In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure

The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p 1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications

Clinical Presentation and Angiographic Characteristics of Saphenous Vein Graft Failure After Stenting Insights From the SOS (Stenting Of Saphenous Vein Grafts) Trial

ObjectivesWe sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS).BackgroundThe mode of SVG failure after stenting has been poorly characterized.MethodsThe SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients.ResultsBinary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non–ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG.ConclusionsSVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure

Brain cytochrome‐c‐oxidase as a marker of mitochondrial function: A pilot study in major depression using NIRS

Background Brain mitochondrial dysfunction is implicated in the pathophysiology of mood disorders. Brain cytochrome‐c‐oxidase (COX) activity is associated with the mitochondrial function. Near‐infrared spectroscopy (NIRS) noninvasively measures oxidized COX (oxCOX) and tissue oxygenation index (TOI) reflecting cerebral blood flow and oxygenation. Methods oxCOX and TOI were assessed in prefrontal cortex (Fp1/2, Brodmann area 10) in patients in a major depressive episode (N = 13) with major depressive disorder (MDD; N = 7) and bipolar disorder (BD; N = 6) compared with the controls (N = 10). One patient with MDD and all the patients with BD were taking medications. Computational modeling estimated oxCOX and TOI related indices of mitochondrial function and cerebral blood flow, respectively. Results oxCOX was lower in patients than controls (p = .014) correlating inversely with depression severity (r = −.72; p = .006), driven primarily by lower oxCOX in BD compared with the controls. Computationally modeled mitochondrial parameters of the electron transport chain, such as the nicotinamide adenine dinucleotide ratio (NAD+/NADH; p = .001) and the proton leak rate across the inner mitochondrial membrane (klk2; p = .008), were also lower in patients and correlated inversely with depression severity. No such effects were found for TOI. Conclusions In this pilot study, oxCOX and related mitochondrial parameters assessed by NIRS indicate an abnormal cerebral metabolic state in mood disorders proportional to depression severity, potentially providing a biomarker of antidepressant effect. Because the effect was driven by the medicated BD group, findings need to be evaluated in a larger, medication‐free population

intomas de ansiedade e depressão em adultos e idosos na pós-intervenção coronária percutânea.

Cardiovascular diseases are among the leading causes of disability and death. One of the forms of treatment for them is the percutaneous coronary intervention (PCI). After a diagnosis or cardiac procedure, patients have psychological symptoms that often go unnoticed and interfere with their health condition. The aim of this article was to evaluate the intensity of anxiety and depression symptoms in adult and elderly patients hospitalized after PCI. The design of the study was cross-sectional, analytical, correlational and comparative. Participants were 266 patients who had undergone PCI. Their average age was 64.5 years (SD =8.9 years) and most of them were men (68%) with a diagnosis of acute myocardial infarction (AMI) (64.3%). The research instruments used were the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory - Second Edition (BDIII). Data collection was performed during the patients’ hospitalization and statistical analysis was carried out by means of the Chi-SquareTest, the Kolmogorov –Smirnov Test and ANOVA. The level of significance used was p ≤ .05. Results showed that the majority of patients presented severe symptoms of anxiety (29.7%) and minimum intensity depressive symptoms (51.9%). The study highlights the importance of assessing and treating psychological symptoms after PCI as these interfere with the patient’s adherence to treatment and with their quality of life.Las enfermedades cardiovasculares están entre las principales causas de incapacidad y mortalidad en el mundo, pero existe un modo de tratamiento para estas denominado intervención coronaria percutánea (ICP). Después de un diagnóstico o procedimiento cardiaco, los pacientes presentan síntomas psicológicos que a menudo pasan desapercibidos e interfieren con su condición de salud. El objetivo del presente artículo fue evaluar la intensidad de los síntomas de ansiedad y depresión en pacientes adultos y adultos mayores hospitalizados después de una ICP. Se utilizó un diseño transversal, analítico, correlacional y comparativo. En total, participaron 266 pacientes a quienes se les había realizado ICP, estos tenían un promedio de edad de 64.5 años (DE = 8.9), 68 % eran hombres y 64.3 % presentaban diagnóstico de infarto agudo de miocardio (IAM). Se utilizó el Inventario de Ansiedad de Beck (BAI) y el Inventario de Depresión de Beck - Segunda Edición (BDI-II) como instrumentos de investigación, y la recolección de datos se realizó durante la hospitalización del paciente. El análisis de datos se llevó a cabo por medio de las pruebas Chi-Cuadrado, Kolmogorov-Smirnov y ANOVA, con un nivel de significancia de p ≤ .05. Los resultados muestran que la mayoría de los pacientes presentó síntomas de ansiedad graves (29.7 %) y síntomas depresivos de intensidad mínima (51.9 %). Estos resultados destacan la importancia de evaluar y tratar los síntomas psicológicos post ICP, debido a que estos interfieren en la adhesión al tratamiento y en la calidad de vida del paciente.As doenças cardiovasculares estão entre as principais causas de incapacidade e mortalidade no mundo. Um dos tratamentos indicados é a intervenção coronária percutânea (ICP). Após um diagnóstico ou procedimento cardíaco, os pacientes apresentam sintomas psicológicos que costumam passar despercebidos e interferem na sua condição de saúde. O objetivo do presente artigo foi avaliar a intensidade dos sintomas de ansiedade e depressão em pacientes adultos e idosos hospitalizados depois de uma ICP. Trata-se de um estudo transversal, analítico, correlacional e comparativo. Participaram 266 pacientes que realizaram ICP. A média de idade dos pacientes foi de 64.5 anos (DP = 8.9), 68% eram homens e 64.3% apresentavam diagnóstico de infarto agudo do miocárdio (IAM). Utilizou-se o Inventário de Ansiedade de Beck (BAI) e o Inventário de Depressão de Beck - Segunda Edição (BDI-II) como instrumentos de pesquisa e a coleta de dados foi realizada durante a hospitalização do paciente. A análise de dados foi realizada por meio dos testes Qui-Quadrado, Kolmogorov-Smirnov e ANOVA, com um nível de significância de p ≤ .05. Os resultados mostram que a maioria dos pacientes apresentou sintomas de ansiedade graves (29.7%) e sintomas depressivos de intensidade mínima (51.9%). Esses resultados destacam a importância de avaliar e tratar os sintomas psicológicos pós-ICP, uma vez que interferem na adesão ao tratamento e na qualidade de vida do paciente