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Titus A, Majmundar V, Taha A, Patel N, Sooraj M, Omkumar JM, Koshy RM, Saji AM, Sherif AA, Titus A, Kadavath S, Vallabhajosyula S, Nasir K, Dani SS. Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Non-ST-Elevation Myocardial Infarction-Propensity Matched Regression Analysis. Am J Cardiol 2023; 200:95-102. [PMID: 37307785 DOI: 10.1016/j.amjcard.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) is indicated in complex interventions. There is a paucity of evidence for outcomes with large studies on using IVUS during PCI in non-ST-elevation myocardial infarction (NSTEMI). Our objective was to compare the in-hospital outcome of IVUS-guided with that of nonguided PCI among NSTEMI hospitalizations. The National Inpatient Sample (2016 to 2019) was queried to identify all hospitalizations with a principal diagnosis of NSTEMI. In our study, we compared outcomes of PCI with and without IVUS guidance using a multivariate logistic regression model after propensity score matching, with the primary outcome being in-hospital mortality. A total of 671,280 NSTEMI-related hospitalizations were identified, of whom 48,285 (7.2%) underwent IVUS-guided PCI compared with 622,995 (92.8%) who underwent non-IVUS PCI. After adjusted analysis on matched pairs, we found that IVUS-guided PCI had a lower risk of in-hospital mortality than that of non-IVUS PCI (adjusted odds ratio [aOR] 0.736, confidence interval (CI) 0.578 to 0.937, p = 0.013). However, there was a higher use of mechanical circulatory support in the IVUS-guided PCI (aOR 2.138, CI 1.84 to 2.47, p <0.001) than in non-IVUS PCI. The odds of cardiogenic shock (aOR 1.11, CI 0.93 to 1.32, p = 0.233) and procedural complications (aOR 0.794, CI 0.549 to 1.14, p = 0.22) were similar between the cohorts. Hence, we conclude that patients with NSTEMIs who underwent IVUS-guided PCI had less risk of in-hospital mortality and a greater requirement of mechanical circulatory support than did those who underwent non-IVUS PCI, with no difference in procedural complications. Large prospective trials are essential to validate these findings.
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Affiliation(s)
- Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Vidit Majmundar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois
| | - Nirav Patel
- Department of Internal Medicine, Saint Michael Medical Center, Newark, New Jersey
| | - Mannil Sooraj
- Department of Medicine, Chandramma Dayanand Sagar Institute of Medical Education and Research, Bangalore, Karnataka, India
| | - Janaki M Omkumar
- Department of Medicine, Government Medical College, Thrissur, India
| | - Rohan Mathews Koshy
- Department of Medicine, Government Medical College, Thiruvananthapuram, India
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Akil Adrian Sherif
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, India
| | - Sabeeda Kadavath
- Department of Cardiology, St Bernards Healthcare, Jonesboro, Arkansas
| | | | - Khurram Nasir
- Department of Cardiology, Houston Methodist, Houston, Texas
| | - Sourabh S Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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Thandra A, Betts L, Aggarwal G, Gujjula N, Haddad TM. Intravascular Lithotripsy for Acute Stent Under-Expansion and In-Stent Restenosis: A Case Series. Curr Probl Cardiol 2023; 48:101511. [PMID: 36402215 DOI: 10.1016/j.cpcardiol.2022.101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Coronary in-stent restenosis (ISR) has an incidence of about 10% of percutaneous coronary interventions (PCIs) performed in the United States. Traditional management strategies for ISR include balloon angioplasty with non-compliant or use of cutting/scoring balloons or atheroablative therapies (like laser and rotational atherectomy), all of which are inherently limited in their ability to treat stent under-expansion or calcification around the stent. Shockwave intravascular lithotripsy (IVL) has recently demonstrated safe and efficacious treatment of severely calcified coronary stenoses with reported cases of treating ISR as an off-label use. In this case series, we describe the successful use of IVL for 6 cases of ISR and 1 case of stent under-expansion using 40-80 IVL pulses per lesion. Angiographic success was obtained in all seven patients, and there were no intra-procedural complications or adverse cardiac events at a mean follow-up of 200 days. Our report indicates that IVL can be safely and effectively used to treat ISR and stent under-expansion.
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Affiliation(s)
- Abhishek Thandra
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE.
| | - Lucas Betts
- Creighton University School of Medicine, Omaha, NE
| | - Gaurav Aggarwal
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Nagarjuna Gujjula
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Toufik M Haddad
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
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Escárcega RO. The Impact of Prior Coronary Intervention on Mortality: Do It Well and Do It Once. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:68-69. [PMID: 36456419 DOI: 10.1016/j.carrev.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ricardo O Escárcega
- Heart and Vascular Institute, Lee Health System, Fort Myers, FL, United States of America.
