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Deferred PCI

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https://www.readbyqxmd.com/read/27646423/percutaneous-coronary-intervention-versus-optimal-medical-therapy-for-stable-angina-in-advanced-ckd-a-decision-analysis
#1
Aisha Khattak, Ernest I Mandel, Matthew R Reynolds, David M Charytan
BACKGROUND: Percutaneous coronary intervention (PCI) use is low in the setting of stable symptomatic angina in individuals with advanced chronic kidney disease (CKD) despite high cardiovascular risk in this population, and PCI is frequently deferred out of concern for precipitating dialysis therapy. Whether this is appropriate is uncertain, and patient-centered data comparing the relative risks and benefits of continued medical therapy versus PCI in patients with advanced CKD and stable angina are scarce...
September 16, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27281577/relation-between-fractional-flow-reserve-value-of-coronary-lesions-with-deferred-revascularization-and-cardiovascular-outcomes-in-non-diabetic-and-diabetic-patients
#2
Zhi Liu, Yasushi Matsuzawa, Joerg Herrmann, Jing Li, Ryan J Lennon, Daniel J Crusan, Taek-Geun Kwon, Ming Zhang, Tao Sun, Shiwei Yang, Rajiv Gulati, Malcolm R Bell, Lilach O Lerman, Amir Lerman
BACKGROUND: FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). METHODS: Patients with FFR assessment and deferred PCI (n=630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values...
September 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27100339/underuse-of-coronary-intervention-and-its-impact-on-mortality-in-the-elderly-with-myocardial-infarction-a-propensity-matched-analysis-from-the-hungarian-myocardial-infarction-registry
#3
András Komócsi, Mihály Simon, Béla Merkely, Tibor Szűk, Róbert G Kiss, Dániel Aradi, Zoltán Ruzsa, Péter Andrássy, Lajos Nagy, Géza Lupkovics, Zsolt Kőszegi, Péter Ofner, András Jánosi
BACKGROUND: Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). METHODS: Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed...
July 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27053444/deferred-versus-conventional-stent-implantation-in-patients-with-st-segment-elevation-myocardial-infarction-danami-3-defer-an-open-label-randomised-controlled-trial
#4
RANDOMIZED CONTROLLED TRIAL
Henning Kelbæk, Dan Eik Høfsten, Lars Køber, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamäki, Ole De Backer, Lia E Bang, Klaus F Kofoed, Jacob Lønborg, Kiril Ahtarovski, Niels Vejlstrup, Hans E Bøtker, Christian J Terkelsen, Evald H Christiansen, Jan Ravkilde, Hans-Henrik Tilsted, Anton B Villadsen, Jens Aarøe, Svend E Jensen, Bent Raungaard, Lisette O Jensen, Peter Clemmensen, Peer Grande, Jan K Madsen, Christian Torp-Pedersen, Thomas Engstrøm
BACKGROUND: Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark...
May 28, 2016: Lancet
https://www.readbyqxmd.com/read/26831901/time-related-changes-in-neointimal-tissue-coverage-of-a-novel-sirolimus-eluting-stent-serial-observations-with-optical-coherence-tomography
#5
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
https://www.readbyqxmd.com/read/26627500/prognostic-role-of-multiple-biomarkers-in-stable-patients-undergoing-fractional-flow-reserve-guided-coronary-angioplasty
#6
Francesco Fracassi, Giampaolo Niccoli, Giancarla Scalone, Giuseppe Di Gioia, Micaela Conte, Jozef Bartunek, Gregory A Sgueglia, Bernard De Bruyne, Rocco A Montone, William Wijns, Filippo Crea, Emanuele Barbato
AIMS: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI), along with optimal medical therapy, improves clinical outcome by targeting ischemia-inducing stenosis. Yet, plaque progression or stent failure may cause recurring cardiac events. We assessed the potential prognostic role of different inflammatory biomarkers, known to be associated with plaque progression or stent failure, in patients undergoing FFR-guided PCI. METHODS: We prospectively enrolled 169 stable angina patients with intermediate coronary stenosis at angiography undergoing FFR-guided PCI...
