Abstract:

Aim: was to compare results of using of direct stenting and coronary artery stenting after pre-dilation (CSaPD) in STEMI patients with occlusive coronary artery thrombosis in terms of frequency of no-reflow syndrome and adverse cardiovascular events (MACE) during in-hospital period.

Material and methods: study included 620 patients with acute myocardial infarction with elevation of the ST segment of the electrocardiogram and occlusive thrombosis of the infarct-dependent coronary artery, who successfully underwent endovascular revascularization by stenting. The CSaPD group included 297 patients who underwent stenting after a preliminary balloon angioplasty. The direct stenting group consisted of 323 patients who underwent stenting without prior dilation. The primary endpoint of the study was the occurrence of no-reflow syndrome, secondary endpoints were cardiac death, certain stent thrombosis, recurrence of myocardial infarction, as well as the combined MACE point. Patients of both groups were monitored during in-hospital period.

Results: there were no significant differences between the groups of CSaPD and direct stenting in main clinical-demographic and clinical-angiographic indicators, with the exception of the average length of hospitalization (11 [8;12] vs 8 [7;9], respectively, p = 0,04). Endpoint analysis revealed differences in the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting groups, respectively, p = 0,03), cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04), as well as the combined MACE point (37 (12,46%) vs 8 (2,48%) in the CSaPD and direct stenting groups, respectively, p = 0,02).

Conclusion: in STEMI patients with occlusive coronary artery thrombosis, direct stenting of the infarct-dependent artery during the restoration of coronary blood flow to TIMI I after passage of coronary guide-wire, significantly reduces the incidence of no-reflow syndrome (34 (11,45%) vs 9 (2,79%) in the CSaPD and direct stenting, respectively, p = 0,03) and cardiac death (31 (10,44%) vs 7 (2,17%) in the CSaPD and direct stenting groups, respectively, p = 0,04).

Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

Abstract:

Aim: was to study the efficacy and functionality of the Yukon Chrome PC stent in clinical practice.

Materials and methods: in 2021, a prospective, observational study of the safety, effectiveness of the Yukon Chrome PC stent, as well as its functionality during implantation in clinical practice, was launched on the basis of 25 domestic clinics. The study included 364 patients who underwent implantation of 495 Yukon Chrome PC stents. Mean age of patients was 62,8 years (from 33 to 89 years). Men were 263 (72,3%). The vast majority (82,4%) of patients were diagnosed with acute coronary syndrome (ACS): without ST segment elevation - 180 (49,45%) patients; with ST segment elevation - 120 (32,9%) patients. Unstable angina was verified in 22 (6%) patients. There were 42 (11,5%) patients with stable angina class 2-3.

Moderate tortuosity of vessels occurred in 27,7% of cases, while severe tortuosity of vessels occurred in 3,57% of cases. Moderate calcification was noted in 115 (31,5%) patients, severe/massive - in 23 (6,3%) cases. A complex lesion combining severe/moderate calcification and severe/moderate tortuosity of the target artery occurred in 79 (21,7%) patients.

Results: technical success of the procedure was achieved in 97,5% of cases. In one patient with severe calcification, the Yukon Chrome PC stent could not be inserted into the affected area. Attempts to implant another stent were also unsuccessful.

Depending on the number of implanted stents, the patients were distributed as follows: 3 stents were inplanted in 31 (8,5%) patients; 2 stents - 102 (28%) patients, 1 stent - 231 (63,5%) patients.

Bifurcation stenting using a two-stent technique was performed in 69 (19%) patients. Stenting of the left main was performed in 11 (3%) cases. Predilation was performed in 245 (67%) patients; postdilation - in 179 (49%) patients.

Conclusion: analysis of hospital results of implantation of Yukon Chrome PC stents indicates good flexibility and deliverability of stents even in patients with moderate and severe sheath calcification.

The overall assessment of the functional characteristics of the stent among endovascular surgeons who performed stenting is quite high.

Abstract:

Introduction: percutaneous coronary intervention plays an important role in treatment of acute myocardial infarction with ST-segment elevation. However, the benefit of performing delayed PCI is controversial (>12h after onset of symptoms typical for STEMI).

Aim: was to compare results of PCI and medical therapy (MT) in patients, who had been admitted to the hospital with verified STEMI, diagnosed 12 hours after the onset of symptoms, and to estimate their effect on clinical outcomes.

Material and methods: data of 100 patients was analyzed, PCI was performed in 62 patients and 38 patients underwent medical therapy. The task was to compare clinical outcomes, which included mortality and major adverse cardiac events (MACE).

Results: all-cause mortality in groups of delayed PCI and MT was 4 (6,45%) and 9 (23,6%) respectively (p <0,05). It was also recorded that minor cases of cardiac death occurred in the group of delayed PCI in comparison with the MT group, 1 (1,6%) and 6 (15,7%) respectively (p <0,05).

