Introduction: Primary percutaneous coronary intervention (PPCI) represents a timely procedure that requires speedy revascularization. Moreover, PPCI in diffuse coronary lesions remains to be ...challenging even in the hands of experienced operators as the use of a long stent may increase the difficulty of the procedure in terms of stent delivery, deployment, and optimization. However, the practicability and clinical outcomes of deployment of a 60-mm-long stent in the setting of PPCI remain to be determined.
Methods: The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients from June 2016 to December 2019, who underwent PPCI with BioMime sirolimus-eluting stents 2.5-3.0/60 mm or 3.0-3.5/60 mm were analyzed at 1 year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE) and target lesion revascularization (TLR).
Results: A total of 88 cases were included in the study; 23 cases underwent PPCI, whereas 65 underwent nonPPCI. The PPCI group had a mean age of 65.7 ± 10.9 years compared with 63.3 ± 9.6 years (P = 0.34) in the nonPPCI group. Eighty-three percentage of PPCI were males compared with 94% of their nonPPCI counterparts (P = 0.20). In addition, the prevalence of hypertension was more common in the PPCI group (87% vs. 63%, P = 0.03). There was no statistically significant difference between the two groups regarding other comorbidities. The most common culprit vessel was the left anterior descending artery (57%) in the PPCI group and the right coronary artery (58%) in the nonPPCI. The use of a stent with a diameter of 2.5-3.0 mm was more common in both groups (61% in PPCI vs. 66% in nonPPCI, P = 0.8). MACCE occurred in four patients during a year of follow-up. One occurred in the PPCI group (4%) compared with three in the nonPPCI group (5%) (P = 1.00). TLR was required in two cases, one in each group (4% vs. 2%, P = 0.46).
Conclusion: The use of a 60-mm-long stent in the setting of PPCI has an excellent 12-month outcome in procedural success, MACCE, and TLR. Large randomized studies are required to confirm these results.
The aim of this study was to compare TIMI flow after administering intracoronary (IC) medications through various routes for the treatment of slow flow/no-reflow during primary PCI.
Two independent ...parallel cohorts of the patients who underwent primary PCI for STEMI and developed slow/no-reflow were recruited. Selection of cohort was based on the route of administration of IC medications as proximal or distal. Post administration TIMI follow was compared between the two cohorts.
A total of 100 patients were included in both, proximal and distal, cohort. Distribution of angiographic, clinical and demographic characteristics was not significant between the two cohorts except prevalence of hypertension, and diabetes mellitus. Frequency of hypertension, and diabetes mellitus were 45 % vs.70 %; p < 0.001 and 28 % vs. 44 %; p = 0.018 among patients in distal and proximal cohort respectively. Final TIMI III flow was achieved in significantly higher number of patients in distal cohort with the frequency of 88 % vs. 76 %; p = 0.027 as compared to proximal cohort.
Administration of IC medication via distal route is observed to be more effective for the treatment of slow flow/no-reflow during primary PCI. Distal route via export catheter or perforated balloon technique should be preferred wherever feasible.
•Administering medications distally at the lesion site produces more beneficial effects irrespective of the drugs used.•Encountering with no-reflow/slow flow in patients undergoing primary percutaneous coronary intervention appropriate management is crucial.•To achieve successful intervention, data suggest distal coronary administration of pharmacological agents using a catheters at the distal site.•Administration of IC medication via distal route is observed to be more effective for the treatment of slow flow/no-reflow during primary PCI.•Distal route via export catheter or perforated balloon technique should be preferred wherever feasible.
