Future Training Pathways in Percutaneous Coronary Interventions: Interventional Critical Care, Complex Coronary Interventions, and Interventional Heart Failure.

While there has been a proliferation of training and practice paradigms in the realm of noncoronary interventions, coronary disease remains the predominant pathology necessitating interventional cardiology expertise. The landscape of coronary disease has also experienced a significant transformation due to rapidly evolving technologies, clinical application of mechanical circulatory support and other device innovations, and increasing acuity and complexity of patients. The modern interventional cardiologist is subject to challenges including decreasing coronary procedural volume, need to maintain clinical and financial productivity, and often also requirements of continued scholastic pursuit.

Mixed Cardiogenic-Vasodilatory Shock: Current Insights and Future Directions.

This state-of-the-art review describes the potential etiologies, pathophysiology, and management of mixed shock in the context of a proposed novel classification system. Cardiogenic-vasodilatory shock occurs when cardiogenic shock is complicated by inappropriate vasodilation, impairing compensatory mechanisms, and contributing to worsening shock. Vasodilatory-cardiogenic shock occurs when vasodilatory shock is complicated by myocardial dysfunction, resulting in low cardiac output.

Image-guided percutaneous revascularization of the coronary arteries.

The European Society of Cardiology recently updated guidelines on the management of chronic coronary syndromes upgrading the use of intracoronary imaging for complex percutaneous coronary interventions (PCI) to a class 1A recommendation. It is essential that the interventional community appreciate the additive value of intracoronary imaging over angiography alone-not only to obtain optimal acute PCI results but also to improve longer-term cardiovascular outcomes. The purpose of this manuscript is to review the latest evidence that informed the recent guideline recommendations and expand on the specific role of the different imaging modalities before, during, and after PCI.

Blueprint for Building and Sustaining a Cardiogenic Shock Program: Qualitative Survey of 12 US Programs.

Background: Multidisciplinary cardiogenic shock (CS) programs have been associated with improved outcomes, yet practical guidance for developing a CS program is lacking.

Methods: A survey on CS program development and operational best practices was administered to 12 institutions in diverse sociogeographic regions and practice settings. Common steps in program development were identified.

Clinical outcomes among patients with mitral valve regurgitation undergoing Impella-supported high-risk PCI.

Background: Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity.

Methods: Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR.

Impact of Inpatient Percutaneous Coronary Intervention Volume on 30-Day Readmissions After Acute Myocardial Infarction-Cardiogenic Shock.

Background: There are limited data on volume-outcome relationships in acute myocardial infarction (AMI) with cardiogenic shock (CS).

Objectives: In this study, the authors sought to evaluate the association between hospital percutaneous coronary intervention (PCI) volume and readmission after AMI-CS.

Methods: Adult AMI-CS patients were identified from the Nationwide Readmissions Database for 2016-2019 and were categorized into hospital quartiles (Q1 lowest volume to Q4 highest) based on annual inpatient PCI volume.

A combination of left ventricular outflow tract velocity time integral and lung ultrasound to predict mortality in ST elevation myocardial infarction.

Development of ventricular failure and pulmonary edema is associated with a worse prognosis in ST-elevation myocardial infarction (STEMI). We aimed to evaluate the prognostic ability of a novel classification combining lung ultrasound (LUS) and left ventricular outflow tract (LVOT) velocity time integral (VTI) in patients with STEMI. LUS and LVOT-VTI were performed within 24 h of admission in STEMI patients.

Influence of Race/Ethnicity and Sex on Coronary Stent Outcomes in Diabetic Patients.

Background: How diabetes mellitus (DM), race/ethnicity, and sex impact ischemic events following coronary artery stent procedures is unknown.

Methods: Using the PLATINUM Diversity and PROMUS Element Plus Post-Approval Pooled Study (N = 4184), we examined the impact of race/ethnicity, sex, and DM on coronary stent outcomes. Primary outcome was 1-year major adverse cardiac events (MACE) (MACE composite: death, myocardial infarction [MI], and target vessel revascularization).

A non-interventional cardiologist's guide to coronary chronic total occlusions.

Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention.

Clinical characteristics and outcomes of patients requiring prolonged mechanical circulatory support after high-risk percutaneous coronary intervention.

Background: There are limited data on the clinical characteristics and outcomes of patients who require prolonged mechanical circulatory support (MCS) after Impella-supported high-risk percutaneous coronary intervention (HR-PCI).

Aims: The aim of this study is to describe the contemporary clinical characteristics, outcomes, and predictors associated with prolonged MCS support after assisted HR-PCI.

Methods: Patients enrolled in the prospective, multicentre, clinical endpoint-adjudicated PROTECT III study who had undergone HR-PCI using Impella were evaluated.

Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative.

Background: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) devices increase systemic blood pressure and end organ perfusion while reducing cardiac filling pressures.

Methods And Results: The National Cardiogenic Shock Initiative (NCT03677180) is a single-arm, multicenter study.

Mechanical Circulatory Support for Complex High-risk Percutaneous Coronary Intervention.

Technological and procedural innovations presently permit the safe and effective performance of increasingly complex percutaneous coronary interventions, while new mechanical circulatory support devices offer circulatory and ventricular support to patients with severely reduced left ventricular systolic function and deranged cardiovascular hemodynamics. Together, these advances now permit the application of complex percutaneous coronary interventions to higher-risk patients who might otherwise be left untreated. Increasing observational data support the use of mechanical circulatory support in appropriate complex and high-risk patients as part of a larger multidisciplinary heart team treatment plan.