Late outcomes following percutaneous coronary interventions: results from a large, observational registry

Factors Affecting In-stent Restenosis in Patients Undergoing Percutaneous Coronary Angioplasty

Percutaneous coronary angioplasty (PCI) and stent implantation are the most common therapeutic strategies for coronary artery stenosis; however, in-stent restenosis (ISR) is one of its important challenges. Although in some studies, coronary artery disease (CAD) factors are deemed to be the causes of ISR, in some others, the relationship between CAD factors and ISR are not observed. Over the past ten years, there has been no review article on factors affecting the ISR. This article aimed to review the possible factors affecting ISR in patients undergoing PCI. This narrative review study was conducted on PubMed, Web of Science, Scopus, and Google Scholar databases between 1 January 1990 and 30 July 2017. After initial screening of 1728 retrieved articles, 1401 articles were excluded to due irrelevancy to the review; and finally, 39 papers were selected for data collection. Our study results showed that the site and length of implanted stent, hypertension and diabetes are the most probable factors affecting ISR. Further studies are required for evaluation of the effect of other possible risk factors such as genetic sequencing, obesity, chronic infections and hemoglobin A1C levels.

Low major adverse cardiac event rates following bioresorbable vascular scaffold implantation: Impact of implantation technique on treatment outcomes

Background and objective

Studies conducted across the world have reported that the rates of major adverse cardiac events (MACE) following the use of bioresorbable vascular scaffolds (BVS) are comparable to that noted with traditional drug eluting stents (DES). However, there is limited data on the immediate and medium-term clinical outcomes following the use of the Absorb BVS (Abbott Vascular, Santa Clara, SA) in the Indian context. This study was conducted to determine real-world evidence on the immediate and medium-term clinical outcomes in all patients undergoing percutaneous coronary intervention (PCI) with the Absorb BVS.

Methods

Data of all patients who were treated with Absorb BVS at our center were evaluated. Between December 2012 and October 2016, 142 patients underwent PCI with BVS. The MACE rates during hospitalization, at 30 days, 3 months, 6 months after PCI, and every 6 months thereafter were the primary endpoints evaluated with median follow up of 13 months.

Results

Mean age of the study participants was 53.7 ± 11.8 years. Intravascular ultrasound imaging was performed in 15.34% of patients. Predilatation and postdilatation were performed in 81.8% and 84.6% of scaffolds, respectively. There were no episodes of MACE during hospitalization. However, 1 BVS-related MACE was observed at the 1-month (0.7%) as well as at the ≥12 month (0.8%) follow up visits. At the 6- and 12-month follow up visits, 2 (1.5%) and 3 (2.5%) non-BVS-related MACEs, respectively, were recorded.

Conclusion

The use of Absorb BVS in this real-world experience was associated with very good immediate and medium-term clinical outcomes.

Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis

Background

Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta‐analysis.

Methods and Results

A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random‐effects meta‐analysis was used to estimate the odds of adverse outcomes. Meta‐regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty‐eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61‐0.78), repeat revascularization (OR 0.60, 95% CI 0.45‐0.80), myocardial infarction (OR 0.64, 95% CI 0.50‐0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50‐0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53‐0.80). A meta‐regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR.

Conclusion

CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score‐based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

INTRODUCTION

Systemic atherosclerosis can result in both coronary artery disease (CAD) and carotid artery disease. Recently it has been shown that patients with CAD have a higher incidence of microembolization during carotid artery stenting (CAS), and it has been hypothesized that they could be at higher risk in this intervention.

MATERIAL AND METHODS

We retrospectively evaluated an institutional registry with 437 consecutive patients who underwent coronary angiography and CAS to evaluate their short-term outcomes and long-term survival with regard to the presence of coexisting multivessel coronary artery disease (MVD).

