Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Radial access reduces vascular complications compared to femoral access. Various factors may influence the patient's pain during coronary intervention.

Aim: To assess what clinical and periprocedural factors affect discomfort and pain intensity during angiography via the radial artery without use of spasmolytics.

Material and methods: A group of 238 patients (M/F 142/96, mean age: 67 ±10 years) who underwent coronary angiography and interventions through the radial artery approach was studied. Every patient had ultrasound assessment of the radial artery. Pain was assessed according to the numerical pain rating scale, where mild pain is 1-3, moderate pain is 4-7, and severe pain is above 7.

Results: We included 238 patients. Most of the participants had a low pain level (n = 133 (55.88%)), while a smaller number had moderate and severe pain level (n = 88 (36.97%) and n = 17 (7.14%), respectively). We analyzed 38 characteristics of the patients in terms of the possible influence on the pain level during angiography.

Conclusions: In our study we analyzed possible factors which may contribute to the severe pain sensation during percutaneous coronary intervention. We found that masculine gender, greater weight and height as well as diabetes mellitus and myocardial infarction diagnosis on admission correlated with lower pain level. Conversely, greater maximal and minimal diameters of the radial artery correlated with stronger pain level.

Introduction: Pericoronary fat thickness (PFT) is a well-established marker crucial for evaluating the extent and severity of coronary artery disease (CAD). While its role in CAD is widely acknowledged, a considerable gap exists in understanding the prognostic implications of PFT after percutaneous coronary intervention (PCI), specifically for coronary chronic total occlusions (CTO).

Aim: This study investigated the relationship between PFT and prognostic outcomes in patients undergoing PCI for CTO.

Material and methods: A retrospective study analyzed data from 415 patients who had undergone coronary computed tomography angiography (CCTA) and coronary angiography (CAG). PFT measurements were taken, and patients were categorized into normal, PCI (non-CTO), and CTO-PCI groups. Prognostic implications within the CTO-PCI group were evaluated based on survival status.

Results: PFT measurements varied significantly among groups. The CTO-PCI group had a 13.9% mortality rate over a median follow-up of 16.6 ±10.3 months. Higher average PFT values were found in the non-survival group (p = 0.013). ROC curve analysis identified an average PFT cut-off value of 13.6 mm (AUC = 0.682, p = 0.011). Cox regression analysis linked mortality with LVEF (HR = 0.938, p = 0.001), albumin (HR = 0.189, p = 0.006), and average PFT (HR = 1.252, p = 0.040). Elevated average PFT was associated with higher mortality (p = 0.001).

Conclusions: PFT is a significant inflammatory marker and a promising prognostic indicator following PCI for CTO. Integrating PFT into risk prediction models may enhance prognostic accuracy and aid in timely clinical interventions.

Introduction: The effect of using intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) on short-term mortality is not well established.

Aim: To evaluate any association between the use of IVUS vs. no IVUS during PCI and mortality in a large inpatient database.

Material and methods: We used the National Inpatient Sample (NIS) database for available ICD-10 codes from 2016-2020 for IVUS and PCIs.

Results: A total of 10,059,56 PCIs were performed. In 206,910, IVUS-guided PCI was performed vs. 9,852,359 without IVUS. Mortality did not differ between the two groups, with 2.52% mortality in the IVUS arm vs. 2.59% in no IVUS cohort, p = 0.4. The mean age of patients with IVUS use was 65.5 vs. 70.1 years without IVUS, p < 0.001. Total in-hospital cost in the IVUS group was double that without IVUS ($141,920 vs. $71,568, p < 0.001). Furthermore, IVUS utilization was significantly higher in patients with private health insurance (28.3% vs. 17.2%, p < 0.001).

Conclusions: In-patient all-cause mortality using IVUS during PCI was similar to that in patients without IVUS utilization, but the cost was doubled, with higher utilization in privately insured patients.

Introduction: Shock indexes (SI) have been associated with in-hospital mortality, particularly in heart failure patients.

Aim: In our study, we aimed to investigate the relationship and prognostic value of the shock index (SI), modified shock index (MSI) and age-adjusted shock index (ASI) with spontaneous echo contrast (SEC) formation in patients with heart failure with reduced ejection fraction (HFrEF).

