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Hemetsberger R, Mankerious N, Muntané-Carol G, Temporal J, Sulimov D, Gaede L, Woitek F, Grau EF, Scalamogna M, Olschewski M, Mitsis A, Ruzsa Z, Toth GG, Heyer H, Toelg R, Gómez-Hospital JA, Mügge A, Hengstenberg C, Mangner N, Gori T, Cassese S, Suárez XC, Abdel-Wahab M, Johnson T, Richardt G, Allali A. In-hospital Outcomes of Rotational Atherectomy in ST-Elevation Myocardial Infarction: Results From the Multicentre ROTA-STEMI Network. Can J Cardiol 2024; 40:1226-1233. [PMID: 38147962 DOI: 10.1016/j.cjca.2023.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Although the use of rotational atherectomy (RA) is off-label in the setting of ST-elevation myocardial infarction (STEMI), it can be the only option in severely calcified culprit lesions to achieve procedural success. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention (PPCI). METHODS This was a retrospective observational study of patients who underwent RA during PPCI from 12 European centres. The main outcomes were procedural success (defined as successful stent implantation with final thrombolysis in myocardial infarction [TIMI] flow 3 and residual stenosis < 30%) and in-hospital mortality. A comparison of patients presenting with and without shock was performed. RESULTS In 104 patients with RA during STEMI, the mean age was 72.8 ± 9.1 years, and 35% presented with cardiogenic shock. Bailout RA was performed in 76.9% of cases. Mean burr size was 1.42 ± 0.21 mm. Procedural success was achieved in 86.5% of cases, with no difference between shocked and nonshocked patients (94.4% vs 82.4%; P = 0.13). In-hospital stent thrombosis occurred in 0.96%, perforation in 1.9% and burr entrapment in 2.9% of cases. In spite of equally high procedural success, in-hospital mortality was higher in shocked (50%) compared with nonshocked patients (1.5%; P < 0.0001). CONCLUSIONS Patients presenting with STEMI requiring RA, represent a high-risk population, frequently presenting with cardiogenic shock. In this analysis of selected patients, RA was performed as a bailout strategy in the majority, and, as such, RA seems to be feasible with a high procedural success rate. In the absence of cardiogenic shock, RA-facilitated PCI seems to be associated with low in-hospital mortality.
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Affiliation(s)
- Rayyan Hemetsberger
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
| | - Nader Mankerious
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Department of Cardiology, Zagazig University, Sharkia, Egypt
| | | | - Justin Temporal
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Dmitriy Sulimov
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Luise Gaede
- Medizinische Klinik 2, Department of Cardiology and Angiology, Universitätsklinikum Erlangen, and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Felix Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Edgar Fadeuilhe Grau
- Unitat Hemodinamica i Cardiologia Intervencionista. Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Maria Scalamogna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Department of Advanced Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Maximilian Olschewski
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Zoltán Ruzsa
- Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szegad, Hungary
| | | | - Hajo Heyer
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Ralph Toelg
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Asklepios Clinic, Bad Oldesloe, Germany; Medical faculty of the Christian-Albrechts University of Kiel, Kiel, Germany
| | | | - Andreas Mügge
- Department of Cardiology and Angiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Christian Hengstenberg
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Xavier Carrillo Suárez
- Unitat Hemodinamica i Cardiologia Intervencionista. Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Johnson
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gert Richardt
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; Asklepios Clinic, Bad Oldesloe, Germany; Medical faculty of the Christian-Albrechts University of Kiel, Kiel, Germany
| | - Abdelhakim Allali
- Heart Center Bad Segeberg, Segeberger Kliniken GmbH, Bad Segeberg, Germany; University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
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2
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Doolub G, Ly HQ, Marquis-Gravel G. Should Rotational Atherectomy Be Used More Often in STEMI to Treat Calcified Culprit Lesions? Can J Cardiol 2024; 40:1234-1236. [PMID: 38278320 DOI: 10.1016/j.cjca.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Affiliation(s)
- Gemina Doolub
- From the Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Hung Q Ly
- From the Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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3
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Wang Q, Ma W, Zhang D, Zhang W, An J, Dou K, Li P, Jiang J, He Y, Tong Q, Zhang X, Pang W, Qiu C, Yang Q, Hu X, Zhong L, Cheng X, Peng X, Kan J, Zhang J, Zhang B, Li Y. Effectiveness and Safety of a Novel Intravascular Lithotripsy System for Severe Coronary Calcification: The CALCI-CRACK Trial. Can J Cardiol 2024:S0828-282X(24)00333-7. [PMID: 38670457 DOI: 10.1016/j.cjca.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Intravascular lithotripsy is effective and safe for managing coronary calcification; however, available devices are limited, and complex lesions have been excluded in previous studies. This study aimed to investigate the effectiveness and safety of a novel intravascular lithotripsy system for severe calcification in a population with complex lesions. METHODS CALCI-CRACK (treatment of severe calcified coronary lesions with a novel intracoronary shock wave lithotripsy system) (ChiCTR2100052058) was a prospective, single-arm, multicentre study. The primary end point was the procedural success rate. Major safety end points included major adverse cardiovascular events (MACE) and target lesion failure (TLF) at 30 days and 6 months, and severe angiographic complications. Calcification morphology was assessed in the optical coherence tomography (OCT) subgroup. RESULTS In total, 242 patients from 15 high-volume Chinese centres were enrolled, including 26.45% of patients with true bifurcation lesions, 3.31% with severely tortuous vessels, and 2.48% with chronic total occlusion, respectively. The procedural success rate was 95.04% (95% confidence interval 91.50%-97.41%), exceeding the prespecified performance goal of 83.4% (P < 0.001). The 30-day and 6-month MACE rates were 4.13% and 4.55%, respectively. TLF rates at those time points were 1.24% and 1.65%, respectively. Severe angiographic complications occurred in 0.42% of patients. In the OCT subgroup (n = 93), 93.55% of calcified lesions were fractured, and minimal lumen area increased from 1.55 ± 0.55 mm2 to 4.91 ± 1.22 mm2 after stent implantation, with acute gain rate of 245 ± 102%. CONCLUSIONS The novel intravascular lithotripsy system is effective and safe for managing severely calcified coronary lesions in a cohort that included true bifurcation lesions, severely tortuous vessels, and chronic total occlusion. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), number ChiCTR2100052058.
