Cardiovascular diseases (CVDs) remain the leading cause of death worldwide with coronary artery disease (CAD) being the first culprit in this group. In terms of CAD, not only its presence but also ...its severity plays a role in the patient’s treatment and prognosis. CAD complexity can be assessed with the indicator named the SYNTAX score (SS). A higher SS is associated with major adverse cardiovascular event (MACE) occurrence in short- and long-term observations. Hence, the risk factors affecting CAD severity based on SS results may help lower the risk among patients with already developed CAD to reduce their impact on coronary atherosclerosis progression. The well-established risk factors of CAD are consistent with those associated with the coronary plaque burden. However, recently, it was shown that new indicators exist, which we present in this paper, that significantly contribute to CAD complexity such as inflammatory parameters, C-reactive protein (CRP), ratios based on blood smear results, and uric acid. Moreover, microbiota alteration, vitamin D deficiency, and obstructive sleep apnea (OSA) also predicted CAD severity. However, sometimes, certain indicators were revealed as significant only in terms of chronic coronary syndromes (CCSs) or specific acute coronary syndromes (ACSs). Importantly, there is a need to apply the interdisciplinary and translational approach to the novel CAD severity risk assessment to maximize the impact of secondary prevention among patients at risk of coronary atherosclerosis progression.
Rotational atherectomy (RA) presents superior efficacy over traditional balloon angioplasty in managing calcified plaques, albeit being associated with a perceived heightened aggressiveness and ...increased risk of periprocedural complications.
To assess the frequency and predictive factors of periprocedural myocardial infarction (MI) following RA.
This was a retrospective observational study, encompassing 534 patients. The definition of periprocedural MI was consistent with the 4
universal definition of MI.
Periprocedural MI occurred in 45 (8%) patients. This subset tended to be older (74.6 ±8.2 vs. 72 ±9.3%;
= 0.04) with SYNTAX Score (SS) > 33 points (
= 0.01), alongside elevated rates of no/slow flow (
= 0.0003). These patients less often fulfilled the indication for RA, which is a non-dilatable lesion. The incidence of traditional risk factors was similar in both groups. Univariable logistic regression models revealed: male gender (OR = 0.54;
= 0.04), non-dilatable lesion (OR = 0.41;
= 0.01), prior coronary artery bypass grafting (CABG) (OR = 0.07;
= 0.01) as negative and SS > 33 (OR = 2.8;
= 0.02), older age (OR = 1.04;
= 0.04), no/slow flow (OR = 7.85;
= 0.002) as positive predictors. The multivariable model showed that occurrence of no/slow flow (OR = 6.7;
= 0.02), SS > 33 (OR = 2.95;
= 0.02), non-dilatable lesion (OR = 0.42;
= 0.02), and prior CABG (OR = 0.08;
= 0.02) were independent predictors of periprocedural MI.
Periprocedural MI after RA was not an uncommon complication, occurring in nearly one-twelfth of patients. Our analysis implicated female gender, older age, and more severe coronary disease in its occurrence. As expected, the presence of no/slow flow amplified the risk of periprocedural MI, whereas prior CABG and non-dilatable lesions mitigated this risk.
In order to improve the percutaneous treatment of coronary artery calcifications (CAC) before stent implantation, methods such as rotational atherectomy (RA), orbital atherectomy (OA), and coronary ...intravascular lithotripsy (IVL) were invented. These techniques use different mechanisms of action and therefore have various short- and long-term outcomes. IVL employs sonic waves to modify CAC, whereas RA and OA use a rapidly rotating burr or crown. These methods have specific advantages and limitations, regarding their cost-efficiency, the movement of the device, their usefulness given the individual anatomy of both the lesion and the vessel, and the risk of specified complications. This study reviews the key findings of peer-reviewed articles available on Google Scholar with the keywords RA, OA, and IVL. Based on the collected data, successful stent delivery was assessed as 97.7% for OA, 92.4% for IVL, and 92.5% for RA, and 30-day prevalence of MACE (Major Adverse Cardiac Events) in OA-10.4%, IVL-7.2%, and RA-5%. There were no significant differences in the 1-year MACE. Compared to RA, OA and IVL are cost-effective approaches, but this is substantially dependent on the reimbursement system of the particular country. There is no standard method of CAC modification; therefore, a tailor-made approach is required.
