percutaneous coronary intervention

The reopening of occluded arteries in myocardial infarction can be achieved through invasive and non-invasive methods.

This study aimed to determine treatment factors and outcomes comparison in acute myocardial infarction patients.

This cross-sectional and retrospective study examined the hospitalization data of 252 myocardial infarction patients referred to Ayatollah Mousavi Hospital from April 2021 to March 2022. The patient's demographic and clinical data, factors influencing treatment intervention selection, and clinical outcomes were assessed. Data were analyzed using the Chi-square test/Fisher's exact test, multiple logistic regression analysis, and ANOVA in SPSS v.22 software.

Primary percutaneous coronary intervention (PPCI) comprised 45.6% of treatments, with thrombolytic therapy comprising 35.3%. Multiple regression analysis revealed that the availability of a 24/7 operational catheterization lab and immediate access to an on-call interventional cardiologist were significant predictors of treatment selection (P< 0.05).
(P<0.05). The success rate of PPCI was 87.2% and thrombolytic therapy was 58.9%. Outcomes such as hospitalization length, analgesia dose, rehospitalization, and mortality rate over a year showed no significant statistical difference between the PPCI and thrombolytic groups (P>0.05).

Access to equipment and specialized manpower is essential for PPCI. There were no complications or clinical outcomes that differed between patients treated with PPCI and thrombolytic therapy. Thrombolytic therapy remains a viable alternative to PPCI when timely intervention is not feasible.

The present post-marketing clinical study was conducted over a 12-month follow-up period to monitor the clinical outcomes of patients treated with the Vector® Percutaneous Transluminal Coronary Angioplasty (PTCA) Balloon Catheter for the dilatation of coronary lesions. The semi-compliant balloon improves balloon-to-vessel wall apposition and minimizes balloon slippage during PTCA, which could reduce complications and improve clinical outcomes. This investigation aimed to assess the safety and effectiveness of the Vector® PTCA Balloon Catheter in real-world settings. A retrospective study was conducted to investigate the safety and efficacy of the Vector® PTCA Balloon Catheter in 125 patients who underwent pre-dilatation and post-dilatation. The primary outcome of the study was major adverse cardiac events (MACE), a composite endpoint encompassing target-lesion revascularization (TLR), cardiac death, and myocardial infarction (MI). The Vector® PTCA Balloon Catheter has shown promising results in a small group of patients undergoing dilatation of normal and intricate coronary artery lesions, reflecting a 100% procedural success rate. The successful delivery to the target lesion, deployment, and subsequent retrieval of the device during the index procedure led to a 100% device success rate without any technical issues. A total of 3.2% (4) patients experienced MACE during the 12-month follow-up, with 1.6% (2) MI, 1.6% (2) TLR, and no cardiovascular deaths.. This study demonstrated the favorable safety and reliability of the Vector® PTCA Balloon Catheter in patients with angina, MI, and a history of coronary artery disease in a real-world setting.

The SYNTAX score is a strong predictor of adverse cardiovascular events such as cardiac death, myocardial infarction, and lesions with revascularization. This rating was also confirmed for patients with left ventricular problems and all the patients referred for percutaneous coronary interventions Percutaneous Coronary Interventions (PCI).

This study was conducted on 107 patients with ST-Elevation Myocardial Infarction (STEMI) who underwent thrombolytic treatment and then angiography. SYNTAX score was calculated in all the patients. Finally, the short-term and long-term prognoses were examined. Finally, the STR values were compared in two groups of people with high syntax and low syntax.

Eighteen patients (16.8%) suffered Congestive Heart Failure (CHF), one (0.9%) experienced GI bleeding, and one (0.9%) suffered ReMI. The patients’ mean±standard deviation, maximum, and minimum SYNTAX scores were 12.82±7.19, 35, and 3, respectively. Twelve patients (11.2%) had SYNTAX scores higher than 22 (high risk), and 95 (88.8%) had scores lower than 22 (low risk).

