No abstract available.
Percutaneous Coronary Intervention

No abstract available.
Korea ; Percutaneous Coronary Intervention

No abstract available.
Percutaneous Coronary Intervention

No abstract available.
Percutaneous Coronary Intervention

Introduction: Though the role of inflammation is reputedly associated with contrast induced nephropathy (CIN), especially in the setting of Acute Coronary Syndrome (ACS), current risk scoring systems do not address inflammatory factors. Neutrophil lymphocyte ratio (NLR), a proportion of two inflammatory markers, is reflective of the balance between innate and adaptive immune responses, and therefore has a strong predictive value. Methods: A cross-sectional analytical study done among adult Filipinos diagnosed with ACS who underwent Percutaneous Coronary Intervention (PCI) from January to December 2018 at Makati Medical Center. Exposure of interest includes baseline NLR count and pre-procedural serum creatinine. Outcome was the incidence of CIN based on serum creatinine 24-48 hours post-procedure. Results and Analysis: A total of 166 ACS patients were analyzed, of which 11 (6.62%) has CIN. Patients with pre-procedural NLR > 4.71 were approximately five times as likely to develop CIN (aOR 1.51 to 17.55, p = 0.009), with sensitivity 63.64%, specificity 80.65%, accuracy 79.52%, Youden’s index 44.29%. On multivariate analysis, NLR and STEMI were associated with increased odds for CIN. STEMI patients had approximately four times the odds of developing CIN (aOR 3.893, 95% CI 1.07 to 14.13, p = 0.039). Conclusion NLR > 4.71 in Filipinos with ACS who underwent PCI is associated with increased risk to develop CIN.
Percutaneous Coronary Intervention

INTRODUCTION

Since earlier days of percutaneous coronary intervention (PCI), there has been improvement in several aspects of PCI including use of transradial approach and third generation drug-eluting stents. Despite data showing its safety, same-day discharge (SDD) PCI has not been widely practiced in our institution and country. At present, there are no published studies from the Philippines showing the safety and outcome of SDD PCI.

The primary objective of this study is to determine and compare the safety and outcomes of SDD versus overnight observation ater PCI in The Medical City from 2018 to 2021.

This was a retrospective cohort study. The primary endpoint was to describe and compare the clinical profile of patients who underwent same-day versus overnight observation after PCI such as age, sex, comorbidities, indication for coronary angiogram, procedure time, total dye used, stent, and drug-eluting stent used. Incidence of major adverse cardiovascular event, mortality, readmission, and access site complications were also determined at 48 hours and 30 days after PCI.

Ninety-three patients were included in the analysis. Reasons for undergoing PCI were a positive noninvasive stress test (45%), stable angina (40%), coronary artery disease (26%), and heart failure (20%). More single-vessel (60%) than multivessel (40%) PCIs were performed. The most frequently affected coronary artery was the LAD (82%), followed by right coronary artery (32%) and left circumflex artery (30%). Compared with patients who stayed longer after PCI, the SDD group had lower mean (±SD) body mass index (25.10 ± 3.12 vs 28.55 ± 4.95 kg/m2), less due to a positive noninvasive test (26% vs 51%), more who underwent a single-vessel PCI (78% vs 54%), lower median amount of injected dye (130 vs 188 mL), shorter median procedural time (74 vs 101.5 minutes), and greater use of sirolimus-eluting stent (22% vs 3%). No adverse outcome of interest was noted in any patient up to 30 days after hospital discharge.

No adverse outcome was noted with SDD PCI. Larger, prospective, randomized comparative studies are needed to ascertain its safety before recommending SDD PCI routinely.

Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.
Humans ; Percutaneous Coronary Intervention* ; Thrombosis

Entrapment of an intravascular ultrasound (IVUS) catheter during coronary intervention is rare, but can cause serious complications. Retrieval of an entrapped catheter can also lead to adverse results for implanted stents. We report a case in which the sheath tip at the guidewire exit port was entrapped and caused stent distortion during a post-stent IVUS procedure with automatic pullback.
Catheters ; Percutaneous Coronary Intervention ; Stents

The primary concern in percutaneous coronary intervention for bifurcation lesions is occlusion of a side branch after stenting of a main branch, especially in high-risk patients. We describe a novel technique, consecutive jailed- and kissing-Corsair technique, using a Corsair microcatheter for protection of side branches in bifurcation lesions.
Humans ; Percutaneous Coronary Intervention ; Stents

BACKGROUND

Primary percutaneous coronary intervention (PPCI) may be complicated by heavy intracoronary thrombus burden leading to decrease in myocardial perfusion and increase in infarct size. The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban during PPCI.

A systematic search for randomized controlled trials that evaluate the safety and efficacy of AT with intracoronary tirofiban in ST-elevation myocardial infarction (STEMI) patients who underwent PPCI was done using PubMed, MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov., and Herdin PH. Studies included those published between 2010 and 2023 and involved human subjects. Search terms included “aspiration thrombectomy,” “intracoronary tirofiban,” “primary percutaneous coronary intervention,” and “STEMI patients.”

Four randomized controlled trials (n = 490 participants) were included in this metaanalysis comparing AT with intracoronary tirofiban versus AT alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST-segment resolution (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97–1.08; P = 0.41, I2 = 0%), myocardial blush grade 2–3, (RR, 1.04; 95% CI, 0.97–1.12; P = 0.22, I2 = 62%), and Thrombolysis In Myocardial Infarction 3 flow (RR, < 1.0; 95% CI, 0.95–1.04; P = 0.87).

The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR, 0.46; 95% CI, 0.19–1.09; P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR, 1.35; 95% CI, 0.64–2.84; P = 0.78, four trials [490 patients]).

In PPCI, major adverse cardiovascular event outcomes of AT with intracoronary tirofiban were similar to those for AT alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during AT.