Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry

Objective: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. Methods: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. Results: A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group. Conclusions: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success

Correlation between CMR T2* and advanced echocardiographic right ventricular function criteria in patients with major thalassemia

Background: Tissue iron deposition is an important adverse effect in patients with major thalassemia, leading to right-sided heart failure. This study was performed to determine the association between cardiovascular magnetic resonance using T2-weighted sequences (CMR T2*) and advanced echocardiographic right ventricular (RV) function criteria in patients with major thalassemia at Rajaie Cardiovascular, Medical, and Research Center in 2014 and 2015. Method: This comparative study assessed the association between CMR T2* and advanced echocardiographic RV function criteria in 38 patients with major thalassemia at Rajaie Cardiovascular, Medical, and Research Center in 2014 and 2015. Results: CMR T2* was correlated with the RV E/E� (echo) (P = 0.0001, r = -0.681), TAPSE (echo) (P = 0.001, r = 0.504), RVEDV (CMR) (P = 0.008, r = 0.425), and RVEDV/BSA (CMR) (P = 0.005, r = 0.443) according to the Spearman test. Additionally, CMR T2* was associated with the basal RV Sm (echo) (P = 0.0001, r = 0.626), RV strain (echo) (P = 0.034, r = 0.382), RVEDV/H (CMR) (P = 0.002, r = 0.483), LVEDV (CMR) (P = 0.022, r = 0.372), and LVEDV/H (CMR) (P = 0.017, r = 0.385) according to the Pearson test. Conclusions: Totally, according to the obtained results, it may be concluded that the RV E/E�, TAPSE, basal RV Sm, and RV strain from echocardiography and the RVEDV, RVEDV/BSA, RVEDV/H, LVEDV, and LVEDV/H from CMR may be indicators of myocardial iron overload in patients with major thalassemia. © 2018, Iranian Heart Association. All rights reserved

Correlation between CMR T2* and advanced echocardiographic right ventricular function criteria in patients with major thalassemia

Background: Tissue iron deposition is an important adverse effect in patients with major thalassemia, leading to right-sided heart failure. This study was performed to determine the association between cardiovascular magnetic resonance using T2-weighted sequences (CMR T2*) and advanced echocardiographic right ventricular (RV) function criteria in patients with major thalassemia at Rajaie Cardiovascular, Medical, and Research Center in 2014 and 2015. Method: This comparative study assessed the association between CMR T2* and advanced echocardiographic RV function criteria in 38 patients with major thalassemia at Rajaie Cardiovascular, Medical, and Research Center in 2014 and 2015. Results: CMR T2* was correlated with the RV E/E� (echo) (P = 0.0001, r = -0.681), TAPSE (echo) (P = 0.001, r = 0.504), RVEDV (CMR) (P = 0.008, r = 0.425), and RVEDV/BSA (CMR) (P = 0.005, r = 0.443) according to the Spearman test. Additionally, CMR T2* was associated with the basal RV Sm (echo) (P = 0.0001, r = 0.626), RV strain (echo) (P = 0.034, r = 0.382), RVEDV/H (CMR) (P = 0.002, r = 0.483), LVEDV (CMR) (P = 0.022, r = 0.372), and LVEDV/H (CMR) (P = 0.017, r = 0.385) according to the Pearson test. Conclusions: Totally, according to the obtained results, it may be concluded that the RV E/E�, TAPSE, basal RV Sm, and RV strain from echocardiography and the RVEDV, RVEDV/BSA, RVEDV/H, LVEDV, and LVEDV/H from CMR may be indicators of myocardial iron overload in patients with major thalassemia. © 2018, Iranian Heart Association. All rights reserved

Outcome of primary PCI in ST-segment-elevation myocardial infarction

Background: We sought to assess the feasibility and outcome of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: Between April 2014 and April 2015, consecutive STEMI patients who underwent primary PCI were prospectively enrolled in a primary PCI registry. The patients� demographics, risk factors, procedural characteristics, and in-hospital and 6-month major adverse cardiac events (MACE) were assessed. Results: A total of 393 patients underwent primary PCI during this period. The mean age was 58±11 years and 80.6 were male. Additionally, 40.7 of the patients were hypertensive, 37.9 had dyslipidemia, 37.7 were smokers, and 29 had diabetes mellitus. Single-vessel disease was found in 36.6 of the study population, 2-vessel disease in 30.5, and multivessel disease in 27.7. At admission, 74.5 of the patients had TIMI grade 0 flow. Following revascularization, 74.7 achieved TIMI grade 3 flow, 22 TIMI grade 2 flow, and 1.8 TIMI grade 1 flow�whereas 1.5 had TIMI grade 0 flow. The predictors of the TIMI flow grade after primary PCI included history of diabetes mellitus, lesion severity, time elapsed from symptom onset to admission, and use of thrombectomy. Stent thrombosis developed in 5.6 of the patients; it was more frequent among those receiving bare-metal stents. The in-hospital and 6-month mortality rates were 5.9 and 2.3, correspondingly. In-hospital mortality was strongly related to the TIMI flow grade. Conclusions: Our study demonstrated that the outcome of primary PCI was strongly related to the postprocedural TIMI flow grade. Patients with lower TIMI flow grades postprocedurally should receive special attention. © 2016, Iranian Heart Association. All rights reserved