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Left main PCI

Rocco A Montone, Giampaolo Niccoli
Patients with left main or multivessel coronary artery disease (CAD) and depressed left ventricular function undergoing coronary artery by-pass grafting (CABG) have a markedly worse prognosis compared with general population, making surgical treatment of CAD unattractive especially when features such as poor distal targets, severe comorbidities, reoperation, advanced age, or impaired renal function are present. At the same time, evidence for improved clinical outcome in this high-risk subset of patients using mini-invasive surgical techniques (i...
March 8, 2018: Minerva Cardioangiologica
Annamaria Dachille, Amelia Focaccio, Lucio Selvetella, Giovanni Napolitano, Carlo Briguori
Although there is not uniform definition of high-risk percutaneous coronary intervention (PCI), patients with severe three-vessel disease, left main disease, single remaining patent vessel and/or depressed left ventricular ejection fraction are considered a high-risk population. In this setting, periprocedural hemodynamic instability represents a serious issue. Percutaneous mechanical circulatory support (MCS) devices may improve both safety and efficacy of high risk PCI. Indeed, MCS help to maintain coronary perfusion pressure and reduce myocardial workload, providing the operator sufficient time to reach the target of complete revascularization...
March 8, 2018: Minerva Cardioangiologica
Alberto Repossini, Lorenzo Di Bacco, Fabrizio Rosati, Maurizio Tespili, Antonio Saino, Alfonso Ielasi, Claudio Muneretto
AIMS: Hybrid revascularization (HCR) has been recently proposed as an alternative strategy in multivessel coronary disease, particularly in patients with high SYNTAX scores and risk scores. The objective of this study is to evaluate the outcomes of HCR versus percutaneous coronary intervention (PCI) drug-eluting stenting in left main treatment. METHODS: A series of 198 consecutive patients with left main stenosis have been treated. HCR, was performed in 77 patients (G1) whereas 121 patients (G2) received PCI on left main...
March 6, 2018: Journal of Cardiovascular Medicine
Harsh Agrawal, Mohamed Teleb, Saba Lahsaei, Luis Carbajal, Ruben Montanez, Joseph P Carrozza
PURPOSE OF THE REVIEW: Coronary artery disease is a major cause of mortality and morbidity in the world, and PCI and CABG account for over a million procedures performed annually in the USA. The goal of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is to achieve complete revascularization (CR) if at all possible. However, restenosis and stent thrombosis (ST) remain the Achilles heel of contemporary PCI with restenosis rates between 10 and 30% with bare metal stents to 5-15% after drug-eluting stents and ST rates of around 0...
March 6, 2018: Current Cardiology Reports
Vamsi Kodumuri, Senthil Balasubramanian, Aviral Vij, Sisir Siddamsetti, Ankur Sethi, Rommy Khalafallah, Sandeep Khosla
Coronary artery bypass grafting (CABG) is the preferred revascularization strategy for unprotected left main disease (UPLMD). Multiple small-scale trials and registry data showed that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a noninferior strategy with a Class IIa American College of Cardiology/American Heart Association recommendation in patients with high surgical risk and favorable anatomy. However, 2 recent large-scale randomized trials showed conflicting evidence. We conducted a meta-analysis of the existing data to compare outcomes of PCI with DES versus CABG for UPLMD...
January 31, 2018: American Journal of Cardiology
S Yokota, J P Ottervanger, M Mouden, M J de Boer, P L Jager, J R Timmer
PURPOSE: Normal myocardial perfusion imaging (MPI) is associated with excellent prognosis. However, in patients with persisting symptoms, it may be difficult to determine the patients in whom invasive angiography is justified to rule out false negative MPI. We evaluated predictors for severe stenosis at invasive angiography in patients with persisting symptoms after normal MPI. METHODS: 229 consecutive patients with normal MPI, without previous bypass surgery, underwent invasive angiography within 6 months...