•One-fifth of rotational atherectomy candidates present with acute coronary syndrome.•This group has higher clinical risk profile than stable angina patients.•Mortality and complication rate in this ...group is higher in postprocedural period.•Procedural success and 1-year outcomes is similar to elective patients.•Rotational atherectomy should be considered in case of urgent indications.
Rotational atherectomy (RA) is an acknowledged method of percutaneous treatment of highly calcified or fibrotic coronary lesions. However, using the rotablator system in patients presenting with acute coronary syndromes (ACS) remains controversial and is considered as a relative contraindication. The aim of our study was to assess in-hospital and 1-year outcomes in patients undergoing RA presenting with ACS, in comparison to elective RA procedures.
This single-center observational study included all consecutive patients who underwent RA and PCI in our institution from April 2008 to October 2015. All patients were subsequently divided into two groups based on clinical presentation: stable angina group (SA) and ACS group. Primary endpoints were in-hospital and 1-year all-cause mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were procedural success and in-hospital complications.
The study included 207 patients, 164 (79%) in SA group and 43 (21%) in ACS group. In-hospital mortality was higher in patients with ACS (4.7% vs. 0%, p=0.01). Procedural success was similar in both groups, 93% in ACS groups vs. 92.7% in SA group, p=0.94. There were no significant differences in the rate of periprocedural complications (4.7% vs. 10.4%, p=0.25), however postprocedural complications were more frequent in ACS group. At 1-year follow-up MACE rate and mortality were numerically higher, however statistically not significant (25.6% vs. 16.5%, p=0.17 and 16.3% vs. 7.9%, p=0.10; respectively).
Despite higher mortality and complication rate in ACS group observed in postprocedural period, we found no significant difference in 1-year outcomes in comparison to elective patients. Procedural success of RA in ACS patients is similar to elective patients with SA and this procedure should be considered in case of urgent indications, if no other options of treatment exist.
The normal healthy valve is devoid of inflammatory cells, however background of aortic stenosis (AS) may include inflammatory processes. Moreover, the link between hyperparathyroidism and heart ...failure is postulated. Simple whole blood analysis with indices is a beneficial tool in cardiovascular diseases’ assessment. The purpose of the study was to evaluate correlation between parathyroid hormone (PTH) and simple blood parameters in severe AS.
The study included 62 patients with severe AS. Patients with inflammatory or autoimmune co-morbidities were excluded. Blood samples were collected, and clinical and demographic data were analyzed.
The final study group comprised 55 patients (31 females, 56.4%; mean age 77.13 (SD 6.76)). In 23 patients (41.8%), PTH concentration was markedly increased. The study group was divided into two subgroups according to the PTH concentration. Patients from both groups did not differ significantly in terms of age and co-morbidities. PTH concentration correlated positively with monocyte-lymphocyte ratio (MLR) (p = 0.008, Spearman rho 0.356) and platelet-lymphocyte ratio (PLR) (p = 0.047, Spearman rho 0.269), creatinine level (p = 0.001, Spearman rho 0.425) and glomerular filtration rate (GFR-MDRD) (p = 0.009, Spearman rho −0.349).
The multivariable logistic regression with backward analysis revealed MLR (p = 0.029) and GFR (p = 0.028) as independent significant predictors of abnormal PTH values.
The receiver operator characteristics (ROC) curve was performed for the model of MLR and GFR-MDRD (AUC = 0.777), yielding the sensitivity of 60.9% and specificity of 90.6%.
PTH concentration correlates with monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in calcified AS.