Conclusion: delayed PCI (12 hours after the onset of the myocardial infarction in STEMI patients) leads to improvement in all-cause mortality and cardiac death rates compared with conservative treatment.

Abstract:

Introduction: vascular closure devices (VCD) for over 20 years have been used as an alternative to manual compression to achieve hemostasis. Despite the fact that clinical efficacy and safety of occlusive type VCD have been confirmed in a number of studies, their use remains controversial due to the formation of complications at the access site when using these devices.

Aim: was to estimate possible advantages and limitations of vascular closure devices of occlusive type (Angio-Seal) in patients, who had underwent percutaneous coronary interventions (PCI) via femoral access in comparison with traditional manual hemostasis.

Material and methods: data of 231 adult patients who underwent therapeutic endovascular procedures in the City Hospital named after M.P. Konchalovsky, Research and Development Center for Preventive Medicine were selected for retrospective research. The main group, with hemostasis after PCI with Angio-Seal (Terumo) obturating device, consisted of 113 patients, control group - included 118 patients with manual hemostasis. Subjective sensations (pain, numbness, etc.), complication rate, hemostasis time, immobilization and hospitalization duration were evaluated.

Results: success of using VCD was 98.23%, complication rate in the main group was 4.37%, in the control group - 6.78% (however, it was not reliable). The time of hemostasis (2.1 min versus 22.25 min), immobilization (3.5 hours versus 20.6 hours) and hospitalization (4 days versus 8 days) significantly decreased, and the patient comfort level was significantly higher in the main group.

Conclusions: the use of Angio-Seal VCD in patients after percutaneous transfemoral therapeutic endovascular procedures is an effective way to reduce hemostasis time in comparison with using of manual compression; allows to reduce patient's immobilization period, significantly increases patient comfort, and reduces patient's hospital stay.

Along with this procedure, it should be considered as an independent surgical intervention and surgeon should follow all necessary rules and stages of its implementation, should control result of hemostasis.

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Abstract

The phenomenon of unrecovered coronary blood flow, or the «no-reflow» phenomenon, is the most formidable and insufficiently studied example of clinical failures after percutaneous coronary intervention (PCI) and is manifested as the absence of filling of distal coronary arteries. As a result, endovascular treatment may be completely unsuccessful or may be complicated by delayed recovery, the development of systolic dysfunction, the formation of heart aneurysm and other serious problems. Many experimental and clinical studies have been devoted to «no-reflow», but the evidence for this or that way of influencing the appearance of this phenomenon is very ambiguous. This article presents modern aspects related to risk factors, pathophysiology and methods for diagnosing this complication, as well as an analysis of methods for the prevention and correction of the developed «no-reflow» phenomenon.

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Abstract

Aim: was to explore clinical efficacy and safety of two distal radial approach (DRA) types in primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) patients.

Materials and methods: 113 ACS patients with endovascular procedure that had been performed through DRA - met entry criteria. Standard DRA was performed within anatomic snuffbox in 82 patients (72,6%) and modified - on the dorsal surface of the palm (dorsopalmar type) in 31 patients (27,4%). Approach conversion was performed in 7 patients (6,2%). PCI on syndrome- related artery was performed in 94 patients (83,2%). On completion of PCI and final approach angiography, hemostasis was performed with bandage application for 6 hours. Hemostasis comfort was determined by 10 point verbal descriptor Gaston-Johansson scale. On the 5th-7th day after PCI, all patients underwent visual check, palpation and ultrasound duplex scan (UDS).

Results: procedure and fluoroscopy time, X-ray load, hemostasis comfort - didn't depend on DRA type. Examination, palpation, UDS performed on the 5th-7th day after PCI didn't reveal cases of forearm radial artery occlusion (RAO). Subcutaneous forearm hematoma (EASY III - IV) was registered in 3 cases (2,7%). RAO was registered in standard DRA group only in 4 cases (3,5%). There were no cases of access side RAO in dorsopalmar DRA group.

Conclusion: DRA modifications for PCI in ACS patients are valuable addition to classic radial approach. Dorsopalmar DRA can be considered as basic approach.

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Abstract

Aim: was to compare annual results of the use of stents with drug eluting - «NanoMed» and Orsiro.

Material and methods: in a randomized prospective study, an analysis of clinical and angiographic data of 1040 patients after stenting of coronary arteries with the observation period of 12 months was performed. The study and control groups randomly included 520 patients with implanted stents «NanoMed» and Orsiro.

Results: main initial clinical demographic and angiographic indicators did not statistically significantly differ. The primary endpoint (TLF - target lesion failure) was achieved in 6.5 and 5.9% in «NanoMed» and Orsiro groups, respectively (p = 0.7). Target lesion revascularization (TLR) was performed in study and control groups, respectively, in 1.7 versus 1.2% of cases (p = 0.4).