March 2, 2018: Netherlands Heart Journal
Slayman Obeid, Nooraldaem Yousif, Andreas Schelldorfer, Mohammady Shahin, Lorenz Räber, Baris Gencer, François Mach, Marco Roffi, Christian M Matter, Stephan Windecker, Thomas F Lüscher
OBJECTIVE: To assess the efficacy and safety of coronary left main (LM) disease interventions in patients with acute coronary syndromes (ACS) as compared to those without LM coronary artery disease. METHODS: A total of 2899 patients with ACS, enrolled in the prospective Swiss Program University Medicine ACS (SPUM-ACS) cohort, were included. The primary endpoints of independently adjudicated major adverse cardiovascular and cerebrovascular event (MACCE) and net adverse clinical event (NACE) were determined at 30-day follow-up...
March 2018: Journal of Invasive Cardiology
Uzma Zahid, Asad Islam
With recent advancements in techniques and technologies in the field of interventional cardiology, Percutaneous Coronary Intervention (PCI) is preferred over Coronary Artery Bypass Grafting (CABG), provided patient selection is kept in mind, and all the technical facilities are available to ensure successful end results without any immediate or late cardiac complications. However, dealing with Left Main Coronary Artery (LMCA) osteal disease can be challenging. We report a case of T and Protrusion (TAP) technique performed at Hearts International Hospital, Rawalpindi, Pakistan...
March 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Kaneshka Masdjedi, Joost Daemen, Roberto Diletti, Jeroen Wilschut, Elisabeth Utens, Peter P de Jaegere, Miguel E Lemmert, Arie-Pieter Kappetein, Felix Zijlstra, Ron van Domburg, Nicolas M Van Mieghem
BACKGROUND AND AIMS: Significant left main (LM) stem disease is potentially life-threatening and mandates revascularization. This study aimed to assess how patients rate the importance of particular features of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), how this determines their preference for a particular treatment strategy, and whether particular personality characteristics influence this preference. METHODS AND RESULTS: In total, 1145 patients who visited the outpatient clinic of the Erasmus Medical Center for stable coronary artery disease were asked to complete a case vignette-questionnaire on a hypothetical significant LM stenosis amenable to PCI or CABG...
February 22, 2018: Journal of Cardiology
Stuart J Head, Milan Milojevic, Joost Daemen, Jung-Min Ahn, Eric Boersma, Evald H Christiansen, Michael J Domanski, Michael E Farkouh, Marcus Flather, Valentin Fuster, Mark A Hlatky, Niels R Holm, Whady A Hueb, Masoor Kamalesh, Young-Hak Kim, Timo Mäkikallio, Friedrich W Mohr, Grigorios Papageorgiou, Seung-Jung Park, Alfredo E Rodriguez, Joseph F Sabik, Rodney H Stables, Gregg W Stone, Patrick W Serruys, Arie Pieter Kappetein
BACKGROUND: Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. METHODS: We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality...
February 22, 2018: Lancet
Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Annapoorna S Kini, Sunil Rao, William Weintraub, Timothy D Henry, Serdar Farhan, Birgit Vogel, Sabato Sorrentino, Zhen Ge, Samir Kapadia, Joseph B Muhlestein, Sandra Weiss, Craig Strauss, Catalin Toma, Anthony DeFranco, Mark B Effron, Stuart Keller, Brian A Baker, Stuart Pocock, George Dangas, Roxana Mehran
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm...
March 2018: Canadian Journal of Cardiology
Sheeren Khaled, Rajaa Matahen
BACKGROUND: Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS. OBJECTIVES: To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS. RESULTS: The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF <40% (64...
January 2018: Indian Heart Journal
Ioanna Kosmidou, Shmuel Chen, A Pieter Kappetein, Patrick W Serruys, Bernard J Gersh, John D Puskas, David E Kandzari, David P Taggart, Marie-Claude Morice, Paweł E Buszman, Andrzej Bochenek, Erick Schampaert, Pierre Pagé, Joseph F Sabik, Thomas McAndrew, Björn Redfors, Ori Ben-Yehuda, Gregg W Stone
BACKGROUND: There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). OBJECTIVES: This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. METHODS: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG...
