CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024.

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 Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023.

Impact of renal function on adverse bleeding events associated with dual antiplatelet therapy in patients with acute coronary syndrome.

It is believed, but not well established, that renal dysfunction increases the risk of adverse bleeding events associated with dual antiplatelet therapy (DAPT), especially in patients with acute coronary syndrome (ACS). The aim of this study is to estimate the impact of renal function on adverse bleeding events associated with DAPT in patients with ACS. A total of 1,264 ACS patients who received DAPT, clopidogrel (n = 530) or prasugrel (n = 734) in addition to aspirin, were assessed in a multicenter observational study.

Temporal variations in ischemic and bleeding event risks after acute coronary syndrome during dual antiplatelet therapy.

Background: This study estimates the temporal risk variations of ischemic and bleeding events during dual antiplatelet therapy (DAPT) among patients stratified according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria, suggesting the optimal period for DAPT after acute coronary syndrome (ACS).

Methods: A total of 1264 ACS patients receiving either clopidogrel or prasugrel with aspirin were classified by ARC-HBR; HBR (n = 574) and non-HBR groups (n = 690). This study was designed as a multicenter observation to evaluate the primary endpoints of ischemic, including cardiovascular death, myocardial infarction, or ischemic stroke, and bleeding events, defined as Bleeding Academic Research Consortium type 3/5.

Novel dual guiding catheter technique for kissing balloon inflation in percutaneous coronary intervention for bifurcated chronic total occlusive lesion.

Traditionally, two bigger-sized guiding catheters (GCs) via the femoral artery have been used in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, those GCs are associated with an increased incidence of bleeding. Therefore, the use of smaller GCs (e.

Estimation of adverse events associated with P2Y12 receptor inhibitors stratified by academic research consortium for high bleeding risk criteria in acute coronary syndrome.

Background: The usefulness of the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in the selection of P2Y12 receptor inhibitors for acute coronary syndrome is unknown. This study investigated whether the selection of antiplatelet agents according to the ARC-HBR criteria could improve clinical outcomes.

Methods: This multicenter retrospective study included 1261 patients with acute coronary syndrome who received dual antiplatelet therapy, namely clopidogrel (75 mg, n = 529) or prasugrel (3.

Histological evaluation of vascular changes after excimer laser angioplasty for neointimal formation after bare-metal stent implantation in rabbit iliac arteries.

Background: Excimer laser is used to treat coronary artery disease, especially in case of lesions with thrombus and in-stent restenosis (ISR). However, there are no in vivo preclinical studies that have evaluated the pathological reactions of the vessel wall after excimer laser ablation.

Methods: Bare-metal stents were placed in the external iliac arteries of six healthy rabbits.

Simple percutaneous coronary intervention strategy with a novel guide extension catheter through a 5-Fr guiding catheter for a tortuous coronary artery.

Unlabelled: A 78-year-old female diagnosed with effort angina underwent coronary angiography. The findings revealed subtotal occlusion in the tortuous circumflex. The lesion was initially treated with a drug-coated balloon alone; however, restenosis occurred after 2 months.

Comparison of Mortality Prediction by the GRACE Score, Multiple Biomarkers, and Their Combination in All-comer Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Objective This study examined the ability of a combination of biomarkers, including N-terminal pro-B-type natriuretic peptide (N-BNP) and high-sensitivity C-reactive protein (hs-CRP), to better predict mortality than the Global Registry of Acute Coronary Events (GRACE) score in acute myocardial infarction (AMI) patients who received primary percutaneous coronary intervention (PPCI). Methods The in-hospital mortality in 754 all-comer patients with AMI who underwent successful PPCI over 8 years was examined. A receiver operating characteristic (ROC) analysis was performed to determine the in-hospital mortality in a single center.

A Case of ST Segment Elevation Myocardial Infarction Within 24 h of a Third Dose of COVID-19 mRNA Vaccine.

Although coronavirus disease 2019 (COVID-19) vaccination is known to carry a slight risk of myocarditis and pericarditis, it remains unclear whether it has any impact on coronary artery disease. Here we present a case without particular thrombotic diathesis with a diagnosis of ST segment elevation acute myocardial infarction (STEMI) 19 h after a third dose of a COVID-19 mRNA vaccine. A primary percutaneous coronary intervention procedure for occluded right coronary artery with thrombus aspiration alone was successful in this patient.

Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina.

