Percutaneous Coronary Intervention

… without resorting to coronary artery bypass surgery (CABG). PCI usually starts by inflating a balloon within the coronary artery stenosis (percutaneous transluminal coronary angioplasty)…

… need for emergency coronary artery bypass surgery… percutaneous coronary interventions to distinguish them from conventional balloon angioplasty (percutaneous transluminal coronary …

… A wide range of patients may be considered for percutaneous coronary intervention. It is essential that the benefits and risks of the procedure, as well as coronary artery bypass graft …

Context Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. Objective To assess …

Percutaneous coronary intervention (PCI) continues to advance at pace with an ever-broadening indication. In this article we will review the recent technological advances in PCI that have enabled more complex coronary disease to be treated. The choice of revascularisation strategy must take into account the evidence—just because we can treat by PCI does not necessarily mean we should. When PCI is indicated, a safe, precision PCI approach guided by physiology, imaging and optimal lesion preparation should be the goal to obtain complete revascularisation and a durable long-term result. When these standards are adhered to, the outcomes can be excellent, in even complex coronary disease. We provide contemporary trial evidence to justify PCI and treatment algorithms that ensure optimal revascularisation decision making to achieve the best patient outcomes.

… Kaplan–Meier curves are shown for the percutaneous coronary intervention (PCI) group and the coronary-artery bypass grafting (CABG) group for death from any cause (Panel A); death…

… ESC Guidelines for percutaneous coronary interventions (PCI), however, have not been established. It is the purpose of these guidelines to give practically oriented recommendations …

The field of interventional cardiology has evolved significantly since the first percutaneous transluminal coronary angioplasty was performed 40 years ago. This evolution began with a balloon catheter mounted on a fixed wire and has progressed into bare-metal stents (BMS), first-generation drug-eluting stents (DES), second- and third-generation biodegradable polymer-based DES, and culminates with the advent of bioabsorbable stents, which are currently under development. Each step in technological advancement has improved outcomes, while new persisting challenges arise, caused by the stent scaffolds, the polymers employed, and the non-selective cytostatic and cytotoxic drugs eluted from the stents. Despite the promising technological advances made in stent technology, managing the balance between reductions in target lesion revascularization, stent thrombosis, and bleeding remain highly complex issues. This review summarizes the evolution of percutaneous coronary intervention with a focus on vascular dysfunction triggered by the non-selective drugs eluted from various stents. It also provides an overview of the mechanism of action of the drugs currently used in DES. We also discuss the efforts made in developing novel cell-selective drugs capable of inhibiting vascular smooth muscle cell (VSMC) proliferation, migration, and infiltration of inflammatory cells while allowing for complete reendothelialization. Lastly, in the era of precision medicine, considerations of patients’ genetic variance associated with myocardial infarction and in-stent restenosis are discussed. The combination of personalized medicine and improved stent platform with cell-selective drugs has the potential to solve the remaining challenges and improve the care of coronary artery disease patients.

In contemporary practice, more than one in five patients treated with percutaneous coronary intervention (PCI) are aged ≥75 years and the proportion of elderly individuals in the …

In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset…

… The possible benefits of percutaneous coronary intervention (PCI) in the management of stable patients with coronary artery disease (CAD) in nonacute settings have been debated for …

Percutaneous coronary intervention is a well-established symptomatic therapy of stable coronary artery disease. Using a literature search with special emphasis on the newly-published FAME 2 trial data, the author wanted to explore why percutaneous coronary intervention fails to reduce mortality and myocardial infarction in stable coronary artery disease, as opposed to surgical revascularisation. In the FAME 2 trial, fractional flow reserve-guided percutaneous coronary intervention with second generation drug eluting stents showed a significant reduction in the primary composite endpoint of 2-year mortality, myocardial infarction and unplanned hospitalization with urgent revascularisation as compared to medical therapy alone. In addition, landmark analysis showed that after 8 days, mortality and myocardial infarction were significantly reduced. The author concludes that percutaneous coronary intervention involving fractional flow reserve guidance and modern stents offers symptomatic, as well as prognostic benefit. Orv. Hetil., 2014, 155(49), 1952–1959.

In the twenty-six years since Gruntzig introduced a simple balloon angioplasty technique, percutaneous coronary intervention has undergone extraordinary growth and has now …

… Percutaneous coronary intervention was completed successfully without conversion to manual operation, and device technical success was achieved in 162 of 164 patients (98.8%). …