Conclusion: thus, in a comparative analysis of the use of stents «NanoMed» and Orsiro for a period of 12 months - no statistically significant difference was revealed.

References

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2.     Joner M, Finn A, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J. Am. Coll. Cardiol. 2006; 48: 193-202.

3.     Sarno G, Lagerqvist B, Fmbert O, et al. Lower risk of stent thrombosis and restenosis with unrestricted use of 'newgeneration' drug-eluting stents: a report from the nation wide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur. Heart J. 2012; 33(5): 606-613.

4.     ittelbach M, Diener T Orsiro - the first hybrid drug-eluting stent, opening up a new class of drug-eluting stents for superior patient outcomes. Interv. Cardiol. 2011; 6(2):142-144.

5.     Kandzari D, Mauri L, Koolen J, et al. Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin, durable polymer everolimus-eluting stents in patients undergoing coronary revascularization (BIOFLOW V): a randomised trial. Lancet. 2017; 390: 1843-1852.

6.     Cutlip D, Windecker S, Mehran R, et al. Clinical End Points in Coronary Stent Trials. A Case for Standardized Definitions. Research Consortium. Circulation. 2007; 115(17): 2344-2351.

7.     Thygesen K, Alpert J, Jaffe A, et al. Third Universal Definition of Myocardial Infarction. ESC/ACCF/AHA/WHF Expert consensus document. Circulation. 2012; 126: 2020-2035.

8.     Silber S, Windecker S, Vranckx P, Serruys PW. Unrestricted randomiseduse of two new generation drug-eluting coronary stents: 2-year patient-related versus stent-related outcomes from the RESOLUTE All Comers Trial. Lancet. 2011; 377: 1241-1247.

9.     Bazylev VV, SHmatkov MG, Morozov ZA. Comparative evaluation of endothelialization of stents with permanent and biodegradable coatings at an early stage with help of optical coherence tomography. Diagnosticheskaya i intervencionnaya radiologiya. 2017: 11(4): 11-15. [In Russ]

10.   Bazylev VV, SHmatkov MG, Morozov ZA. Comparative results of the use of coronary stents with drug coating «Nanomed» and Orsiro. Angiologiya i sosudistaya hirurgiya. 2019 ; 25(2): 57-62. [In Russ]

11.   Prohorihin AA, Bajstrukov VI, Grazhdankin IO, et al. Simple, blind, prospective, randomized, multicenter study of the efficacy and safety of the KalIpso sirolimus-eluting coronary stent and the XiencePrime everolimus-eluting coronary stent: PATRIOT study results. Patologiya krovoobrashcheniya i kardiohirurgiya. 2017; 21(3): 76-85. [In Russ]

Abstract:

Background: the use of vascular closure devices (VCD) reduces the time of hemostasis, accelerates activation and discharge of the patient. Suture-mediated closure devices are closest in it's structure to the traditional surgical method of hemostasis. Advantages and disadvantages of these devices are mainly associated with design features. Stenoses, atherosclerosis, calcification and scars at the site of access are predictors of complications in the use of suturing devices. Although the effectiveness of these devices has been proven in several foreign studies, their data are not sufficient to draw clear conclusions.

Aim: was to evaluate advantages and disadvantages of using the suture-mediated closure devices after PCI.

Material and methods: study enrolled 208 adult patients, who underwent PCI in City Clinical Hospital named after M.P Konchalovsky, Moscow; FSBI «3 Central clinical military hospital n.a. A. A. Vishnevsky» Defense Ministry RF and SMRC preventive medicine of Department of Healthcare. Study group, where hemostasis after PCI was achieved by means of suture-mediated closure devices Perclose Pro Glide (Abbott Vascular), consisted of 90 patients, control group - 118 patients with manual hemostasis. Subjective feelings (pain, numbness, etc.) were assessed using a rating scale. The incidence of complications in the study group was 5.56%, in the control group - 6.78%. The comfort level of patients was higher in the study group

Results of the study: showed that the use of the Perclose device to achieve hemostasis after PC does not increase the frequency of regional vascular complications in compatison with manual hemostasis. But, at the same time, the use of VCD is an effective way to reduce the time of hemostasis, reduces the period of immobilization of the patient, which increases the patient's comfort and reduces patient's hospital stay.

References

1.      Caputo RP: Currently approved vascular closure devices. Card Interv Today: 70-76, 2012.

2.      Bechara CF, Annambhotla S, LinP H:Access site management with vascular closure devices for percutaneous transarterial procedures. J VascSurg 2010; 52:1682-1696. http://dx.doi.org/10.1016/j.jvs. 2010. 04.079.