September 2016: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/26442702/natural-history-and-implantable-cardioverter-defibrillator-implantation-after-revascularization-for-stable-coronary-artery-disease-with-depressed-ejection-fraction
#7
Geoffrey F Lewis, Adam C Harless, Lauren Vazquez, Freddy M Abi-Samra, Michael L Bernard, Sammy Khatib, Glenn M Polin, Daniel P Morin
BACKGROUND: Following revascularization, most payors require 3 months of medical therapy, followed by left ventricular ejection fraction (LVEF) reassessment, before implantable cardioverter-defibrillator (ICD) implantation possibly contributing to incomplete follow-up and suboptimal utilization of ICD therapy. The natural history of these patients, and their fate regarding ICD implantation, is unknown. HYPOTHESIS: We hypothesized that a waiting period after revascularization for stable CAD results in missed opportunities to provide care with regard to ICD implantation...
December 2015: Clinical Cardiology
https://www.readbyqxmd.com/read/26424728/the-impact-of-fractional-flow-reserve-on-revascularization
#8
Islam Y Elgendy, Calvin Choi, Anthony A Bavry
INTRODUCTION: Fractional flow reserve (FFR) is recommended by society guidelines for assessment of the hemodynamic significance of intermediate coronary lesions when non-invasive evidence of myocardial ischemia is unavailable. However, the prevalence of FFR usage in current practice and how FFR values impact revascularization decisions are not well known. METHODS: At a single-center Veterans Administration Hospital, all subjects referred for coronary angiography for any indication from the period from May 2012 until January 2014 were prospectively entered into a database...
December 2015: Cardiology and Therapy
https://www.readbyqxmd.com/read/26086864/risk-of-no-reflow-in-culprit-lesion-versus-culprit-vessel-pci-in-acute-stemi
#9
MULTICENTER STUDY
Uğur Arslan, Mehmet Yaman, İbrahim Kocaoğlu, Oğuzhan Ekrem Turan, Huriye Yücel, Aytekin Aksakal, İlksen Atasoy Günaydin, Ahmet Hakan Ateş
OBJECTIVES: The present report describes patients with acute ST-elevation myocardial infarction who had at least two lesions in the culprit vessel (CV) during primary percutaneous coronary intervention (PCI). Here, we aimed to examine two different strategies, namely, PCI of only culprit lesion (CL) versus PCI of all lesions in the CV in the setting of acute ST-elevation myocardial infarction. PATIENTS AND METHODS: Patients who underwent primary PCI were examined for the presence of an additional lesion in the infarct-related artery and divided into two groups according to the PCI strategy: CV versus CL groups...
September 2015: Coronary Artery Disease
https://www.readbyqxmd.com/read/25965708/the-third-danish-study-of-optimal-acute-treatment-of-patients-with-st-segment-elevation-myocardial-infarction-ischemic-postconditioning-or-deferred-stent-implantation-versus-conventional-primary-angioplasty-and-complete-revascularization-versus-treatment-of
#10
RANDOMIZED CONTROLLED TRIAL
Dan Eik Høfsten, Henning Kelbæk, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Peter Clemmensen, Christian Torp-Pedersen, Hans-Henrik Tilsted, Hans Erik Bøtker, Lisette Okkels Jensen, Lars Køber, Thomas Engstrøm
BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening of the infarct-related artery could have protective effects, by reducing the risk of injury caused by distal embolization and microvascular obstruction...
May 2015: American Heart Journal
https://www.readbyqxmd.com/read/25632623/visual-functional-mismatch-and-results-of-fractional-flow-reserve-guided-percutaneous-coronary-revascularization
#11
Thamarath Chantadansuwan, Wirash Kehasukcharoen, Anek Kanoksilp, Boonjong Saejueng, Vathanyoo Plainetr, Narin Sukhavasharin, Sudaratana Tansuphaswadikul, Kriengkrai Hengrussamee
OBJECTIVE: To identify mismatches in the significance ofcoronary artery stenosis determined by physician 's visual estimation (VE) vs. quantitative coronary angiography (QCA), by VE vs. fractional flow reserve (FFR), and independent predictors for mismatch between VE and FFR. Second objective was to evaluate the clinical outcomes ofpatients receiving FFR-guided percutaneous coronary intervention (PCI). MATERIAL AND METHOD: Two hundreds eighty consecutive patients (338 coronary lesions including non-left main (non-LM) 316 lesions and left main (LM) 22 lesions) underwent coronary angiography, offline edge detection QCA, and FFR measurement between August 2011 and December 2013 were included in the present study...