RESULTS

We performed 220 CAS procedures in MVD patients and 318 CAS procedures in non-MVD patients. The incidence of in-hospital CAS-related adverse events was 2.7% and 2.5% in the MVD and non-MVD groups, respectively (p = 0.88). At 30 days, there was no significant difference between the groups in terms of the number of patients with adverse events (hierarchically death/stroke/myocardial infarction; 8.8% vs. 5.5%; p = 0.18). The median duration of follow-up was 4.23 years. Survival free of all-cause mortality at 1, 3 and 5 years was 90% (95% CI: 86-94%), 79% (95% CI: 73-85%) and 70% (95% CI: 64-77%), and 92% (95% CI: 89-95%), 85% (95% CI: 80-90%) and 76% (95% CI: 70-82%) for the MVD and non-MVD groups (p = 0.02), respectively.

CONCLUSIONS

These results suggest that patients with MVD combined with carotid artery disease are probably not at higher risk of early post-CAS adverse clinical events, but they have significantly worse long-term survival rates.

Long-Term Survival and Quality of Life of Patients Undergoing Emergency Coronary Artery Bypass Grafting for Postinfarction Cardiogenic Shock

BACKGROUND

This study evaluated the long-term outcome of patients undergoing emergency coronary artery bypass grafting (eCABG) for cardiogenic shock after acute myocardial infarction.

METHODS

Sixty-seven consecutive patients underwent eCABG for cardiogenic shock at 2 European institutions during an 11-year period. Preoperative, intraoperative, postoperative, and long-term follow-up data of all patients were prospectively collected.

RESULTS

Hospital survival was 86% (58 of 67), with all deaths due to cardiac causes. At a mean follow-up of 78 ± 48 months (range, 1 to 153 months), 43 of the 58 patients (74%) discharged from the hospital were alive. Causes of death in 9 of the 15 follow-up deaths (60%) were noncardiac. Overall survival rate at the end of follow-up was 64% (43 of 67). Of the 43 survivors, 41 (95%) were in New York Heart Association Functional Classification I to II, ischemia free, had a Karnofsky performance status exceeding 80, and an excellent quality of life as assessed by the Seattle Angina Questionnaire. The use of cardiopulmonary bypass and the internal thoracic artery were associated with significantly better long-term survival.

CONCLUSIONS

The long-term survival and quality of life of patients who undergo eCABG for cardiogenic shock after acute myocardial infarction are good, and eCABG should be considered a valuable therapeutic option in this setting. The use of cardiopulmonary bypass and the internal thoracic artery at the time of the operation are strongly advocated.

The 'all comer' Coroflex Please drug-eluting stent registry in Europe and Asia - an overall and transcontinental assessment of the 10-month major adverse cardiac events

BACKGROUND

Randomized trials assess the potential of a medical device in well defined indications while "all comer studies" reveal the device performance in the real clinical environment.

AIMS

This 'all comers' registry assessed the 10-month outcome of the Coroflex(®) Please drug-eluting stent in Europe and Asia by clinically driven major adverse cardiac events.

METHODS

The Coroflex(®) Please Registry was an international, prospective, multicenter registry enrolling patients with symptomatic ischemic heart disease. The primary endpoint was clinically driven target lesion revascularization (TLR) at 9 months. Secondary endpoints were technical success, in-hospital outcomes, definite stent thrombosis and major adverse cardiac events (death, myocardial infarction, or TLR) for subgroup analyses.

RESULTS

Of the enrolled 1230 patients (63.6 ± 11.2 years, 33.9% diabetics), 339 (27.6%) had an acute coronary syndrome, 148 (12.1%) STEMI and 191 (15.6%) NSTEMI. After 10.5 ± 3.8 months (follow-up rate 92.8%), the target lesion revascularization rate (TLR) was 7.8% overall, 8.3% in STEMI, and 11.3% in NSTEMI patients. Total MACE was 11.1% and significantly higher in ACS with either diabetes mellitus (22.9%, p = 0.017) or age ≥75 years (25.4%, p = 0.026). In European and Asian patients MI rates (5.2% vs 3.1%, p = 0.135) and cardiac death rates (1.6% vs 0.9%, p = 0.414) were similar. The MACE rate was higher in Europe (13.6% vs 4.7%, p < 0.001) driven by a six times higher TLR rate.

CONCLUSIONS

TLR and MACE occurred within the range of previously published data. The incidence of MI and cardiac death were not different between Europe and Asia. MACE were higher in Europe driven by target lesion revascularization.