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Left main PCI

Bo Xu, Björn Redfors, Yuejin Yang, Shubin Qiao, Yongjian Wu, Jilin Chen, Haibo Liu, Jue Chen, Liang Xu, Yanyan Zhao, Changdong Guan, Runlin Gao, Philippe Généreux
OBJECTIVES: The aim of this study was to assess the impact of operator experience on prognosis after left main coronary artery (LM) percutaneous coronary intervention (PCI). BACKGROUND: LM PCI can be technically challenging and potentially risky considering the amount of supplied myocardium. METHODS: Consecutive patients who underwent unprotected LM PCI at a single institution were included and compared according to whether the primary operator was an experienced, high-volume LM operator (defined as an operator who performed at least 15 LM PCIs per year for at least 3 consecutive years) or not...
October 24, 2016: JACC. Cardiovascular Interventions
Dae Young Hyun, Myung Ho Jeong, Doo Sun Sim, Yun Ah Jeong, Kyung Hoon Cho, Min Chul Kim, Hyun Kuk Kim, Hae Chang Jeong, Keun Ho Park, Young Joon Hong, Jun Han Kim, Youngkeun Ahn, Jung Chaee Kang
Background/Aims: This study appraised the long term clinical outcomes of patients treated with percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease. There are limited data regarding long-term clinical outcomes after PCI for ULMCA disease. Methods: From 2001 to 2011, a total of 448 patients who underwent PCI for ULMCA disease and had 2-year clinical follow-up, were analyzed. The study patients were divided into two groups: group I (stable angina pectoris [SAP], n = 60, 48 men, 62 ± 10 years) and group II (acute coronary syndrome [ACS], n = 388, 291 men, 64 ± 10 years)...
October 18, 2016: Korean Journal of Internal Medicine
Leonida Compostella, Nenad Lakusic, Nicola Russo, Tiziana Setzu, Caterina Compostella, Elia Vettore, Giambattista Isabella, Giuseppe Tarantini, Sabino Iliceto, Fabio Bellotto
BACKGROUND: Depressed heart rate variability (HRV) is usually considered a negative long-term prognostic factor after acute myocardial infarction. Anyway, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention (PCI). Main aim of this study was to evaluate if HRV still retains prognostic significance in our era of immediate PCI. METHODS AND RESULTS: Two weeks after STEMI treated by primary PCI, time-domain HRV was assessed from 24-h Holter recordings in 186 patients: markedly depressed HRV (SDNN <70ms or <50ms) was present in 16% and in 5% of cases, respectively; patients with left ventricle ejection fraction (LVEF) <40% presented more often SDNN values in the lowest quartile...
September 23, 2016: International Journal of Cardiology
Chaofan Wang, Shuguang Han, Tongda Xu, Fengli Wang, Xiaoping Wang, Jing Chen, Chunfeng Hu, Dongye Li
The aim of this study was to explore the significance of delayed enhancement magnetic resonance imaging (DE-MRI) combined with two-dimensional speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) to assess viable myocardium (VM) in the patients with old myocardial infarction (OMI) associated with congestive heart failure (CHF). Thirty five hospitalized OMI patients with regional wall motion abnormalities and left ventricular ejection fraction (LVEF) < 50% were recruited based on routine echocardiography...
2016: American Journal of Translational Research
Kensuke Takagi, Yusuke Fujino, Toru Naganuma, Yusuke Watanabe, Hiroto Yabushita, Satoru Mitomo, Hiroyoshi Kawamoto, Satoko Tahara, Tsuyoshi Kobayashi, Takayuki Warisawa, Kenichi Karube, Takahiro Matsumoto, Tomohiko Sato, Hisaaki Ishiguro, Naoyuki Kurita, Shotaro Nakamura, Koji Hozawa, Sunao Nakamura
BACKGROUND: There is no consensual opinion regarding the percutaneous coronary intervention (PCI) procedure for unprotected distal left main (UDLM) lesion. METHODS: Between April 2005 and August 2011, 586 consecutive patients with UDLM stenosis treated with drug-eluting stents were recruited for this study to clarify the impact of combination of full-coverage stenting and proximal optimization technique (POT) for UDLM lesion. An optimal strategy of full-coverage stenting and POT was performed in 353 patients and the other 233 patients were not optimally treated...
