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Deferred PCI

Naga Venkata Pothineni, Mohan M Edupuganti, Ahmed Almomani, Jason Payne, Sameer Raina, Shailesh Fnu, Amjad Abualsuod, Joseph Wong, Barry F Uretsky, Abdul Hakeem
AIMS: Intracoronary adenosine (ICA) yields similar fractional flow reserve (FFR) results as the "gold standard" of intravenous adenosine (IVA). Whether they have similar prognostic significance is unknown. METHODS AND RESULTS: 576 patients with 787 lesions in whom PCI was deferred based on FFR >0.75 were studied. Primary outcome was the first major adverse cardiovascular event [MACE defined as death, myocardial infarction (MI), or target vessel revascularization (TVR)] and secondary outcome was a composite of MI and target vessel failure (TVF)...
June 13, 2017: EuroIntervention
Jacob Lønborg, Thomas Engstrøm, Kiril Aleksov Ahtarovski, Lars Nepper-Christensen, Steffen Helqvist, Niels Vejlstrup, Kasper Kyhl, Mikkel Malby Schoos, Ali Ghotbi, Christoffer Göransson, Litten Bertelsen, Lene Holmvang, Frants Pedersen, Erik Jørgensen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Lene Kløvgaard, Dan Eik Høfsten, Lars Køber, Henning Kelbæk
BACKGROUND: Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting. OBJECTIVES: This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO) in patients with STEMI...
June 13, 2017: Journal of the American College of Cardiology
Hong-Bin Liang, Qian Guo, Xin-Lu Zhang, Xue-Wei Liu, Yong-Zhen Tang, Wei-Yu Chen, Yu-Qing Hou, Jian-Cheng Xiu
OBJECTIVE: To evaluate the long-term clinical outcomes of intravascular ultrasound(IVUS) in guiding the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome (ACS). METHODS: A total of 25 patients with intermediate coronary lesions(stenosis of 40%-70%) confirmed by coronary angiography were performed with IVUS. When MLA≥4 mm(2), we deferred the PCI treatment and performed optimal medical treatment (OMT). The patient were followed up for 12 month...
May 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Francesco Saia
Up to 15-23% of the patients with percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation need a surgical procedure <12 months from PCI. Perioperative risk stratification in these patients is challenging and should take into account many individual clinical and anatomic variables, along with the intrinsic surgical risk for ischemic and bleeding events. The presence of DES has always been considered as a harbinger of doom. In fact, DES are associated with delayed vascular healing and require longer dual antiplatelet treatment...
April 2017: Journal of Thoracic Disease
Nobuhiro Tanaka, Masato Nakamura, Takashi Akasaka, Kazushige Kadota, Shirou Uemura, Tetsuya Amano, Nobuo Shiode, Yoshihiro Morino, Kenshi Fujii, Yutaka Hikichi
BACKGROUND: Clinical use of fractional flow reserve (FFR) has been rapidly increasing, but outcomes after FFR-based coronary intervention in Japanese daily clinical practice have not been well investigated.Methods and Results:The prospective multicenter cardiovascular intervention therapeutics registry (CVIT)-DEFER enrolled consecutive patients for whom FFR measurement was clinically indicated. This study comprised 3,857 vessels in 3,272 patients. Lesions were categorized into 4 groups according to FFR result and revascularization strategy: group 1: FFR >0...
April 26, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
Shiv Kumar Agarwal, Srikanth Kasula, Mohan M Edupuganti, Sameer Raina, Fnu Shailesh, Ahmed Almomani, Jason J Payne, Naga V Pothineni, Barry F Uretsky, Abdul Hakeem
BACKGROUND: Fractional flow reserve (FFR) value between 0.75 and 0.80 is considered the "gray zone" and outcomes data relative to treatment strategy (revascularization vs medical therapy alone [deferral]) are limited for this group. METHODS AND RESULTS: A total of 238 patients (64.3 ± 8.6 years; 97% male; 45% diabetic) with gray-zone FFR were followed for the primary endpoint of major adverse cardiovascular event (MACE), defined as a composite of death, myocardial infarction (MI), and target-vessel revascularization...
