Intracoronary imaging guided percutaneous coronary intervention outcomes among individuals with cardiogenic shock

BACKGROUND: Limited data exist around the utility of intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and cardiogenic shock (CS), who are inherently at a high risk of stent thrombosis (ST). METHODS: All PCI procedures for ACS patients with CS in England and Wales between 2014 and 2020 were retrospectively analysed, stratified into two groups: ICI and angiography-guided groups. Multivariable logistic regression analyses were performed to examine odds ratios (OR) of in-hospital outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE; composite of all-cause mortality, acute stroke/transient ischaemic attack (TIA), and reinfarction) and major bleeding, in the ICI-guided group compared with angiography-guided PCI. RESULTS: Of 15,738 PCI procedures, 1240(7.9%) were ICI-guided. The rate of ICI use amongst those with CS more than doubled from 2014 (5.7%) to 2020 (13.3%). The ICI-guided group were predominantly younger, males, with a higher proportion of non-ST-elevation ACS and ST. MACCE was significantly lower in the ICI-guided group compared with the angiography-guided group (crude: 29.8% vs. 38.2%, adjusted odds ratio (OR) 0.65 95% confidence interval [CI] 0.56-0.76), driven by lower all-cause mortality (28.6% vs. 37.0%, OR 0.65 95% CI 0.55-0.75). There were no differences in other secondary outcomes between groups. CONCLUSION: ICI use among CS patients has more than doubled over 6 years but remains significantly under-utilized, with less than 1-in-6 patients in receipt of ICI-guided PCI by 2020. ICI-guided PCI is associated with prognostic benefits in CS patients and should be more frequently utilized to increase their long-term survival

Outcomes of nonemergent percutaneous coronary intervention requiring mechanical circulatory support in patients without cardiogenic shock

BACKGROUND: The utilization of mechanical circulatory support (MCS) for percutaneous coronary intervention (PCI) using percutaneous ventricular assist device (PVAD) or intra-aortic balloon pump (IABP) has been increasing. We sought to evaluate the outcome of coronary intervention using PVAD compared with IABP in noncardiogenic shock and nonacute myocardial infarction patients. METHOD: Using the National Inpatient Sampling (NIS) database from 2005 to 2014, we identified patients who underwent PCI using ICD 9 codes. Patients with cardiogenic shock, acute coronary syndrome, or acute myocardial infarction were excluded. Patient was stratified based on the MCS used, either to PVAD or IABP. Univariate and multivariate logistic regression were performed to study PCI outcome using PVAD compared with IABP. RESULTS: Out of 21,848 patients who underwent PCI requiring MCS, 17,270 (79.0%) patients received IABP and 4,578 (21%) patients received PVAD. PVAD patients were older (69 vs. 67, p \u3c .001), were less likely to be women (23.3% vs. 33.3%, p \u3c .001), and had higher rates of hypertension, diabetes, hyperlipidemia prior PCI, prior coronary artery bypass graft surgery, anemia, chronic lung disease, liver disease, renal failure, and peripheral vascular disease compared with IABP group (p ≤ .007). Using Multivariate logistic regression, PVAD patients had lower in-hospital mortality (6.1% vs. 8.8%, adjusted odds ratio [aOR] 0.62; 95% CI 0.51, 0.77, p \u3c .001), vascular complications (4.3% vs. 7.5%, aOR 0.78; 95% CI 0.62, 0.99, p = .046), cardiac complications (5.6% vs. 14.5%, aOR 0.29; 95% CI 0.24, 0.36, p \u3c .001), and respiratory complications (3.8% vs. 9.8%, aOR 0.37; 95% CI 0.28, 0.48, p \u3c .001) compared with patients who received IABP. CONCLUSION: Despite higher comorbidities, nonemergent PCI procedures using PVAD were associated with lower mortality compared with IABP

Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography.

BACKGROUND: The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES: This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS: Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed unfavorable feature on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS: Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age \u3e85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC \u3e30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate \u3e7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH85 years, time-to-ROSC \u3e30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge. CONCLUSIONS: Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable

Mechanical circulatory support for patients with cardiogenic shock

Mortality from cardiogenic shock primarily in the setting of acute myocardial infarction is unchanged at approximately 50%, despite the availability of advanced ventricular assist devices. A description of currently available mechanical circulatory support (MCS) devices is provided with a suggested algorithm for therapy with different MCS devices in cardiogenic shock. In order to increase survival placement of these devices in cardiogenic shock prior to percutaneous coronary intervention of the infarct related artery is strongly recommended

ESTIMATION OF TOTAL FACTOR PRODUCTIVITY GROWTH IN AGRICULTURE SECTOR IN PUNJAB, PAKISTAN: 1970-2005

An experiment was conducted at Postharvest laboratory, Department of Horticulture, The University of Agriculture Peshawar, during 2010 to evaluate the "Influence of calcium chloride (CaCl 2 ) on fruit quality of pear (Pyrus communis) cv. Le-conte". The experiment was laid out in Randomized Complete Block Design (RCBD) with three factors i.e. CaCl 2 concentration (0, 3, 6 and 9%), dipping time (5, 10 and 15 minutes) and storage durations (0, 10, 20, 30 and 40 days). The maximum ascorbic acid (7.93 mg/100 g), reducing sugar (5.86%), while the least percent weight loss (4.52%), pH of fruit juice (4.42), total soluble solids (TSS) (19.83%) and percent disease incidence (2.56%) were observed in fruits treated with 9% CaCl 2 solution. The dipping time also significantly influenced the quality attributes of pear fruits during storage. The more ascorbic acid (6.88 mg/100 g) and reducing sugar (5.44%) were recorded in the pear fruits dipped for 15 minutes. Storage duration significantly affected the fruit quality during 40 days storage. The highest reducing sugar recorded in fresh pear fruits while the highest ascorbic acid (7.83 mg/100 g) were observed in pear fruit stored for 10 days storage duration, while more non-reducing sugar (7.03%) recorded in the fruits stored for 30 days. In the interaction of CaCl 2 concentration × dipping time, the highest total soluble solid (31.88%) noted in the fruits stored for 40 days and dipped for 5 minutes in CaCl 2 solution. It is concluded that pear fruit perform best in the postharvest life when treated with 9% CaCl 2 solution and dipped for 15 minutes. It retained most of the quality attributes up to 10 days storage at ambient temperature while a significant decline was recorded in fruit quality when extended the storage duration from 20 to 40 days

A Practical Approach to Mechanical Circulatory Support in Patients Undergoing Percutaneous Coronary Intervention: An Interventional Perspective

Percutaneous mechanical circulatory support has been used to stabilize patients in cardiogenic shock and provide hemodynamic support during high-risk percutaneous coronary interventions for several decades. The goal of this paper is to provide a practical approach to percutaneous mechanical circulatory support in patients undergoing percutaneous coronary intervention with cardiogenic shock and/or high risk features to aid in decision making for interventional cardiologists