October 2014: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
https://www.readbyqxmd.com/read/25524333/effect-of-prasugrel-pre-treatment-strategy-in-patients-undergoing-percutaneous-coronary-intervention-for-nstemi-the-accoast-pci-study
#12
RANDOMIZED CONTROLLED TRIAL
Gilles Montalescot, Jean-Philippe Collet, Patrick Ecollan, Leonardo Bolognese, Jurrien Ten Berg, Dariusz Dudek, Christian Hamm, Petr Widimsky, Jean-François Tanguay, Patrick Goldstein, Eileen Brown, Debra L Miller, LeRoy LeNarz, Eric Vicaut
BACKGROUND: After percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction (NSTEMI), treatment with a P2Y12 antagonist with aspirin is recommended for 1 year. OBJECTIVES: The oral P2Y12 antagonists ticagrelor and prasugrel have higher recommendations than clopidogrel, but it is unknown if administration before the start of PCI is beneficial. METHODS: In the randomized, double-blind ACCOAST (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non-ST-segment elevation myocardial infarction) trial, 4,033 patients were diagnosed with NSTEMI and 68...
December 23, 2014: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/25482682/meta-analysis-of-deferral-versus-performance-of-coronary-intervention-based-on-coronary-pressure-derived-fractional-flow-reserve
#13
REVIEW
Bruno R Nascimento, Ana Flávia L Belfort, Fernando Augusto C Macedo, Fernando M Sant'Anna, Gabriel T R Pereira, Marco A Costa, Antonio L P Ribeiro
Fractional flow reserve (FFR) has been proposed as the gold standard to assess functional severity of coronary artery stenosis and to stratify which lesions should be subjected to intervention (percutaneous coronary intervention [PCI]). A systematic review was performed in MEDLINE and EMBASE including studies indexed until November 2013 that used FFR for deferral or performance of PCI. Outcomes of interest were death, acute myocardial infarction (AMI), and new revascularization (RV). Nineteen studies were included, totaling 3,097 patients (3,796 lesions)...
February 1, 2015: American Journal of Cardiology
https://www.readbyqxmd.com/read/25410812/long-term-outcome-after-deferral-of-revascularization-in-patients-with-intermediate-coronary-stenosis-and-gray-zone-fractional-flow-reserve
#14
COMPARATIVE STUDY
Yasutsugu Shiono, Takashi Kubo, Atsushi Tanaka, Yasushi Ino, Tomoyuki Yamaguchi, Takashi Tanimoto, Takashi Yamano, Yoshiki Matsuo, Tsuyoshi Nishiguchi, Ikuko Teraguchi, Shingo Ota, Yuichi Ozaki, Makoto Orii, Kunihiro Shimamura, Hironori Kitabata, Kumiko Hirata, Toshio Imanishi, Takashi Akasaka
BACKGROUND: A strategy of deferred percutaneous coronary intervention for coronary stenosis with fractional flow reserve (FFR) 0.75-0.80, termed the gray zone, remains a matter of debate. The aim of this study was to assess the safety of deferring revascularization for patients with FFR 0.75-0.80 compared with those with FFR >0.80. METHODS AND RESULTS: We assessed 3-year clinical outcome in 150 patients with angiographically intermediate stenosis who had revascularization deferred on the basis of FFR ≥ 0...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/25336221/risk-model-for-estimating-the-1-year-risk-of-deferred-lesion-intervention-following-deferred-revascularization-after-fractional-flow-reserve-assessment
#15
Jeremiah P Depta, Jayendrakumar S Patel, Eric Novak, Brian F Gage, Shriti K Masrani, David Raymer, Gabrielle Facey, Yogesh Patel, Alan Zajarias, John M Lasala, Amit P Amin, Howard I Kurz, Jasvindar Singh, Richard G Bach
AIMS: Although lesions deferred revascularization following fractional flow reserve (FFR) assessment have a low risk of adverse cardiac events, variability in risk for deferred lesion intervention (DLI) has not been previously evaluated. The aim of this study was to develop a prediction model to estimate 1-year risk of DLI for coronary lesions where revascularization was not performed following FFR assessment. METHODS AND RESULTS: A prediction model for DLI was developed from a cohort of 721 patients with 882 coronary lesions where revascularization was deferred based on FFR between 10/2002 and 7/2010...
