TCT 2002 Abstracts
Summaries
of important articles from major peer-reviewed journals
| Outcomes of Patients With Chronic Renal Insufficiency in the BARI Study | L. Szczech | Circulation. 2002;105:2253 |
News (italiano) Jun 2002
Il danno miocardico dopo
impianto di stent influisce sull'outcome
l riscontro di rialzo dei livelli degli enzimi di necrosi miocardica
successivamente...
Full text journal article Jun
2002
Prognostic Significance
of Creatine Kinase-MB Elevation After Percutaneous Coronary Intervention in
Patients With Chronic Renal Dysfunction
CK-MB elevation in patients with chronic renal insufficiency after PCI is an
independent predictor of late mortality.
Full text journal article Aug
2002
Role of Target Vessel
Size and Body Surface Area on Outcomes After Percutaneous Coronary Interventions
in Women
Read about the correlation of vessel size and mortality rates following
coronary angioplasty.
Full text journal article Ago
2002
Short-Term Outcomes
After Percutaneous Coronary Intervention: Effects of Stenting and Institutional
Volume Shifts
Since its introduction, PTCA has undergone rapid advances in both
application and technique.
Low PCI volumes still
translate into worse outcomes, even in the stent era
The ACC/AHA guidelines recommend that operators perform a minimum number of
75 PCIs per year to reduce risk of adverse outcomes, but a new study of 8
Michigan hospitals suggests that this cut-off may not be high enough, despite
technological advancements in the field.
(American Heart Association Scientific Sessions 2002.) [ Dec 02, 2002 ]
http://www.theheart.org/documents/page.cfm?from=590000007&doc_id=590000007&archive=yes
A
contemporary overview of percutaneous coronary interventions. The American
College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)
Anderson HV, et al.
J Am Coll Cardiol
2002;39:1096-103.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923031
This report presents the first data collected and analyzed by the ACC-NCDR. It
portrays a contemporary overview of coronary interventional practices and
outcomes, using uniform data collection and reporting standards. These data
reconfirm overall acceptable results that are consistent with other reported
data, but also confirm large variations between individual institutions.
Enoxaparin
is superior to unfractionated heparin for preventing clinical events at 1-year
follow-up of TIMI 11B and ESSENCE
Antman EM, et al.
Eur Heart J
2002;23:308-14.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11812067
The stable absolute difference in event rates of 2.5% seen at 8 days and again
at 1 year favouring enoxaparin may be due to more effective control of the
thrombotic process surrounding the index event. Once the pharmacological effect
of enoxaparin had dissipated there was no rebound increase in events. Thus,
those patients who had received enoxaparin acutely were protected from
experiencing a deterioration of the original therapeutic benefit. These findings
regarding enoxaparin add to the data to be considered by clinicians when
selecting an antithrombin for the acute phase of management of unstable
angina/non- ST elevation myocardial infarction.
Comparison
of one-year outcomes after percutaneous coronary intervention among current
smokers, ex-smokers, and nonsmokers
Ashby DT, et al.
Am J Cardiol
2002;89:221-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792347
Comparison
of clinical outcomes using stents versus no stents after percutaneous coronary
intervention for proximal left anterior descending versus proximal right and
left circumflex coronary arteries
Ashby DT, et al.
Am J Cardiol
2002;89:1162-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12008168
Patients
with proximal stenoses treated with non-stenting strategies have lower
procedural success than those treated with stenting strategies; the patients
with proximal LAD non-stent PCI have significantly higher rates of clinical
restenosis than patients with proximal right and circumflex stenoses. A stenting
strategy for proximal LAD stenoses appears to attenuate the differences of
clinical restenosis noted after non-stent PCI.
The
impact of renal insufficiency on clinical outcomes in patients undergoing
percutaneous coronary interventions
Best PJ, et al.
J Am Coll Cardiol
2002;39:1113-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923033
Renal
insufficiency is a strong predictor of death and subsequent cardiac events in a
dose-dependent fashion during and after PCI. Patients with renal insufficiency
have more baseline cardiovascular risk factors, but renal insufficiency is
associated with an increased risk of death and other adverse cardiovascular
events, independent of all other measured variables.