Ever since coronary angioplasty was first undertaken, treatment of coronary bifurcation lesions has posed technical problems.w1 w2 Specific difficulties involving access to the side branch and the snow plough effect, as well as the role of kissing balloon inflation, have been rapidly identified even before the era of near universal stenting. Consequently, until the late 1980s, patients with bifurcation lesions were generally referred for surgery and seldom treated by percutaneous techniques. However, in cases where angioplasty was considered an option, the kissing dilatation technique was widely used in order to avoid recurrent problems of plaque shifting observed when the two branches were dilated separately.w3 The new tools developed in the early 1990s seemed likely at first to facilitate the approach to bifurcation lesions. However, the results achieved with the debulking technique alone (rotative or directional atherectomy) were rather disappointing. Conversely, coronary stenting through its scaffolding properties became the treatment of choice, at least for reducing the risk of acute complications. In the mid 1990s, the question remained as to how to perform optimal stenting of the main branch while preserving the side branch. The data collected from bench test studies proved crucial. They allowed the operators to understand stent behaviour and the effect of empirically implemented strategies, and to develop new concepts such as dedicated stents. Numerous techniques of stent deployment in bifurcation lesions have been described.1–5w4–w21 These techniques have been indexed6 in our institution and evaluated in vitro in a bench test mimicking coronary bifurcations with diameters of 3.5 mm for the main branch and 3.00 mm for the side branch. The pitfalls of such a model are the absence of stenosis, the constant longitudinal diameter of the main branch, and the impossibility to study other branch diameters. Nevertheless, the problem of access …

Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.

… Balloon Angioplasty Balloon catheters are used as the sole devices in percutaneous transluminal coronary angioplasty (PTCA), or “balloon angioplasty,” and as adjunctive dilating …

… coronary angioplasty . A second level of bias concerns the pool of patients who might have been referred to a particular center because of geography, reputation and other factors. In …

… We investigated whether coronary angioplasty is a viable alternative to bypass surgery in patients who are in need of revascularization and are suitable candidates for either procedure. …

… ABSTRACT To determine the effects of coronary angioplasty on coronary flow reserve (CFR)… single-vessel coronary angioplasty and 31 patients evaluated late after angioplasty (7.5 + …

… and Judkins performed transluminal angioplasty of femoral arterial … in coronary arteries, 2 and in September 1977 he performed the first percutaneous transluminal coronary angioplasty …

… of primary coronary angioplasty alone. Percutaneous transluminal coronary angioplasty for … therapy with regard to the restoration of normal coronary blood flow 1 and is associated with …

… on the basis of experience with both coronary angioplasty and atherectomy, as well as familiarity … Each operator was required to have performed more than 400 coronary-angioplasty …

… coronary artery bypass graft surgery (CABG) and medical therapy in patients with coronary … Over the past decade, the use of coronary angioplasty (PTCA) has increased dramatically, …

… coronary angioplasty This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (… Coronary angioplasty (PTCA) via the femoral or brachial arteries may …

… coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) in patients with one, two, or three diseased coronary … two or more diseased coronary arteries. The intended …

… Coronary angioplasty is frequently performed in the United … patients who underwent coronary angioplasty during 1988-… , and by whether the angioplasty was performed in an institution …

… coronary angioplasty (PTCA). Briefly, after 4 years their status is as follows. Patient 1 is … angioplasty in patients with left main artery stenosis, but why? Shouldn’t we attempt angioplasty …

… for percutaneous transluminal coronary angioplasty. An … and carefully beyond the coronary stenosis, permitting safe … (56 stenoses) with single vessel coronary artery disease, with an …

… patients to undergo elective coronary angioplasty (PTCA) at … Emergency coronary artery bypass graft surgery (CABG) was … of a major complication: multivessel coronary disease, lesion …

… This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. … in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five …

… of the procedure in restoring coronary flow, 11 relieving symptoms… first patients who underwent coronary angioplasty and were … of repeat coronary angioplasty and the need for coronary …

… Published reports on primary angioplasty consist of 1 single-center, … of direct angioplasty.rsJ6 To provide additional evidence about the outcomes and event rates of direct angioplasty in …

… Coronary-stent placement is a new technique in which a balloon-expandable, stainless-… a coronary stenosis. The purpose of this study was to compare the effects of stent placement and …

… Coronary stent placement reduces the restenosis rate compared with that after percutaneous transluminal coronary … All patients with successful coronary stent placement were eligible …

… Coronary stent placement is an established treatment for patients with symptomatic coronary … the influence of vessel size on angiographic restenosis after coronary stent placement. …

… coronary stent placement neutralizes the excess risk that diabetic patients usually present after coronary … stent coronary placement and compare these results with those achieved after …

… coronary stent types. To the best of our knowledge, this is the largest series with coronary stenting … as follows: restenosis after coronary stent placement affects about one third of the …

… -stent restenosis is still a vexing problem of coronary stenting, it was truly refractory in a minority of patients in this study. Diffuse in-stent … late after coronary stent placement, as shown in …

… coronary stent placement. This study includes 2,736 consecutive patients with coronary stent placement. … increased by multiple stent placement and overlapping stents that were also …

… ” of physician expertise in coronary interventions (13)because … and outcome for coronary stent placement are not available … experience in coronary stent placement procedures and early …

… The risk of coronary stent thrombosis from dislodgement due to MRI early after stent placement is … recommend postponing MRI studies until eight weeks after coronary stent placement. …

