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multi vessel stage pci

Yushu Wang, Sui Zhu, Peijuan Gao, Qing Zhang
BACKGROUND: The optimal revascularization strategy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD) and multivessel disease (MVD) remains unclear. METHODS: Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception until June 2016. Studies that evaluate the comparative benefits of DES versus CABG in CKD patients with multi-vessel disease were considered for inclusion...
April 8, 2017: European Journal of Internal Medicine
Wen Shen, Rodrigo Aguilar, Alex R Montero, Stephen J Fernandez, Allen J Taylor, Christopher S Wilcox, Michael S Lipkowitz, Jason G Umans
BACKGROUND: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. METHODS: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database...
2017: American Journal of Nephrology
Zhenwei Li, Yijiang Zhou, Qingqing Xu, Xiaomin Chen
INTRODUCTION: In patients with acute ST-elevation myocardial infarction (STEMI), the preferred intervention is percutaneous coronary intervention (PCI).Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is more beneficial and safer in terms of treating the non-culprit vessel during the primary PCI procedure is unclear. We performed a meta-analysis of all randomized and non-randomized controlled trials comparing S-PCI with MV-PCI in patients with acute STEMI and MVD. METHODS: Studies of STEMI with multivessel disease receiving primary PCI were searched in PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January 2004 to December 2014...
2017: PloS One
Wei-Chieh Lee, Bo-Jui Wu, Chih-Yuan Fang, Chien-Jen Chen, Cheng-Hsu Yang, Hon-Kan Yip, Chi-Ling Hang, Chiung-Jen Wu, Hsiu-Yu Fang
The optimal timing of a staged percutaneous coronary intervention (PCI) for non-culprit lesions in patients with STsegment elevation myocardial infarction (STEMI) patients with multi-vessel disease (MVD) remains controversial. We focused on patients with anterior wall STEMI with MVD and determined the clinical effects for timing of staged PCI.From November 2005 to December 2014, 258 patients were diagnosed with anterior wall STEMI with MVD in our hospital. Among them, 37 patients received staged PCI within 3 weeks, 50 patients received staged PCI during 3 weeks to one year, and 167 patients received only primary PCI for culprit lesions...
July 27, 2016: International Heart Journal
Laurent Bonello, Marc Laine, Franck Thuny, Franck Paganelli, Gilles Lemesle, Antoine Roch, François Kerbaul, Françoise Dignat-George, Julie Berbis, Corinne Frere
BACKGROUND: P2Y12-ADP receptor blockade during percutaneous coronary intervention (PCI) is critical to prevent thrombotic events. In patients under chronic P2Y12 blockers, the use of additional loading dose (LD) before an elective PCI is debated. We aimed to investigate the rate of high on-treatment platelet reactivity (HTPR) in patients undergoing elective PCI during chronic clopidogrel or ticagrelor therapy. METHODS AND RESULTS: We performed a sub-group analysis of a randomized trial comparing ticagrelor and clopidogrel in acute coronary syndrome (ACS) patients undergoing PCI...
August 1, 2016: International Journal of Cardiology
Gioel Gabrio Secco, Alessio Mattesini, Rossella Fattori, Rosario Parisi, Fausto Castriota, Matteo Vercellino, Gianni Dall'Ara, Lucia Uguccioni, Lucia Marinucci, Giuseppe De Luca, Paolo Nicola Marino, Gianfranco Pistis, Carlo Di Mario
BACKGROUND: DES has reduced rates of restenosis compared with BMS but it has been associated with delayed healing and increase of stent thrombosis. The aim of our study was to evaluate the vascular time-related changes following implantation of a new SES coated with an amorphous silicon carbide that allows faster re-endothelisation (Orsiro-Biotronik). METHODS: This prospective registry enrolled STEMI-patients with multi-vessel disease, thus candidates for a two-step procedure...
January 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Gennaro Sardella, Luigi Lucisano, Roberto Garbo, Mauro Pennacchi, Erika Cavallo, Rocco Edoardo Stio, Simone Calcagno, Fabrizio Ugo, Giacomo Boccuzzi, Francesco Fedele, Massimo Mancone
BACKGROUND: A lack of clarity exists about the role of complete coronary revascularization in patients presenting with non-ST-segment elevation myocardial infarction. OBJECTIVES: The aim of our study was to compare long-term outcomes in terms of major adverse cardiovascular and cerebrovascular events of 2 different complete coronary revascularization strategies in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease: 1-stage percutaneous coronary intervention (1S-PCI) during the index procedure versus multistage percutaneous coronary intervention (MS-PCI) complete coronary revascularization during the index hospitalization...
January 26, 2016: Journal of the American College of Cardiology
Andrés M Pineda, Ramesh Chandra, Saqib A Gowani, Orlando Santana, Christos G Mihos, Ajay J Kirtane, Gregg W Stone, Paul Kurlansky, Craig R Smith, Nirat Beohar
BACKGROUND: A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. METHODS: A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated...
September 2016: Catheterization and Cardiovascular Interventions
Tassilo Bonzel, Volker Schächinger, Hilmar Dörge
OBJECTIVE AND BACKGROUND: We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study)...
May 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Li-Xiang Ma, Zhen-Hua Lu, Le Wang, Xin Du, Chang-Sheng Ma
OBJECTIVE: To explore the impact of a "one-week" staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE). METHODS: We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and September 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a "one-week" staged multivessel PCI...
