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At least 19 recordsLinked to original sources
PubMed2001

Safety and efficacy of suture-mediated closure after percutaneous coronary interventions.

Percutaneous coronary interventions (PCI) performed with concomitant use of heparin and platelet inhibitors are safe procedures with reported vascular complication rates of approximately 6.1%. EPILOG investigators demonstrated that utilizing a low-dose heparin regimen with abciximab, along with early sheath removal, vascular access-related bleeding was significantly lower than that reported in EPIC. Recently, a suture-mediated closure (SMC) device has been reported to be safe, appears effective, and may improve patient comfort by allowing early ambulation. We conducted a retrospective analysis (January 1999 to March 2000) of complication frequencies among PCI patients who underwent SMC and those who had manual compression (non-SMC). Furthermore, we compared the overall rates of complications to patients who underwent PCI prior to the introduction of SMC (1995-1998). When comparing the current cohort to the historical cohort, there was a significant decrease in the number of retroperitoneal bleeds (0.3% vs. 0.9%; P = 0.003), hematomas (5% vs. 9%; P < 0.001), pseudoaneurysms (1.2% vs. 2.7%; P < 0.001), and need for vascular surgery (0.9% vs. 2.8%; P < 0.001). There was no difference in the number of arterio-venous fistulas and a slight increase in transfusion needs (12% vs. 10%; P = 0.03). Within the current cohort, there was no difference in the vascular complications between SMC and non-SMC PCI patients, although there were lower rates of pseudoaneurysms (0.5% vs. 1.8%; P = 0.02) and transfusion requirements (72/880 vs. 132/874; P < 0.001). These results suggest that the complication rates for SMC are not different and may be lower when compared to non-SMC patients after PCI. At our institution, the practice of early sheath removal and less aggressive heparin dosing has led to a decrease in vascular complication rates and a 66% reduction in vascular surgeries on post-PCI patients. Because of the limitations of retrospective analyses, further studies will be necessary to confirm these findings.

Aged↗
PubMed2006

Mechanical thrombectomy options in complex percutaneous coronary interventions.

Percutaneous coronary interventions (PCI) of thrombus-containing lesions are associated with an increased risk of acute complications and poorer long term vessel patency. Dealing with these vessels provides many technical challenges, especially with the significant risk of coronary no reflow and distal embolization. Pharmacological strategies, including intravenous and intracoronary glycoprotein IIbIIIa inhibitors reduce intracoronary thrombus propagation, improve TIMI flow and are associated with a reduction in adverse event rates. Mechanical strategies (particularly embolic protection and thrombectomy catheters) help to improve coronary blood flow and myocardial perfusion. However, their impact on clinical outcomes is less clear. The use of embolic protection devices is associated with better perfusion, blood flow, and clinical outcomes among patients undergoing saphenous vein graft (SVG) PCI. However, the role for these devices in primary PCI and native coronary artery interventions is uncertain. This study examines the current approaches to manage thrombotic lesions during PCI and reviews the evidence in support of the different mechanical thrombectomy options that are available to the interventional cardiologist.

Angioplasty, Balloon, Coronary↗
PubMed2003

New frontiers and unresolved controversies in percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) has become a key modality of therapy of patients with coronary artery disease. However, with the exception of acute coronary syndromes, there is as yet no conclusive evidence from randomized controlled trials that PCI improves survival and outcome compared with optimal medical therapy. Randomized trials comparing PCI and coronary artery bypass grafting in patients with stable coronary artery disease conducted before stenting showed superiority of the surgical approach. Early results from stent trials continue to indicate better symptom relief and less need for repeat intervention with the surgical approach, although myocardial infarction and mortality are similar with the 2 revascularization modalities. In the setting of acute coronary syndromes, however, recent trials suggest superiority of an aggressive approach, including PCI, compared with a conservative strategy of medical therapy only. This benefit extends to patients with acute ST-elevation myocardial infarction, including those with shock. In the latter setting, mortality remains high and novel approaches to protect myocardial metabolism and improve perfusion will be needed to further improve survival. The role of revascularization in patients with completed myocardial infarction and persistently occluded arteries is much less clear. Although the late open artery hypothesis is widely accepted and interventional cardiologists routinely open late infarct-related coronary occlusions, the available evidence to justify this strategy is weak. New devices, such as thrombectomy devices in thrombus-laden lesions and drug-eluting stents, offer promise, although all lack the degree of proof of benefit and safety typically required of new pharmaceutical agents. As new technologies and therapies with the potential to improve outcomes and decelerate the atherosclerotic process are developed, it will be important for investigators and industry to collaborate in incorporating these advances into ongoing and new trials testing the efficacy of PCI in all settings.

Angioplasty, Balloon↗
PubMedDate not supplied

Nursing outcomes: percutaneous coronary interventions.

Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.

