Yüksek işlem başarısı, düşük komplikasyon oranı ve düşük majör kardiyak olay oranı; BRS'lerin NSTEMI hastalarında da tecrübeli operatörler tarafından uygulandığı takdirde güvenle tercih edilebileceğini göstermektedir. Daha iyi sonuçlar elde etmek için radiyal gücü iyi olan, strut kalınlığı daha ince ve daha kısa sürede eriyebilen BRS'lerin geliştirilmesi gerekmektedir.Aim: Patients with percutaneous coronary intervention (PCI) in our daily practice constitute patients referred to the Acute Coronary Syndrome (ACS) or Stable Angina Pectoris (SAP) chart. Patients who applied to our hospital with the diagnosis of ACS constitute a more risky group in terms of early major cardiac events than patients with SAP diagnosis. Bioresorbable stents (BRS) are used in the last stage of stent technology and have less information than drug-eluting stents (DES). There are many publications on these stents that have been studied in patients with SAP and whose results are encouraging. We also aimed to evaluate the early clinical outcomes of BRS in patients who were admitted with non-ST-segment elevation myocardial infarction (NSTEMI), a type of ACS in our study. Method: The study included 39 patients with a total of 53 coronary lesions who were treated with BRS in Istanbul Medipol University Faculty of Medicine between June 2015-April 2016. Endpoints were considered as device failure, procedural success, stent thrombosis, and major cardiac events (MACE). Result: The transactions took place with 98,1% of device success and 98,1% of transaction success. Target lesion revascularization (TLR) was performed in 1 (one) patient without death in any patient or detection of stent thrombosis. A total MACE of 1.9 was detected. During the procedure and during admission, complications developed in 2 (two) patients. Conclusion: High procedural success, low complication rate and low rate of major cardiac events; BRSs can be safely chosen if they are operated by experienced operators in NSTEMI patients. To obtain better results, it is necessary to develop BRSs that have good radial strength, thinner strut thickness and shorter dissolution time

A novel biochemical marker for predicting the severity of ACS with unstable angina pectoris: Asprosin

WOS: 000439103800039PubMed ID: 29274804Ischemic Heart Disease (IHD) is the leading cause of death world-wide, accounting for 12.7% of global mortality[1] . Acute Coronary Syn-drome (ACS) covers a wide spectrum of clinical conditions ranging fromunstable angina to Non-ST Elevation Myocardial Infarction (N-STEMI)and ST Elevation Myocardial Infarction (STEMI). New treatments andmanagement guidelines emerge for the care of patients with ACS; riskstratification is the cornerstone in the initial evaluation of these patients[2] . That inflammatory mediators play a role duringthe evolution of ACSis indicated by the widespread coronary inflammation found during un-stable angina pectoris (UAP), throughout theentire coronary artery bed,and in the extent that ACS outcome is related to a concurrent inflamma-toryresponse[3,4] . Circulatingasprosin,a protein hormone, responds tolow dietary glucose by triggering the release of liver glucose stores, andthe reduction of asprosin protects against the hyperinsulinism associat-ed with metabolic syndrome

Long-term results of long segment coronary artery lesions overlapped with novolimus-eluting DESolve scaffold: Disappointment or futuristic?

Objective: The data on using novolimus-eluting DESolve bioresorbable scaffolds (BVS) for long-segment coronary artery lesions remains insufficient. In this study, our main objective was to assess the long-term effects of the overlapping applications of both DESolve-DESolve and the drug-eluting stent (DES)-DESolve. Methods: A single-centered study of 103 patients scheduled for DESolve placement for long-segment lesions (>28 mm) was conducted (October 2013 to November 2016). A DESolve-DESolve overlap was used on 43 patients and a DES-DESolve overlap on 60 patients. Acute procedural success and major adverse cardiac events (MACE) (stent thrombosis, targeted vessel revascularization, targeted lesion revascularization, and cardiac death) were evaluated. The patients were followed up for 48 months. Results: Revascularization was performed on 4 (6.7%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group for target lesion revascularization. Among the study population, 10 (9.7%) patients had MACE, including 5 (8.3%) patients in the DES-DESolve group and 5 (11.6%) patients in the DESolve-DESolve group. Conclusion: The positive results of our study concerning the use of DESolve for the treatment of long coronary lesions demonstrate that BVS will emerge with new platforms and become non-inferior to the DES

A Case of Sac-Shaped Subadventitial Dissection of the Distal Right Coronary Artery Resulting from Pressure Generated During Contrast Injection

Iatrogenic dissections during coronary interventions can be observed in daily practice. However, dissections due to opaque injection are much less common. Herein, we present a case of subaventitial dissection developed in the distal segment of right coronary artery after opaque injection. Dissection was not catheter-related and was conservatively treated as there was no leak out of the coronary artery

A giant left main coronary artery aneurysm

WOS: 000421966900020PubMed ID: 26142803A 67-year old woman with a history of hypertension and atrial fibrillation presented with exertional dyspnea. Her electrocardiogram was consistent with diffuse ST segment depression on the pericardial leads. The patient was referred for coronary angiography, which revealed non-obstructive coronary atherosclerosis and a giant 26x21 mm coronary aneurysm originating from the distal left main system (Fig. A and B, Videos 1 and 2**). The right coronary artery was normal, but had extensive tortuosity. Contrast-enhanced computed tomography (CT) was performed to further define the anatomy and it confirmed the size and origin of the giant left main coronary artery (LMCA) aneurysm (Fig. C and Fig. D). After consultation, the institutional heart team decided that the huge size and proximal localization of the aneurysm precluded percutaneous options, including coil embolization and graft stenting