February 20, 2018: Journal of the American College of Cardiology
Waleed E Ali, Satyanarayana R Vaidya, Sylvester U Ejeh, Kingsley U Okoroafor
BACKGROUND: Results on the safety and long-term efficacy of drug-eluting stent placement in unprotected left main coronary artery disease (ULMCAD) compared with those of coronary artery bypass surgery (CABG) remain inconsistent across randomized clinical trials and recent meta-analysis studies. We aimed to compare the clinical outcomes and safety over short- and long-term follow-ups by conducting a meta-analysis of large pooled data from randomized controlled trials and up-to-date observational studies...
February 2018: Medicine (Baltimore)
Chieh-Shou Su, Yu-Wei Chen, Ching-Hui Shen, Tsun-Jui Liu, Yen Chang, Wen-Lieng Lee
Significant unprotected left main (LM) coronary artery disease is frequently associated with severe multivessel disease and increased mortality and morbidity compared with non-LM coronary artery disease. This study compared the clinical outcomes of patients with LM disease who received percutaneous coronary intervention (PCI) with stenting, conventional coronary-artery bypass grafting (C-CABG), and robot-assisted CABG (R-CABG).This retrospective study analyzed 472 consecutive LM disease patients who underwent three different revascularization approaches at a tertiary medical center between January 2005 and November 2013...
February 2018: Medicine (Baltimore)
Kazuhiro Dan, Ron Waksman, Hector M Garcia-Garcia
No abstract text is available yet for this article.
January 6, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Hui-Ping Zhang, Hu Ai, Ying Zhao, Hui Li, Guo-Dong Tang, Nai-Xin Zheng, Fu-Cheng Sun, Jing-Hua Liu
BACKGROUND: There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs. METHODS: A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27...
February 2018: American Journal of the Medical Sciences
Pavel Overtchouk, Julien Pascal, Guillaume Lebreton, Jean-Sebastien Hulot, Charles-Edouard Luyt, Alain Combes, Mathieu Kerneis, Johanne Silvain, Olvier Barthelemy, Pascal Leprince, Nicolas Brechot, Gilles Montalescot, Jean-Philippe Collet
AIMS: To identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with need for extracorporeal life support (ECLS). METHOD AND RESULTS: This observational single-tertiary-centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63...
February 6, 2018: EuroIntervention
George S Mina, Hussam Watti, Demiana Soliman, Anand Shewale, Jessica Atkins, Pratap Reddy, Paari Dominic
BACKGROUND: Most data guiding revascularization of multivessel disease (MVD) and/or left main disease (LMD) favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). However, those data are based on trials comparing CABG to bare metal stents (BMS) or old generation drug eluting stents (OG-DES). Hence, it is essential to outcomes of CABG to those of new generation drug eluting stents (NG-DES). METHODS: We searched PUBMED and Cochrane database for trials evaluating revascularization of MVD and/or LMD with CABG and/or PCI...
January 5, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Toshiki Fujiyoshi, Nobusato Koizumi, Toshiya Nishibe, Kayo Sugiyama, Hitoshi Ogino
BACKGROUND: Localized aortic dissection on the left coronary cusp with critical malperfusion of the left main trunk (LMT) is rare and carries a high risk of death. CASE PRESENTATION: We report a case of a 48-year-old patient who developed localized aortic dissection of the left coronary cusp complicated by critical malperfusion of the LMT of the coronary artery. After percutaneous coronary intervention (PCI) for the LMT, a Koster-Collins-like direct repair of the localized aortic dissection was carried out by closure of the false channel using BioGlue (CyroLife, Inc...
January 30, 2018: Annals of Thoracic and Cardiovascular Surgery
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