May 2015: Journal of Geriatric Cardiology: JGC
Jing Zhang, Qingsheng Wang, Hongmei Yang, Lixiang Ma, Xianghua Fu, Weijing Hou, Jianshuang Feng, Xiaoyuan Liu
OBJECTIVE: To investigate the effect and medical cost of different revascularization strategies for acute myocardial infarction (AMI) patients with multi-vessel disease (MVD). METHODS: A prospective randomized controlled trial (RCT) was conducted. From January 2009 to June 2012, patients with AMI and MVD undergoing primary percutaneous coronary intervention (PCI) were enrolled. They were randomly assigned to group A [staged PCI for non-infarction related artery (non-IRA) within 7-10 days after AMI] and group B (subsequent PCI for non-IRA recommended only for those with evidence of ischemia)...
March 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Khagendra Dahal, Jharendra Rijal, Raju Panta, Juyong Lee, Michael Azrin, Robert Lootens
INTRODUCTION: Percutaneous coronary intervention (PCI) is preferred in patients with acute ST-elevation myocardial infarction (STEMI). In patients with acute STEMI with multivessel disease (MVD), the guidelines recommend culprit vessel PCI (CV-PCI) in the absence of hemodynamic instability. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing multi-vessel PCI (MV-PCI) with CV-PCI or staged PCI (S-PCI) in patients with acute STEMI and MVD. METHODS: PubMed, EMBASE and CENTRAL were searched for publications since inception to December 2013...
November 2014: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Ruogu Li, Shuansuo Yang, Lei Tang, Yiqing Yang, Hui Chen, Shaofeng Guan, Wenzheng Han, Hua Liu, Jinjie Dai, Qian Gan, Weiyi Fang, Xinkai Qu
BACKGROUND AND PURPOSE: Coronary chronic total occlusion (CTO) is the last stage of coronary artery atherosclerosis. Percutaneous coronary intervention (PCI) is a therapeutic procedure used to recanalize vessels with total occlusion. However, successful recanalization of CTO is still not optimal, and the key influence factors are still uncertainty. Therefore, a scientific evaluation on the effective of PCI for CTO treatment is necessary. METHODS: Relevant studies of PCI treatment for CTO were examined...
2014: Journal of Cardiothoracic Surgery
Victar Hsieh, Shamir R Mehta
Primary angioplasty of the culprit coronary artery lesion is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) when timely access to a catheterization laboratory is available. The presence of multi-vessel disease (MVD) in patients undergoing primary PCI is common, occurring in about 40 %-50 % of patients. The presence of MVD in patients who have undergone successful primary PCI substantially increases the risks of mortality and major adverse cardiac events, such as reinfarction or need for urgent revascularization...
February 2013: Current Treatment Options in Cardiovascular Medicine
Petr Widimsky, David R Holmes
Over 50% of ST-segment elevation myocardial infarction (STEMI) patients suffer multi-vessel coronary artery disease, which is known to be associated with worse prognosis. Treatment strategies used in clinical practice vary from acute multi-vessel percutaneous coronary intervention (PCI), through staged PCI procedures to a conservative approach with primary PCI of only the infarct-related artery (IRA) and subsequent medical therapy unless recurrent ischaemia occurs. Each approach has advantages and disadvantages...
February 2011: European Heart Journal
Kurt G Barringhaus, Kay Lee Park, David D McManus, Philippe Gabriel Steg, Gilles Montalescot, Frans Van de Werf, José López-Sendón, Gordon FitzGerald, Joel M Gore et al.
BACKGROUND: CABG and PCI are effective means for revascularization of patients with multi-vessel coronary artery disease, but previous studies have not focused on treatment of patients that first undergo primary PCI. METHODS: Among patients enrolled in the global registry of acute coronary events (GRACE), clinical outcomes for patients presenting with STEMI treated with primary PCI were compared according to whether residual stenoses were treated medically, surgically, or with staged PCI...
April 1, 2011: Catheterization and Cardiovascular Interventions
A A Khattab, M Abdel-Wahab, C Röther, B Liska, R Toelg, G Kassner, V Geist, G Richardt
BACKGROUND: Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size...
January 2008: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Marzenna Zielinska, Izabela Plesiewicz, Andrzej Walczak, Ryszard Jaszewski, Jan Henryk Goch
AIMS: There is a group of patients with acute myocardial infarction (AMI), who, according to results of emergency coronary angiography and regardless of performed or not performed primary percutaneous coronary intervention (PCI), are qualified for elective coronary artery bypass grafting (CABG). The authors have not found a publication that focuses on this problem. They tried to determine the base-line characteristic of this subgroup as well as appreciate its operative surgical risk. METHODS AND RESULTS: Emergency coronary angiography - followed by primary PCI when appropriate - was performed in 1867 consecutive patients with AMI...
April 2007: Acta Cardiologica
Wolfgang Bocksch, Suzanne Fateh-Moghadam, Eda Mueller, Sonja Huehns, Juergen Waigand, Rainer Dietz
Patients with end-stage renal disease (ESRD) represent a growing number of patients in the cardiac catheterization laboratories worldwide. This is a consequence of the growing absolute number of ESRD patients in developed countries, better noninvasive diagnostic tools, better catheterization facilities and last-but-not-least better education of referring physicians about the incidence and prognosis of coronary artery disease (CAD) for patients with ESRD. There is growing evidence of the positive impact of coronary revascularization on long-term outcome of these patients...
2005: Kidney & Blood Pressure Research
Sigmund Silber, Per Albertsson, Francisco F Avilés, Paolo G Camici, Antonio Colombo, Christian Hamm, Erik Jørgensen, Jean Marco, Jan-Erik Nordrehaug, Witold Ruzyllo, Philip Urban, Gregg W Stone, William Wijns
In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference...
April 2005: European Heart Journal
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