Results of the present study indicated that patients with SYNTEX scores >22 had STR lower than 50. CHF incidence rate in patients with SYNTAX scores higher than 22 (high risk) was higher. There was also a significant relationship between the patients’ prognosis and SYNTAX scores.

Assessing right ventricular performance using twodimensional (2D) echocardiography has been difficult due to its complex shape. Tissue Doppler imaging was used as a noninvasive method in this study to evaluate right ventricular function in patients with acute inferior wall ST-elevation myocardial infarction (IWMI) treated with primary percutaneous coronary intervention (PCI).

Forty patients with IWMI admitted to a tertiary care hospital in India were included in this prospective, observational study. The patient’s detailed history, physical examination along with laboratory parameters, electrocardiogram, echocardiogram, and coronary angiogram profile were recorded from which the decision for PCI was made. The followup period for each patient was 6 weeks, during which 2D color Doppler and pulse-wave echocardiographic parameters were assessed.

This study comprised 40 patients, among which 16 patients had right ventricular myocardial infarction (RVMI), and the mean age of RVMI patients was 56.65 ± 12.03 years. In RVMI patients, tricuspid annular plane systolic excursion (mm) and RV FAC (%) values were lower than in IWMI patients, and a surge in its respective value to 15.66 ± 1.20 and 32.64 ± 3.17 (P = 0.03) was observed post-PCIs. Furthermore, an inclination in tissue annular systolic velocity (Sm; cm/s) to 11.24 ± 1.55, P = 0.02, and early diastolic tissue annular velocity (Em; cm/s) to 10.98 ± 1.27, P = 0.003, from the baseline was observed after revascularization. The myocardial performance index value accounted to be higher in RVMI patients; however, after PCI, a change from 0.73 ± 0.06 to 0.61 ± 0.12 was noted (P = 0.002).

In this study, a significant difference in the echocardiographic parameters assessing RV function in RVMI and IWMI patients was noted, and hence, it can be considered a reliable diagnostic tool to predict the RV performance.

 Previous studies have investigated the potential influence of prior aspirin use on cardiac function in patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). However, the results from these studies have been conflicting. This study aimed to investigate whether prior aspirin use affects left ventricular (LV) function in these patients using echocardiography.

 The study included 260 consecutive STEMI patients, who were divided into two groups based on the presence or absence of prior aspirin use. Echocardiographic parameters, such as maximal left atrial (LA) size, LV ejection fraction (LVEF), early diastolic velocity (e’), E/A ratio, and E/e’ ratio, were assessed within 72 hours of admission.

 Aspirin users had an older age compared to non-users, as well as lower body mass index and renal function. They also had a greater history of hypertension and were more likely to be taking statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and calcium channel blockers. There were no significant differences in LVEF, maximal LA size, E/A ratio, E/e’ ratio, and deceleration time between aspirin users and non-users. e’ wave was marginally lower in aspirin users (P=0.054). After controlling for confounding variables, the previous use of aspirin did not show a significant impact.

 Prior aspirin use in STEMI patients does not have a significant impact on LV echocardiographic parameters. Our conclusions remained consistent even after adjusting for potential confounders.

We present a modified floating wire technique for aorto-ostial coronary stenting. This novel approach ensures accurate ostial alignment without stent protrusion. The technique involves using a second wire as a marker at the true ostium to guide optimal stent placement. A balloon catheter is advanced on the floating wire to delineate the aorto-ostial plane. This method reduces the need for contrast media, prevents deep intubation of the guide catheter, and resembles the stent draw-back technique. The modified floating wire technique offers a safe and effective method for aorto-ostial coronary stenting and has potential for broader clinical application.

Most cases of congenital coronary artery fistula (CAF) resolve spontaneously, symptomatic patients with severe shunting require surgical intervention. Our aim is to evaluate success rate and outcome of CAFs treatment using transcatheter interventional methods.This retrospective study conducted on 28 CAF patients who were referred to Rajaie Cardiovascular Medical and Research Center in Tehran between 2015 and 2020. Baseline characteristics were collected by assessing hospital records, and patients were followed up annually for long-term evaluation. All of 28 patients gone throughtranscatheter closure of CAF. In 23 patient’s it was proximal type (82.1%) and in 5 patients was distal type (17.9%). In 11 patients, the fistula originated from the RCA (39.3%) and in 11 patients, it originated from the LAD and Diagonal. Most common drainage site was the pulmonary artery (82.1%). Coil used in 23 patients(82.1%). PDA occluder (7.1%) for 2 patients. VSD occluder for one patient (3.6%) and VSD+PDA occluder combination was used for one patient (3.6%). Procedure failure was in only one patient. Non-significant remaining shunt in the injection immediately after the procedure was seen in 4 patients (14.3%), which was reduced during the follow-up. None of the patients had significant shunt or clinical symptoms during long-term follow-up. As for complications, fistula dissection occurred in only one patient.The transcatheter interventional approach for the treatment of CAFs leads to favorable long-term results.

 Percutaneous Coronary Intervention (PCI) is a fundamental procedure for coronary artery disease management, yet the risk of adverse events such periprocedural myocardial injury (PMI) persists. This double-blind, randomized clinical trial aims to assess the efficacy of empagliflozin in preventing myocardial injury during PCI procedure.

 A total of 90 patients were randomly assigned to two groups A and B; Group A as the intervention group received empagliflozin 25 mg 24 hours before and empagliflozin 10 mg 1-2 hours before coronary intervention and group Bas the control group received placebo at similar intervals. The primary outcome involved comparing baseline, 8-hour, and 24-hour cTnI and baseline and 24-hour hs-CRP levels after PCI in both groups to measure the incidence of periprocedural myocardial injury (PMI) and anti-inflammatory effects of empagliflozin.

 Baseline cTnI levels with P=0.955, 8 hours after PCI with P=0.469, and 24 hours after the intervention with P=0.980 were not statistically different in the two groups. Baseline levels of hs-CRP in both intervention and control groups were not statistically significantly different (P=0.982). Also, there was no statistically significant difference in hs-CRP levels 24 hours after PCI in two groups (P=0.198). Finally, the results showed that MACEs did not occur in any of the groups.

 The results of this trial could not express the advantages of acute pretreatment with empagliflozin in preventing PCI-related myocardial injury.

Percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI); however, reduced left ventricular ejection fraction (LVEF) remains a critical issue post-PCI. Serum uric acid (SUA) has emerged as a biomarker linked to cardiovascular events and may be associated with LVEF. This study aims to investigate the relationship between SUA levels and LVEF in STEMI patients treated with primary PCI and identify potential biomarkers for predicting patient outcomes.  This prospective study was conducted at Afshar Hospital, Shahid Sadoughi University of Medical Sciences of Yazd, from September 2019 to March 2021. Participants included 254 consecutive ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. Exclusion criteria were contraindications for angiography, history of myocardial infarction, PCI, CABG, NSTEMI, thrombolytic treatment, kidney diseases, gout, or alcoholism. Demographic data, clinical history, SUA levels, and echocardiographic parameters were collected. Statistical analysis was performed using SPSS version 20.0, with significance at p<0.05.  81.49% of patients were male, with a mean age of 57.7±11.47 years. Hypertension was the most prevalent condition (42.9%). SUA levels did not significantly differ between patients with LVEF below and above 40% (p=0.39). However, smoking was significantly associated with reduced LVEF (p<0.001). A weak negative correlation between SUA and LVEF was observed in males (p=0.012) but not in females (p=0.097). Overall, a weak negative correlation between SUA and LVEF was statistically significant (p=0.05).  Our findings revealed a weak but statistically significant overall negative correlation between SUA and EF. Further research with larger, more diverse populations is necessary to elucidate the relationship between SUA and cardiac function in STEMI patients.

Prehospital factors are critical contributors to delays in managing patients with ST elevation myocardial infarction (STEMI), potentially leading to increased mortality and morbidity. Identifying and addressing these obstacles could significantly reduce the mortality and morbidity of these patients and enhance healthcare performance.

This study aims to evaluate the prehospital factors associated with delays in primary percutaneous coronary intervention (PPCI) among patients with STEMI.

In this prospective study, 394 STEMI patients treated with PPCI were evaluated, with the interval between symptom onset and the start of the procedure being measured and recorded. Patients were categorized into two groups based on this interval: Appropriate and delayed (< 90 minutes vs. ≥ 90 minutes). The potential predictors of delay were identified and assessed.

In this study, 394 STEMI patients were evaluated and categorized into 192 patients with delayed PPCI and 202 patients with on-time PPCI. Multivariate analysis revealed that being female (OR: 1.59, 95% CI: 1.08 - 2.01, P-value: < 0.01), having no past medical history of cardiovascular disease (CVD) (OR: 1.49, 95% CI: 1.09 - 1.90, P-value: < 0.01), no family history of CVD (OR: 1.28, 95% CI: 1.04 - 1.53, P-value: 0.03), a lower education level than academic (OR: 1.44, 95% CI: 1.05 - 1.84, P-value: < 0.01), symptom onset between 18:00 and 06:00 (OR: 1.58, 95% CI: 1.10 - 2.06, P-value: 0.01), and transport by ambulance versus private vehicle (OR: 1.57, 95% CI: 1.07 - 2.08, P-value: < 0.01) were significantly associated with a higher risk of delayed PCI. Conversely, higher socioeconomic status (OR: 0.68, 95% CI: 0.51 - 0.86, P-value: 0.02) and having a caregiver at home (OR: 0.52, 95% CI: 0.32 - 0.72, P-value: < 0.01) were significantly associated with a lower risk of delayed PPCI.

Reducing factors that contribute to delays in PPCI can lead to improved public health outcomes and greater health opportunities for the population. Delays in STEMI patients were significantly associated with living in rural areas, lower education levels, and female gender. Conversely, using private vehicles for transport, having a caregiver present, and higher socioeconomic status may reduce the risk of delayed PPCI.

Previous studies have reported a higher incidence of ischemic events in African Americans (AAs) than in non-AAs following percutaneous coronary intervention (PCI). Moreover, AAs are known to experience worse COVID-19-related outcomes. However, the impact of the COVID-19 pandemic on the first occurrence of ischemic events among race and gender-stratified post-PCI patients remains unknown.
 
In this retrospective study, we compared patient demographics and the first adverse events post-PCI before (2018-2020) and during (2020-2021) the COVID-19 pandemic. Continuous variables were expressed as mean ± standard deviation and compared using the 2-sample t-test, while categorical variables were compared using the χ2 test. Univariate and multivariate logistic regression analyses were performed using Stata17 software.
 
The study population consisted of 1022 patients, with 511 patients before and 511 after the onset of the pandemic. The first occurrence of cardiovascular death, ischemic events, and myocardial infarction was higher during the COVID-19 pandemic than during the pre-pandemic period (P<0.05). During the pandemic, AAs experienced a significantly higher incidence of first ischemic events than non-AAs (P=0.03). Notably, AA men had significantly higher rates of ischemic events than AA women, non-AA men, and non-AA women during the COVID-19 pandemic (P<0.05).
 
These findings further emphasize the importance of addressing the increased thrombogenic risk among AAs, who exhibit higher ischemic risk than their non-AA counterparts. (Iranian Heart Journal 2024; 25(3): 35-50)

Patients who receive percutaneous coronary interventions often display inadequate levels of self-care actions, which could create difficulties in managing the disease and achieving favorable treatment results. This study investigates the impact of using an educational mobile application on self-care behaviors in patients undergoing percutaneous coronary intervention.

Methods & Materials: 

 A randomized clinical trial was conducted with 110 patients undergoing percutaneous coronary interventions at Shahid Rajaei Hospital in Karaj, Iran, in 2023. The study enrolled and assigned them to either the intervention group (n=55) or the control group (n=55) by block randomization. In addition to training upon discharge, the experimental group received educational resources via a mobile phone application. The data collection instruments included MSCBS. Patients completed the MSCBS before the intervention and 4 weeks later. The data were analyzed with SPSS 21. The study's level of significance was set to P<0.05.

Before the intervention, there was no significant difference in the self-care scores and the subscales between the two groups (P<0.05). Nonetheless, After the intervention, a significant difference was observed in the self-care scores and the subscales between the control and intervention groups, (p=0.001), and the difference in scores between the control and intervention groups increased significantly after the intervention and the scores of the intervention group had a significant increase compared to the scores of the control group.

The study showed that the mobile phone educational application could improve self-care behaviors in patients undergoing percutaneous coronary interventions. Therefore, it can be recommended that nurses working in medical centers use this educational application to enhance self-care in these patients.

Fractional flow reserve (FFR) is crucial to evaluating coronary artery stenosis in patients diagnosed with chronic coronary syndrome (CCS). By assessing the severity of stenosis, FFR assists in determining whether percutaneous coronary intervention (PCI) is necessary.

Conducted at Tehran Heart Center from 2013 through 2017, this cohort study involved 52,248 CCS patients who underwent coronary angiography. Among them, 598 symptomatic individuals, despite receiving comprehensive medical treatment, underwent FFR assessment. Subsequently, 225 patients with positive FFR (≤0.80) underwent PCI, while 373 patients received solely medical treatment. The patients were monitored for 3 years to evaluate primary and secondary endpoints.

After 3 years, the PCI group demonstrated a lower incidence of the primary composite endpoint, consisting of all-cause mortality, nonfatal myocardial infarction, repeat target vessel/lesion revascularization (TVR/TLR), and coronary artery bypass graft surgery, than the medical treatment group (HR, 0.85; 95% CI, 0.74 to 0.98; P=0.012). Additionally, urgent TVR/TLR significantly decreased in the PCI group (HR, 0.56; 95% CI, 0.42 to 0.74; P<0.001).

FFR-guided PCI demonstrated effectiveness in reducing long-term major adverse cardiac events, primarily by lowering the incidence of TVR/TLR. The results emphasize the significance of FFR-guided PCI in addressing stenosis rather than alleviating ischemia.

Balloon aortic valvuloplasty (BAV) is a therapeutic option as palliative or bridging therapy in severe aortic stenosis, even though it is a risky procedure, especially in patients with concomitant left ventricular dysfunction. The use of percutaneous ventricular assist devices, such as the Impella CP, in this scenario provides optimal circulatory support and considerably reduces the risk of the procedure. Two patients with severe aortic stenosis and left ventricular dysfunction underwent BAV with the support of the Impella-CP. The Impella CP provided adequate support in both high-risk patients and safely allowed BAV.

 Ischemic heart disease stands as the foremost cause of death among cardiovascular conditions. The most commonly employed revascularization method for treating ischemic heart disease is percutaneous coronary intervention (PCI). An improvement in the patient's quality of life frequently serves as the primary measure of PCI's success.

 The purpose of this study was to assess the impact of an educational program grounded in the information-motivation-behavioral skills (IMB) model on the quality of life of patients who have undergone PCI.