… Our study included 802 consecutive patients undergoing elective coronary stent placement. Before PCI, patients received a loading dose of 600 mg clopidogrel followed by 75 mg daily. …

… Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with …

The objective of this randomized trial was to assess whether differences in stent design are translated in different clinical outcomes in patients undergoing coronary stent placement. This multicenter randomized trial included 1,147 patients who were randomly assigned to receive one of five types of stainless steel stents: Inflow, MULTI-LINK, NIR, Palmaz-Schatz, and PURA-A stent. Primary endpoint of the study was event-free survival at 1 year. Event-free survival at 1 year was significantly different between the groups (P = 0.014), ranging from 69.4% to 82.4%. Similarly, freedom from myocardial infarction was also significantly different (P = 0.022), with values between 88.2% and 95.2%. Diameter stenosis at 6 months varied from 38.1% +/- 25.0% to 45.6% +/- 27.7% (P = 0. 046), late lumen loss ranged from 1.01 +/- 0.70 mm to 1.20 +/- 0.82 mm (P = 0.085), and the incidence of restenosis varied between 25.3% and 35.9% (P = 0.145). Thus, stent design has a significant impact on the long-term results after coronary stent placement.

… In our study, coronary stent placement was performed in healthy animals. For clinical MR-guided coronary stent placement, focal coronary artery stenoses must be localized on the real-…

… In-stent restenosis occurred within the stented MB segment in 3 of 5 MB stent group patients … In conclusion, inadvertent MB stent placement in left anterior descending artery lesions …

… Palmaz-Schatz intracoronary stent implantation does not increase the risk for coronary artery … affected by the development of a coronary artery aneurysm after PTCA or stent placement. …

… stent placement may represent a valid alternative therapeutic option. Indeed, stent placement was effective in preventing anginal attacks and methylergometrine-induced coronary artery …

… coronary stent placement, platelet activation is a major determinant of the risk of subacute stent … and aspirin reduced platelet activation after coronary stenting1. Although combined …

… stenting. Dextran infusion was initiated as early as possible when coronary artery dissection occurred if acute stenting … All patients were observed for 30 minutes after stent placement, …

… Subacute stent thrombosis is a major life-threaten- ing complication after coronary stent placement and occurs in approximately 1% of the patients according to studies performed in …

… of a catheter-based laser system for percutaneous myocardial revascularization and analyses the … in patients with end-stage coronary artery disease (CAD) and severe angina pectoris. …

… coronary arteries and their angiographic suitability for catheter-based revascularization … The clinical significance of successful revascularization of totally occluded coronary arteries by …

OBJECTIVES We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980. BACKGROUND Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention. METHODS Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old. RESULTS In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993. CONCLUSIONS Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.

… made in the cardiac catheterization laboratory using sensor-… absolute coronary flow reserve, the relative coronary flow … Measurements of coronary physiology in the catheterization …

… These authors further predicted that when revascularization therapy becomes reality, this … coronary artery through the Progreat catheter (Terumo, Tokyo, Japan) a mini infusion catheter, …

… This study of coronary revascularization procedures during the year after catheterization compared men and women with the same extent of coronary artery disease and ejection fraction…

Aim: The connection between revascularization for coronary artery disease (CAD) and the incidence of recurrent events of atrial fibrillation (AF) after ablation is unclear. This study aimed to explore the relationship between coronary revascularization and AF recurrence in patients who underwent radiofrequency catheter ablation (RFCA). Methods: Four hundred and nineteen patients who underwent performed coronary angiography at the same time as RFCA were enrolled in this study. Obstructive CAD was defined as at least one coronary artery vessel stenosis of ≥75% and percutaneous coronary intervention (PCI) was recommended. Non-obstructive CAD was defined as coronary artery vessel stenosis of <75%. The endpoint was freedom from recurrence from AF after RFCA during the 24-month follow-up. Results: In total, 102, 95, and 212 patients were undergone coronary angiography and diagnosed as having obstructive CAD, Non-obstructive CAD, and Non-CAD, respectively. During the 24-month follow-up period, patients without obstructive CAD were significantly more likely to achieve freedom from AF than patients with obstructive CAD (hazard ratio [HR]: 1.72; 95% confidence interval [CI]: 1.23–2.41; P = 0.001). The recurrence rate of AF was significantly lower in patients who underwent PCI than in those who did not (HR: 0.45; 95% CI: 0.25–0.80; P = 0.007). The multivariate regression analysis showed that the other predictors of AF recurrence for obstructive CAD were multivessel stenosis (HR: 1.92; 95% CI: 1.04–3.54; P = 0.036) and left atrial diameter (HR: 2.56; 95% CI: 1.31–5.00; P = 0.006). Conclusions: This study suggests that obstructive CAD is associated with a higher rate of AF recurrence. Additionally, For patients with CAD, coronary revascularization is related to a lower recurrence rate of AF after RFCA.