September 4, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Rafael Cavalcante, Yohei Sotomi, Yaping Zeng, Cheol Whan Lee, Jung-Min Ahn, Carlos Collet, Erhan Tenekecioglu, Pannipa Suwannasom, Yoshinobu Onuma, Seung-Jung Park, Patrick W Serruys
OBJECTIVE: In patients with multivessel disease and proximal left anterior descending artery (LAD) involvement, the best revascularisation strategy is still unclear. We assess outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents in a pooled analysis of individual patient-level data of the SYNTAX and BEST randomised trials. DESIGN: Proximal LAD involvement was defined by any lesion ≥ 50% diameter stenosis in the arterial segment starting from the left-main bifurcation up to (and including) the origin of the first major septal branch...
September 20, 2016: Heart: Official Journal of the British Cardiac Society
Devraj Sukul, Milan Seth, Simon R Dixon, Mark Zainea, Nicklaus K Slocum, Elizabeth J Pielsticker, Hitinder S Gurm
OBJECTIVES: We examined clinical outcomes following percutaneous coronary intervention (PCI) in patients turned down for surgical revascularization across a broad population. BACKGROUND: Prior studies suggest that surgical ineligibility is associated with increased mortality in patients with unprotected left main or multivessel coronary artery disease undergoing PCI. METHODS: This study included consecutive patients who underwent PCI in a multicenter registry in Michigan from January 2010 to December 2014...
September 21, 2016: Catheterization and Cardiovascular Interventions
Arie Pieter Kappetein, Patrick W Serruys, Joseph F Sabik, Martin B Leon, David P Taggart, Marie-Claude Morice, Bernard J Gersh, Stuart J Pocock, David J Cohen, Lars Wallentin, Ori Ben-Yehuda, Gerrit-Anne van Es, Charles A Simonton, Gregg W Stone
AIMS: Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD...
September 18, 2016: EuroIntervention
Józefa Dąbek, Mariusz Bałys, Michał Majewski, Zbigniew T Gąsior
BACKGROUND: Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are heterogeneous individuals with different clinical status compared to patients without DM. OBJECTIVES: The aim of this study was to analyze the group of diabetic patients with ST-segment elevation MI (STEMI) or non-ST-segment elevation infarction (NSTEMI) including risk factors, medical history, laboratory findings, advancement of coronary vessel atherosclerosis, and diagnostics and therapeutic modalities performed...
July 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Ashok Padukone, Ahmed K Sayeed, Nandor Marczin, Diana García Sáez, Bartlomiej Zych, Prashant N Mohite, Mohamed Zeriouh, Robert D Smith, Andre R Simon, Anton Sabashnikov, Aron-Frederik Popov
Spontaneous left main coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death, constituting less than 1% of all epicardial coronary artery dissections. It is often fatal and is mostly recognized at post-mortem examination in young victims of sudden death. More than 70% of the reported cases occurred in women, particularly during pregnancy and the peripartum period and those on oral contraceptives. The clinical presentation is highly variable and prognosis varies widely, depending predominantly on the speed of diagnosis...
September 13, 2016: Perfusion
Pil Hyung Lee, Jung-Min Ahn, Mineok Chang, Seunghee Baek, Sung-Han Yoon, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Duk-Woo Park, Seung-Jung Park
Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity...
September 13, 2016: Journal of the American College of Cardiology
J-M Sinning, A Welz, G Nickenig
The heart team, consisting of conservative cardiologists, cardiac surgeons and interventional cardiologists, is important for a balanced, multidisciplinary decision-making process for patients suffering from coronary artery disease (CAD). Standard evidence-based, interdisciplinary, institutional protocols can be used for commonly encountered case scenarios to avoid the need for a systematic case by case review. Complex cases with a SYNTAX score of more than 32, diabetes mellitus and lesions of the left main stem or three-vessel disease should in general not be treated by an ad hoc percutaneous coronary intervention (PCI) but first discussed in the heart team...
September 5, 2016: Herz
Salim Barywani, Max Petzold
OBJECTIVE: A substantial part of deaths and readmissions in octogenarians with acute coronary syndrome (ACS) is assumed to be of non-cardiovascular causes. However, limited data on cause-specific long-term mortality and hospital readmissions are available. This study was aimed to investigate 5-year cause-specific deaths and re-hospitalizations as well as their prognostic predictors among octogenarians with ACS managed with percutaneous coronary intervention (PCI). METHODS: A total of 181 octogenarians managed with PCI on ACS indication during 2006-2007 at Sahlgrenska University Hospital were included...