We present a case of a 74-year old woman with a history of diabetes, hypertension, carotid endarterectomy and stenting of iliac arteries because of peripheral artery disease (PAD), admitted with the ...recognition of non ST-segment elevation myocardial infarction. Immediate coronary angiography revealed multivessel disease with critical calcified left main (LM) stenosis (Figure 1 A). Additionally, tight aortic stenosis (AS) with reduced left ventricle ejection fraction (LVEF 40%) was diagnosed. Unfortunately, after transfer to the intensive care unit pulmonary oedema occurred, successfully treated with pharmacotherapy. An urgent heart team meeting was held and the patient was disqualified from open-heart surgery because of comorbidities and high risk (EuroSCORE II – 17%). We decided to perform a hybrid procedure, including one stage balloon aortic valvuloplasty (BAV), percutaneous coronary intervention (PCI) and finally transcatheter aortic valve implantation (TAVI). Moreover, computed tomography revealed highly calcified aortic annulus and due to PAD only an alternative approach for TAVI was possible (Figure 1 B corner).
We present a case of a 70-year-old man with a medical history of exacerbated coronary artery disease, arterial hypertension, diabetes mellitus and hypercholesterolemia. After diagnostic coronary ...angiography the patient was qualified to undergo angioplasty of significant calcified stenosis in the right coronary artery (RCA). The distal RCA lesion was successfully predilated, but predilatations of the medial and proximal parts of the RCA at maximal pressure of 18 atm did not bring the expected result. Due to the undilatable character of the lesion rotational atherectomy (RA) was applied with several runs of the 1.5 mm burr. Unfortunately, the 3.5 × 20 mm non-compliant (NC) balloon was not fully opened again. The next step was the use of a 1.75 mm burr, but at this point the visualisation of the artery using optical coherence tomography (OCT) was introduced. Unexpectedly, OCT revealed highly calcified lesions with extensive dissection in the proximal RCA (Figures 1 A, B) which were not clearly visible in angiography.
Abstract Background This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish ...Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI). Methods and results All patients who underwent TAVI in the participating centers between 2013
and
2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35–93 years old (79.31 ± 7.53); 457 (55.29%) women. Endpoints noted: severe bleeding – 130 (15.72%) pts, vascular complications – 135 (16.32%) pts, thromboembolic events – 29 (3.5%) pts, myocardial infarction – 24 (2.90%) pts, deaths – 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI 0.345–0.938; p = 0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI 0.0217–0.372; p = 0.001) and bleeding (OR 0.138 95%CI 0.043–0.447; p = 0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI 0.009–0.529; p = 0.01 for vascular complications, OR 0.176 95%CI 0.049–0.627; p = 0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively. Conclusion Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.
Conflicting data exist regarding the risk factors for transcatheter heart valve thrombosis (THVT). In addition, no optimal pharmacological strategy to treat THVT has been established so far Aims: The ...aim of this study was to assess the incidence, risk factors, diagnostic workup, and treatment of THVT in Poland.
Data were collected retrospectively in themulticenter registry of patients with THVT (ZAK‑POLTAVI) between November 2008 and November 2018. Transcatheter heart valve thrombosis was defined as an increased mean transvalvular gradient accompanied by a decreased effective orifice area or severe aortic regurgitation, reversible after treatment. Baseline characteristics and procedural data were compared between patients with THVT and those without THVT (matched by age, sex, and diabetic status).
In a group of 2307 patients undergoing transcatheter aortic valve implantation (TAVI), 26 patients with THVT were identified (incidence, 1.14%). In half of the patients, THVT was diagnosed within 6 months after TAVI. As compared with the control group, patients with THVT more frequently had chronic obstructive pulmonary disease (P = 0.035), a smaller aortic valve area (P = 0.007), a higher mean postprocedural transvalvular gradient (P = 0.037), and a lower platelet count (P = 0.029) at the time of the diagnosis. A total of 24 patients (84.6%) received anticoagulation therapy for THVT, and complete resolution of THVT was noted in 12 individuals (46.1%). We observed thromboembolic complications in 2 patients (7.7%).
Transcatheter heart valve thrombosis is a rare complication of TAVI. However, a higher risk of THVT may be expected in patients with chronic obstructive pulmonary disease, a smaller aortic valve area, a higher mean postprocedural transvalvular gradient, and a lower platelet count. Anticoagulation alone or combined with antiplatelet therapy seems to be the optimal pharmacological treatment in this population.
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