… artery bypass grafting (CABG) or percutaneous coronary … for Outcomes Assessment in Coronary Heart Disease (… patients undergoing cardiac catheterization and revascularization in the …

… ostial branch stenoses, multivessel coronary artery disease, and … revascularization in patients with multivessel coronary artery … of coronary physiology in the catheterization laboratory for …

The management of intermediate coronary lesions, defined by a diameter stenosis of 40% to 70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Intravascular ultrasound (IVUS) and fractional flow reserve index (FFR) provide anatomic and functional information that can be used in the catheterization laboratory to designate patients to the most appropriate therapy. The purpose of this review is to discuss the critical information obtained from IVUS and FFR in guiding treatment of patients with intermediate coronary lesions. In addition, the importance of IVUS and FFR in the management of patients with serial stenosis, bifurcation lesions, left main disease, saphenous vein graft disease, and acute coronary syndrome will be discussed.

… trial restrictions on use of invasive and revascularization procedures; data were available for in-… cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery …

… catheterization and in whom coronary artery bypass surgery would be performed within 5 to 7 days if warranted based on findings at the time of cardiac catheterization… acute coronary …

… artery may produce small distal emboli, causing further reduction in the coronary flow during … revascularization, it is easily diagnosed with certainty during acute percutaneous coronary …

There are few studies analyzing the association between the presence of coronary artery disease (CAD) and recurrence of atrial fibrillation (AF). This study evaluated the clinical impact of concomitant CAD and coronary revascularization on the recurrence of AF after catheter ablation.

… imaging 23 likely have contributed to decreasing catheterization and revascularization rates, although the COURAGE trial itself would not explain our results because it was not …

… coronary angiography was performed at hospitals with and without on-site cardiac catheterization … affected by the rapid availability of coronary revascularization at hospitals with on-site …

… did not undergo revascularization after their cardiac catheterization despite results of the catheterization showing that these patients had more severe coronary anatomy (Table 2). …

… coronary tree in 2954 patients with acute coronary syndromes in the Acute Catheterization … ≥2.0 mm remained after percutaneous coronary intervention. The primary outcome was 1-…

… LIMA to LAD placement can be combined with catheter-based intervention on non-LAD … Hybrid coronary revascularization is an example for functioning direct cooperation between …

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939–1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called “percutaneous transluminal dilatation”. Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920–1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated his 75th birthday. This article is dedicated to his memory.

… A new theory of the mechanism of percutaneous arterial angioplasty is advanced. For this … from the media were histologically demonstrated following angioplasty. It is proposed that the …

… Dissection during balloon angioplasty appears to correlate with the bulk of atherosclerotic … of balloon angioplasty has in part stimulated the development of new percutaneous devices …

… Balloon angioplasty typically injures the vessel wall by … 2 and elastic recoil 3 after balloon angioplasty are implicated as … may enhance the success of angioplasty by limiting both injury …

The advances in percutaneous coronary interventions (PCI) have been, above all, dependent on the work of pioneers in surgery, radiology and interventional cardiology. From Grüntzig's first balloon angioplasty, PCI has expanded through technology development, improved protocols, and dissemination of best-practice techniques. We can nowadays treat more complex lesions in higher-risk patients with favourable results. Guidewires, balloon types and profiles, debulking techniques such as atherectomy or lithotripsy, stents and scaffolds all represent evolutions that have allowed us to tackle complex lesions such as an unprotected left main coronary artery, complex bifurcations, or chronic total occlusions. Best-practice PCI, including physiology assessment, imaging, and optimal lesion preparation are now the gold standard when performing PCI for sound indications, and new technologies such as intravascular lithotripsy for lesion preparation, or artificial intelligence, are innovations in the steps of 4 decades of pioneers to improve patient care in interventional cardiology. The present review describes major innovations in PCI since the first balloon angioplasty and also uncertainties and obstacles inherent to such medical advances.

… treated with balloon angioplasty only. Of the 110 patients assigned to balloon angioplasty, 40 … was thus seen in 36.4% of the balloon angioplasty group, whereas cross-over to balloon …

… efficacy of percutaneous laser thermal angioplasty as an adjunct to balloon angioplasty were … balloon angioplasty procedures was obtained in 12 of 15 vessels (80%), with inadequate …

… A clinical trial of laser balloon angioplasty in the percutaneous treatment of peripheral arterial in… insight into the potential role of laser balloon angioplasty in the prevention of restenosis. …