3.      Sheth RA, Walker TG, Saad WE, et al: Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol. 2014; 25: 73-84. http://dx.doi.org/10.1016Zj.jvir.2013.08.011.

4.      Haas PC, Krajcer Z, Diethrich Edward B: Closure of large percutaneous access sites using the Prostar XL percutaneous vascular surgery device. J Endovasc Surg. 1999; 168-170.

5.      Barbetta I, van den Berg J: Access and hemostasis: femora and popliteal approaches and closure devices — Why, what, when, and how? Semin Interv Radiol 2014; 31:353-360. http://dx.doi.org/10. 1055/s-0034-1393972.

6.      Boschewitz J M, Pieper CC, Andersson M, et al: Efficacy and time-to-hemostasis of antegrade femoral access closure using the exoseal vascular closure device: A retrospective single-center study. Eur J Vasc Endovasc Surg 2014; 48:585-591. http://dx.doi.org/10.1016/ j.ejvs.2014. 08.006.

7.      Gutzeit A, van Schie B, Schoch E, et al: Feasibility and safety of vascular closure devices in an antegrade approach to either the common femoral artery or the superficial femoral artery. 2012; Cardiovasc Intervent Radiol 35:1036-1040. http://dx.doi.org/10.1007/s0 0270012-0454-5.

8.      Ward TJ, Weintraub J L: Vascular closure device update. Endovasc Today: 2015; 54-60.

9.      Hon LQ, Ganeshan A, Thomas SM, et al: An overview of vascular closure devices: What every radiologist should know. Eur J Radiol. 2010; 73:181-190,. http://dx.doi.org/10.1016/j.ejrad.2008.09.023.

10.    Krajcer Z: The preclose technique for AAA repair. Endovasc Today: 2011; 46-54.

11.    Gerckens U, Cattelaens N, Lampe EG, Grube E. Management of arterial puncture site after catheterization procedures: evaluating a suture-mediated closure device. Am J Cardiol. 1999; 83:1658-63.

12.    Baim DS, Knopf WD, Hinohara T, et al. Suture-mediated closure of the femoral access site after cardiac catheterization: results of the suture to ambulate and discharge (STAND I and STAND II) trials. Am J Cardiol. 2000; 85:864-9.

13.    Fram D.B., Giri S., Jamil G., et al. Suture closure of the femoral arteriotomy following invasive cardiac procedures: a detailed analysis of efficacy, complications, and the impact of early ambulation in 1200 consecutive, unselected cases. Cathet Cardiovasc Interv. 2001; 53:163-73.

14.    Balzer J.O., Scheinert D., Diebold T., et al. Postinterventional transcutaneous suture of femoral artery access sites in patients with peripheral arterial occlusive disease: a study of 930 patients. Cathet Cardiovasc Interv. 2001;53.

Abstract:

Aim: was to evaluate the prognostic effectiveness of the method of cardiac magnetic resonance imaging (MRI) in patients with ischemic heart disease (IHD) with dysfunctional myocardium after endovascular interventions

Materials and methods: a total of 114 patients were included in the study Inclusion criteria: myocardial infarction in previously; myocardial ischemia according to stress tests; occlusion or subtotal stenosis of one or more coronary arteries according to digital angiography (SYNTAX score <32); viable myocardium in the zone of the occluded/stenotic artery; heart failure of I-III functional class (NYHA); left ventricular ejection fraction (LVEF) less than 50%. Patients were randomized into 2 equivalent groups: in the I group, myocardial viability was determined by cardiac magnetic resonance imaging (MRI) with delayed contrast, in the II group - by stress-echocardiography with dobutamine. All patients underwent stenting of coronary arteries in the zone of the viable myocardium with drug-eluting stents. Long-term results of treatment were followed to 12 months after endovascular intervention in all patients.

Results: all patients had a significant improvement in the local contractility of the myocardium after performed endovascular myocardial revascularization. After 12 months, a significant decrease in the mass fraction of ischemic viable myocardium in the peri-infarction zone was noted among patients from group I, compared with preoperative data (32.8 ± 2.4 and 24,3±2,3%, respectively, p<0.05). Thus, in I group the volume of ischemic myocardium decreased by 26%. In all studied groups, there was a significant increase in LVEF, compared with data obtained when the patient was discharged from the hospital. Survival in the I group was 100%, whereas in the II group - 97.3% (p> 0.05). The incidence of non-fatal MI was 0.88 and 3.5% in groups I and II, respectively (p <0.05).

Conclusion: cardiac MRI with delayed contrast is more effective and sensitive for diagnosis of myocardial viability and patient prognosis after endovascular intervention, compared with stress echocardiography with dobutamine. 

References

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2.      Katritsis D.G., loannidis J.P. Percutaneous coronary intervention versus conservative therapy in non-acute coronary artery disease: a meta-analysis. Circulation. 2005; 111(22):2906-2912.

