Current trends and procedural outcomes in the era of rotational atherectomy expansion in Poland in the period 2014-2017 (based on the nationwide ORPKI registry)

ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry

BACKGROUND

Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients.

MATERIALS AND METHODS

Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram.

RESULTS

Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%).

CONCLUSIONS

Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.

Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary artery perforations within chronic total occlusions

Introduction

Patients treated within chronic total occlusions (CTO) using percutaneous coronary intervention (PCI) are at increased risk of periprocedural complications.

Aim

To assess the frequency of periprocedural complications with particular emphasis on coronary artery perforations (CAPs) among patients treated with PCIs stratified according to CTOs and their predictors.

Material and methods

Based on a nationwide registry (ORPKI), we analysed 535,853 patients treated with PCI between 2014 and 2018. The study included 12,572 (2.34%) patients treated with CTO PCI. We compared CTO PCI to a non-CTO PCI group before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of periprocedural complications and CAPs which occurred within the catheterization laboratory.

Results

Frequencies of all periprocedural complications (2.75% vs. 1.93%, p < 0.001) and CAP (0.72% vs. 0.16%, p < 0.001) were significantly higher in the CTO PCI group. Multifactorial regression analysis performed in the all-comers group of patients treated with PCI showed that PCI within CTO was related to a higher CAP rate (odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.68–2.82, p < 0.001). After PSM, we extracted 5,652 patients treated within CTO and 5,652 patients with non-CTO PCI. CTO PCI was also related to a higher frequency of CAPs (OR = 1.89; 95% CI: 1.11–3.31, p = 0.01).

Conclusions

The frequency of periprocedural complications and CAPs remained stable during the assessed period of time. CTO PCI was confirmed to be among the predictors of increased CAP rate in the overall group of patients treated within CTO.

Aspiration Thrombectomy in Patients with Acute Myocardial Infarction-5-Year Analysis Based on a Large National Registry (ORPKI)

Blood flow restoration after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction (AMI) may not always be achieved and could be complicated by the no-reflow phenomenon (NRP). The aim of the current study was to assess the frequency of thrombus aspirations (TAs) and NRPs in patients with AMI and treated with pPCI based on the data collected during a 5-year period in the national ORPKI registry, as well as the frequency of periprocedural strokes and predictors of TA and NRP. This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2018, and included 200,991 patients treated due to AMI out of 535,857 patients treated using PCI. Among them, 16,777 patients underwent TA. TA was mainly used in the STEMI subgroup of 14,207 patients (84.8%). The frequency of NRP among AMI patients in the thrombectomy group was 2.75% and in the non-thrombectomy group 0.82%. Predictors of TA and NRP were also assessed using multivariate analysis. The percentage of patients treated with pPCI and with PCI alone increased significantly in all of the three selected groups of patients from 88.7% to 94.3% in the AMI group (p < 0.001), from 82.3% to 90.3% in the STEMI subgroup (p < 0.001), and from 96.3% to 98.2% in the NSTEMI subgroup (p < 0.001) during the analysed period. NRP occurred more often in the thrombectomy group for the NSTEMI (0.58% vs. 3.07%, p < 0.05) and STEMI (1.06% vs. 2.69%, p < 0.05) subgroups. Periprocedural stroke occurred more often in the thrombectomy group in comparison to the non-thrombectomy group with AMI (0.03% vs. 0.01%, p < 0.05) and the NSTEMI (0.16% vs. 0.02%, p < 0.05). In conclusion, the frequency of TA has been experiencing a steady decline in recent years, regardless of AMI type, among patients treated with pPCI.

Transradial and Transfemoral Approach in Patients with Prior Coronary Artery Bypass Grafting

The relationship between periprocedural complications and the type of vascular access in patients with prior history of coronary artery bypass grafting (CABG) and treated with percutaneous coronary interventions (PCIs) is less investigated than in the overall group of patients treated with PCI. The aim of the current study was to assess the relationship between the type of vascular access and selected periprocedural complications in a group of patients with prior history of CABG and treated with PCIs. Based on a Polish nationwide registry of interventional cardiology procedures called ORPKI, the authors analyzed 536,826 patients treated with PCI between 2014 and 2018. The authors extracted 32,225 cases with prior history of CABG. Then, patients with femoral and radial access as well as right and left radial access were compared. This comparison was proceeded by propensity score matching (PSM). After PSM, a multifactorial analysis revealed that patients treated with PCI from femoral access were significantly more often related to periprocedural deaths (odds ratio [OR]: 1.79; 95%, confidence interval [CI]: 1.1–3.0, p = 0.02) and cardiac arrests (OR: 1.98; 95%, CI: 1.38–2.87, p < 0.001). After inclusion of the Killip class grade and the occurrence of cardiac arrests before PCI into the PSM, the significance remained for procedural related cardiac arrests (OR: 1.55; 95%, CI: 1.07–2.28, p = 0.022]). However, a comparison of right and left radial access showed no significant differences between procedure-related complications. It has been confirmed that there is a statistical association between femoral access (compared to radial access) and a higher rate of periprocedural cardiac arrests in patients with prior history of CABG treated with PCI.