OBJECTIVES We conducted a systematic overview (meta-analysis) of randomized trials of balloon angioplasty versus coronary atherectomy, laser angioplasty, or cutting balloon atherotomy to evaluate the effects of plaque modification during percutaneous coronary intervention. BACKGROUND Several mechanical approaches have been developed that ablate or section atheromatous plaque during percutaneous coronary interventions to optimize acute results, minimize intimal injury, and reduce complications and restenosis. METHODS Sixteen trials (9,222 patients) constitute the randomized controlled experience with atherectomy, laser, or atherotomy versus balloon angioplasty with or without coronary stenting. Each trial tested the hypothesis that ablative therapy would result in better clinical or angiographic results than balloon dilation alone. RESULTS Short-term death rates (<31 days) were not improved by the use of ablative procedures (0.3% vs. 0.4%, odds ratio [OR] 0.94 [95% confidence interval 0.46 to 1.92]), but periprocedural myocardial infarctions (4.4% vs. 2.5%, OR 1.83 [95% CI 1.43 to 2.34]) and major adverse cardiac events (5.1% vs. 3.3%, OR 1.54 [95% CI 1.25 to 1.89]) were increased. Angiographic restenosis rates (6,958 patients) were not improved with the ablative devices (38.9% vs. 37.4%, OR 1.06 [95% CI 0.97 to 1.17]). No reduction in revascularization rates (25.2% vs. 24.5%, OR 1.04 [95% CI 0.94 to 1.14]) or cumulative adverse cardiac events rates up to one year after treatment were seen with ablative devices (27.8% vs. 26.1%, OR 1.09 [95% CI 0.99 to 1.20]). CONCLUSIONS The combined experience from randomized trials suggests that ablative devices failed to achieve predefined clinical and angiographic outcomes. This meta-analysis does not support the hypothesis that routine ablation or sectioning of atheromatous tissue is beneficial during percutaneous coronary interventions.

… angioplasty by Grüntzig 2 in Zurich, Switzerland—we reflect on the progress in percutaneous … In this, the first in this Series on percutaneous coronary intervention, we focus on balloon …

… standard percutaneous transluminal coronary angioplasty (… after CB angioplasty versus conventional balloon angioplasty in … the CB compared with conventional balloon angioplasty. CB …

… artery disease and acute myocardial infarction with cardiogenic shock, PCI of the culprit … lesions) was superior to immediate multivessel PCI with respect to a composite end point of …

BACKGROUND Experimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODS In a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTS A total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval [CI], 0.78 to 1.39; P=0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONS In patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. (Funded by the French Ministry of Health and NeuroVive Pharmaceutical; CIRCUS ClinicalTrials.gov number, NCT01502774; EudraCT number, 2009-013713-99.).

… of ischemia after PCI in … myocardial infarction. Whether bivalirudin is safe and effective for patients with ST-segment elevation myocardial infarction who are undergoing primary PCI has …

… ACC/AHA primary PCI guidelines. This … PCI after STEMI, as shown in DANAMI-3-PRIMULTI. Although follow-up stress testing is not routinely indicated after PCI for myocardial infarction, …

… a myocardial infarction correlate with the size of the infarct, … Primary PCI consists of urgent balloon angioplasty (with or … the infarct-related artery during an acute myocardial infarction with …

… , who had ST-segment elevation suggestive of an acute myocardial infarction, who were eligible for fibrinolytic therapy or primary PCI, and for whom the estimated time to diagnostic …

While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.

BackgroundIn the era of primary percutaneous coronary intervention (PPCI), the incidence of post-cardiac injury syndrome (PCIS) in patients with acute myocardial infarction (AMI) following PPCI has become less common. However, the intrinsic pathogenesis of this medical condition remains largely uncertain. Unlike the prior reports, the present paper provides new mechanistic clues concerning the pathogenesis of PCI-related PCIS.Case presentationA 45-year-old male with AMI had developed an early onset of PCIS at 3 h after PPCI. A significantly slower TIMI flow (grade ≤ 2) for the culprit arteries was observed through follow-up coronary angiography (CAG); no stent thrombosis or any significant evidence of iatrogenic trauma due the intervention procedures was found. Nevertheless, the the serum level of HsCRP showed similar variation trend as the neutrophil count and troponin T in continuous blood monitoring, which suggested a potential association between PPCI-related coronary microvascular dysfunction (CMD) and pathogenesis of PCIS.ConclusionsThe reported case had excessive inflammatory reaction and CMD resulting from cardiac ischemia-reperfusion injury in an AMI patient with risk factors of endothelial dysfunction. There exists a potential reciprocal causation between PCIS and performance of PPCI in the AMI patient who was susceptible to endothelial damage.

… with acute MI who survived the first year after PCI without a … therapy in patients undergoing PCI. As demonstrated here and … of dual antiplatelet therapy after an acute coronary event (4–6…

… analogous treatment groups in the Danish Trial in Acute Myocardial Infarction 2 (DANAMI-2), 11 the largest previous clinical trial that favored primary PCI over in-hospital fibrinolysis. In …