Postprocedure
creatine kinase-MB elevation and baseline left ventricular dysfunction predict
one-year mortality after percutaneous coronary intervention
Dangas G, et al.
Am J Cardiol 2002;89:586-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867045
Stroke
complicating percutaneous coronary interventions: incidence, predictors, and
prognostic implications
Fuchs S, et al.
Circulation 2002;106:86-91.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12093775
http://www.circulationaha.org/cgi/content/full/106/1/86
http://www.circulationaha.org/cgi/content/abstract/106/1/86
Stroke
associated with contemporary PCI is associated with substantial increased
mortality. Elderly patients who experience intraprocedural complications
necessitating the use of IABP are at particularly high risk.
Relationship
of the TIMI myocardial perfusion grades, flow grades, frame count, and
percutaneous coronary intervention to long-term outcomes after thrombolytic
administration in acute myocardial infarction
Gibson CM, et al.
Circulation
2002;105:1909-13.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11997276
http://www.circulationaha.org/cgi/content/full/105/16/1909
http://www.circulationaha.org/cgi/content/abstract/105/16/1909
Both
improved epicardial flow (TFG 2/3 and low CTFCs) and tissue-level perfusion (TMPG
2/3) at 90 minutes after thrombolytic administration are independently
associated with improved 2-year survival, suggesting complementary mechanisms of
improved long-term survival. Although rescue PCI reduced long-term mortality,
improved microvascular perfusion (TMPG 2/3) before PCI was also related to
improved mortality independently of epicardial blood flow and the performance of
rescue or adjunctive PCI. Further prospective trials are warranted to re-examine
the benefit of early PCI with thrombolysis.
Survival
after coronary revascularization in the elderly
Graham MM, et al.
Circulation
2002;105:2378-84.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021224
http://www.circulationaha.org/cgi/content/full/105/20/2378
http://www.circulationaha.org/cgi/content/abstract/105/20/2378
Elderly
patients paradoxically have greater absolute risk reductions associated with
surgical or percutaneous revascularization than do younger patients. The
combination of these results with a recent randomized trial suggests that the
benefits of aggressive revascularization therapies may extend to subsets of
patients in older age groups.
Clinical
outcome following percutaneous coronary interventions in patients with chronic
renal failure
Gruberg
L, et al.
Catheter Cardiovasc Interv
2002;55:66-72.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11793497
PCI
in patients with impaired renal function, whether on dialysis or not, is
associated with poor in-hospital and 1-year survival.
Favourable
long-term outcome by repeated percutaneous coronary revascularization in
diabetic haemodialysis patients
Hase H, et al.
Nephrol Dial Transplant
2002;17:100-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11773471
http://ndt.oupjournals.org/cgi/content/full/17/1/100
http://ndt.oupjournals.org/cgi/content/abstract/17/1/100
Multiple
repeated percutaneous interventions reduce the long-term mortality of diabetic
and non-diabetic haemodialysis patients with coronary artery disease similarly.
Multiple repeated percutaneous coronary interventions are a viable option for
controlling myocardial ischaemia and improving the long-term outcome in
high-risk diabetic haemodialysis patients.
Long-term
clinical and angiographic follow-up after coronary stent placement in native
coronary arteries
Kimura T, et al.
Circulation
2002;105:2986-91.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12081992
http://www.circulationaha.org/cgi/content/full/105/25/2986
http://www.circulationaha.org/cgi/content/abstract/105/25/2986
The
efficacy and safety of coronary stenting seemed to be clinically sustained at 7
to 11 years of follow-up. However, late luminal renarrowing beyond 4 years was
common, which demonstrates the need for further follow-up.
Practice
patterns and outcomes of percutaneous coronary interventions in the United
States: 1995 to 1997
Lauer MA, et al.