February 21, 2015: European Heart Journal
https://www.readbyqxmd.com/read/24890532/the-quality-of-antiplatelet-and-anticoagulant-medication-administration-among-st-segment-elevation-myocardial-infarction-patients-transferred-for-primary-percutaneous-coronary-intervention
#16
Tracy Y Wang, David J Magid, Henry H Ting, Shuang Li, Karen P Alexander, Matthew T Roe, Eric D Peterson
BACKGROUND: Timely and appropriate use of antiplatelet and anticoagulant therapies has been shown to improve outcomes among ST-segment elevation myocardial infarction (STEMI) patients but has not been well described in patients transferred for primary percutaneous coronary intervention (PCI). METHODS: We examined 16,801 (26%) transfer and 47,329 direct-arrival STEMI patients treated with primary PCI at 441 Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines hospitals...
June 2014: American Heart Journal
https://www.readbyqxmd.com/read/24841388/cost-benefit-for-assessment-of-intermediate-coronary-stenosis-with-fractional-flow-reserve-in-public-and-private-sectors-in-australia
#17
J C Murphy, P S Hansen, R Bhindi, G A Figtree, G I C Nelson, M R Ward
BACKGROUND: Fractional Flow Reserve (FFR) is a proven technology for guiding percutaneous coronary intervention (PCI), but is not reimbursed despite the fact that it is frequently used to defer PCI. METHODS: Costs incurred with use of FFR were compared in both the public and private sectors with the costs that would have been incurred if the technology was not available using consecutive cases over a two year period in a public teaching hospital and its co-located private hospital...
September 2014: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/24837255/outcomes-of-coronary-stenoses-deferred-revascularization-for-borderline-versus-nonborderline-fractional-flow-reserve-values
#18
Jeremiah P Depta, Jayendrakumar S Patel, Eric Novak, Shriti K Masrani, David Raymer, Gabrielle Facey, Yogesh Patel, Alan Zajarias, John M Lasala, Jasvindar Singh, Richard G Bach, Howard I Kurz
Current evidence supports deferral of revascularization for lesions with fractional flow reserve (FFR) values >0.80. The natural history after deferral of revascularization of lesions with borderline FFR values is unknown. This study evaluated the outcomes of patients after deferred revascularization of coronary stenoses based on a borderline FFR value. We retrospectively studied 720 patients with 881 intermediate-severity coronary stenoses who underwent FFR assessment from October 2002 to July 2010 and were deferred revascularization...
June 1, 2014: American Journal of Cardiology
https://www.readbyqxmd.com/read/24816634/modification-of-treatment-strategy-after-ffr-measurement-cvit-defer-registry
#19
MULTICENTER STUDY
Masato Nakamura, Masakazu Yamagishi, Takafumi Ueno, Kazuhiro Hara, Sugao Ishiwata, Tomonori Itoh, Ichiro Hamanaka, Tetsuzo Wakatsuki, Teruyasu Sugano, Kazuya Kawai, Takashi Akasaka, Nobuhiro Tanaka, Takeshi Kimura
The impact of the fractional flow reserve (FFR) on clinical decision-making remains unclear in daily practice. The CVIT-DEFER registry is a prospective multicenter registry enrolling consecutive patients with angiographically intermediate coronary stenosis for whom FFR measurement is clinically indicated. The treatment strategy determined from angiographic findings alone and the strategy selected after FFR measurement were compared. Data on the treatment strategy were obtained for 3093 subjects. The average age of these subjects was 69...
January 2015: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/24664513/prevalence-of-visual-functional-mismatch-regarding-coronary-artery-stenosis-in-the-cvit-defer-registry
#20
MULTICENTER STUDY
Masato Nakamura, Masakazu Yamagishi, Takafumi Ueno, Kazuhiro Hara, Sugao Ishiwata, Tomonori Itoh, Ichiro Hamanaka, Tetsuzo Wakatsuki, Teruyasu Sugano, Kazuya Kawai, Takashi Akasaka, Nobuhiro Tanaka, Takeshi Kimura
The fractional flow reserve (FFR) is considered to be a reliable index for the assessment of clinically relevant coronary artery stenosis. However, mismatch in assessing the severity of coronary stenosis between coronary angiography and the FFR has been pointed out. The cardiovascular intervention therapeutics (CVIT)-DEFER registry is a prospective multicenter registry study that has enrolled 3,228 consecutive patients among 3,804 patients with angiographically moderate coronary artery lesions in whom FFR analysis was clinically indicated...
October 2014: Cardiovascular Intervention and Therapeutics
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