3.      Pitt M., Dutka D., Pagano D. The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function. Eur Heart J. 2004; 25: 500 -507.

4.      Saidova, M.A., Belenkov Yu.N., Akchurin R.S. Diagnosticheskaya tsennost i prognosticheskie vozmozhnosti dobutaminovoi stress-ekhokardiografii i prefuzionnoi stsintigrafii miokarda v vyyavlenii zhiznesposobnogo miokarda u bol'nykh ishemicheskoi bolezn'yu serdtsa s vyrazhennoi disfunktsiei levogo zheludochka i otbore patsientov na khirurgicheskuyu revaskulyarizatsiyu. [Diagnostic value and prognostic possibilities of dobutamine stress echocardiography and myocardial perfusion scintigraphy in the detection of viable myocardium in patients with coronary heart disease with severe left ventricular dysfunction and selection of patients for surgical revascularization]. Kardiobgiya. 1999; (8):4-12 [In Russ].

5.      Vorozhtsova I.N., Bukhovets I.L., Bezlyak V.V. et al. Sopostavlenie rezultatov stress-ekhokardiografii i stsintigrafii miokarda s 99m-tekhnetrilom i probe s sublingval'nym priemom nitroglitserina v otsenke zhiznesposobnosti miokarda u bol'nykh s postinfarktnym kardiosklerozom. [Comparison of results of stress echocardiography and myocardial scintigraphy with 99m-technetril and a sample with sublingual nitroglycerin intake in assessing the viability of the myocardium in patients with postinfarction cardiosclerosis]. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2001;(3):15-20 [In Russ]

6.      Shinkel A.F., Bax J.J., Poldermans D. et al. Hibernating myocardium: diagnosis and patient outcomes. Curr. Probl. Cardiol. 2007; (32):375-410.

7.      Saurabh J., Scott D.F., Deborah H.K. Revascularization in heart failure in the post-STICH era. Curr. Heart Fail. 2013; (10):365-372.

8.      Kwon D.H., Hachamocitch R., Popovic Z.B. et al. Survival in patients with severe ischemic cardiomyopathy undergoing revascularization versus medical therapy: association with end-systolic volume and viability. Circulation. 2012; (126):3-8.

9.      Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2014; (35):2541-2619.

10.    Dickstein K., Cohen-Solal A., Filippatos G.,et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology: Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur. Heart. J. 2008; 29: 2388-2442.

11.    Got'e S.V., Mironkov A.B., Sakhovskii S.A. Sostoyanie problemy revaskulyarizatsii miokarda u patsientov s vyrazhennoi sistolicheskoi disfunktsiei levogo zheludochka [The state of the problem of myocardial revascularization in patients with severe left ventricular systolic dysfunction.] Vestnik transplantologii i iskusstvennykh organov. 2017; 19(1): 103-110 [In Russ].

12.    Camici P.G., Kumak S.P., Rimoldi O.E. Stunning, Hybernating and Assesment of Myocardial Viability. Circulation. 2008; (117):103-114.

13.    Trufanov G.E., Rud' S.D., Zheleznyak S.E. MRT v diagnostike ishemicheskoi bolezni serdtsa: ucheb.posobie. [MRI in the diagnosis of coronary heart disease: education guidance]. SPb.: Izd-vo «ELBI-SPb». 2012;. 63s [In Russ].

14.    West A.M., Kramer C.M. Cardiovascular magnetic resonance imaging of myocardial infarction, viability and cardiomyopathies. Curr. Probl. Cardiol. 2010; (35): 176-220.

15.    Kramer C.M., Schulz-Menger J., Bluemke D.A., et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustee's task force on standardized protocols. J. Cardiovasc. Magn. Reson. 2013; 15(1): 35.

16.    Wellnhofer E., Olariu A., Klein C. Magnetic resonance low-dose dobutamine test is superior to SCAR quantification for the prediction of functional recovery. Circulation. 2004; 109(18): 2172-4.

17.    Gerber B.L., Rousseau M.F., Ahn S.A., et al. Prognostic value of myocardial viability by delayed-enhanced magnetic resonance in patients with coronary artery disease and low ejection fraction: impact of revascularization therapy. Journal of the AmericanCollege of Cardiology. 2012; 59(9): 825-835.

18.    Bax J.J., Poldermans D., Elhendy A., et al. Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium. Current Problems in Cardiology. 2001; 26 (2): 141-186.

19.    Underwood S.R., Bax J.J., vom Dahl J., et al. Imaging techniques for the assessment of myocardial hibernation: report of a Study Group of the European Society of Cardiology. European Heart Journal. 2004; 25(10): 815836.

