Interventional Cardiology
PCI vs. CABG in left main coronary disease patients with and without diabetes—a pooled analysis of 4 trials
22 Mar, 2024 | 11:41h | UTCStudy Design and Population: This research pooled individual patient data from four randomized clinical trials (SYNTAX, PRECOMBAT, NOBLE, and EXCEL), comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in 4393 patients with left main coronary artery disease. The trials included both patients with and without diabetes, allowing for a comparative analysis of outcomes based on the revascularization method and the presence of diabetes.
Main Findings: Patients with diabetes exhibited higher rates of 5-year mortality, spontaneous myocardial infarction (MI), and repeat revascularization compared to those without diabetes. However, mortality rates following PCI vs. CABG were similar in diabetic (15.3% vs. 14.1%, respectively) and non-diabetic patients (9.7% vs. 8.9%, respectively). PCI was associated with a lower risk of stroke within the first year post-operation across all patients. Notably, diabetic patients underwent higher rates of spontaneous MI and repeat revascularization after PCI compared to CABG, with a more significant absolute excess risk observed beyond the first year compared to non-diabetic patients.
Implications for Practice: For patients with left main disease deemed suitable for either PCI or CABG, diabetes status significantly influences long-term outcomes, including death and cardiovascular events. While PCI offers a lower early risk of stroke, it is associated with increased risks of spontaneous MI and repeat revascularization, particularly in diabetic patients. These findings underscore the importance of considering patient-specific factors, such as diabetes status, in choosing between PCI and CABG for left main coronary artery disease revascularization.
Reference
Prakriti Gaba et al. (2024). Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation, 0. DOI: 10.1161/CIRCULATIONAHA.123.065571. Access the study here: Link
Meta-Analysis: No mortality benefit of early vs. delayed/selective coronary angiography in out-of-hospital cardiac arrest without ST-elevation
21 Mar, 2024 | 11:40h | UTCStudy Design and Population: This article presents a systematic review and meta-analysis of five randomized controlled trials comparing early/immediate versus delayed/selective coronary angiography (CAG) in 1512 patients who experienced out-of-hospital cardiac arrest (OHCA) without ST-segment elevation. The population had a mean age of 67 years, with 26% female and 23% having a prior myocardial infarction. Follow-up duration was at least 30 days across included studies.
Main Findings: The analysis revealed no significant difference in the odds of all-cause death between early/immediate and delayed/selective CAG strategies (Odds Ratio [OR] 1.12, 95% CI 0.91–1.38). Similar results were found for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95% CI 0.89–1.36). Subgroup analysis showed no significant effect modification based on age, initial cardiac rhythm, history of coronary artery disease, the presumed ischemic cause of arrest, or time to return of spontaneous circulation. Interestingly, a trend toward increased odds of death was observed in women receiving early CAG compared to men, although this finding approached but did not reach statistical significance.
Implications for Practice: The findings suggest that for OHCA patients without ST-segment elevation, an early/immediate CAG strategy does not confer a mortality benefit over a delayed/selective approach across major subgroups. Notably, the potential for increased mortality risk in women with early CAG warrants further investigation. Clinicians should consider these results when deciding on the timing of CAG in this patient population, keeping in mind the overall lack of mortality benefit and the nuanced differences among subgroups.
Reference: Fardin Hamidi et al. (2023). Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials. Clinical Research in Cardiology, 113(561–569). Access the study here: [Link]
Review | An approach to non-left main bifurcation lesions
11 Aug, 2023 | 15:22h | UTCAn Approach to Non-left Main Bifurcation Lesions: A Contemporary Review – US Cardiology Review
Commentary on Twitter
?Do you know how to classify, assess, and treat non-left main bifurcation lesions with PCI?
New #USCardiology Review by @ANazmiCalik, @mirvatalasnag et al. @radcliffeCARDIO
?https://t.co/PeUcLxUerx pic.twitter.com/qh2FdUTbdE
— Amit Goyal MD MAS (@AmitGoyalMD) August 4, 2023
Review | Interventional cardio-oncology: unique challenges and considerations in a high-risk population
8 Aug, 2023 | 13:27h | UTC
Expert Panel | Assessment and management of older adults undergoing percutaneous coronary intervention
7 Aug, 2023 | 14:55h | UTC
Perspective | The most important trial in modern cardiology (Critical appraisal of the ISCHEMIA trial)
2 Aug, 2023 | 14:11h | UTCChapter 3: The Most Important Trial in Modern Cardiology – Sensible Medicine
See also:
Chapter 1: What Does it Mean to Discover a Coronary Blockage? – By Dr John Mandrola
Chapter 2: On the meaning of a coronary blockage – By Dr John Mandrola
Related/Original Articles:
ISCHEMIA Trial: Initial Invasive vs. Conservative Strategy for Stable Coronary Disease
ISCHEMIA Trial: Management of Coronary Disease in Patients with Advanced Kidney Disease
2023 AHA/ACC clinical performance and quality measures for coronary artery revascularization
31 Jul, 2023 | 14:31h | UTCNews Release: New Coronary Artery Revascularization Clinical Performance and Quality Measures Released – American College of Cardiology
Key Points: 2023 Clinical Performance Measures for Coronary Revascularization – American College of Cardiology
Commentary: New AHA/ACC Performance and Quality Metrics for Coronary Revascularization – TCTMD
ISCHEMIA Trial 2ry Analysis | Patients with CCD and daily/weekly angina seem to benefit most from complete revascularization
26 Jul, 2023 | 13:33h | UTCComplete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentaries:
Complete Revascularization and Angina-Related Health Status – American College of Cardiology
More Angina Relief With Complete Revascularization in Stable CAD: ISCHEMIA – TCTMD
Related/Original Articles:
ISCHEMIA Trial: Initial Invasive vs. Conservative Strategy for Stable Coronary Disease
ISCHEMIA Trial: Management of Coronary Disease in Patients with Advanced Kidney Disease
Perspective | What does it mean to discover a coronary blockage?