April 15, 2017: Journal of Invasive Cardiology
Chao-Feng Lin, Ya-Hui Chang, Nai-Fang Chi, Ming-Tsang Chuang, Li-Nien Chien
AIMS: To investigate the association between early percutaneous coronary intervention (PCI) and pneumonia risk in patients with acute myocardial infarction (AMI) by using Taiwan's National Health Insurance Research Database. METHODS AND RESULTS: In total, 4,732 patients with non-ST-elevation myocardial infarction (NSTEMI) and 5,465 with ST-elevation myocardial infarction (STEMI) who had received PCI during AMI hospitalisation (early PCI) were evaluated. Patients who did not receive PCI during AMI hospitalisation (deferred PCI) were matched through propensity score matching...
April 18, 2017: EuroIntervention
Joo-Yong Hahn, Seung-Hyuk Choi, Jin-Ok Jeong, Young Bin Song, Jin-Ho Choi, Yong Hawn Park, Woo Jung Chun, Ju Hyeon Oh, Dae Kyoung Cho, Seong-Hoon Lim, Yu Jeong Choi, Eul-Soon Im, Kyung-Heon Won, Sung Yun Lee, Sang-Wook Kim, Hyeon-Cheol Gwon
BACKGROUND: Although coronary angiography is still the technique most widely used to guide percutaneous coronary intervention (PCI), the appropriate angiographic indication of revascularization for intermediate coronary lesions remains controversial. The aim of this study was to compare conservative versus aggressive strategies with angiographic guidance alone in patients with intermediate coronary lesions. METHODS AND RESULTS: A total of 899 patients with intermediate coronary lesions between 50% and 70% diameter stenosis by quantitative coronary analysis were randomly assigned to the conservative group (n=449) or the aggressive group (n=450)...
March 18, 2017: International Journal of Cardiology
Alec Vishnevsky, Howard M Julien, David L Fischman, Paul Walinsky, J David Ogilby, Nicholas J Ruggiero, Babu Jasti, Michael P Savage
OBJECTIVE: The goal of this study was to demonstrate the importance of intracoronary nitroglycerin (IC NTG) administration during diagnostic coronary angiography and prior to percutaneous coronary intervention (PCI). BACKGROUND: PCI has been a mainstay treatment for patients with symptomatic coronary artery disease. While current guidelines emphasize the importance of periprocedural antithrombotic medications, they fail to mention the use of nitroglycerin prior to PCI...
March 20, 2017: Catheterization and Cardiovascular Interventions
Inna Kim, Min Chul Kim, Hae Chang Jeong, Keun Ho Park, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Ki-Bae Seung, Kiyuk Chang, Youngkeun Ahn
BACKGROUND AND OBJECTIVES: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the optimal timing of staged percutaneous coronary intervention (PCI) remains unclear. SUBJECTS AND METHODS: This study was a retrospective analysis of 753 STEMI patients with MVD who were treated by multivessel PCI in the Convergent Registry of Catholic and Chonnam University for Acute myocardial infarction (MI). Patients were divided into 3 groups according to the time from initial to staged PCI: group 1 (n=316, multivessel PCI performed during the index procedure), group 2 (n=360, staged PCI within 1 week), and group 3 (n=77, staged PCI after 1 week)...
January 2017: Korean Circulation Journal
Joo Myung Lee, Tae-Min Rhee, Haseong Chang, Chul Ahn, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo-Yong Hahn
BACKGROUND: We sought to evaluate safety and efficacy of the deferred stenting versus immediate stent implantation of infarct-related arteries in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: A meta-analysis using random-effects models were conducted. The primary outcome, major adverse cardiac events (MACE), was a composite of all-cause mortality, myocardial infarction (MI), any unplanned target vessel revascularization (TVR), and hospitalization due to cardiac cause...
March 1, 2017: International Journal of Cardiology
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...
March 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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
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
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
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
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
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
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
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
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