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

BACKGROUND An appropriate duration of dual antiplatelet therapy after percutaneous coronary intervention for acute myocardial infarction that has been treated with guideline-recommended complete revascularization and a contemporary drug-eluting stent remains unclear. METHODS We conducted a multicenter, open-label, randomized trial at 40 European sites. Adults with acute myocardial infarction who had undergone successful complete revascularization within 7 days after the infarction and had subsequently completed 1 month of dual antiplatelet therapy with no ischemic or major bleeding events were randomly assigned to transition to a P2Y12 inhibitor as monotherapy or to continue dual antiplatelet therapy for an additional 11 months. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, or major bleeding (defined by the Bleeding Academic Research Consortium [BARC] as a bleeding event of type 3 or 5) at 11 months after randomization (tested for noninferiority with a margin of 1.25 percentage points). The main secondary outcome was BARC type 2, 3, or 5 bleeding (clinically relevant bleeding) at 11 months after randomization (tested for superiority). RESULTS Among the 2246 enrolled patients, 1942 underwent randomization: 961 to receive P2Y12-inhibitor monotherapy and 981 to continue dual antiplatelet therapy. A primary-outcome event occurred in 20 patients (2.1%) in the P2Y12-inhibitor monotherapy group and in 21 patients (2.2%) in the dual antiplatelet therapy group (difference, -0.09 percentage points; 95% confidence interval [CI], -1.39 to 1.20; P = 0.02 for noninferiority). BARC type 2, 3, or 5 bleeding occurred in 2.6% of the patients in the P2Y12-inhibitor monotherapy group and in 5.6% of those in the dual antiplatelet therapy group (hazard ratio, 0.46; 95% CI, 0.29 to 0.75; P = 0.002 for superiority). Stent thrombosis was infrequent, and the incidence was similar in the two groups. The incidence of serious adverse events appeared to be similar in the two groups. CONCLUSIONS Among low-risk patients with acute myocardial infarction who had undergone early complete revascularization and had completed 1 month of dual antiplatelet therapy without complications, P2Y12-inhibitor monotherapy was noninferior to continued dual antiplatelet therapy with respect to the occurrence of adverse cardiovascular and cerebrovascular events and resulted in a lower incidence of bleeding events. (Funded by MicroPort [France]; TARGET-FIRST ClinicalTrials.gov number, NCT04753749.).

… of arrival of the ambulance in the acute phase of MI before or during PCI qualified for this analysis. … to the first episode of VF, either before the PCI procedure or during the PCI procedure. …

… While providing a benchmark for the future evaluation of care processes and outcomes associated with acute MI and PCI procedures, the results from this report highlight several unique …

… PCI is more effective than delayed standard primary PCI in patients who have large myocardial infarctions… 1–3 h before planned PCI results in a worse outcome than PCI alone. This …

BACKGROUND Complete revascularization using either angiography-guided or fractional flow reserve (FFR)-guided strategy can improve clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in un-necessary PCI of the non-infarct-related artery (non-IRA), and its long-term prognosis is still unclear. OBJECTIVES This study sought to evaluate clinical outcomes after non-IRA PCI according to the quantitative flow ratio (QFR). METHODS We performed post hoc QFR analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease) trial, which randomly allocated 562 patients into either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR ≤0.80 and QFR >0.80 groups. The primary outcome was a major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (n = 60) underwent non-IRA PCI despite having QFR >0.80 in the non-IRA. Conversely, only 2.7% (n = 4) among 209 patients in the FFR-guided PCI group had QFR >0.80 in the non-IRA. At a median follow-up of 3.5 years, the rate of MACEs was significantly higher among patients with non-IRA PCI despite QFR >0.80 than in patients with deferred PCI for non-IRA lesions (12.9% vs 3.1%; HR: 4.13; 95% CI: 1.10-15.57; P = 0.036). Non-IRA PCI despite QFR >0.80 was associated with a higher risk of non-IRA MACEs than patients with deferred PCI for non-IRA lesions (12.9% vs 2.1%; HR: 5.44; 95% CI: 1.13-26.19; P = 0.035). CONCLUSIONS In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions. (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease [FRAME-AMI] ClinicalTrials.gov number; NCT02715518).

BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).

… in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (… Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR …

The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.

ABSTRACT Introduction Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifested as intracoronary stent restenosis (ISR). Even with advances in stent technology and medical therapy, this complication is reported to affect around 10% of all percutaneous coronary intervention (PCI) procedures. Depending on stent type (drug-eluting versus bare metal), ISR has subtle differences in mechanism and timing and offers different challenges in diagnosing etiology and subsequent treatment options. Areas covered This review will be visiting the definition, pathophysiology, and risk factors of ISR. Expert opinion The evidence behind management options has been illustrated with the aid of real life clinical cases and summarized in a proposed management algorithm.

… restenosis. 9 In the present study, we report a prospective registry examining the effectiveness and safety of intracoronary … Washington Radiation for In-Stent restenosis Trial (WRIST), a …

… of the present study, we submit that intracoronary γ-radiation using 192 Ir is an important and viable therapeutic option for patients who suffer from recurrence of in-stent restenosis. …

… of restenosis after stent placement. We aimed to compare the effects of intracoronary β … placebo for clinical and angiographic outcomes of patients with diffuse in-stent restenosis. …

… Intracoronary radiation should be considered in cases with therapy refractory forms of diffuse in-stent restenosis… , myocardial infarction), in-stent restenosis has been disclosed as a new …

In-stent restenosis (ISR) is a novel pathobiologic process, histologically distinct from restenosis after balloon angioplasty and comprised largely of neointima formation. As percutaneous …

BACKGROUND Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations. RESULTS The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]). CONCLUSION Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it.