Conventional radial access (cRA) for percutaneous coronary intervention (PCI) has become the current standard due to low bleeding complications, although recently, distal radial access (dRA) has attracted attention as an alternative. Here, the usefulness of dRA is shown in a case in whom neither side could be used for cRA. The patient was a woman in her 70 s diagnosed with unstable angina pectoris at another hospital.

Effect of Cardiac Rehabilitation on Glomerular Filtration Rate Using Serum Cystatin C Concentration in Patients With Cardiovascular Disease and Renal Dysfunction.

Purpose: Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD.

Methods: We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.

Coronary orbital atherectomy using a five-French guiding catheter.

Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI).

First Reported Use of a Visualization Device for the Radial Artery With Near-Infrared Rays Through the Transradial Approach.

Objectives: The transradial approach (TRA) is recommended in coronary catheterization due to the lower rate of bleeding complications compared with the transfemoral approach. However, a disadvantage of TRA is difficulty in puncturing under palpation of the radial pulse alone without arterial visibility. To overcome this limitation, a vessel visualization device using near-infrared rays, Art View (Forte Grow Medical Company), was used in the puncture of the radial artery (RA).

Effects of cardiac rehabilitation on physical function and exercise capacity in elderly cardiovascular patients with frailty.

Background: The effects of cardiac rehabilitation (CR) on long-term prognosis of cardiovascular disease (CVD) are well known. However, the effect of CR on frail CVD patients has not been fully addressed.

Methods: This study consisted of 89 CVD patients with their age ≥65 years old (68 males, 75 ± 6 years), who participated in the outpatient CR program for 3 months.

Distal radial approach: a review on achieving a high success rate.

Introduction: The transradial approach is the standard for percutaneous coronary intervention (PCI). Moreover, to lead to the evolution of PCI, a new approach site was developed, namely the distal radial approach (dRA).

Anatomy And Vessel Diameter: The vessel diameter of the distal radial artery is smaller than that of the forearm radial artery; hence, use of 1 Fr size or a sheath with a thinner outer diameter is recommended.

Impact of dedicated hemostasis device for distal radial arterial access with an adequate hemostasis protocol on radial arterial observation by ultrasound.

There is no established hemostasis method or protocol for the transdistal radial approach. Therefore, this study aimed to determine whether "the PreludeSYNC DISTAL" radial compression device (PSD; Merit Medical Systems, Inc., South Jordan, UT) can effectively prevent distal radial artery (dRA) occlusion following catheterization procedures.

Effect of high-dose strong statin for preventing periprocedural ischemic complications of carotid artery stenting.

Statin therapy has been shown to induce carotid atherosclerotic plaque regression and reduce the periprocedural ischemic complications of carotid artery stenting (CAS). This study assessed the safety and usefulness of pretreatment using a high-dose strong statin (HDSS) to reduce the periprocedural ischemic complications of CAS. We analyzed 117 carotid lesions treated by CAS that were evaluated with magnetic resonance imaging (MRI) within 48 h after the procedure.

Incidence and In-Hospital Outcomes of Patients Presenting With Stent Thrombosis (from the Japanese Nationwide Percutaneous Coronary Intervention Registry).

Clinical presentation of stent thrombosis (ST) and its sequela under contemporary practice have not been fully elucidated largely due to rare incidence of ST. We sought to assess the characteristics in patients with clinical presentation of ST and their in-hospital outcomes, utilizing nationwide registration system for percutaneous coronary interventions (J-PCI). The present study included acute coronary syndrome (ACS) patients undergoing PCI with clinical findings of definite ST from January 2014 to December 2016.

Simultaneous computed tomographic angiography of the coronary and radial arteries.

Our aim was to assess a method of simultaneous computed tomographic (CT) angiography of the coronary and radial arteries without increasing contrast medium usage. Radial access is a standard approach in coronary interventions. However, radial artery puncture is difficult due to the small size of the radial artery and potential unexpected anomaly.

Evaluation of the diameter of the distal radial artery at the anatomical snuff box using ultrasound in Japanese patients.

Catheter angioplasty or angiography via the distal access point of the radial artery (dRA), located at the anatomical snuff box, is a less invasive strategy for coronary intervention attracting considerable attention. Determining the diameter of the dRA is necessary to minimize the risk of artery occlusion and safely perform catheter intervention. This was a retrospective observational study including patients who underwent coronary angiography or coronary intervention at Aomori Kyoritsu Hospital, Aomori, Japan, between February 2018 and August 2018.