September 5, 2016: Scandinavian Cardiovascular Journal: SCJ
Pil Sang Song, Young Bin Song, Joo Myung Lee, Joo-Yong Hahn, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Kyung Woo Park, Hyo-Soo Kim, Yangsoo Jang, Ki Bae Seung, Ju Hyeon Oh, Hyeon-Cheol Gwon
OBJECTIVES: This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES). BACKGROUND: There are limited data on outcomes of the 2-stent strategy in bifurcation PCI. METHODS: Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts...
September 26, 2016: JACC. Cardiovascular Interventions
Rafael Cavalcante, Yohei Sotomi, Cheol W Lee, Jung-Min Ahn, Vasim Farooq, Hiroki Tateishi, Erhan Tenekecioglu, Yaping Zeng, Pannipa Suwannasom, Carlos Collet, Felipe N Albuquerque, Yoshinobu Onuma, Seung-Jung Park, Patrick W Serruys
BACKGROUND: Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES: This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS: We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials...
September 6, 2016: Journal of the American College of Cardiology
Cyril Stechovsky, Petr Hajek, Simon Cipro, Josef Veselka
Acute coronary syndrome is a common cause of sudden cardiac death. We present a case report of a 60-year-old man without a history of coronary artery disease who presented with ST-elevation myocardial infarction. During transportation to the hospital, he developed ventricular fibrillation (VF) and later pulseless electrical activity. Chest compressions with LUCAS 2 (Medtronic, Minneapolis, MN) automated mechanical compression-decompression device were initiated. Coronary angiography showed total occlusion of the left main coronary artery and primary percutaneous coronary intervention (PCI) was performed...
September 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Adel Aminian, Juan F Iglesias, Carlos Van Mieghem, Andrea Zuffi, Angela Ferrara, Roukos Manih, Dariouch Dolatabadi, Jacques Lalmand, Shigeru Saito
PURPOSE: To assess the feasibility and safety of the 7 French (Fr) Glidesheath Slender for complex transradial (TR) percutaneous coronary interventions (PCI). BACKGROUND: The TR approach is increasingly used worldwide for coronary and peripheral vascular interventions. However, the small size of the radial artery remains an important limitation for the use of large-bore guiding catheters (>6 Fr), restricting thereby the treatment of highly complex lesions through the TR approach...
August 27, 2016: Catheterization and Cardiovascular Interventions
Stefano De Servi, Jochen Goedicke, Marco Ferlini, Tullio Palmerini, Mikko Syvänne, Gilles Montalescot
BACKGROUND: Acute coronary syndrome (ACS) mortality increases when the culprit lesion is in the left anterior descending (LAD) artery. We investigated the effects of prasugrel versus clopidogrel according to site of culprit lesion causing ACS treated with percutaneous coronary intervention (PCI) in the TRITON-TIMI 38 study. METHODS: Patients were divided into three groups based on the native coronary artery culprit lesion location. The LAD artery group included also patients with the culprit lesion in the left main (LM) artery...
November 15, 2016: International Journal of Cardiology
Carlos López-Aguilar, Arturo Abundes-Velasco, Guering Eid-Lidt, Yigal Piña-Reyna, Jorge Gaspar-Hernández
BACKGROUND: The best revascularization method of the unprotected left main is a current and evolving topic. METHODS: Within 3 years, 2439 percutaneous coronary interventions (PCI) were registered. We included all the patients with PCI of the unprotected left main, n=48 and matched with patients who underwent coronary artery bypass graft (CABG), n=50. Mayor adverse cerebral-cardiac events (MACCE) were assessed in-hospital and out-hospital during a 16 months follow up...
August 20, 2016: Archivos de Cardiología de México
Khaled Yazji, Fairoz Abdul, Senthil Elangovan, Nick Ossei-Gerning, Anirban Choudhury, James Cockburn, Richard Anderson, Mamas Mamas, Tim Kinnaird
Although randomized trial data suggest that complete revascularization improves outcomes after percutaneous coronary intervention (PCI), the impact of differing revascularization strategies in octogenarians is not well defined. We performed a retrospective analysis, which was conducted of 9,628 consecutive patients who underwent PCI at a large UK center. Octogenarians were more likely to have significant co-morbidity, a higher Mehran bleed risk score (24.5 ± 6.8 vs 13.3 ± 7.4, p <0.0001), and more complex disease (baseline SYNTAX score 18...
October 15, 2016: American Journal of Cardiology
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