OBJECTIVES This study was performed to determine predictors of in-stent restenosis from a high volume, single-center practice. BACKGROUND Intracoronary stents have been shown to reduce the restenosis rate as compared with balloon angioplasty, but in-stent restenosis continues to be an important clinical problem. METHODS Between April 1993 and March 1997, 1,706 patients with 2,343 lesions were treated with a variety of intracoronary stents. The majority of stents were placed with high pressure balloon inflations and intravascular ultrasound (IVUS) guidance. Angiographic follow-up was obtained in 1,173 patients with 1,633 lesions (70%). Clinical, angiographic and IVUS variables were prospectively recorded and analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent restenosis defined as a diameter stenosis > or =50%. RESULTS In-stent restenosis was angiographically documented in 282 patients with 409 lesions (25%). The restenosis group had a significantly longer total stent length, smaller reference lumen diameter, smaller final minimal lumen diameter (MLD) by angiography and smaller stent lumen cross-sectional area (CSA) by IVUS. In lesions where IVUS guidance was used, the restenosis rate was 24% as compared with 29% if IVUS was not used (p < 0.05). By multivariate logistic regression analysis, longer total stent length, smaller reference lumen diameter and smaller final MLD were strong predictors of in-stent restenosis. In lesions with IVUS guidance, IVUS stent lumen CSA was a better independent predictor than the angiographic measurements. CONCLUSIONS Achieving an optimal stent lumen CSA by using IVUS guidance during the procedure and minimizing the total stent length may reduce in-stent restenosis.

… -eluting stents is the standard of care for treatment of native coronary artery stenoses, but optimum treatment strategies for bare metal stent and drug-eluting stent in-stent restenosis (ISR…

… In-stent restenosis (ISR) after successful intracoronary stent … have shown efficacy of intracoronary radiation delivered by … Washington Radiation for In-Stent Restenosis Trial (WRIST), …

Because of limited alternative options, intracoronary brachytherapy (ICBT) continues to be used for treating in-stent restenosis (ISR). We examined the indications, characteristics, and …

… Our study clearly demonstrates a new complication of intracoronary radiation for patients with in-stent restenosis—late total occlusion. This phenomenon is more pronounced after …

… At 6 months, the binary angiographic restenosis rate was 73%, 45… the rate of recurrent restenosis in diffuse in-stent restenosis. The … Long and diffuse in-stent restenosis (ISR) remains a …

… In-stent restenosis after stent implantation remains to be … the prevention of in-stent restenosis. Second, species differences … of corticosteroids on in-stent restenosis was not prominent on …

… For patients with DES restenosis, the optimal management strategy remains unknown. … of restenosis (3, 4, 5) and the lessons learned from the management of bare metal stent restenosis…

… nine months after intracoronary radiotherapy with the clinical outcome after placebo therapy in patients with documented myocardial ischemia due to in-stent restenosis. The trial …

The use of coronary stents has increased exponentially since their introduction into clinical practice in the early 1990s. It is currently estimated that stents are used in 60-70% of all percutaneous coronary revascularization procedures. Enthusiasm for the widespread use of stents is based not only on the ability to achieve a large, smooth lumen and effectively treat acute or threatened vessel closure but also upon their ability to reduce restenosis.1-4 However, with the increased use of coronary stents, in-stent restenosis has developed as an important clinical problem. The reaction to the placement of a coronary stent has been shown to involve both the stented and adjacent vessel and consists of a combination of intimal hyperplasia and tissue remodeling, which tapers off as the distance from the stented segment increases.5 In-stent restenosis is generally defined as a 50% or greater narrowing within, or at the proximal or distal sites of (or 5 mm from) a previously placed stent.6 Recurrent in-stent restenosis is defined as a 50% or greater stenosis, which occurs more than 1 month after treatment of in-stent restenosis. Rates of primary and recurrent in-stent restenosis vary considerably depending on many factors including whether the initial lesion was ‘focal’ ( 10 mm in length) or diffuse ( 10 mm in length).

… that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the …

Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.