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Affiliation(s)
- Qiuhe Wang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Wenshuai Ma
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Dongwei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Wei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jian An
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, China
| | - Kefei Dou
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Li
- Department of Cardiology, First People's Hospital of Yulin, Yulin, China
| | - Jun Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Tong
- Department of Cardiology, Bethune First Hospital of Jilin University, Changchun, China
| | - Xiaoyong Zhang
- Department of Cardiology, Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, China
| | - Wenyue Pang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunguang Qiu
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinqun Hu
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Zhong
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiang Cheng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Peng
- Department of Cardiology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Zhang
- Department of Cardiology, Guangdong People's Hospital, Guangzhou, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, China.
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Brami P, Fischer Q, Pham V, Seret G, Varenne O, Picard F. Evolution of Coronary Stent Platforms: A Brief Overview of Currently Used Drug-Eluting Stents. J Clin Med 2023; 12:6711. [PMID: 37959177 PMCID: PMC10648187 DOI: 10.3390/jcm12216711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiovascular disease, including ischemic heart disease, is the leading cause of death worldwide, and percutaneous coronary interventions (PCIs) have been demonstrated to improve the prognosis of these patients on top of optimal medical therapy. PCIs have evolved from plain old balloon angioplasty to coronary stent implantation at the end of the last century. There has been a constant technical and scientific improvement in stent technology from bare metal stents to the era of drug-eluting stents (DESs) to overcome clinical challenges such as target lesion failure related to in-stent restenosis or stent thrombosis. A better understanding of the underlying mechanisms of these adverse events has led DESs to evolve from first-generation DESs to thinner and ultrathin third-generation DESs with improved polymer biocompatibility that seems to have reached a peak in efficiency. This review aims to provide a brief historical overview of the evolution of coronary DES platforms and an update on clinical studies and major characteristics of the most currently used DESs.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
- INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
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5
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Peles I, Barrett O, Cafri C, Garcia-Garcia H, Tsaban G, El-Nasasra A, Abramowitz Y, Shmueli H, Rosenstein G, Merkin M, Zahger D, Koifman E. Predictors of Adverse Outcome in High-Risk Percutaneous Coronary Interventions Patients. Can J Cardiol 2023; 39:1369-1379. [PMID: 37127066 DOI: 10.1016/j.cjca.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Identifying high-risk percutaneous coronary intervention (PCI) patients is challenging. We aimed to evaluate which high-risk patients are prone to adverse events. METHODS We performed a retrospective study including consecutive high-risk PCIs from 2005 to 2018 in a large tertiary medical centre. Patients with unprotected left main (LM) disease, last patent coronary vessel, or 3-vessel coronary artery disease with left ventricular ejection fraction < 35% were included. A predictive 30-day major adverse cardiac events (MACE) score consisting of any myocardial infarction, all-cause death, or target-vessel revascularisation was constructed. RESULTS From 2005 to 2018, a total of 1890 patients who underwent PCI met the predefined high-risk PCI criteria. Mortality rate was 8.8% at 30 days and 20.7% at 1 year, and 30-day MACE rate was 14.2% and 33.5% at 1 year. Predictors of short-term MACE were New York Heart Association functional class (NYHA) 4 (hazard ratio [HR] 6.65; P < 0.001), systolic blood pressure (SBP) < 90 mm Hg (HR 4.93; P < 0.001), creatinine > 1.3 mg/dL (HR 3.57; P < 0.001), hemoglobin < 11.0 g/dL (HR 3.07; P < 0.001), pulmonary artery systolic pressure > 50 mm Hg (HR 2.06; P < 0.001), atrial fibrillation (HR 1.74; P < 0.001), and LM disease (HR 2.04; P < 0.001) or last patent vessel (HR 1.70; P = 0.002). A score constructed from these parameters reached a sensitivity of 90% and a specificity of 81% with areas under the receiver operating characteristic curve of 0.92 for MACE and 0.94 with 89% sensitivity and 87% specificity for all-cause mortality. CONCLUSIONS Specific features such as LM lesion or last patent conduit, pulmonary hypertension, atrial fibrillation, anemia, and renal failure, along with low SBP and NYHA 4, aid risk stratification and consideration of further treatment measures.
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Affiliation(s)
- Ido Peles
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Barrett
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Carlos Cafri
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Gal Tsaban
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aref El-Nasasra
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yigal Abramowitz
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hezzy Shmueli
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gabriel Rosenstein
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Miri Merkin
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Zahger
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Edward Koifman
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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6
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Marquis-Gravel G, Tanguay JF. Forty Years of Innovations: The Past, Present, and Future of Interventional Cardiology. Can J Cardiol 2022; 38:S1-S2. [PMID: 35870692 DOI: 10.1016/j.cjca.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
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