Prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention: a retrospective observational cohort study using routinely-collected health data.

Aims: To identify the prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention among six public hospitals in one Australian State.

Methods And Results: A retrospective observational research design was used. A total of 4387 cases were obtained from the State Cardiac Outcomes Registry and National Hospital Cost Data Collection.

Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI.

Background: Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies.

Methods: Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017-December 31, 2020) from the Queensland Cardiac Outcomes Registry.

Prehospital Activation of the Cardiac Catheterization Laboratory in ST-Segment-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention.

Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment-elevation myocardial infarction (STEMI) performance measures. However, there are equivocal data, particularly within Australia, regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in patients with STEMI treated with primary percutaneous coronary intervention from the Queensland Cardiac Outcomes Registry (QCOR).

Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial.

Background: TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) examined the effects of text message-delivered cardiac education and support on medication adherence after an acute coronary syndrome.

Methods: TEXTMEDS was a single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome. The control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone).

The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers: The 3M TAVR Study.

Objectives: The authors sought to prospectively determine the safety and efficacy of next-day discharge using the Vancouver 3M (Multidisciplinary, Multimodality, but Minimalist) Clinical Pathway.

Background: Transfemoral transcatheter aortic valve replacement (TAVR) is an alternative to surgery in high- and intermediate-risk patients; however, hospital stays average at least 6 days in most trials. The Vancouver 3M Clinical Pathway is focused on next-day discharge, made possible by the use of objective screening criteria as well as streamlined peri- and post-procedural management guidelines.

Quantified dual energy computed tomography perfusion imaging using myocardial iodine concentration: Validation using CT derived myocardial blood flow and invasive fractional flow reserve in a porcine model.

Background: Myocardial CT perfusion imaging with dual energy (DE-CTP) can produce myocardial iodine perfusion maps. This study evaluated the accuracy of first pass myocardial iodine concentration in DE-CTP compared to CT derived dynamic myocardial blood flow (MBF) to determine regional myocardial ischemia in an animal model of coronary stenosis using invasive Fractional Flow Reserve (FFR).

Methods: Seven anaesthetised pigs (mean weight 51 ± 4 kg) had a graded coronary artery stenosis produced in six vessels (plus one control animal) using a methacrylate plug with FFR recorded in the target artery (ischemia = FFR<0.

Development of a Porcine Model of Coronary Stenosis Using Fully Percutaneous Techniques Suitable For Performing Cardiac Computed Tomography, CT-Perfusion Imaging and Fractional Flow Reserve.

Background: The aim of this study was to develop and describe percutaneous coronary angiographic techniques to create a porcine model of acute coronary stenosis with methacrylate plugs that can by assessed using fractional flow reserve (FFR), invasive coronary angiography and coronary computed tomographic (CT) perfusion imaging without introducing artefacts associated with surgical models.

Methods: Following animal care and institutional approval and using percutaneous coronary catheterisation techniques within an animal laboratory we introduced precision drilled methacrylate plugs into one of the three main coronary arteries of 10 experimental female pigs. Coronary pressure wire measurements were performed across the experimental stenosis for the calculation of FFR.

Myocardial perfusion pressure in patients with hypertension and coronary artery disease: implications for DBP targets in hypertension management.

Background: The target blood pressure (BP) in patients with hypertension and coronary artery disease (CAD) has been controversial. Whether patients with both diabetes mellitus and CAD should follow targets for either diabetes mellitus or CAD is uncertain. Focusing only on one determinant of coronary blood flow (CBF) - myocardial perfusion pressure (MPP) - coronary BP in patients with hypertension was used to estimate the impact of setting BP targets.

A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography.

Background: Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction.

Objective: We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability.

Methods: Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min.

Intracoronary imaging of coronary fibromuscular dysplasia with OCT and IVUS.

Fibromuscular dysplasia (FMD) is a segmental non-atherosclerotic, non-inflammatory vasculopathy typically of small- to medium-muscular arteries. Coronary FMD (CFMD) is believed to be rare. However, we have found an association between spontaneous coronary artery dissection (SCAD) and FMD as the cause of myocardial infarction in ∼25% of young women age <50 years.

Perforation during stenting of a coronary artery with morphologic changes of fibromuscular dysplasia: an unrecognized risk with percutaneous intervention.

Fibromuscular dysplasia (FMD) is increasingly recognized as a nonatherosclerotic pathology in young women presenting with acute coronary syndromes. The angiographic appearance of these lesions may mimic typical atherosclerosis, and a high index of suspicion is needed. The pathophysiological changes in the intima and media alter the vessel's elasticity and may adversely affect the lesion's response to balloon dilatation and stenting.

3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis.

Objectives: This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR).

Background: Moderate or severe PAR after TAVR is associated with increased morbidity and mortality.

Methods: A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve.

Cardiac computed tomography follow-up of left atrial appendage exclusion using the Amplatzer Cardiac Plug device.

Functional exclusion of the left atrial appendage using transcatheter devices has been developed as an alternative therapy for atrial fibrillation in patients for whom formal anticoagulation is contraindicated. Noninvasive follow-up imaging of these devices is desirable. Transthoracic echocardiography has limitations due to field of view, limited available imaging windows, and metallic shadowing.

Development and validation of the fractional flow reserve (FFR) angiographic scoring tool (FAST) to improve the angiographic grading and selection of intermediate lesions that require FFR assessment.

Background: Visual angiographic assessment of intermediate coronary lesions is poor at determining the functional significance. We sought to identify independent clinical and angiographic parameters associated with stenosis functional significance and applied them in a weighted fractional flow reserve angiographic scoring tool (FAST) to improve intermediate lesion selection for fractional flow reserve (FFR) assessment.

Methods And Results: Data from 100 patients with intermediate lesions previously assessed by FFR were retrospectively analyzed, and four independent variables that predicted FFR of less than or equal to 0.

Coronary CT angiography of patients with a normal body mass index using 80 kVp versus 100 kVp: a prospective, multicenter, multivendor randomized trial.

Objective: We determined the effect of reduced 80-kVp tube voltage on the radiation dose and image quality of coronary CT angiography (CTA) in patients with a normal body mass index (BMI).

Subjects And Methods: A prospective, multicenter, multivendor trial was performed of 208 consecutive patients with a normal BMI (< 25 kg/m(2)) who had been referred for coronary CTA and did not have a history of coronary revascularization. Patients were randomized to 80-kVp imaging (n = 103) or 100-kVp imaging (n = 105).

Fame comes at a cost: a Canadian analysis of procedural costs in use of pressure wire to guide multivessel percutaneous coronary intervention.

The FAME-study authors claimed that fractional flow reserve (FFR)-guided multivessel percutaneous coronary intervention (PCI) achieved superior clinical outcome and lower cost compared with no FFR. However, patients were intended to undergo multivessel PCI with drug eluting stents prior to randomization, which tipped the cost-analysis heavily in favour of FFR. We retrospectively evaluated 100 intermediate coronary lesions assessed by FFR, and determined whether to perform PCI based on visual angiographic assessment alone.

Localized pulmonary artery compression due to saphenous vein graft perforation during percutaneous coronary intervention.

Saphenous vein graft interventions are recognised as high risk procedures for adverse outcomes. We present a case of a ruptured vein graft causing a focal hematoma that led to pulmonary artery compression and cardiogenic shock without the classical signs of tamponade. Multi-modality imaging revealed the aetiology and the hematoma resolved after the patient received cardio-pulmonary resuscitation during attempted percutaneous drainage.