20.    Romero J., Xue X., Gonzales W. et al. CMR imaging assessing viability in patients with chronic ventricular dysfunction due to coronary artery disease: a meta-analysis of prospective. JACC Cardiovasc. Imaging. 2012; 5(5): 494-508.

Abstract:

The aim of the study was to evaluate results of percutaneous coronary interventions (PCI) in patients with ischemic cardiomyopathy (ICMP) - potential candidates for heart transplantation. The study included 37 patients with ICMP. All the patients before PCI and within the 7 days after it undergo ec-hocardiography and ECG-gated SPECT. The amount of irreversibly damaged myocardium of the left ventricle (LV) was about 50 % of its volume. In these patients ECG-gated SPECT did not show sufficient amount of the viable myocardium, capable to restore the heart function after revascularization. The main result of intervention was increase in survival rate of patients with ICMP within 4 years of observation in comparison with traditional methods of conservative therapy. The first clinical effect of PCI was disappearance or reduction of dyspnea, noted in the majority of the patients. These changes had been confirmed by improvement of a functional class of patients (NYHA class score increase to 3,2±0,5 from 1,7+65; p=0,007) and increase of tolerance to physical excersise. Positive changes of a clinical condition after PCI have taken place due to decrease in rigidity of LV myocardium: It became apparent due to decrease of LV end-diastolic pressure (35,7+9,3 vs. 23,5+9,9 Hg mm; p=0,04) and pressure in pulmonary artery (44+1 2 vs. 33+7 Hg mm; p=0,03). No changes of LV volumes and ejection fraction values in the given category of patients were seen.

Reference 

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Abstract:

Article presents the results of analysis of risk factors associated with early stent thrombosis after percutaneous coronary intervention (PCI) ir patients with acute myocardial infarction (AMI). The study is designed as an observational cohort study prospectively including 140 patients with a PCI treated AMI admitted to our hospital. Patients were divided into two groups: with and without type 2 diabetes rnellitus (DM). A number of early stent thrombosis risk factors including a complete or not complete revascularization and myocardial blush grade during PCI, based on the predictive model were analyzed. The results of the study show that DM in patients with AMI who underwent PCI was not associated with a high risk of early stent thrombosis, however, incomplete revascularization was.

References

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Abstract:

Cardiovascular disease is a leading cause of mortality and morbidity in octogenarian patients. The number of such patients and the number of percutaneous coronary interventions are increasing.

Methods: literature report is based on data, searched in PubMed database, Elibrary, electronic catalog of the Russian State Library, published until January 2017.

Results: review showed reasons why this group of patients refers to high-risk patients. Also, we analyzed modern approaches to the treatment of such patients, significance of PCI, intraoperative factors affecting the outcome of treatment of patients with myocardial infarction.

Conclusion: worse results of PCI in elderly patients in comparison with younger group have multifactorial reasons. Different authors point on higher percent of comorbidity, and previous MI, worse cardiac function, higher iatrogenity Based on received data, we showed clinical problems in these patients, the solution of which would improve results of treatment of this group of challenging patients. 

References

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3.     Roth, Gregory A. et al. «Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality.» The  New England journal of medicine 372.14(2015):1333-1341. PMC. Web. 9 Jan. 2017.

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6.     Bauer T., Mollmann H., Weidinger F., Zeymer U., SeabraGomes R., Eberli F., Serruys P, Vahanian A., Silber S., Wijns W., Hochadel M., Nef H.M., Hamm C.W., Marco J., Gitt A.K. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol. 2011; 151:164-169.

7.     Antonsen L., Jensen L.O., Terkelsen C.J., Tilsted H. H., Junker A., Maeng M., Hansen K.N., Lassen J.F., Thuesen L., Thayssen P Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with STsegment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013; 81:912-919.

8.     Daniel I. Bromage, Daniel A. Jones, Krishnaraj S. Rathod. Outcome of 1051 Octogenarian Patients With STSegment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. Journal of the American Heart Association. 2016;5:e003027.

9.     Caretta G., Passamonti E., Pedroni PN., Fadin B.M., Galeazzi G.L., Pirelli S. Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty. Clin Cardiol. 2014; 37:9:523-529.

10.   Spoon D.B., Psaltis PJ., Singh M., et al. Trends in cause of death after percutaneous coronary intervention. Circulation. 2014; 129:1286-1294.

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13.   Semitko S.P. Metody rentgenjendovaskuljarnoj hirurgii v lechenii ostrogo infarkta miokarda u bol'nyh starshego

Abstract:

Aim: was to review the efficiency of complex methods of bleeding prevention in elderly patients with acute coronary syndrome (ACS) receiving combined anticoagulant and antiplatelet therapy during percutaneous coronary interventions (PCI).