Material and methods: We designed our research as a two-center, retrospective study. A total of 537 patients with left ventricular ejection fraction (LVEF) ≤ 40 and appearance of SEC within the left ventricular cavity, meeting the study criteria, were included. The primary endpoint included each component of ischemic cerebrovascular occlusion (CVO) and mortality. The secondary endpoint was considered cumulative events, which included the combination of CVO and mortality.

Results: There were 146 patients in the group with SEC and 391 patients in the group without SEC. SI (0.65 ±0.15 vs. 0.61 ±0.14, respectively, p = 0.014), MSI (0.92 ±0.22 vs. 0.87 ±0.20, respectively, p = 0.007) and ASI (42.76 ±11.71 vs. 39.83 ±12.25, respectively, p = 0.013) were significantly higher in the group with SEC. Ischemic CVO (10.3% vs. 3.3%, p = 0.001) and mortality (34.9% vs. 24.6%, p = 0.016) were significantly higher in the SEC group. In addition, the cumulative rate of mortality and ischemic CVO (39.7% vs. 26.1%, p = 0.002) was significantly higher in the SEC group. We found that the parameters SEC (OR = 2.822, 95% CI: 1.328-5.998, p = 0.007) and ASI (OR = 1.034, 95% CI: 1.002-1.066, p = 0.038) were independent predictors of ischemic CVO.

Conclusions: SI, MSI and ASI may be quickly accessible and calculable indices to predict SEC in HFrEF patients.

Introduction: Left atrial appendage closure (LAAC) with Watchman device prevents thromboembolism in patients with atrial fibrillation (AF). However, thrombus may develop on the atrial surface of the device.

Aim: To investigate the incidence and predictors of device-related thrombus (DRT) in patients with AF who were treated with LAAC.

Material and methods: Ninety-one consecutive patients with AF underwent LAAC procedure using first-generation Watchman 2.5 device followed by antiplatelet therapy. In our analysis we have included all patients (n = 78) who had clinical follow-up visits with transesophageal echocardiography (TEE) after the procedure.

Results: The median (IQR) CHA₂DS₂-VASc score was 4 (4.0-6.0) and HAS-BLED score was 3 (3.0-4.0). DRTs were observed in 5 (6.4%) patients. When compared with patients without DRT, those with DRT presented more often with lower median ejection fraction (40% (23.5-45.5) versus 55% (48.0-60.0); p = 0.005), lower emptying velocity of LAA (25 cm/s (17.5-27.0) versus 53 cm/s (26.5-78.0); p = 0.009), and with greater depth of implantation (18 mm (14.0-20.5) versus 8 mm (5.0-11.0); p < 0.001). Furthermore, patients with DRT had greater depth of LAA (35 mm (29.5-41.0) versus 29 mm (25.5-31.0); p = 0.003), greater mean (SD) dimension in 90⁰ (22.4 mm (3.2) versus 19 mm (2.7); p = 0.02). Patients with DRT were also younger than those without DRT (67.4 years (7) versus 75 years (8.3), p = 0.045).

Conclusions: The DRT after Watchman device implantation remains a rare complication. Its formation was related to several patient and procedural characteristics, which need to be confirmed in larger studies.

Introduction: The systemic immune inflammation index (SII), based on lymphocyte, neutrophil, and platelet counts, has been shown to be an independent indicator of no-reflow phenomenon during percutaneous intervention. However, the relationship between SII and no-reflow phenomenon (NRP) that develops after the procedure of saphenous vein grafts is unknown.

Aim: In this study, we aimed to investigate the relationship between no-reflow phenomenon and SII during percutaneous intervention on saphenous vein grafts.

Material and methods: A total of 133 patients who underwent percutaneous intervention for saphenous vein grafts due to acute coronary syndrome between 2019 and 2022 were included in this study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. The multivariate regression was used to analyse the correlation between no-reflow and SII.

Results: The median value of SII was significantly higher in patients with no-reflow in comparison with normal reperfusion (543 (447, 717) vs. 861 (642, 1272), p < 0.001). The optimal threshold for SII in predicting the no-reflow phenomenon was 613, with sensitivity and specificity of 84% and 66%, respectively. The area under the ROC curve (AUC) was 0.80 (95% CI: 0.73-0.89, p < 0.001). In multivariate analysis, SII ≥ 613 showed an independent predictive value for the no-reflow (OR = 4.02, 95% CI: 1.40-11.57, p < 0.001).

Conclusions: Our results showed that high SII levels were independently associated with the development of no-reflow phenomenon in patients presenting with acute coronary syndrome and undergoing percutaneous intervention to the SVG.