Impact of Post-PCI FFR Stratified by Coronary Artery.

Background: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.

Objectives: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.

Trans-Stent FFR Gradient as a Modifiable Integrant in Predicting Long-Term Target Vessel Failure.

Background: Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is associated with long-term outcomes. Data relating FFR-based trans-stent gradient (TSG) after PCI to long-term outcomes are sparse.

Objectives: The aim of this study was to test whether TSG is associated with adverse events at follow-up after PCI.

Elective percutaneous coronary intervention performed during contrast-induced hypotension.

Objectives: To demonstrate the feasibility and safety of performing elective percutaneous coronary intervention (PCI) during contrast reaction producing severe hypotension.

Background: The development of profound hypotension due to a contrast reaction requires emergency treatment and usually signals procedure termination.

Methods And Results: We report successful completion of planned PCI with blood pressure support with vasopressors during contrast-induced hypotension in nine procedures in three patients with previously known contrast reaction causing hypotension.

Derivation and validation of Pd/Pa in the assessment of residual ischemia post-intervention: A prospective all-comer registry.

Background: Measurement of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) demonstrates residual ischemia in a large percentage of cases deemed angiographically successful which, in turn, has been associated with worse long-term outcomes. It has recently been shown that a resting pressure index, Pd/Pa, has prognostic value post stenting, however, its diagnostic value relative to FFR post-PCI has not been evaluated.

Methods: The diagnostic accuracy of Pd/Pa in identifying ischemia (FFR≤0.

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation.

Pseudoaneurysm (PSA) formation is a rare but well-known complication of coronary stenting. It develops after a procedural perforation disrupts the integrity of the vessel wall but is contained by a single wall layer, usually pericardium, extravascular thrombosis and later fibrosis. Medical literature of PSA consists primarily of case reports.

Prospective Evaluation of the Strategy of Functionally Optimized Coronary Intervention.

Background Long-term outcomes after percutaneous coronary intervention (PCI) relate in part to residual ischemia in the treated vessel, as reflected by post-PCI fractional flow reserve (FFR). The strategy of FFR after PCI and treatment of residual ischemia-known as functionally optimized coronary intervention (FCI)-may be feasible and capable of improving outcomes. Methods and Results Feasibility and results of FCI using an optical-sensor pressure wire were prospectively evaluated in an all-comer population with 50% to 99% lesions and ischemic FFR (≤0.

Prolonged Balloon Inflation to Effect Full Stent Expansion in Critical CAD During Left Ventricular Support.

The extent to which a stent is expanded is a primary factor in determining both short- and long-term outcomes during percutaneous coronary intervention (PCI). This paper presents the first case of prolonged balloon inflation using the pressure optimization protocol allowing full stent expansion during PCI of critical coronary artery disease with severely reduced ejection fraction using the Impella. ().

Use of "super-glue" to seal a perforation during chronic total occlusion coronary intervention and the potential to "unglue" it.

Coronary perforation remains a dreaded complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We present a case of successful CTO recanalization complicated by a perforation treated by n-butyl-cyanoacrylate (medical "super-glue"). We also present an in vitro experiment showing that a glue plug in a plastic tube can acutely be passed by a low tip load guide wire and undergo balloon angioplasty recreating a lumen.

Retrograde recanalization of a nonchronic total occlusion lesion.

The use of the retrograde approach to treat chronic total occlusion (CTO) has improved overall success rate in this lesion subgroup. Its use to treat complex non-CTO lesions unable to be revascularized by an antegrade approach has not been described. We report a case of the use of the retrograde approach to recanalize a non-CTO lesion under Impella support in a patient with critical stenosis and poor left ventricular function.

National Landscape of Unplanned 30-Day Readmissions in Patients With Left Ventricular Assist Device Implantation.

The number of patients with advanced heart failure receiving left ventricular assist device (LVAD) implantation has increased dramatically over the last decade. There are limited data available about the nationwide trends of complications leading to readmissions after implantation of contemporary devices. Patients who underwent LVAD implantation from January 2013 to December 2013 were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 37.

National Trends and Outcomes in Dialysis-Requiring Acute Kidney Injury in Heart Failure: 2002-2013.

Background: Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.

Methods: We used the Nationwide Inpatient Sample (2002-2013) to identify HF hospitalizations with and without D-AKI.

Nationwide Trends in Hospital Outcomes and Utilization After Lower Limb Revascularization in Patients on Hemodialysis.

Objectives: This study aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis hospitalized for peripheral artery disease (PAD).

Background: PAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality. There is a paucity of information on trends in endovascular and surgical revascularization and post-procedure outcomes in this population.

National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation.

Background: Atrial fibrillation (AF) is a common cause for hospitalization, but there are limited data regarding acute kidney injury requiring dialysis (AKI-D) in AF hospitalizations. We aimed to assess temporal trends and outcomes in AF hospitalizations complicated by AKI-D utilizing a nationally representative database.

Methods And Results: Utilizing the Nationwide Inpatient Sample, AF hospitalizations and AKI-D were identified using diagnostic and procedure codes.

Clinical and angiographic predictors of persistently ischemic fractional flow reserve after percutaneous revascularization.

Aims: Despite optimal angiographic results after percutaneous coronary intervention (PCI), some lesions may continue to produce ischemia under maximal hyperemia. We evaluated the factors associated with persistently ischemic fractional flow reserve (FFR) after angiographically successful PCI.

Methods And Results: A total of 574 consecutive patients with 664 lesions undergoing PCI who had FFR pre- and post-PCI were analyzed.

Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes.

Objectives: Fractional flow reserve (FFR) has been suggested to have value in acute coronary syndromes (ACSs). The clinical and prognostic value of ischaemia reduction assessed by post-percutaneous coronary intervention (PCI) FFR has not been studied in this population.

Methods: Consecutive stable ischaemic heart disease (SIHD) (N=390) and patients with ACS (N=189) who had pre-PCI FFR and post-PCI FFR were followed for 2.

Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes.

Objectives: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes.

Background: Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known.

A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status.

Background And Purpose: With the "weekend effect" being well described, the Brain Attack Coalition released a set of "best practice" guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a "weekend effect" in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect.

Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial.

Background: Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain.

Methods: The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA.

Incidence, Risk Factors, and Outcome Trends of Acute Kidney Injury in Elective Total Hip and Knee Arthroplasty.

Over the past decade, there has been a marked increase in the number of primary and revision total hip and knee arthroplasties performed in the United States. Acute kidney injury (AKI) is a common complication of these procedures; however, little is known about its epidemiology in the elective arthroplasty population. We conducted a study to determine the incidence, risk factors, and outcomes of AKI after elective joint arthroplasty.