Am J Cardiol 2002;89:924-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950429
This
study sought to determine the real-world impact of changes in the use of stents
and anticoagulant agents in PCI on outcomes and costs. A nationally
representative sample of 37,088 patients who underwent PCI from October 1995 to
October 1997 was identified from in-patient hospital claims data acquired from
HCIASachs. Acute events (death, urgent CABG, or PCI) decreased (p <0.001),
whereas use of stents, abciximab, or both, increased (p <0.001). Dosages of
heparin and bleeding complications declined significantly (p <0.001) over the
2- year period. Heparin dosages were higher in patients who experienced bleeding
or death than in those who did not (p <0.001). The average hospital length of
stay decreased significantly (p <0.001), largely driven by a reduction in
time between the procedure and hospital discharge. By the end of the study
period, bleeding was the most frequent (5.5%) complication of PCI and was
associated with considerable costs, adding $10,225 to baseline costs.
Incidence,
morphology, angiographic findings, and outcomes of intramural hematomas after
percutaneous coronary interventions: an intravascular ultrasound study
Maehara A, et al.
Circulation
2002;105:2037-42.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11980682
http://www.circulationaha.org/cgi/content/full/105/17/2037
http://www.circulationaha.org/cgi/content/abstract/105/17/2037
Outcome
of nonobstructive residual dissections detected by intravascular ultrasound
following percutaneous coronary intervention
Nishida T, et al.
Am J Cardiol
2002;89:1257-62.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12031724
Intravascular
ultrasound identified intramural hematomas after 6.7% of PCIs. The mechanism
appeared to be a dissection into the media where blood accumulated because of a
lack of re-entry. A third of ultrasound-identified hematomas showed no
angiographic abnormalities. There was a high rate of non-Q-wave myocardial
infarction, need for repeat revascularization, and sudden death in patients with
hematomas.
Impact
of final coronary flow velocity reserve on late outcome following stent
implantation
Nishida T, et al.
Eur Heart J 2002;23:331-40.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11812070
The presence of a final coronary
flow velocity reserve of < 2.0 is an independent predictor of the need for
target lesion revascularization after stent implantation in native coronary
artery lesions.
Coronary
pressure measurement after stenting predicts adverse events at follow-up: a
multicenter registry
Pijls NH, et al.
Circulation 2002;105:2950-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12081986
http://www.circulationaha.org/cgi/content/full/105/25/2950
http://www.circulationaha.org/cgi/content/abstract/105/25/2950
FFR
after stenting is a strong independent predictor of outcome at 6 months
Coronary
intervention in the diabetic patient: improved outcome following stent
implantation compared with balloon angioplasty
Savage MP, et al.
Clin Cardiol 2002;25:213-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12018879
Compared
with balloon angioplasty, stent placement in diabetic patients with focal de
novo lesions resulted in superior procedural results, reduced restenosis, and
improved clinical outcome with fewer repeat revascularization procedures.
Impact
of normalized myocardial perfusion after successful angioplasty in acute
myocardial infarction
Stone GW, et al.
J Am Coll Cardiol
2002;39:591-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849856
Abnormal
myocardial perfusion is present in most patients following primary or rescue PCI
in AMI, despite restoration of brisk epicardial coronary flow. In high risk
patients achieving TIMI-3 flow after intervention, the myocardial blush score
may be used to stratify prognosis into excellent, intermediate and poor survival.
Further study is warranted to examine whether adjunctive mechanical or
pharmacologic strategies can further improve myocardial perfusion and survival
of patients with acute myocardial infarction undergoing intervention.
The
effect of completeness of revascularization on event-free survival at one year
in the ARTS trial
van den Brand MJ, et al.
J Am Coll Cardiol
2002;39:559-64.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849851
Complete
revascularization was more frequently accomplished by bypass surgery than by
stent implantation. One year after bypass, there was no significant difference
in event-free survival between surgically treated patients with complete
revascularization and those with incomplete revascularization, but patients
randomized to stenting with incomplete revascularization had a greater need for
subsequent bypass surgery.