Interventional Cardiology
Cohort Study: Late ventricular arrhythmias are rare in STEMI patients without left ventricular dysfunction post-primary PCI – JAMA Netw Open
11 May, 2024 | 14:15h | UTCStudy Design and Population: This cohort study analyzed data from the US National Cardiovascular Data Registry Chest Pain–MI Registry, involving 174,126 adults with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) from 2015 to 2018. The population included a broad demographic with a focus on those experiencing late ventricular tachycardia (VT) or ventricular fibrillation (VF) post-PCI, specifically examining occurrences one day or more after the intervention.
Main Findings: The study found that 8.9% of the patients developed VT or VF after PCI, with 2.4% experiencing these arrhythmias late in the hospitalization period. Among patients with uncomplicated STEMI, late VT or VF with cardiac arrest was exceedingly rare, occurring in only 0.1%. Notably, reduced left ventricular ejection fraction was strongly associated with an increased risk of late VT or VF with cardiac arrest. The presence of late VT or VF significantly correlated with higher in-hospital mortality rates.
Implications for Practice: The findings suggest that late VT or VF after primary PCI in STEMI patients is infrequent, particularly among those without complications. This data supports the potential for safe earlier hospital discharge in uncomplicated cases. However, vigilance is advised due to the significant mortality risk associated with late VT or VF events. Clinicians should consider patient-specific risk factors such as left ventricular function when making discharge decisions.
Reference (link to free full-text):
RCT: Post-1 month ticagrelor monotherapy vs. dual antiplatelet therapy significantly reduces bleeding events in acute coronary syndromes
30 Apr, 2024 | 13:26h | UTCIn this randomized, placebo-controlled, double-blind clinical trial, 3400 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) were assessed to compare the effects of ticagrelor alone versus ticagrelor plus aspirin from 1 to 12 months post-PCI. The study aimed to determine if ticagrelor alone could reduce bleeding without increasing major adverse cardiovascular or cerebrovascular events (MACCE). The primary findings indicated that ticagrelor alone resulted in significantly lower clinically relevant bleeding (2.1% vs. 4.6%, p<0.0001) and demonstrated non-inferiority in MACCE rates compared to the dual therapy group (3.6% vs. 3.7%, pnon-inferiority<0.0001). These outcomes suggest that ticagrelor monotherapy, starting one month post-PCI, may be an effective alternative to standard dual antiplatelet therapy in reducing bleeding risks without compromising safety.
Commentary on X:
Ticagrelor, in combination with #aspirin for 1 month, followed by ticagrelor alone,
after #PCI (GLOBAL LEADERS): a randomised superiority trial https://t.co/Bo8gfHIZLeRegister now to freely access #ESCCongress #LancetCardiology content up to Sept 10! https://t.co/6wOSrV9yXM pic.twitter.com/8EV5d8s1c8
— The Lancet (@TheLancet) August 27, 2018
Reference (link to abstract – $ for full-text):
RCT: Efficacy and safety of microaxial flow pump in STEMI-related cardiogenic shock
28 Apr, 2024 | 20:17h | UTCThis randomized clinical trial assessed the impact of a microaxial flow pump (Impella CP) on mortality in 355 patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Patients were randomly assigned to receive either the microaxial flow pump plus standard care or standard care alone. The primary outcome was mortality at 180 days. Results showed a significant reduction in death rates in the microaxial flow pump group (45.8%) compared to the standard care group (58.5%) with a hazard ratio of 0.74 (95% CI, 0.55 to 0.99; P=0.04). However, the incidence of severe adverse events was notably higher in the microaxial flow pump group, including severe bleeding and device-related complications.
Reference (link to abstract – $ for full-text):
RCT: Reduction in cardiac events through preventive PCI in vulnerable atherosclerotic coronary plaques
28 Apr, 2024 | 17:39h | UTCThis multicenter, open-label, randomized controlled trial assessed the effectiveness of preventive percutaneous coronary intervention (PCI) versus optimal medical therapy alone in treating patients with non-flow-limiting vulnerable coronary plaques identified by intracoronary imaging. Conducted across 15 research hospitals in four countries, the trial enrolled 1,606 patients, with 803 in each treatment group. After 2 years, major adverse cardiac events were significantly lower in the PCI group (0.4%) compared to the medical therapy group (3.4%), with a p-value of 0.0003. These results suggest that preventive PCI can effectively reduce cardiac events in patients with high-risk vulnerable plaques, supporting the expansion of PCI indications to these patients.
Reference (link to abstract – $ for full-text):
RCT: Intravascular ultrasound guidance improves outcomes in percutaneous coronary intervention for acute coronary syndrome
28 Apr, 2024 | 17:22h | UTCThis randomized clinical trial evaluated 3505 acute coronary syndrome (ACS) patients across 58 centers in China, Italy, Pakistan, and the UK, comparing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI. The study’s primary endpoint was target vessel failure—comprising cardiac death, myocardial infarction, or revascularisation—after 1 year. The IVUS-guided group showed significantly lower rates of the primary endpoint (4.0%) compared to the angiography-guided group (7.3%), with a hazard ratio of 0.55. This outcome was primarily driven by reductions in myocardial infarction and revascularisation, with similar safety profiles between the two groups.
Reference (link to abstract – $ for full-text):
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