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Oh S, Kim JH, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH. Association between baseline smoking status and clinical outcomes following myocardial infarction. Front Cardiovasc Med 2022; 9:918033. [PMID: 35935630 PMCID: PMC9354586 DOI: 10.3389/fcvm.2022.918033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Whether the effect of smoking on clinical outcomes following an acute myocardial infarction (AMI) is beneficial or detrimental remains inconclusive. We invesetigated the effect of smoking on the clinical outcomes in patients following an AMI. Methods Among 13,104 patients between November 2011 and June 2015 from a nationwide Korean AMI registry, a total of 10,193 participants were extracted then classified into two groups according to their smoking habit: (1) smoking group (n = 6,261) and (2) non-smoking group (n = 3,932). The participants who smoked were further subclassified according to their smoking intensity quantified by pack years (PYs): (1) <20 PYs (n = 1,695); (2) 20–40 PYs (n = 3,018); and (3) ≥40 PYs (n = 2,048). Each group was compared to each other according to treatment outcomes. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs), which is a composite of all-cause mortality, non-fatal MI (NFMI), any revascularization, cerebrovascular accident, rehospitalization, and stent thrombosis. Secondary outcomes included the individual components of MACCEs. The Cox proportional hazard regression method was used to evaluate associations between baseline smoking and clinical outcomes following an AMI. Two propensity score weighting methods were performed to adjust for confounders, including propensity score matching and inverse probability of treatment weighting. Results While the incidence of all clinical outcomes, except for stent thrombosis, was lower in the smoking group than in the non-smoking group in the unadjusted data, the covariates-adjusted data showed statistical attenuation of these differences but a higher all-cause mortality in the smoking group. For smokers, the incidence of MACCEs, all-cause mortality, cardiac and non-cardiac death, and rehospitalization was significantly different between the groups, with the highest rates of MACCE, all-cause mortality, non-cardiac death, and rehospitalization in the group with the highest smoking intensity. These differences were statistically attenuated in the covariates-adjusted data, except for MACCEs, all-cause mortality, and non-cardiac death, which had the highest incidence in the group with ≥40 PYs. Conclusion Smoking had no beneficial effect on the clinical outcomes following an AMI. Moreover, for those who smoked, clinical outcomes tended to deteriorate as smoking intensity increased.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
- *Correspondence: Ju Han Kim,
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
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Intracoronary lithotripsy use for in-stent restenosis, including multilayer ISR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:10-13. [DOI: 10.1016/j.carrev.2022.06.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022]
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Lemor A, Basir MB, Truesdell AG, Tamis-Holland JE, Alqarqaz M, Grines CL, Villablanca PA, Alaswad K, Pinto DS, O'Neill W. Trends in the Outcomes of High-risk Percutaneous Ventricular Assist Device-assisted Percutaneous Coronary Intervention, 2008-2018. Am J Cardiol 2021; 156:65-71. [PMID: 34344515 DOI: 10.1016/j.amjcard.2021.06.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Percutaneous ventricular assist devices (pVAD) are frequently utilized in high-risk percutaneous coronary intervention (HR-PCI) to provide hemodynamic support in patients with complex cardiovascular disease and/or multiple comorbidities who are poor candidates for surgical revascularization. Using the National Inpatient Sample we identified pVAD-assisted PCI (excluding intra-aortic balloon pump) in patients without cardiogenic shock from January 2008 to December 2018. We evaluated the trends in patient and procedural characteristics, and complication rates across the 11-year study period. A total of 26,661 pVAD-PCI was performed. From 2008 to 2018 there has was a 27-fold increase in the number of pVAD-PCIs performed annually. There has also been an increase in the proportion of procedures performed in small to medium sized hospitals. The use of atherectomy, image-guided PCI, FFR/iFR, drug-eluting stents, and multi-vessel intervention has significantly increased. Patients undergoing pVAD-PCI had a higher burden of comorbidities, without a significant difference in mortality over time. There were decreased rates of acute stroke and blood transfusions over time, while vascular complications and acute kidney injury (AKI) requiring dialysis remained mostly unchanged. In conclusion, the use of pVAD for HR-PCI has increased significantly, along with adjunctive PCI techniques such as atherectomy, intravascular imaging, and physiologic lesion assessment. With increasing use of this device, there appeared to be lower rates of peri-procedural stroke, and blood transfusions. Despite a higher burden of comorbidities, adjusted mortality remained stable over time.
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Rahman N, Ullah I, Adnan G, Khan MA, Farhad A, Shah I, Abidi J. Clinical Outcomes and Prevalence of Intravascular Ultrasound Use at a Tertiary Care Hospital in a South Asian Country. J Clin Imaging Sci 2021; 11:42. [PMID: 34513206 PMCID: PMC8422435 DOI: 10.25259/jcis_93_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Intravascular ultrasound (IVUS) plays a pivotal role in the current era of coronary interventions. We aimed to determine the prevalence of IVUS use and clinical outcomes of IVUS-guided percutaneous treatment of coronary arteries lesions in a South Asian country. Material and Methods: It is a retrospective observational study, a total of 134 consecutive patients having done IVUS, was enrolled from January 2013 to March 2020 at a single center. Results: Out of 134 patients, 97 (72.4%) were male with a mean age of 63.1 ± 12.9 years. The prevalence of IVUS in our center was 3.0%. The most frequent comorbidity observed was dyslipidemia, n = 111 (82.8%). Non-ST-elevation myocardial infarction, n = 50 (37.3%), was the common mode of presentation. On coronary angiogram, the left main (LM) disease was found in n = 46 (34.3%), however, single-vessel disease, n = 51 (38.1%), was most commonly noted. IVUS utilization was higher in the left anterior descending, n = 94 (70.1%), followed by LM, n = 46 (34.3%). The LM mean minimal luminal area was 6.0 ± 2.6 mm2 and minimal luminal diameter was 4.53 mm ± 0.6 (mean). The coronary artery dissection was noted in n = 15 (11.2%). The mean duration of follow-up in our study was 40.3 ± 30.1 months. Major adverse cardiac events (MACEs) were recorded in n = 13 (9.7%), which included heart failure, n = 4 (3%). Cardiovascular death and target vessel revascularization occurred in n = 3 (2.2%). Conclusion: IVUS results in a significant decrease in MACE. Our data might support the broader use of IVUS in both developed and in our part of the world.
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Affiliation(s)
- Nasir Rahman
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ihsan Ullah
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ghufran Adnan
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Maria Ali Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Awais Farhad
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Izat Shah
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Jabir Abidi
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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