Does the use of rotational atherectomy procedure during percutaneous coronary interventions influence the frequency of procedure-related myocardial injury assessed by cardiac magnetic resonance?

The usage of gadolinium-enhanced cardiac magnetic resonance (CMR) in the differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease has been demonstrated in previously published studies. It currently remains one of the basic methods for assessing myocardial ischemia, which has been reflected in many international guidelines, including those of the European Society of Cardiology (1-3). Also, T2 mapping for myocardial edema, cine CMR for regional wall motion abnormalities, rest first pass and adenosine stress perfusion are well sanctioned methods of myocardial ischemia assessment, also used in patients with acute coronary syndromes (4-6)

Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission

The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patientswith AMI. Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA. This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am-10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm-6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan-Meier method. The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P=.001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan-Maier survival curves (P=.001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P=.099). Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period

Impact of sex on the follow-up course and predictors of clinical outcomes in patients hospitalised due to myocardial infarction with non-obstructive coronary arteries : a single-centre experience

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs more often in women. Aims: We sought to assess the relationship between sex and clinical outcomes during follow-up in patients after MINOCA and to identify predictors of major adverse cardiac and cerebrovascular events (MACCE). Methods: The study comprised 134 patients (78 women) at the mean age of 61.6 years, who were diagnosed with MINOCA at the Department of Cardiology between January 2015 and June 2018. The mean follow-up duration was 609.5 ± 412.2 days. Pri­mary study endpoints were MACCE, which included all-cause death, myocardial infarction, reintervention, and cerebral stroke. Secondary endpoints were recurrent chest pain during follow-up and rehospitalisation for reasons other than MACCE. Results: Kaplan-Meier survival curve analysis did not reveal any significant differences in the frequency of MACCE (p = 0.63) or mortality rate (p = 0.29) between men and women. There was no significant impact of sex on secondary study endpoints either. Sex was not identified as a predictor of primary or secondary study endpoints in univariate or multivariate analysis. Troponin index (risk ratio [RR] 1.002; 95% confidence interval [CI] 1.0005–1.0026, p = 0.004), age (RR 1.04; 95% CI 1.008–1.065, p = 0.01), serum creatinine level (RR 1.01; 95% CI 1.001–1.01, p = 0.02), hyperlipidaemia (RR 0.26; 95% CI 0.07–0.75, p = 0.01), and prior venous thromboembolic disease (RR 8.28; 95% CI 1.15–38, p = 0.04) were found to be predictors of MACCE in multivariate analysis. Conclusions: Sex was not found to be significantly associated with clinical outcomes during the follow-up period in patients with MINOCA

Chronic obstructive pulmonary disease affects the angiographic presentation and outcomes of patients with coronary artery disease treated with percutaneous coronary interventions

The incidence of chronic obstructive pulmonary disease (COPD) in patients treated with percutaneous coronary intervention (PCI) is underestimated, and the effect of COPD on atherosclerosis and the outcomes of PCI is not fully understood. The aim of this study was to assess the impact of COPD on periprocedural outcomes of PCI, as well as its relationship with clinical presentation and the type of coronary artery lesions. Data were prospectively collected using a national electronic registry of PCI procedures performed in Poland between January 2015 and December 2016. Out of the 221 187 PCIs, 5594 patients had been diagnosed with COPD before the intervention. Patients with COPD were older than those without COPD (mean [SD] age, 70.3 [9.9] years vs 67 [$^{10.8]}$ years; P <0.001) and more often were males (72.3% vs 67.8%; P <0.001). Non-ST‑segment elevation myocardial infarction (NSTEMI) was a more common clinical presentation of coronary artery disease (CAD) in the COPD group, while ST‑segment elevation myocardial infarction (STEMI) occurred more frequently in the non‑COPD group. Multivessel disease (MVD) with or without left main coronary artery (LMCA) involvement and separate LMCA was diagnosed more often in the COPD group. At baseline, the culprit lesion was more often restenosis and in‑stent thrombosis in the COPD group, whereas de‑novo lesion-in the non‑COPD group. The rates of periprocedural mortality and myocardial infarction did not differ between the groups with and without COPD (0.13% vs 0.12%, P = 0.88 and 0.53% vs 0.45%, P = 0.39, respectively). COPD was found to be an independent predictor of restenosis assessed before PCI in patients with a history of PCI (P = 0.006). Patients with COPD diagnosed before PCI are at an increased risk of MVD with or without LMCA involvement and NSTEMI. Restenosis and in‑stent thrombosis occur more often in patients with COPD before PCI

Bailout rotational atherectomy in patients with myocardial infarction is not associated with an increased periprocedural complication rate or poorer angiographic outcomes in comparison to elective procedures (from the ORPKI Polish National Registry 2015-2016)

Introduction: Many years of experience and refinement of existing rotational atherectomy (RA) techniques have resulted in improved clinical outcomes and a tendency to broaden the spectrum of RA usage. Aim: To compare the angiographic effectiveness and periprocedural complications in patients with stable angina (SA) and acute myocardial infarction (AMI) treated using RA. Material and methods: Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all percutaneous coronary interventions (PCIs) performed in Poland in 2015 and 2016. In total, 975 RA procedures were recorded out of 221,187 PCI procedures. Results: We compared angiographic effectiveness and periprocedural complications in 530 patients with SA and 245 with AMI in the RA group of patients, and 60,522 patients with SA and 91,985 with AMI in the non-RA group. The overall rate of periprocedural complications did not differ between SA and AMI patients in the RA group (2.3% vs. 2.0%; p = 0.84), while it was lower in AMI patients from the RA group compared to those from the non-RA group (2.0% vs. 3.0%; p = 0.34). The percentage of patients with angiographic success in the RA group was similar to the non-RA group in SA patients (97.3% vs. 97.1%; p = 0.75), whereas in the AMI group it was significantly higher compared to the non-RA group (96.7% vs. 92.6%; p < 0.001). Conclusions: The angiographic effectiveness of PCI with RA in patients with AMI was not worse than in patients with SA

Transradial and transfemoral approach in patients with prior coronary artery bypass grafting

The relationship between periprocedural complications and the type of vascular access in patients with prior history of coronary artery bypass grafting (CABG) and treated with percutaneous coronary interventions (PCIs) is less investigated than in the overall group of patients treated with PCI. The aim of the current study was to assess the relationship between the type of vascular access and selected periprocedural complications in a group of patients with prior history of CABG and treated with PCIs. Based on a Polish nationwide registry of interventional cardiology procedures called ORPKI, the authors analyzed 536,826 patients treated with PCI between 2014 and 2018. The authors extracted 32,225 cases with prior history of CABG. Then, patients with femoral and radial access as well as right and left radial access were compared. This comparison was proceeded by propensity score matching (PSM). After PSM, a multifactorial analysis revealed that patients treated with PCI from femoral access were significantly more often related to periprocedural deaths (odds ratio [OR]: 1.79; 95%, confidence interval [CI]: 1.1–3.0, p = 0.02) and cardiac arrests (OR: 1.98; 95%, CI: 1.38–2.87, p < 0.001). After inclusion of the Killip class grade and the occurrence of cardiac arrests before PCI into the PSM, the significance remained for procedural related cardiac arrests (OR: 1.55; 95%, CI: 1.07–2.28, p = 0.022]). However, a comparison of right and left radial access showed no significant differences between procedure-related complications. It has been confirmed that there is a statistical association between femoral access (compared to radial access) and a higher rate of periprocedural cardiac arrests in patients with prior history of CABG treated with PCI