Materials and methods: between January of 2011 to 2015 in «Pokrovskaya City Hospital» of St. Petersburg, 1435 PCI were performed in patients with ACS, the percentage of patients older than 80 years was more than 9%. To reduce bleeding risk we used: transradial access, diminished time of eptifibatide infusion, bivalirudin, intraoperative control of activated clotting time (ACT).

Results: significant decrease of bleeding episodes in patients with high risk of bleeding requiring transfusion at 0, 25% in the early postoperative period was shown.

Conclusions: the reduction of the bleeding risk will increase management efficiency among patients undergoing PCI.  

References 

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10.  Bertrand O.F. Meta-Analysis Comparing Bivalirudin Versus Heparin Monotherapy on Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention. Am. J. Cardiol. 2012; 110:599-606.

11.  Marso S.P, Amin A.P Assotiation between of bleeding avoidance strategies and risk of bleeding among patients undergoing PCI. JAMA. 2010 2; 303 (21): 2156-64.

12.  Mehran R., Lansky A.J., Witzenbichler B., et al. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomized controlled trial. Lancet. 2009; 374:1149-59.

13.  Reduction in Cardiac Mortality With Bivalirudinin Patients With and Without Major Bleeding. Gregg W. Stone et all. J. Am. Coll. Cardiol. 2014;63:15-20.

14.  Michael Lincoff A., John A. Bittl. Bivalirudin and Provisional Glycoprotein 11 b/111 a Blockade Compared With Heparin and Planned Glycoprotein IIb/IIIa Blockad During Percutaneous Coronary Intervention. REPLACE-2 Randomized Trial. JAMA. 2003 February; 289: 19.

15.  Stone G.W., White H.D., Ohman E.M., et al. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. Lancet. 2007; 369:907-19.

16.  Lopotovskiy P.Yu., Parkhomenko M.V., Larin A.G., Korobenin A.Yu. Primenenie bivalirudina v klinicheskoi praktike. [The use of bivalirudin in clinical practice.] Diagnosticheskaya i intervencionnaya radiologia. 2012 (6) #4: 79-88 [in Russ].

Abstract:

Aim: was to evaluate the safety and efficacy of coronary stents «MedEng» and to compare them with results of the use of other coronary stents.

Materials and methods: the study included 147 patients with coronary artery disease, which in the period from January to March 2014 underwent coronary stenting. Stents «MedEng» were implanted in 61 patients (group 1). The second group (control) consisted of 86 patients who underwent implantation of stents «Driver». Average follow-up was 6,2±0,5 months. Endpoints were: the return or retention of not less than 2 angina functional class (on CCS); death by cardiac causes, myocardial infarction (MI), repeated intervention on the target vessel, restenosis> 50%, confirmed by angiography and/or the data of optical coherence tomography (OCT)

Results: success rate of stenting was 100%. Death and MI during follow-up were not observed. Restenosis was observed in 9(14,7%) patients in group «MedEng» and in 13 (15,1%) patients from «Driver» group (p = 0,9). The average degree of coronary restenosis was 76,1±8,4% and 76,2±6,4% in the first and second groups, respectively (p=0.9). According to results of logistic regression, stents «MedEng» was not a predictor of restenosis (OR=1,998; 95% CI (0,158-312,551); p = 0,314).

Conclusions: the use of stents «MedEng» is safe and effective in myocardial revascularization. Results of implantation of stents «MedEng» do not different from results of the use of stents «Driver».  

References 

1.    Hoffmann R., Mintz G. Coronary in-stent restenosis - predictors, treatment and prevention. European Heart Journal 2000; 21: 1739-1749.

2.    Ben-Dor I., Waksman R., Pichard A.et al. The Current Role of Bare-Metal Stents. Cardiac interv. 2011; 1: 57-62.

3.    Kastrati A., Sch^mig A., Elezi S., Dirschinger J et al. Prognostic Value of the Modified American College of Cardiology/American Heart Association Stenosis Morphology Classification for Long-Term Angiographic and Clinical Outcome After Coronary Stent Placement. Circulation. 1999; 100: 1285-1290.

4.    Lagerqvist B., James S., Stenestrand U., Lindbck J., Nilsson T., Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N. Engl. J. Med. 2007; 356: 1009-1019

5.    Sketch M., Ball M., Rutherford B., Popma J.J., Russell C., Kereiakes D.J. Driver Investigators. Evaluation of the Medtronic (Driver) cobalt-chromium alloy coronary stent system. Am. J. Cardiol. 2005;95:8-12.

6.    Farb A., et al., Pathology of acute and chronic coronary stenting in humans. Circulation. 1999; 99(1): p. 44-52.

7.    Sarno G., et al. Lower risk of stent thrombosis and restenosis with unrestricted use of newgeneration drug-eluting stents: a report from the nation wide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur. Heart J. 2012; 33(5): p. 606-13.

