There are limited data on the outcomes of chronic liver disease (CLD) patients admitted for percutaneous coronary intervention (PCI). All PCI hospitalizations from the Nationwide Inpatient Sample (2004 to 2015) were analyzed and stratified by the presence, cause and severity of CLD, as well as the indication for PCI. Multivariable logistic regression analysis was performed to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes in patients with CLD compared with those without CLD. Among 7,296,679 PCI admissions, 54,368 (0.7%) had a CLD diagnosis. Among patients with CLD, 36,853 (67.8%) had severe CLD. Patients with CLD had higher likelihood of adverse outcomes including major adverse cardiovascular and cerebrovascular events (MACCE) (aOR 1.25, 95%CI 1.20 to 1.30), mortality (aOR 1.43, 95%CI 1.35 to 1.51), major bleeding (aOR 2.22, 95%CI 2.12 to 2.32). When accounting for severity, only severe CLD subgroup was more likely to have MACCE and all-cause mortality compared to no-CLD patients (p <0.001). Among CLD etiologic subgroups, those with ‘alcohol-related liver disease’ and ‘other CLD’ were consistently more likely to develop MACCE, all-cause mortality and major bleeding in comparison to no-CLD patients, while ‘chronic viral hepatitis’ subgroup had only increased odds of major bleeding (p <0.001). In conclusion, CLD patients admitted for PCI are more likely to have worse in-hospital outcomes, particularly in the severe CLD subgroup and ‘alcohol-related liver disease’ and ‘other CLD’ etiologic subgroups.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18162号 / 医博第3882号 / 新制||医||1003(附属図書館) / 31020 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 佐藤 俊哉, 教授 坂田 隆造 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18868号 / 医博第3979号 / 新制||医||1008(附属図書館) / 31819 / 京都大学大学院医学研究科医学専攻 / (主査)教授 横出 正之, 教授 坂田 隆造, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20283号 / 医博第4242号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 福原 俊一, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Background: Percutaneous coronary intervention (PCI) outcomes for patients with significant calcification have been consistently inferior compared to patients without significant calcification. Procedural success and long-term outcomes after PCI have been worse in patients with severe coronary calcium. Objective: A Bayesian meta-analysis of outcomes comparing rotational atherectomy (RA) with orbital atherectomy (OA) was performed. Methods: PubMed, Embase, and Cochrane Library databases were searched through 30th November 2018 and identified 4 observational studies. Results: The primary end-point, Major Adverse Cardiac Event (MACE) composing of death, MI and stroke at 1 year was more likely with RA (OR = 1.61; 95% CI: 1.11–2.33; p = 0.01) as compared to OA. The driver of the difference in MACE between the two groups was a statistically significant difference in mortality favoring OA (OR = 4.65; 95% CI: 1.36–15.87; p = 0.01). Peri-procedural MI, the other component of the primary end-point was 1.3 times more likely in the RA arm (OR = 1.35; 95% CI 0.95–1.92; p-0.09) and was not statistically different between the groups. The odds of a vascular complication were not different in the two groups (OR = 1.26; 95% CI: 0.73–2.17; p = 0.41). In an adjusted Bayesian analysis, mortality (OR = 3.69; 95% CI: 0.30–38.51), MACE (OR = 1.68; 95% CI: 0.55–5.49), MI (OR = 1.42; 95% CI: 0.50–4.29) and dissections/perforations (OR = 0.38; 95% CI: 0.10–1.38) were not different in RA and OA groups. Conclusion: Our study is the first published Bayesian meta-analysis comparing MACE and peri-procedural outcomes in RA compared to OA. These findings lay the foundation for a randomized comparison between the two competing technologies.

Background: Early post-percutaneous coronary intervention chest pain (EPPCP) appears to be a common clinical phenomenon. EPPCP has not been fully explained or studied in the literature despite the abundance of clinical trials on percutaneous coronary intervention (PCI). The objective of this questionnaire-based survey is to assess the current perception of EPPCP among practicing interventional cardiologists nationwide. Methods: A survey questionnaire was designed utilizing the Survey Monkey tool to address the perceptions and current practices regarding key aspects of EPPCP among interventional cardiologists. The survey was sent to the interventional cardiologists via email. Results: The survey questionnaire regarding EPPCP was provided to 2615 practicing interventional cardiologists and resulted in 623 total survey responses, with 503 of those respondents completing all eight survey questions. A total of 50.2% of the interventional cardiologists perceive that the incidence of EPPCP is 5–10%, and 57.5% consider that repeat angiography or PCI is rarely needed (1 in 1000 cases). A total of 47.1% of the participants think that EPPCP is due to transient microvascular dysfunction, while 39% perceive it as a different entity requiring a different approach. When asked about developing a standardized labeling for the phenomenon of EPPCP, 34.8% of responders indicated that they believe EPPCP should be labeled as a benign form of chest pain/angina, and 28% preferred to describe EPPCP in non-standardized terms. Among interventional cardiologists, 80% thought that the treatment of this entity is a combination of reassurance and vasodilators and, without ischemic ECG changes, medical management is appropriate. Conclusion: A total of 72% of interventional cardiologists in our survey preferred to label EPPCP as standard nomenclature to facilitate communication between healthcare providers, patients and families in a consistent way. There is a diversity of opinion regarding EPPCP, no standard nomenclature, and no guideline to standardize practice. Further large-scale prospective studies are needed to better understand the pathophysiological mechanisms, optimal management strategies, prognostic implications, and clinical reporting of EPPCP.

