Publications by authors named "Uretsky B"
Background: The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.
Methods: We examined the performance of the individual J-CTO scores in a large multicenter registry.
Results: The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%).
Article Synopsis
- Exercise stress testing (EST) is frequently used to assess chest pain, often aiming for 85% of the age-predicted maximum heart rate (APMHR), calculated with the formula 220 minus age.
- The reliability of this formula and the 85% target has been questioned, as not reaching this threshold (chronotropic insufficiency) could indicate a higher cardiovascular risk.
- Alternative metrics like percentage heart rate reserve (%HRR), maximum rate pressure product (MRPP), and maximum metabolic equivalent of tasks (METs) may provide better predictions for cardiovascular health than solely focusing on the 85% APMHR.
Flow Matters: Optimizing Invasive Coronary Physiology to Improve Long-Term Outcomes.
Cardiovasc Drugs Ther
October 2024
Article Synopsis
- Plaque modification microcatheters (PM), specifically Tornus and Turnpike Gold, are specialized devices used to treat chronic total occlusion (CTO) in coronary artery interventions.
- In a study analyzing their use across multiple centers, PMs were employed in 242 cases, representing only 1.6% of total procedures, with usage declining over time.
- The results showed that both types of microcatheters had similar success rates and complication levels, indicating that while they are seldom used, they are effective and safe in CTO interventions.
Background: Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.
Objectives: This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).
Article Synopsis
- Intravenous enoxaparin is compared with unfractionated heparin (UFH) as a safer, more effective anticoagulant for percutaneous coronary intervention (PCI) in a study of 1019 patients from January 2015 to December 2019.
- The study found high procedural success (98.2%) with very low rates of complications, including 0 deaths and minimal bleeding events.
- Results suggest that enoxaparin is a viable alternative anticoagulant for low-risk and elective PCI cases accessed via the radial artery.
Background: Coronary pseudoaneurysm is a rare, potentially fatal, complication of coronary intervention. A challenging management case of a giant right coronary pseudoaneurysm is presented.
Case Summary: A 56-year-old man presented with an atypical presentation for ST-elevation myocardial infarction.
Article Synopsis
- Aspirin has long been used for treating acute coronary syndromes and preventing coronary diseases, but recent evidence questions its use, especially for primary prevention, particularly with newer drugs available.
- Studies show that P2Y12 inhibitors, when used alone, can lead to less bleeding compared to combining them with aspirin for patients with coronary artery disease.
- This review aims to discuss the evidence supporting aspirin’s role in both primary and secondary prevention related to coronary conditions and surgical procedures.
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.
Background And Aims: Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) reflects residual atherosclerotic burden and is associated with future events. How much post-PCI FFR can be predicted based on baseline basic information and the clinical relevance have not been investigated.
Methods: We compiled a multicenter registry of patients undergoing pre- and post-PCI FFR.
Background: Although discouraged, ad hoc chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is occasionally performed.
Methods: We examined the clinical, angiographic characteristics, and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).
Results: Of the 10,998 patients included in the registry, 899 (8.
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed.
View Article and Find Full Text PDFIntroduction: Antegrade dissection and re-entry (ADR) is an integral part of the hybrid algorithm, which has allowed for improved outcomes in chronic total occlusion (CTO) coronary intervention (PCI).
Methods: A new ADR method, Subintimal Antegrade FEnestration and Re-entry (SAFER), is described. The results of a first-in-man series are presented.
"CHIP-ping" away at the definition of PCI "complexity" and "risk".
Catheter Cardiovasc Interv
August 2023
Background: Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention.
Methods: We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO).
Results: Of the 12 928 patients who underwent CTO percutaneous coronary intervention between 2012 and 2022, 52 (0.
Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) can be lengthy procedures. We sought to investigate the effect of procedural time on CTO PCI outcomes. We examined the procedural time required for the various steps of CTO PCI in 6,442 CTO PCIs at 40 US and non-US centers between 2012 and 2022.
View Article and Find Full Text PDFThe impact of a previous failure on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We examined the clinical and angiographic characteristics and procedural outcomes of 9,393 patients who underwent 9,560 CTO PCIs at 42 United States and non-United States centers between 2012 and 2022. A total of 1,904 CTO lesions (20%) had a previous failed PCI attempt.
View Article and Find Full Text PDFArticle Synopsis
- Bivalirudin is rarely used in chronic total occlusion (CTO) percutaneous coronary interventions (PCI), with only 0.75% of procedures utilizing it in a study from 2012 to 2022.
- There were no significant differences in primary outcomes like net adverse cardiac events (NACE), major adverse cardiac events (MACE), or vascular complications between the bivalirudin and unfractionated heparin groups.
- Further research is necessary to evaluate the safety and efficacy of bivalirudin for CTO-PCIs, given its limited use and comparable outcomes to traditional heparin.
Background: The impact of occlusion length on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 10,335 CTO PCIs at 42 US and non-US centers between 2012 and 2022. The cohort was divided into two groups based on lesion length (≥20 mm vs.
Article Synopsis
- Approximately 6.3% of patients who underwent chronic total occlusion percutaneous coronary intervention (CTO-PCI) between 2012 and 2022 presented with acute coronary syndrome (ACS).
- ACS patients tended to be older and had a higher prevalence of comorbid conditions, but technical success rates and major adverse cardiovascular events (MACE) were similar to those without ACS.
- The study suggests that performing CTO-PCI on ACS patients yields comparable outcomes to non-ACS patients.