8.    Camenzind E., Steg P., Wijns W. Stent thrombosis late after implantation of First-generation drug-eluting stents: a cause for concern. Circulation. 2007; 115: 1440-155.

9.    Lagerqvist B., James S., Stenestrand U., Lindbck J., Nilsson T., Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N.Engl. J. Med. 2007; 356: 1009-1019.

10.  Bavry A., Kumbhani D., Helton T., et al. Late thrombosis of drug-eluting stents: a metaanalysis of randomized clinical trials. Am. J. Med. 2006;119:1056-1061.

11.  Morice M., Urban P., Greene S., Schuler G., Chevalier B. Why are we still using Coronary Bare-Metal Stents? JACC. 2013;61;1122-3.

12.  Steinberg D., Mishra S., Javaid A., et al. Comparison of effectiveness of bare metal stents versus drug-eluting stents in large (>3.5 mm) coronary arteries. Am. J. Cardiol. 2007;99:599-602.

13.  Kim T., Nam C., Hur S., et al. Two-year clinical outcomes after large coronary stent (4.0 mm) placement: comparison of bare-metal stent versus drug-eluting stent. Clin. Cardiol. 2010;33:620-625.

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Abstract:

Aim: was to improve results of treatment of patients with myocardial infarction who underwent emergency coronary stenting, by prevention of bleeding complications from puncture place.

Materials and methods: we present retrospective analysis of clinical case of interventional treatment of myocardial infarction, with late post-puncture bleeding complication (41 day after PCI). Its consequences caused the thrombosis of the external iliac vein with further pulmonary embolism, and acute reocclusion of previously stented coronary artery

Results: developed complications were surgically treated (recurrent coronary stenting, elimination of defect of the femoral artery, implantation of cava filter with its subsequent removal), and thrombolytic therapy Patient was discharged to outpatient care without any indications of cardiopulmonary insufficiency and compensated arterial and venous circulation of operated lower limb. After 11 months, the patient’s condition was without negative dynamics with a satisfactory quality of life.

Conclusion: this clinical example demonstrates how difficult is to detect bleeding from a puncture wound. In cases of femoral access, the routine use of vascular closure devices can reduce the risk of bleeding complications. 

References 

1.    Rekomendacii po lecheniju ostrogo koronarnogo sindroma bez stojkogo pod#joma segmenta ST Evropejskogo obshhestva kardiologov [European cardiological society recommendation: treatment of acute coronary syndrome without stable ST-segment elevation]. Racional'naja farmakoterapija v kardiologii. 2012; 2: 2-64[In Russ].

2.    Sulimov V.A. Antitromboticheskaja terapija pri chreskozhnyh koronarnyh vmeshatel'stvah [Antithrombotic therapy during percutaneous coronary interventions]. Racional'naja farmakoterapija v kardiologii. 2008; 3: 91-100 [In Russ].

3.    Goloshhapov-Aksjonov R.S., Sitanov A.S. Luchevoj arterial'nyj dostup - prioritetnyj dostup dlja vypolnenii chreskozhnoj koronarnoj angioplasti

Abstract:

The cardiac complications' risk factors and it’s stratifications in patients with non-ST elevation acute coronary syndrome are considered in detail. The interrelation between risk factors, features and character of defeat of coronary arteries is defined. Early selective coronarograthy is most informative to identify patients with culpite lesion in this category. Early interventional radiology treatment has allowed to reach more favorable in-hospital and 12-month follow-up period results (patients’s lethality, non-fatal MI).

Abstract:

Aim: was to estimate parameters of left ventricle (LV) perfusion and kinetics at ischemic chronic heart failure (CHF), which initial values are predictors of increased myocardial functional reserve and patients clinical status improvement as a result of revascularization.

Materials and methods: examined 157 patients (146 men and 11 women; age from 33 to 72 years) before and in 2 - 3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III-IV echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion and function disorders were estimated with use of ECG-gated single photon emission computed tomography (SPECT).

Results: in 48% of cases 6-minute walk test increased more than 150%; NYHA class decreased by 2 classes (group 1). In 52% cases 6-minute walk test increased less than 50% and the NYHA class decreased on 1 class or did not change (group 2). Comparison of initial LV condition and clinical effect revealed following conformities. The revascularization effect is limited not to extent of coronary blood flow recovery, but first of all a cardiac muscle condition, the quantitative relation of the functioning myocardium and a focal cardiosclerosis. Thus, critical size to define the favorable forecast of revascularization is perfusion disorder more than a half of LV and kinetics disorder more than a third of cardiac muscle volume. Prevalence of a cardiosclerosis over the functioning myocardium limits clinical effect of a revascularization and growth of a functional reserve.

Conclusion: degree of initial LV myocardium perfusion and movement disorders at patients with severe ischemic heart failure is the key indicator, influencing clinical efficiency of coronary intervention

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