26 Jul, 2023 | 13:31h | UTCChapter 1: What Does it Mean to Discover a Coronary Blockage? – By Dr John Mandrola
Chapter 2: On the meaning of a coronary blockage – By Dr John Mandrola
M-A | P2Y12 monotherapy after 1-3 months DAPT safely reduces bleeding in PCI patients with CAD and CKD
26 Jul, 2023 | 13:18h | UTCRelated:
De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis – Nature Reviews Cardiology (if the link is paywalled, try this one)
Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention: 3-Year Follow-up of the SMART-CHOICE Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)
Consensus Paper | De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and PCI
24 Jul, 2023 | 13:08h | UTCDe-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis – Nature Reviews Cardiology (if the link is paywalled, try this one)
RCT | Half-dose Tenecteplase + later PCI if indicated seems to be viable option in older individuals when timely PCI is unavailable
21 Jul, 2023 | 13:36h | UTCHalf-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment–Elevation Myocardial Infarction in STREAM-2: A Randomized, Open-Label Trial – Circulation (link to abstract – $ for full-text)
Commentary on Twitter
In the #STREAMI-2 trial of older adults w/ early-presenting STEMI, half-dose tenecteplase w/ PCI if indicated comparable to primary PCI for ECG/angio endpoints and 30d clinical efficacy but w/ higher risk of ICH @Cardio_KULeuven @CVC_UAlberta @BaineyKevin https://t.co/zFE6C1U98n pic.twitter.com/noWWhJ6y9h
— Circulation (@CircAHA) July 18, 2023
Review | Guiding the use of invasive cardiac interventions in patients with advanced malignancies
17 Jul, 2023 | 13:23h | UTC
Review | Functional coronary angiography for the assessment of the epicardial vessels and the microcirculation
27 Jun, 2023 | 13:33h | UTC
Commentary on Twitter
? STATE OF THE ART: Functional coronary angiography for the assessment of the epicardial vessels and the microcirculation by Faria D, et al. https://t.co/gMUMILNCdc angiography-for-the-assessment-of-the-epicardial-vessels-and-the-microcirculation pic.twitter.com/mSUihEZf78
— EuroIntervention (@EuroInterventio) June 20, 2023
M-A | Similar death rates in left main disease patients treated with PCI or CABG, both in patients with and without ACS
15 Jun, 2023 | 14:59h | UTCPercutaneous Coronary Intervention vs Coronary Artery Bypass Graft Surgery for Left Main Disease in Patients With and Without Acute Coronary Syndromes: A Pooled Analysis of 4 Randomized Clinical Trials – JAMA Cardiology (link to abstract – $ for full-text)
Commentary: CABG and PCI Comparable in ACS Patients With Left Main CAD – TCTMD
Consensus Statement | Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging
13 Jun, 2023 | 13:49h | UTCClinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group – Nature Reviews Cardiology (if the link is paywalled, try this one)
Commentary on Twitter
Check out our new Consensus Statement by @ProfDewey and the Quantitative Cardiovascular Imaging Study Group on the optimal use of imaging modalities to detect and assess coronary artery stenosis and atherosclerosis | https://t.co/WcKzwvE3UU pic.twitter.com/bipgb1zYuE
— Nature Reviews Cardiology (@NatRevCardiol) June 8, 2023
Consensus Paper | Applied coronary physiology for planning and guidance of percutaneous coronary interventions
30 May, 2023 | 11:58h | UTC
Review | Bail-out techniques in percutaneous intervention for Ellis Grade III coronary perforation in left main distal bifurcation lesions
29 May, 2023 | 10:51h | UTC
Commentary on Twitter
#Perforations of #LeftMainBifurcations can be fatal. Hemostasis & maintenance of flow in coronaries are critical. Covered stents can be life-saving.
➡️https://t.co/JkvBWzZFkJ @esbrilakis @GreggWStone @kleechuyMD pic.twitter.com/pXJpvyCnlC
— MyJSCAI (@MyJSCAI) April 20, 2023
SCAI Consensus Statement | Management of in-stent restenosis and stent thrombosis
22 May, 2023 | 13:41h | UTCNews Release: Guidance on management of in-stent restenosis and stent thrombosis – Society for Cardiovascular Angiography and Interventions
Stent angioplasty in coronary artery anomalies with intramural course: when, why, how, with what results?
16 May, 2023 | 14:38h | UTC
Commentary on Twitter
Comprehensive review on #PCI for #CoronaryArteryAnomalies. CAA are associated w cardiac death in select patients w ectopic origins. Acute ischemia may be seen in young athletes & #PCI may be appropriate in select patients.
➡️ https://t.co/j4ELX7jZxp @SarasVallabhMD @RizikMd pic.twitter.com/fHSXeIftcU
— MyJSCAI (@MyJSCAI) May 2, 2023
Review | Dilemmas in cardiology: when to recanalize a chronic total occlusion
12 May, 2023 | 13:19h | UTCSee all articles in the series here
M-A | PCI vs. CABG in non–ST-elevation coronary syndromes and multivessel disease
10 May, 2023 | 15:35h | UTC
Expert Panel | Appropriate use criteria for the management of aortic stenosis
5 May, 2023 | 15:22h | UTC
Contemporary percutaneous management of coronary calcification: current status and future directions
18 Apr, 2023 | 13:06h | UTC
Single arm trial | Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography
12 Apr, 2023 | 13:06h | UTC