Association between Contrast Media Volume and 1-Year Clinical Outcomes in Patients Undergoing Coronary Angiography

Assessment of Cutting-Balloon Angioplasty with Novel Bioabsorbable Polymer-Coated Everolimus-Eluting Stent in Treating Calcified Coronary Lesions Guided by Intravascular Ultrasound (CUPID Trial): study design and protocol

BACKGROUND

Various devices and techniques have been used for plaque modification in the treatment of severe coronary artery calcification. This prospective, multicenter, randomized, open-label study aims to evaluate the safety and efficacy of cutting balloon angioplasty using a novel bioabsorbable polymer-coated everolimus-eluting coronary stent for treating various degrees of calcified coronary lesions.

METHODS

We outline the trial design aimed at assessing whether the cutting balloon (Wolverine™) is non-inferior to the non-compliant balloon in treating patients with calcified lesions, encompassing both de novo and in-stent restenosis (ISR) lesions. We aim to enroll 250 patients who have undergone bioabsorbable polymer-coated everolimus-eluting coronary stent (Synergy™) implantation. The primary endpoint is the minimal stent cross-sectional area at the calcium site as determined by intravascular ultrasonography. The secondary endpoints include major adverse cardiac events and target lesion revascularization at 12 months, alongside procedural convenience and operator-centric parameters, such as the number of balloons used, procedure time, and total contrast medium volume used.

DISCUSSION

In this study, we will evaluate the efficacy and safety of Wolverine™ and non-compliant balloon in patients with calcified coronary lesions and provide a rationale for which type of balloons will optimally modify calcium lesions. In addition, we will attempt to expand the indications of the cutting balloon for treating mild-to-severe calcified coronary lesions. As the scope of insurance coverage for cutting balloons remains limited in some countries, this study may provide evidence for extending insurance coverage to the treatment of de novo calcified and ISR lesions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06177808. Registered on January 1, 2024.

Percutaneous Intervention in Diffuse Coronary Disease: Overlapping Versus Single Very Long Stent Technique. Results From the OVERLONG Registry

BACKGROUND

Both stent length and stent overlap are associated with worse outcomes in the percutaneous treatment of diffuse coronary artery disease (dCAD). However, evidence comparing these issues is scarce. We aimed to compare the results between the use of single very long stent (VLS) and ≥2 overlapping stents (OS) in the treatment of dCAD.

METHODS

Seven hundred twenty-four consecutive lesions were included: 275 treated with a single VLS (≥40 mm) and 449 with ≥2 OS. Procedural characteristics were assessed, and survival analysis was performed to compare the incidence of major adverse cardiovascular events (MACE; composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization [TLR], or stent thrombosis) during a median follow-up of 31 months.

RESULTS

Procedures with VLS required less contrast volume (268 ± 122 vs 302 ± 113 cm3; P < .01), fluoroscopy time (16 ± 8 vs 21 ± 16 minutes; P < .01), and procedure duration (37 ± 18 vs 47 ± 27 minutes; P < .01) than the OS procedures. The VLS group showed lower incidence of MACE (4.4% vs 10.7%; P < .01), driven mainly by lower TLR rate (1.1% vs 4.7%; P < .01). The use of OS was an independent predictor of MACE.

CONCLUSIONS

In this study, the use of VLS for the treatment of dCAD was associated with better outcomes compared to OS.

Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions

Background

The diagnosis of contrast-induced nephropathy (CIN) is usually based on changes in serum creatinine (sCr). However, sCr has poor sensitivity as a biomarker of kidney injury. The aim of this study was to investigate the usefulness of serum cystatin C (sCysC) to predict CIN after intra-arterial interventions.

Methods

A total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography. SCr, sCysC, and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48, 72 h, and 7 days after the procedure.

Results

Thirty-one patients (8.61%) developed CIN. Receiver operating characteristic (ROC) curve analysis showed that pre-operative sCysC levels had good discriminatory power (area under the curve [AUC] = 0.634; 95% confidence interval [CI] = 0.526–0.743) for evaluating the risk of CIN after an endovascular procedure, with a sensitivity of 53.33% and specificity of 73.70%. ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure (AUC = 0.735; 95% CI = 0.647–0.822) with satisfactory sensitivity of 74.20% and specificity of 63.90%. Diabetes mellitus was an independent risk factor for CIN (odds ratio = 2.778; 95% CI = 1.045–7.382; P = 0.040).

Conclusions

SCysC is an appropriate biomarker to predict the occurrence of CIN. Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN. A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.