Risk stratification for patients undergoing coronary artery bypass surgery (CABG) for left main coronary artery (LMCA) disease is essential for informed decision-making. This study explored the ...potential of machine learning (ML) methods to identify key risk factors associated with mortality in this patient group.BACKGROUNDRisk stratification for patients undergoing coronary artery bypass surgery (CABG) for left main coronary artery (LMCA) disease is essential for informed decision-making. This study explored the potential of machine learning (ML) methods to identify key risk factors associated with mortality in this patient group.This retrospective cohort study was conducted on 866 patients from the Gulf Left Main Registry who presented between 2015 and 2019. The study outcome was hospital all-cause mortality. Various machine learning models logistic regression, random forest (RF), k-nearest neighbor, support vector machine, naïve Bayes, multilayer perception, boosting were used to predict mortality, and their performance was measured using accuracy, precision, recall, F1 score, and area under the receiver operator characteristic curve (AUC).METHODSThis retrospective cohort study was conducted on 866 patients from the Gulf Left Main Registry who presented between 2015 and 2019. The study outcome was hospital all-cause mortality. Various machine learning models logistic regression, random forest (RF), k-nearest neighbor, support vector machine, naïve Bayes, multilayer perception, boosting were used to predict mortality, and their performance was measured using accuracy, precision, recall, F1 score, and area under the receiver operator characteristic curve (AUC).Nonsurvivors had significantly greater EuroSCORE II values (1.84 (10.08-3.67) vs. 4.75 (2.54-9.53) %, P<0.001 for survivors and nonsurvivors, respectively). The EuroSCORE II score significantly predicted hospital mortality (OR: 1.13 (95% confidence interval: 1.09-1.18), P<0.001), with an AUC of 0.736. RF achieved the best ML performance (accuracy=98, precision=100, recall=97 and F1 score=98). Explainable artificial intelligence using SHAP demonstrated the most important features as follows: preoperative lactate level, emergency surgery, chronic kidney disease (CKD), NSTEMI, nonsmoking status, and sex. QLattice identified lactate and CKD as the most important factors for predicting hospital mortality this patient group.RESULTSNonsurvivors had significantly greater EuroSCORE II values (1.84 (10.08-3.67) vs. 4.75 (2.54-9.53) %, P<0.001 for survivors and nonsurvivors, respectively). The EuroSCORE II score significantly predicted hospital mortality (OR: 1.13 (95% confidence interval: 1.09-1.18), P<0.001), with an AUC of 0.736. RF achieved the best ML performance (accuracy=98, precision=100, recall=97 and F1 score=98). Explainable artificial intelligence using SHAP demonstrated the most important features as follows: preoperative lactate level, emergency surgery, chronic kidney disease (CKD), NSTEMI, nonsmoking status, and sex. QLattice identified lactate and CKD as the most important factors for predicting hospital mortality this patient group.This study demonstrates the potential of ML, particularly the Random Forest, to accurately predict hospital mortality in patients undergoing CABG for LMCA disease and its superiority over traditional methods. The key risk factors identified, including preoperative lactate levels, emergency surgery, chronic kidney disease, NSTEMI, nonsmoking status, and sex, provide valuable insights for risk stratification and informed decision-making in this high-risk patient population. Additionally, incorporating newly identified risk factors into future risk scoring systems can further improve mortality prediction accuracy.CONCLUSIONThis study demonstrates the potential of ML, particularly the Random Forest, to accurately predict hospital mortality in patients undergoing CABG for LMCA disease and its superiority over traditional methods. The key risk factors identified, including preoperative lactate levels, emergency surgery, chronic kidney disease, NSTEMI, nonsmoking status, and sex, provide valuable insights for risk stratification and informed decision-making in this high-risk patient population. Additionally, incorporating newly identified risk factors into future risk scoring systems can further improve mortality prediction accuracy.
Objectives
Arrhythmias are a common complication following cardiac surgery, and can significantly affect patients’ outcomes. In some cases, post-operative arrhythmias may lead to hemodynamic ...instability, congestive heart failure, or even sudden cardiac death. Various types of cardiac surgery result in varying rates of post-operative arrhythmias, with more complex procedures causing higher rates. Risk factors for post-operative arrhythmias include advanced age, pre-existing cardiovascular disease, electrolyte imbalances, and the type of cardiac surgery. In this study, we aim to determine the incidence and demographic characteristics of patients who underwent cardiac surgery from November 15, 2020, till November 30, 2021, in a tertiary center in the Kingdom of Bahrain.
Material and Methods
All adult patients (18 years or older) who were booked for cardiac surgery during the study period were included. Patients with pre-existing documented arrhythmias were excluded from the study. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, and mortality. Descriptive statistics was used to analyze the data, including frequency distributions, means, and standard deviations. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality.
Results
A total of 161 patients were enrolled in the study with a mean age of 56.75 ± 1.68 years. Among the total enrolled population, 68.32% were male and 31.68% were female. The majority of patients (61.49%) had undergone urgent surgery. Approximately, half (49.07%) of the patients had coronary artery bypass surgery. Premature ventricular complexes (PVC), atrial fibrillation (AF), junctional rhythm, heart block, and atrial flutter were reported in 30.43%, 29.19%, 11.18%, 9.31%, and 8.07% of patient populations respectively. Pleural effusion (50.31%) and bleeding (19.25%) were common post-surgery complications observed among the patients. The mean oxygen saturation (sO
2
) of the patients on the day of arrhythmia was 95.67 ± 2.05%. Epinephrine/norepinephrine (71.43%) was the most used inotropic agent used after cardiac surgery.
Conclusion
Cardiac surgery is associated with various arrhythmias. The two most common arrhythmias observed in patients after cardiac surgery are premature ventricular contractions and atrial fibrillation.