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.

Abstract available through the Journal of the American College of Cardiology.

INTRODUÇÃO: Os suportes vasculares bioabsorvíveis (SVB) surgiram com a finalidade de aumentar a segurança tardia das intervenções coronárias percutâneas (ICP). Estes dispositivos liberam o fármaco antiproliferativo no local da obstrução e são absorvidos com o passar do tempo. A utilização do ultrassom intracoronário (USIC) pode ajudar na avaliação do processo de absorção deste dispositivo. OBJETIVOS: Primário: avaliar e comparar, pelo USIC, o volume e a área da luz, do vaso e do SVB imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses. Objetivos secundários: avaliar e comparar, pelo USIC, o volume e área da placa imediatamente após o implante da prótese, e, tardiamente, aos 6 e 18 meses e os diâmetros do vaso, lúmen e SVB após ICP e no seguimento. Percentual de estenose e perda tardia do lúmen pela angiografia no seguimento e incidência de eventos cardíacos adversos maiores (ECAM) até os 18 meses. MÉTODO: Trata-se de um estudo prospectivo, não randomizado com a inclusão de 20 pacientes que foram submetidos ao implante do SVB DESolve®. Foi realizado o USIC após o procedimento e aos 6 e 18 meses de seguimento. RESULTADOS: Dos 20 pacientes selecionados, um paciente recusou realizar o USCI aos 6 meses e dois não realizaram o exame aos 18 meses, sendo excluídos do estudo. Totalizando 17 pacientes analisados. A idade média foi de 58,59 ± 8,73 anos e 70,6% eram do sexo masculino. O quadro clínico predominante era de angina estável. A via de acesso preferencial foi a radial, todos os pacientes foram submetidos à pré e pós-dilatação e o sucesso angiográfico ocorreu em todos os casos. No seguimento, houve aumento significativo na área (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) e diâmetros do dispositivo, pelo USIC, aos 6 meses quando comparado ao procedimento índice. Não houve alteração significativa nas áreas, nos volumes e nos diâmetros do vaso e lúmen, em qualquer comparação no seguimento. A perda tardia foi de 0,22 ± 0,30 mm aos 6 e de 0,33 ± 0,44 mm aos 18 meses. Não houve nenhum caso de reestenose angiográfica e trombose do dispositivo. No seguimento, não houve casos de ECAM. CONCLUSÕES: A ICP com a utilização do SVB DESolve® para o tratamento da doença arterial coronária não complexa demonstrou resultados promissores. Houve aumento do volume e área do dispositivo aos 6 meses e uma supressão eficaz da hiperplasia intimal sem ECAM no seguimento. / INTRODUCTION: The bioresorbable vascular scaffolds (BVS) emerged in order to increase late safety of percutaneous coronary interventions (PCI). These devices release the antiproliferative drug to the site of obstruction and are absorbed over time. The use of intravascular ultrasound (IVUS) can help in the evaluation of this device absorption process. OBJECTIVES: The primary endpoint was to evaluate and compare, through IVUS, the volume and the area of the lúmen, the vessel and the device immediately after its implantation, and later at 6 and 18 months. The secondary endpoints were to evaluate and compare, through IVUS, the volume and the area of the plaque immediately after its implantation, and later at 6 and 18 months and diameters of the vessel, lúmen and BVS after PCI and at follow-up. Percentage of stenosis and late lúmen loss by angiography and incidence of major adverse cardiac events (MACE) up to 18 months. METHOD: This is a prospective, non-randomized study, with the inclusion of 20 patients who underwent implantation of DESolveTM. IVUS was performed after the procedure and at 6 and 18 months of follow-up. RESULTS: Of the 20 patients selected, one patient refused to perform the USCI at 6 months and two did not undergo the exam at 18 months and were excluded from the study. In total, 17 patients were analyzed. The average age was 58.59 ± 8.73 years and 70,6% were male. The most common clinical presentation was stable angina. The preferred vascular acess was to radial, all patients underwent pre- and post-dilation and angiographic success occurred in all cases. At follow-up there was a significant increase in area (6,41 ± 1,35 mm2 vs. 7,35 ± 1,53 mm2, p < 0,002), volume (101,19 ± 20,9 mm3 vs. 118,51 ± 26,6 mm3, p = 0,001) and diameters of the device, by IVUS, at 6 months when compared to the index procedure. There was no significant change in the areas, volumes and diameters of the vessel and lúmen, in any comparison at follow-up. The late loss was 0,22 ± 0,30 mm at 6 and 0,33 ± 0,44 mm at 18 months. There were no cases of restenosis and scaffold thrombosis. During follow-up there was no case of MACE. CONCLUSIONS: PCI with the use of DESolve scaffold for the treatment of non-complex coronary artery disease has shown promising results. There was an increase in the volume and area of the device at 6 months and an effective suppression of intimal hyperplasia without MACE at follow-up.