Activities of Daily Living↗
PubMed2007

Role of intravascular ultrasound in unprotected left main percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) to the unprotected left main stem offers an attractive alternative to bypass grafting, but is associated with a significant clinical risk and therefore demands special consideration. Successful left main PCI is dependent upon the morphology of the lesion and the technical quality of the procedure. For these reasons, intravascular ultrasound (IVUS) has been the most popular adjunct to coronary angiography during left main PCI. However, trials of IVUS in left main PCI have produced inconclusive results, and most data predate the use of drug-eluting stents. Despite this, IVUS offers practical benefits in both case selection, and in guiding angioplasty and stenting. Here, we review the arguments for the present and future role of IVUS in left main PCI.

Angioplasty, Balloon, Coronary↗
PubMed2004

Coronary artery dissection and perforation complicating percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Despite its numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. We herein review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, large registries of PCI-related coronary artery perforations are summarized. The management of coronary artery dissection and perforation is discussed at length, including the application of newer modalities such as covered stents.

Aortic Dissection↗
PubMed2005

Follow-up of patients undergoing percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) has become a mainstay in the treatment of patients with coronary artery disease in recent years. Although increasingly complex lesions and higher-risk patients are being successfully treated, restenosis, incomplete revascularization and progression of disease continue to cause a need for a clinical functional assessment, in order to reduce morbidity. Angiographic systematic follow-up, although traditionally considered the gold standard for restenosis and disease progression, should nowadays be considered a valuable approach only to monitor small groups of very high-risk patients. Recurrence of symptoms itself has low sensitivity and specificity in detecting restenosis and myocardial ischemia. Exercise testing may provide useful information on symptoms and functional capacity of the patient; however, it has a low diagnostic power for restenosis and myocardial ischemia with a low sensitivity and specificity. Conversely, the significantly increased sensitivity and specificity obtained by stress nuclear or echocardiographic imaging provide great advantage for the clinical assessment of these patients. Additional advantages of stress imaging are the ability to assess location and extent of myocardial ischemia regardless of symptoms as well as to evaluate patients who are unable to exercise or who have an uninterpretable electrocardiogram. Furthermore, the clear superiority of stress imaging with regard to specificity and predictive value for post-revascularization events makes this functional approach of paramount importance for assessing prognosis of such patients. However, as predictive values of functional stress tests are highly dependent on the pre-test probability of disease, follow-up following PCI should always take into consideration the clinical characteristics of the patient (such as diabetes and age), the angiographic characteristics (severity of disease, myocardium at risk, left ventricular function), the procedural characteristics (length of the lesion, vessel size, number of stents implanted, etc.), symptoms and physical activity of the patient. All these parameters together will assess the risk of the patient and will help to choose a functional appropriate follow-up protocol.

Angioplasty, Balloon, Coronary↗
PubMed2004

Facilitated percutaneous coronary intervention versus primary percutaneous coronary intervention: design and rationale of the Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) trial.

BACKGROUND: Percutaneous coronary intervention (PCI) has emerged as the strategy of choice in reestablishing effective flow in occluded infarct-related arteries in patients with acute myocardial infarction (MI) if it can be administered in a timely fashion. Patients who enter the catheterization laboratory with Thrombolysis In Myocardial Infarction (TIMI) grade 3 blood flow in the infarct-related vessel have better clinical outcomes than patients presenting with impaired flow. We hypothesize that a strategy of early pharmacologic reperfusion therapy with abciximab alone or in conjunction with reduced-dose reteplase, followed by PCI will improve the outcome of patients eligible for primary PCI. STUDY DESIGN: The Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) study is a 3000-patient, prospective, multicenter, randomized, double-blind, placebo-controlled trial. The study is designed to compare the efficacy and safety of early administration of reduced-dose reteplase and abciximab combination therapy or abciximab alone followed by PCI with abciximab alone administered just before PCI for acute MI. Patients will be randomized to one of these 2 facilitated PCI treatments or primary PCI in a 1:1:1 fashion. The primary efficacy end point of FINESSE is the composite of all-cause mortality or post-MI complications within 90 days of randomization. The primary safety outcome assessment will be Thrombolysis In Myocardial Infarction (TIMI) major bleeding. CONCLUSIONS: The FINESSE study will answer important questions regarding the efficacy and safety of "upstream" medical therapy followed by planned intervention for patients with ST-elevation MI, potentially expanding the population eligible for a primary PCI approach. This study will also provide insight as to which facilitated regimen (reteplase/abciximab combination therapy or abciximab monotherapy) provides the best balance of efficacy and safety.

Abciximab↗
PubMed2006

Predictive factors of TIMI-3 flow before percutaneous coronary intervention in facilitated percutaneous coronary intervention for acute myocardial infarction.

The outcome for facilitated percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is known to be more favorable in cases in which TIMI-3 flow is obtained before PCI. We investigated factors that affect the acquisition of TIMI-3 flow before PCI. