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  • 1
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    Online Resource
    Complete revascularization in stable multivessel coronary artery disease: A real world analysis from the British Columbia Cardiac Registry
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 99, No. 3 ( 2022-02), p. 627-638
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 99, No. 3 ( 2022-02), p. 627-638
    Abstract: More than half of patients undergoing percutaneous coronary intervention (PCI) have multivessel disease (MVD). The prognostic significance of PCI in stable patients has recently been debated, but little data exists about the potential benefit of complete revascularization (CR) in stable MVD. We investigated the prognostic benefit of CR in patients undergoing PCI for stable disease. Methods We compared CR versus incomplete revascularization (IR) in 8,436 patients with MVD. The primary outcome was all‐cause mortality at 5 years. Results A total of 1,399 patients (17%) underwent CR during the index PCI procedure for stable disease. CR was associated with lower mortality (6.2 vs. 10.7%, p   〈  .001) and lower repeat revascularization at 5 years (12.7 vs. 18.4%, p  〈  .001). Multivariable‐adjusted analyses indicated that CR was associated with lower mortality (HR = 0.73, 95% CI: 0.58–0.91, p = .005) and repeat revascularization at 5 years (HR = 0.78, 95% CI: 0.66–0.93, p =  .005). These findings were also confirmed in propensity‐matched cohorts. Subgroup analyses indicated that CR conferred survival in older patients, male patients, absence of renal disease, greater angina (CCS Class III‐IV) and heart failure (NYHA Class III‐IV) symptoms, and greater burden of coronary disease. In sensitivity analyses where patients with subsequent repeat revascularization events were excluded, CR remained a strong predictor for lower mortality (HR = 0.69, 95% CI: 0.54–0.89, p = .004). Conclusions In this study of stable patients with MVD, CR was an independent predictor of long‐term survival. This benefit was specifically seen in higher risk patient groups and indicates that CR may benefit selected stable patients with MVD.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v99.3
    DOI: 10.1002/ccd.29564
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 2
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    Bespoke valve sizing avoids annular rupture in patients treated with a balloon‐expandable transcatheter heart valve
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. 5 ( 2022-11), p. 823-831
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. 5 ( 2022-11), p. 823-831
    Abstract: Annular and left ventricular outflow tract (LVOT) calcification increase the risk of annular rupture following transcatheter aortic valve replacement (TAVR). The outcomes of a strategy of routine use of a balloon‐expandable valve (BEV) for all patients irrespective of annular or LVOT calcium is unknown. Objectives We evaluated the impact of bespoke sizing on annular rupture in patients treated with a BEV. Methods All consecutive patients undergoing TAVR at a single centre (February 2020–February 2022) were treated only with a BEV. No other valve design was used. Annular/LVOT calcification was assessed using a standardized grading system. For each annular area, we determined the percentage valve oversizing with nominal deployment. The balloon deployment volume was then adjusted when required (over‐/underfilled) to achieve over‐sizing of approximately 5% in the presence of annular/LVOT calcium and 5%–10% in the absence of annular/LVOT calcium. Adjusted valve areas were assumed to change proportionately to the change in balloon deployment volume. Results Among 533 TAVR treated patients, annular/LVOT calcification was present in 166 (31.1%) and moderate or severe in 90 (16.9%). In patients with annular/LVOT calcification, the adjusted oversizing was 3.5 ± 3.6% and in patients without annular/LVOT calcification, the adjusted oversizing was 6.8 ± 4.7% ( p   〈  0.001). There were no cases of annular rupture and no cases with more than mild paravalvular leak (PVL). Mild PVL was more frequent in patients with annular/LVOT calcium (10.8% vs 4.6%, p  = 0.01). Conclusion Bespoke BEV sizing by adjustment of balloon deployment volume avoided annular rupture in patients undergoing TAVR.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.5
    DOI: 10.1002/ccd.30402
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 3
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    The prognostic impact of revascularization strategy in acute myocardial infarction and cardiogenic shock: Insights from the British Columbia Cardiac Registry
    Wiley ; 2018
    In:  Catheterization and Cardiovascular Interventions Vol. 92, No. 5 ( 2018-11)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 92, No. 5 ( 2018-11)
    Abstract: In patients with acute myocardial infarction (AMI) and cardiogenic shock (CS), percutaneous coronary intervention (PCI) of the culprit vessel is associated with improved outcomes. A large majority of these patients have multivessel disease (MVD). Whether or not PCI of non‐culprit disease in the acute setting improves outcomes continues to be debated. We evaluated the prognostic impact of revascularization strategy for patients presenting with AMI and CS. Methods We compared culprit vessel intervention (CVI) versus multivessel intervention in 649 patients with AMI, CS, and MVD enrolled in the British Columbia Cardiac Registry. We evaluated mortality at 30 days and 1 year. Results CVI was associated with lower mortality at 30 days (23.7% vs. 34.5%, P  = 0.004) and 1 year (32.6% vs. 44.3%, P  = 0.003). CVI was an independent predictor for survival at 30 days (HR = 0.63, 95% CI: 0.45–0.88, P  = 0.009) and 1 year (HR = 0.72, 95% CI: 0.54–0.96, P  = 0.027). These findings were confirmed in propensity‐matched cohorts. Subgroup analyses indicated that CVI was associated with lower mortality in patients aged 〈 80 years; non‐diabetics; and those presenting with ST‐elevation MI. When analyzing non‐culprit anatomy, PCI of non‐culprit LAD disease was associated with higher 1‐year mortality (HR = 1.51, 95% CI: 1.13–2.01, P  = 0.006), primarily with non‐culprit proximal LAD disease (HR = 1.82, 95% CI: 1.20–2.76, P  = 0.005). However, PCI of non‐culprit non‐proximal LAD, LCx, and RCA disease was not associated with mortality. Conclusions In patients with AMI and CS, a strategy of CVI appears to be associated with lower mortality. These findings are consistent with recently published randomized‐controlled trial data.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v92.5
    DOI: 10.1002/ccd.27648
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 4
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    The MLD MAX OCT algorithm: An imaging‐based workflow for percutaneous coronary intervention
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. S1 ( 2022-01)
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. S1 ( 2022-01)
    Abstract: Although extensive clinical data support the utility of intravascular imaging to guide and optimize outcomes following percutaneous coronary interventions (PCI), clinical adoption remains limited. One of the primary reasons for limited utilization may be a lack of standardization on how to best integrate the data provided by intravascular imaging practically. Optical coherence tomography (OCT) offers a high‐resolution intravascular imaging modality with integrated software automation that allows for incorporation of OCT into the routine workflow of PCIs. We suggest use of an algorithm called MLD MAX to incorporate OCT for imaging‐guided interventions: the baseline OCT imaging run is intended to facilitate procedural planning and strategizing, consisting of assessment for predominant lesion morphology (M), measurement for stent length (L) and determination of stent diameter (D); the post‐PCI OCT imaging run is designated for assessment of need for further optimization of stent result, and consists of analysis for medial dissections (M), adequate stent apposition (A) and stent expansion (X). Incorporation of the MLD MAX algorithm into daily practice guides an efficient and easily‐memorable workflow for optimized PCI procedures.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.S1
    DOI: 10.1002/ccd.30395
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 5
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    Coronary stent assessability by 64 slice multi‐detector computed tomography
    Wiley ; 2007
    In:  Catheterization and Cardiovascular Interventions Vol. 69, No. 7 ( 2007-06), p. 933-938
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 69, No. 7 ( 2007-06), p. 933-938
    Abstract: Background : We evaluated the assessability of contemporary stent platforms by 64‐slice multi‐detector computed tomography (MDCT). Methods . Patients undergoing coronary stenting were included in a prospective protocol of MDCT imaging within 48 hr of stent implantation. MDCT data were acquired using a “Sensation 64” MDCT scanner (Siemens Medical Solutions, Forchheim, Germany). Stent assessability was assessed by two independent blinded observers and disagreement was resolved by a third observer. Assessability was defined at visualization of the in‐stent lumen without influence of partial volume effects, beam hardening, motion, calcification, or contrast to noise limitations. Results : Fifty four stents (Cypher n = 25, Vision/Minivision n = 19, Taxus Express n = 8, Liberte n = 1, Driver n = 1) in 44 patients were included in the study. The two independent observers classified 30 of 54 stents (56%) as assessable. Interobserver reproducibility was good with κ = 0.66. Stent size was the most important determinant of assessability. Consistently assessable stents were 3.0 mm or larger (85%), whereas those under 3 mm were mostly nonassessable (26%). Conclusions : Contemporary stent designs evaluated on a 64‐slice MDCT scanner showed artifact free assessability only in larger stents. Increase in spatial resolution of MDCT scanners or modifications in stent design will be necessary to noninvasive evaluate stents 〈 3 mm in diameter, where in‐stent restenosis is more frequent. © 2007 Wiley‐Liss, Inc.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v69:7
    DOI: 10.1002/ccd.21130
    Language: English
    Publisher: Wiley
    Publication Date: 2007
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  • 6
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    First in‐human evaluation of a novel intravascular ultrasound and optical coherence tomography system for intracoronary imaging
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 99, No. 3 ( 2022-02), p. 686-698
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 99, No. 3 ( 2022-02), p. 686-698
    Abstract: We evaluated the first in‐human performance of a novel hybrid imaging catheter that permits simultaneous and co‐registered acquisition of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) images. Methods and Results A total of 17 patients undergoing planned percutaneous coronary intervention (PCI) were imaged between August 2018 and August 2019. Eleven patients with both pre‐ and post‐PCI IVUS and OCT images were included in the offline image analysis. IVUS and OCT images were analyzed separately then together with co‐registered images for pre‐stent findings, and only separately for post‐stent findings. A total of 926 frames were analyzed (218 pre‐PCI, 708 post‐PCI). There was substantial agreement to detect calcific plaque between co‐registered IVUS‐OCT and standalone IVUS (Kappa 0.72 [0.65–0.79]) and standalone OCT (Kappa 0.75 [0.68–0.81] ) while standalone imaging modalities showed lower agreement to detect lipidic and fibrotic plaques compared with co‐registered IVUS‐OCT. There were more frames with stent underexpansion on IVUS than OCT [72 (28.7%) vs. 58 (23.1%), respectively, p  = 0.039]. Detection rates of incomplete stent apposition (present on 20 OCT frames vs. 2 IVUS frames, p   〈  0.001) and tissue protrusion (40 vs. 27 frames, p   〈  0.001) were higher on OCT than IVUS. One stent edge dissection was detected in the image analysis and was seen on OCT but not IVUS. All 177 frames with image artifacts contained at least one co‐registered imaging modality with interpretable diagnostic content. There were no study device‐related adverse events. Conclusions Hybrid image acquisition was safe. The availability of both IVUS and OCT changed image interpretation compared to either modality alone, suggesting a complementary role of these two techniques.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v99.3
    DOI: 10.1002/ccd.30001
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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