Complications of percutaneous coronary intervention.

Complications of percutaneous coronary intervention (PCI) can lead to significant morbidity and mortality. In-depth understanding of the mechanisms and management options of these complications as well as timely recognition and action can sometimes be lifesaving. In this review we discuss the mechanisms, prevention methods, diagnosis, and management of three major PCI complications: a) perforation b) acute vessel closure, and c) equipment loss.

Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD.

Background: Chronic kidney disease (CKD) is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain if a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (Hgb 7-8 g/dL) strategy.

Methods: Among the 3,504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with non-missing creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.

Prognostic Value of Serum TMAO Measurement in Patients with STEMI: A Systematic Literature Review.

Background: Gut microbiota-derived metabolite Trimethylamine-N-oxide (TMAO) is increasingly recognized as a potential novel prognostic biomarker for cardiovascular disease. Our research work aimed to investigate the potential utility of TMAO measurement in patients with STelevation Myocardial Infarction (STEMI).

Methods: We performed a systematic literature search in PubMed from inception to the 1st of February 2024 to identify all studies examining the association between plasma TMAO levels and disease complexity or clinical outcomes in STEMI patients.

Estimating the Risk of Cardiovascular Events in U.S. Veterans Using the SMART Risk Score.

Background: Estimation of long-term risk for cardiovascular events using the SMART (Secondary Manifestations of Arterial Disease) risk score can be potentially valuable in devising risk mitigation strategies.

Objectives: The objective of this study was to apply the SMART risk score to compute the risk for major adverse cardiovascular events (MACE) in the U.S.

Metabolic Syndrome and Associated Factors Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy in Northern Tanzania.

Purpose: Chronic systemic inflammation from human immunodeficiency virus (HIV) may cause metabolic abnormalities in lipid metabolism. Additionally, the development of metabolic syndrome has been associated with specific anti-retroviral therapy, particularly dolutegravir. This study aimed to determine the prevalence and associated factors of metabolic syndrome among people living with HIV on dolutegravir-based anti-retroviral therapy.

Bifurcation Percutaneous Coronary Intervention in Patients Aged ≥80 and Patients Aged ≥90: Insights from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions Registry.

The outcomes of bifurcation percutaneous coronary intervention (PCI) in patients aged ≥80 and ≥90 years have received limited study. We compared the procedural characteristics and outcomes of bifurcation PCIs in patients aged ≥80 years and those aged <80 years in a multicenter registry. Of 1,253 patients who underwent 1,262 bifurcation PCIs between 2014 and 2024 at 6 centers, 194 (15%) were aged ≥80 and ≥90 years.

Electrical dyssynchrony mapping and optimization of nonresponders in patients programmed with the adaptive cardiac resynchronization therapy algorithm.

Background: The adaptive cardiac resynchronization therapy (CRT) (aCRT) algorithm provides an important clinical benefit. However, a significant number of patients are nonresponders.

Objectives: The goals of this study were to quantify electrical synchrony in patients programmed with aCRT and to assess the echocardiographic effects of optimization in CRT nonresponders and incomplete responders.

Comprehensive Overview of Retrograde-Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques.

Background: Advancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization.

Objectives: To detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios.

Methods: We describe the two main techniques, tip-in and rendezvous, and their derivatives such a facilitated tip-in, manual MC-tip modification, tip-in the balloon, tip-in the stent, deep dive rendezvous, catch-it and antegrade microcatheter probing.

Association of Proximal Vessel Tortuosity with Technical Success and Clinical Outcomes: Analysis From the Progress-CTO Registry.

Background: Proximal vessel tortuosity can hinder wiring and equipment delivery during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: We sought to examine the association of proximal vessel tortuosity with the short and long-term outcomes of patients undergoing CTO PCI.

Methods: We examined the association of proximal vessel tortuosity with clinical outcomes in patients who underwent CTO PCI at 50 US and non-US centers between 2012 and 2024.

Sequential Dual Guide Catheter Technique for Chronic Total Occlusion Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery.

Triple arterial access is sometimes necessary for complete visualization of the collateral circulation and distal vessel anatomy, and to facilitate the retrograde approach in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass surgery (CABG) and multiple sources of collaterals. We present two CTO PCI cases in prior CABG patients with complex occlusions supplied by multiple sources of collaterals for which a "sequential dual guide technique" was used, reducing the number of necessary arterial access points from three to two.

SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI.

ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality in the United States. Timely reperfusion with primary percutaneous coronary intervention is associated with improved outcomes. The Society for Cardiovascular Angiography & Interventions puts forth this expert consensus document regarding best practices for cardiac catheterization laboratory team readiness, arterial access with an algorithm to help determine proper arterial access in STEMI, and diagnostic angiography.

Gender disparity in morbidity and mortality among patients with ST-elevation myocardial infarction due to spontaneous coronary artery dissection complicated by cardiogenic shock.

Background: There is limited data on gender differences among patients with spontaneous coronary artery dissection (SCAD) who present as ST-elevation myocardial infarction (STEMI) and develop cardiogenic shock (CS).

Objectives: To describe outcomes of SCAD patients presenting with STEMI and CS and outline the differences between men and women.

Methods: We queried the US Nationwide Readmissions Database (NRD) from January 2016 to December 2020 to identify patients with SCAD presenting with STEMI who developed CS.

Successful Percutaneous Transcatheter Aortic Valve Replacement for Severe Aortic Regurgitation in a High-risk Patient with Cardiorenal Syndrome.

The absence of a Food and Drug Administration-approved percutaneous valve technology for the treatment of severe aortic regurgitation (AR) presents a challenge for high-risk patients. In this report, we describe the successful treatment of an 84-year-old male patient suffering from severe symptomatic AR and concomitant cardiorenal syndrome with renal failure using a 34 mm Evolut R (Medtronic) self-expanding transcatheter aortic valve replacement. This intervention resulted in the resolution of AR, cardiorenal syndrome, and congestive heart failure symptoms.

Angiography-Derived Fractional Flow Reserve: Newer Data and Future Directions.

Several novel software systems have been developed for the reconstruction of the coronary artery tree and the calculation of fractional flow reserve (FFR) from coronary artery angiography images without coronary artery instrumentation: FFR, Computational pressure-flow dynamics derived FFR, quantitative flow ratio (QFR), and vessel FFR. In this report, we review the current evidence on each software, their contemporary use, and future directions.

Update on the diagnosis and treatment of coronary complications of percutaneous coronary interventions.

Prevention, prompt diagnosis, and rapid treatment are crucial for improving outcomes of complications that occur during percutaneous coronary intervention (PCI). The authors summarize studies on PCI complications published between January 1, 2023, and May 1, 2024, including coronary dissection, no reflow, perforation, and equipment loss/entrapment.

Feasibility of redo-TAVI in the self-expanding ACURATE neo2 valve: a computed tomography study.

Background: Redo-transcatheter aortic valve implantation (TAVI) may be unfeasible because of the risk of compromising coronary flow or coronary access by the pinned back leaflets of the index transcatheter aortic valve.

Aims: We aimed to evaluate the feasibility of redo-TAVI using the balloon-expandable SAPIEN 3 (S3) implanted within the self-expanding ACURATE neo2 (ACn2) valve and to identify predictors associated with a high risk of compromising coronary flow.

Methods: A total of 153 post-ACn2 TAVI cardiac computed tomography scans were analysed.

Validation of the coronary artery specific chronic total occlusion percutaneous coronary intervention angiographic difficulty scores in the PROGRESS-CTO registry.

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%).

Device dislodgement and embolization associated with a new leadless pacemaker.

Introduction: Currently, there are two approved single chamber leadless pacemakers (LP) in the United States (US), Micra VR™; approved since 2016 and AVEIR VR™; approved in 2022. A potential complication of LPs is dislodgement and/or embolization (D/E) during or after implant. According to the IDE trials, there appears to be a significant difference in D/E rates between the two LPs that have different fixation mechanisms; Micra uses nitinol tines, while AVEIR uses an active screw helix.

Impact of Diabetes Mellitus on Bifurcation Percutaneous Coronary Intervention: Insights from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions Registry.

The impact of diabetes mellitus (DM) on the outcomes of bifurcation percutaneous coronary intervention (PCI) has received limited study. We compared the procedural characteristics and outcomes of patients with and without DM in 1,302 bifurcation PCIs (1,147 patients) performed at 5 centers between 2013 and 2024. The prevalence of DM was 33.