… after experienced femoral operators have done 20 transradial coronary angiograms.20 … Ascent of the “learning curve” is likely to be slower for trainees new to coronary angiography. …

… coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography … to normal maximal flow), in addition to angiography, improves outcomes. …

OBJECTIVES This study aimed to determine the effect on long-term survival of using optical coherence tomography (OCT) during percutaneous coronary intervention (PCI). BACKGROUND Angiographic guidance for PCI has substantial limitations. The superior spatial resolution of OCT could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical endpoints. METHODS This was a cohort study based on the Pan-London (United Kingdom) PCI registry, which includes 123,764 patients who underwent PCI in National Health Service hospitals in London between 2005 and 2015. Patients undergoing primary PCI or pressure wire use were excluded leaving 87,166 patients in the study. The primary endpoint was all-cause mortality at a median of 4.8 years. RESULTS OCT was used in 1,149 (1.3%) patients, intravascular ultrasound (IVUS) was used in 10,971 (12.6%) patients, and angiography alone in the remaining 75,046 patients. Overall OCT rates increased over time (p < 0.0001), with variation in rates between centers (p = 0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS-guided group, and longest in the OCT-guided group. OCT-guided procedures were associated with greater procedural success rates and reduced in-hospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS-guided (12.2%) or angiography-guided (15.7%; p < 0.0001) PCI, with differences seen for both elective (p < 0.0001) and acute coronary syndrome subgroups (p = 0.0024). Overall this difference persisted after multivariate Cox analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.26 to 0.81; p = 0.001) and propensity matching (hazard ratio: 0.39; 95% CI: 0.21 to 0.77; p = 0.0008; OCT vs. angiography-alone cohort), with no difference in matched OCT and IVUS cohorts (HR: 0.88; 95% CI: 0.61 to 1.38; p = 0.43). CONCLUSIONS In this large observational study, OCT-guided PCI was associated with improved procedural outcomes, in-hospital events, and long-term survival compared with standard angiography-guided PCI.

… coronary angiography (CA) or percutaneous coronary intervention (PCI) in patients with prior TAVI. … and require urgent or elective coronary angiography (CA) or percutaneous coronary …

… was therefore to compare radiation exposure between transradial access and transfemoral access for diagnostic coronary angiograms and percutaneous coronary interventions (PCI). …

OBJECTIVES This study was performed to assess whether angiography six months after coronary balloon angioplasty or stent implantation has an influence on clinical management …

Abstract Objective To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. Design Systematic review and meta-analysis. Data sources PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. Study selection Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. Main outcome measures Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. Results In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. Conclusions Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. Systematic review registration PROSPERO CRD42023433568.

… cardiology, we designed the Assessing Angiography (A2) project. We randomly selected coronary angiograms from patients undergoing percutaneous coronary intervention (PCI) at 7 …

Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is an important adjunct to invasive coronary angiography.

Objectives : The aim of this study was to evaluate temporal trends in characteristics and outcomes among patients referred for invasive coronary procedures within a national health care …

Since its introduction by Lucien Campeau three decades ago, percutaneous radial artery approach at the forearm has been shown to provide advantages over the femoral approach and has become the standard approach for coronary angiography and intervention. Though infrequent, vascular complications still remain, mainly radial artery occlusion.

… coronary intervention (PCI). Peripheral arteries, such as the femoral or radial artery, provide the access to the coronary … with CAD undergoing diagnostic coronary angiography (CA) or …

BACKGROUND The debate surrounding the efficacy of coronary physiology guidance, compared to conventional angiography, in achieving optimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. OBJECTIVES First, demonstrating the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex and high-risk procedures (CHIP). Second, establishing the non-inferiority of angiography-derived FFR guidance compared to microcatheter-derived FFR guidance. METHODS Patients showing obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive either a physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, left main stem disease. The primary outcome was invasive post-PCI FFR value. Optimal post-PCI FFR value was defined as >0.86. RESULTS A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared to the conventional angiography-based PCI group (77% vs. 54%; absolute difference 23%, relative difference 30%, p<0.0001). The occurrence of the primary outcome did not differ between the two physiology-based PCI subgroups, demonstrating the non-inferiority of angiography- vs. microcatheter-derived FFR (p<0.01). CONCLUSIONS In CHIP patients, procedural planning and guidance based on physiology (either through angiography-or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values.

© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Coronary CT angiography (CTA) is recommended as the firstline diagnostic evaluation for patients presenting with chest pain. As a result, a significant proportion of patients referred to the catheterisation laboratory now undergo coronary CTA assessment before the invasive procedure. This approach has been shown to reduce the frequency of major procedurerelated complications. Nonetheless, coronary CTA is primarily used as a trigger for deciding to perform an invasive angiogram. Despite the undeniable value of coronary CTA in providing anatomical information, its role in guiding revascularisation procedures is often underutilised. The systematic utilisation of coronary CTA in the field of interventional cardiology is hindered by the limited familiarity of interventional cardiologists with CT imaging. However, for readers who are wellversed in invasive angiography and intravascular imaging, grasping the fundamentals of coronary CTA is relatively straightforward. To enhance comprehension, figure 1 provides a comprehensive overview of the essential CT reconstructions pertinent to the revascularisation procedure and the approaches for plaque characterisation. This visual resource facilitates a better understanding of the concepts discussed in this manuscript. In this review, we aim to shed light on the critical assessment of anatomical and functional information derived from coronary CTA that is relevant in the decisionmaking process, planning and successful execution of percutaneous revascularisation procedures. We will explore how CTguided percutaneous coronary intervention (PCI) can improve clinical outcomes.