Tissue coverage of paclitaxel and sirolimus eluting stents in long term follow-up: Optical coherence tomography study

Background: Implantation of drug eluting stents (DES) has become a standard treatment ofpatients undergoing percutaneous coronary intervention (PCI). Incomplete strut coverage isa potential risk factor for late stent thrombosis. Optical coherence tomography (OCT) enablesin vivo identification of incomplete neointimal coverage.Methods: Study included 62 patients after sirolimus eluting stents (SES) or paclitaxel elutingstents (PES) implantation. OCT examination was performed at least 24 months after theinitial procedure (35.4± 9.4 months). In cross-sectional still frames selected from each 1 mm ofanalyzed stents a total number of visible struts and number of struts with or without completeneointimal coverage was assessed. Measurements of neointimal coverage, presented as a meanthickness of tissue, were performed. Patients were followed up for 3 years and the frequency ofmajor adverse cardiac events was recorded.Results: In the analyzed 28 SES and 37 PES 9998 struts were identified. Complete neointimalcoverage was observed in 83.5% and 79.2% of SES and PES struts respectively (p = 0.48).There was no difference in incidence of not covered or malapposed struts between SES and PES groups. Mean thickness of the tissue covering SES struts was 0.165 ± 0.095 mm, and 0.157 ± 0.121 mm for PES. The mean neointimal thickness difference (SES vs. PES) was notstatistically significant. In a 36 months follow-up 1 death was observed — potentially attributedto stent thrombosis.Conclusions: A long term OCT follow-up after DES implantation shows high incidence ofuncovered struts regardless of the stent type. Clinical significance of this finding remains questionableand requires further large scale trials

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

Background: Bioresorbable vascular scaffold (BVS) implantation is a new, promising treat­ment method of coronary artery disease. Preliminary data in patients with stable angina are encouraging. However, the utility of BVS was not sufficiently evaluated in the setting of acute thrombotic lesions. The aim of this study was an optical coherence tomography (OCT) assessment of acute procedural result of the everolimus-eluting BVS implantation in patients with ST segment elevation myocardial infarction (STEMI) and evaluation of mid-term clinical outcomes. Methods: OCT examination was conducted in 23 STEMI patients who underwent primary angioplasty with BVS implantation. Off-line qualitative and quantitative coronary angiography and OCT analyses were performed by an independent core laboratory. Results: Successful procedural and clinical results were achieved in 95.7% of patients, and device success was observed in all patients. In OCT evaluation, most of the struts (95.4 ± ± 7.96%) were well apposed, 4.6 ± 5.71% were classified as malapposed. The final minimum lumen diameter was 2.6 ± 0.35 mm, minimum scaffold area was 6.9 ± 1.54 mm2 and final residual stenosis was 8.8 ± 24.37%. Edge dissections were found in 3 (7.7%) lesions. Median follow-up period was 229 (interquartile range 199–248) days. One myocardial infarction, due to sub-acute stent thrombosis, occurred in a patient who discontinued pharmacotherapy. Conclusions: The study shows that everolimus-eluting BVS implantation in STEMI is safe and feasible. The OCT evaluation confirmed excellent acute performance with appropriate scaffold expansion and low rate of malapposition.  

Standard podstawowej opieki kardiologicznej w zakresie prewencji chorób układu sercowo-naczyniowego w warunkach ambulatoryjnych - doniesienie wstępne programu POLKARD-SPOK

W pracy przedstawiono wstępne wyniki drugiej edycji badania POLKARD-SPOK (Standard Podstawowej Opieki Kardiologicznej), którego celem jest ocena opieki kardiologicznej w warunkach podstawowej opieki zdrowotnej (POZ). Badaną populację stanowili chorzy z grupy wysokiego ryzyka zgonu z przyczyn sercowo-naczyniowych w perspektywie kolejnych 10 lat, wyselekcjonowani według kryteriów Systematic Coronary Risk Evaluation (SCORE), zalecanych przez Europejskie Towarzystwo Kardiologiczne (ESC, European Society of Cardiology). Przedstawiono dane pochodzące z 6827 ankiet przeprowadzonych w reprezentatywnej, wybranej losowo próbie 314 lekarzy POZ. Spośród ankietowanych 80,3% stanowili pacjenci z udokumentowaną chorobą niedokrwienną serca lub innym stanem uznawanym za ekwiwalent ryzyka. Pozostałe 19,7% stanowili pacjenci z co najmniej jednym czynnikiem ryzyka, bez jawnych klinicznie cech choroby niedokrwiennej serca. Oszacowana wartość ryzyka zgonu z przyczyn sercowo-naczyniowych w perspektywie 10 lat w badanej populacji wyniosła 6,9%. Wstępna analiza danych, pochodzących z drugiej edycji programu POLKARD-SPOK, potwierdza znaczną częstość poddających się modyfikacji czynników ryzyka wśród pacjentów zagrożonych wysokim ryzykiem zgonu z przyczyn sercowo-naczyniowych, określonego według kryteriów SCORE. Wdrożenie zasad profilaktyki kardiologicznej przez lekarzy POZ u tych chorych ma zasadnicze znaczenie w obniżaniu zarówno śmiertelności, jak i zapadalności na choroby układu sercowo-naczyniowego

Long-term outcomes and quality of life following implementation of dedicated mitral valve Heart Team decisions for patients with severe mitral valve regurgitation in tertiary cardiovascular care center

Background: This study was purposed to investigate which treatment strategy was associated with the most favourable prognosis for patients with severe mitral regurgitation (MR) following Heart Team (HT)-decisions implementation. Methods: In this retrospective study, long-term outcomes of patients with severe MR qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and MitraClip (MC) procedure or OMT and mitral valve replacement (MVR) were evaluated. The primary endpoint was defined as cardiovascular (CV) death and the secondary endpoints included all-cause mortality, myocardial infarctions (MI), strokes, hospitalizations for heart failure exacerbation and CV events during a mean (standard deviation [SD]) follow-up of 29 (15) months. Results: From 2016 to 2019, 176 HT meetings were held and a total of 157 participants (mean age [SD] = 71.0 [9.2], 63.7% male) with severe MR and completely implemented HT decisions (OMT, MC or MVR for 53, 58 and 46 patients, respectively) were included into final analysis. Comparing OMT, MC and MVR groups statistically significant differences between the implemented procedures and occurrence of primary and secondary endpoints with the most frequent in OMT-group were observed (p < 0.05). However, for interventional strategy MC was non-inferior to MVR for all endpoints (p > 0.05). General health status assessed at the end of follow-up were significantly the lowest for MVR, then for MC and the highest for OMT-group (p < 0.01). Conclusions: In the present study it was demonstrated that after careful HT evaluation of patients with severe MR at high risk of surgery, percutaneous strategy (MC) can be considered as equivalent to surgical treatment (MVR) with non-inferior outcomes

Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies

Objectives: The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. Background: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ∼10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. Methods: The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. Results: Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. Conclusions: This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data