 This quasi-experimental study involved 84 patients selected from those referred to the Cardiovascular Clinic of Razi Hospital in Birjand city, located in eastern Khorasan. Participants were required to fill out a demographics form and the Short Form of the Quality-of-Life Questionnaire (SF-12). They were then divided into an intervention group (n = 42) and a control group (n = 42) through the use of the permuted block method. Those in the intervention group participated in a 6-week educational program (meeting once weekly) designed around the IMB model. The control group received the standard care available at the Cardiovascular Clinic. Both groups were asked to return to the Cardiology Clinic 6 weeks after the initial test to complete the SF-12 (posttest). All participants were surveyed again one month after the second questionnaire completion (follow-up).

 The intervention group showed a significant increase in the mean score of physical health immediately and one month after the intervention, compared to the pretest scores (P = 0.001 and P = 0.004, respectively). Furthermore, the mean posttest score for psychological health in the intervention group significantly improved compared to the pretest (P < 0.001), and their follow-up score improved significantly compared to the posttest score (P = 0.02). There were no significant changes in the mean scores for physical and psychological health in the control group over time (P > 0.05).

 This study indicates that the quality of life for patients post-PCI can be significantly improved through participation in an educational program based on the IMB model. This research provides a foundation for the development of interventions with more enduring effects on post-PCI patient outcomes.

Percutaneous coronary intervention (PCI) is the gold standard approach to ST-Segment Elevation Myocardial Infarction (STEMI). Fibrinolysis followed by PCI has been recommended. The current study aims to investigate the no-reflow phenomenon incidence in patients undergoing post-thrombolytic therapy PCI. This cross-sectional study was conducted on 250 patients with STEMI who primarily received fibrinolytic therapy followed by early (3-24 hours) (n=231) or delayed (> 24 hours) (n=19) PCI. They were also subcategorized into four intervals: <6 hours (n=98), 6-12 hours (n=93), 12-24 hours (n=38), and ≥24 hours (n=21). The demographic and medical data of the patients were retrieved. The Thrombolysis in Myocardial Infarction score (TIMI) was assessed at baseline and at the end of PCI. A TIMI score other than 3 was defined as no-reflow. The incidence of the no-reflow phenomenon was not associated with any of the underlying demographic and medical characteristics of the patients (P-value>0.05). Despite the significantly higher rate of improvement in TIMI grading among those undergoing early PCI (P-value=0.04), as well as within less than 6 hours after thrombolytic therapy (P-value=0.031), the rate of the no-reflow phenomenon did not differ between the groups, neither by sorting them as early versus delayed (P-value=0.518) nor by categorizing them into four intervals (P-value=0.367). Based on the findings of the current study, early PCI after fibrinolysis led to significantly improved TIMI flow. However, the incidence of no-reflow did not differ between the groups with early versus delayed post-fibrinolysis PCI.

The effectiveness of cardiac rehabilitation (CR) programs following either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has been separately studied. Few studies have compared the effects of similar CR programs between PCI and CABG. This study aimed to compare the effects of CR in patients recruited following either PCI or CABG on coronary heart disease risk factors, psychological variables, and functional capacity. For this retrospective study, the documents of the CR program registry of the Isfahan Cardiovascular Research Institute were reviewed from 2008 to 2021. Patients with ischemic heart disease undergoing PCI or CABG were enrolled in an 8-week exercise-based cardiac rehabilitation program. Demographics, smoking status, clinical data, echocardiographic parameters, laboratory data, functional capacity, and psychological status were assessed. Patients who underwent CABG (n=557) were more likely to be referred to CR than those who underwent PCI (n=440). All variables changed significantly after the CR program compared to their baseline value in both the PCI and CABG groups. However, low-density lipoprotein and total cholesterol levels, peak systolic blood pressure, and resting and peak diastolic blood pressure did not change in any of the groups, and fasting blood sugar (p=0.01) and triglyceride (TG) (p=0.01) levels significantly decreased only in the PCI group. Between-group comparisons indicated that after adjustment, no significant difference was observed between the PCI and CABG groups except for TG, which was significantly reduced in the PCI group (p=0.01). The CR program was equally effective in patients who underwent either PCI or CABG.