Uzun segment koroner lezyonlarda biyoeriyebilen stentlerin güvenlik ve etkinlik sonlanımları

Introduction: There is limited knowledge about the use of bioresorbable scaffolds (BRSs) in long segment coronary artery lesions. We aimed to evaluate the clinical outcomes of BRS-BRS and drug eluting stents (DESs)-BRS overlapping applications. Patients and Methods: Cross-sectional, single-center study between 2013 and 2016 enrolled 97 patients and 100 lesions scheduled for BRS placement in long segment lesions (> 28 mm). BRS-BRS overlap was performed in 30 patients and 30 lesions, DES-BRS overlap was performed in 67 patients and 70 lesions. Acute procedural success and major adverse cardiac events (MACE) (death, stent thrombosis, and target lesion reintervention) were assessed. Results: Acute procedural success was 97.1% in the overall group. MACE was observed in 6 patients (6.2%) in the entire group, 4 (5.9%) in the DES-BRS group, and 2 (6.6%) in the BRS-BRS group. Conclusion: BRS use might be a safe and effective option for the treatment of long segment lesions. Both BRS-BRS overlap and BRS-DES overlap may be performed with short overlap segment.Giriş: Uzun segment lezyonlarda biyoeriyebilen stentlerin (BRS) kullanımı ile ilgili sınırlı bilgimiz olduğundan hem BRS-BRS hem de İlaç salınımlı metal stent (DES)-BRS overlap uygulanan hastaların klinik sonuçlarını değerlendirmeyi planladık. Hastalar ve Yöntem: Tek merkezli, kesitsel planlanan; Ocak 2013-Haziran 2016 tarihleri arasında uzun segment lezyonlara (> 28 mm) BRS yerleştirilmesi planlanan 97 hasta ve 100 lezyon çalışmaya alındı. Otuz hasta ve 30 lezyonda BRS-BRS overlap uygulanırken , 67 hasta 70 lezyona DES-BRS overlap uygulandı. Akut işlem başarısı ve MACE (ölüm, stent trombozu, hedef damara yeniden girişim) değerlendirildi. Bulgular: Akut işlem başarısı %97.1 idi. Tüm hasta grubunda toplam MACE 6 (%6.2) hastada gelişirken, DES-BRS grubunda 4 (%5.9), BRS-BRS grubunda 2 (%6.6) hastada MACE gerçekleşti. Sonuç: Uzun segment lezyonlarda BRS kullanımı seçenek olarak değerlendirilebilinir. BRS-BRS veya BRSDES overlap yapacak şekilde yerleştiriken kısa segment overlap olacak şekilde gerçekleştirilmelidir

Efficacy of different self-assessment anxiety scales for predicting radial artery spasm during coronary interventions

European-Society-of-Cardiology Congress -- AUG 25-29, 2018 -- Munich, GERMANYWOS: 000459824001042…European Society of Cardiolog

Acute myocarditis or Kounis Syndrome? Role of cardiac MRI and speckle-tracking echocardiography for differential diagnosis

WOS: 000335966800237

Pocket haematoma after cardiac electronic device implantation in patients receiving antiplatelet and anticoagulant treatment: A single-centre experience

Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (ß = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (ß = –0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations

A novel predictor of radial spasm: Arterial stiffness

WOS: 000445748200006PubMed ID: 29985200ObjectiveIn this study, we aimed to assess the relationship between radial artery spasm (RAS) and arterial stiffness (AS) measured by the oscillometric method.Materials and methodsA total of 123 consecutive patients scheduled for elective coronary angiography in a single default radial center were enrolled for the study. AS [namely, augmentation pressure; augmentation index (AIx); and pulse wave velocity] was assessed using a validated oscillometric device (Mobil-O-Graph NG 24h PWA). Central arterial pressures were also recorded. In the cath lab, the number of puncture attempts, total procedural time (TPT), and largest catheter size were noted. If greater than two catheters were required to complete imaging, it was additionally specified. RAS was considered to exist if two or more of predefined clinical features were present.ResultsRAS was observed in 20 (16.3%) patients. Patients were divided into two distinct groups in terms of the occurence of RAS. In the RAS(+) group, the proportion of hypertensive individuals was significantly higher, whereas there were fewer smokers. With respect to operational data, TPT (24.39.8 vs. 29.3 +/- 9.1mins; P=0.038) and procedures carried out with more than one puncture attempts were significantly higher in the RAS(+) group. Among all oscillometric parameters, augmentation pressure, AIx, and PR were found to be higher in the RAS(+) group. According to multivariate analysis, TPT (P=0.029) and AIx (odds ratio: 1.044, 95% confidence interval=0.977-1.117; P=0.009) were found to be independent predictors of RAS.ConclusionAlong with conventional risk factors, AS assessment, as a practical, noninvasive method, may help to predict RAS in angiographic procedures