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Deferred PCI

Yumiko Haraguchi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Ikue Nakashima, Hiroshi Wada, Masamitsu Sanui, Shin-Ichi Momomura, Hideo Fujita
Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma...
February 23, 2018: International Heart Journal
Samuel M Butman
There is some surrogate outcome data supporting deferring PCI in STEMI No hard data to support deferring PCI in STEMI No hard data to refute deferring PCI in STEMI Current national quality measures do not offer a method to adequately document appropriateness of deferring PCI.
February 1, 2018: Catheterization and Cardiovascular Interventions
Yong Liu, Sheikh Mohammed Shariful Islam, Clara K Chow, Shiqun Chen, Muhammad Umer Siddiqui, Qiang Li, Kai-Yang Lin, Kun Wang, Guoli Sun, Ying-Ling Zhou, Jiyan Chen, David Brieger
INTRODUCTION: Primary or emergent percutaneous coronary intervention (PCI) with stenting is the standard treatment for patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI acute coronary syndromes (ACS) at high risk. The value of delayed stenting following balloon-facilitated reperfusion in these patients is largely unknown. METHODS AND ANALYSIS: This systematic review aims to assess whether delayed stenting (vs immediate stenting) improves angiographic and cardiovascular clinical outcomes for patients with STEMI or non-STEMI ACS undergoing primary or emergent PCI...
November 2017: Medicine (Baltimore)
Pravesh Kumar Bundhun, Chakshu Gupta, Feng Huang
BACKGROUND: Nowadays, fraction flow reserve (FFR) is being discussed in every percutaneous coronary intervention (PCI) capable hospitals. Owing to recent development in the medical field, FFR-guided PCI should be able to find a place in Interventional Cardiology. At present, the importance of FFR to stratify patients who require PCI has seldom systematically been investigated. In this analysis, we aimed to compare the major adverse cardiac events (MACEs) mainly in patients with stable coronary artery disease (CAD) to whom PCI was recommended and deferred respectively based on the FFR value...
November 2017: Medicine (Baltimore)
Tycho Vuurmans, Lee Er, Alexander Sirker, Ognjenka Djurdjev, Gerald Simkus, Adeera Levin
BACKGROUND: Revascularization in patients with chronic kidney disease (CKD) and coronary artery disease (CAD) is often deferred because of concern over progression of renal failure. HYPOTHESIS: Revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) leads to progression of renal failure, but improves survival compared with medical therapy in patients with CKD. PATIENTS AND METHODS: Linkages between the British Columbia Cardiac Registry and the British Columbia Renal Registry of patients with established CAD and CKD who underwent CABG, PCI, or were treated medically were propensity matched...
January 2018: Coronary Artery Disease
S Baumann, A C Schaefer, A Hohneck, K Mueller, T Becher, M Behnes, M Renker, M Borggrefe, I Akin, D Lossnitzer
Coronary angiography is considered as the gold standard in the morphological representation of coronary artery stenosis. Coronary angiography is often performed without preprocedural non-invasive proof of ischemia and the assessment of the severity of a coronary lesion by morphology is very subjective. Thus, invasive fractional flow reserve (FFR) measurement represents the current standard for estimation of the hemodynamic relevance of coronary artery stenosis and facilitates decision making for percutaneous coronary intervention (PCI) and stenting...
August 23, 2017: Herz
Ahmed N Mahmoud, Marwan Saad, Akram Y Elgendy, Amgad Mentias, Islam Y Elgendy
OBJECTIVES: To perform a meta-analysis of randomized trials comparing a deferred versus immediate stenting strategy for primary percutaneous coronary intervention (PCI). BACKGROUND: Deferred stent implantation has emerged as a potential strategy aiming to reduce the thrombus burden and improve micro-vascular reperfusion during primary PCI. METHODS: Electronic databases were searched for randomized trials that compared a deferred stent implantation versus immediate stent implantation strategy in patients undergoing primary PCI...
August 11, 2017: Catheterization and Cardiovascular Interventions
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...
August 25, 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...
November 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...
December 1, 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
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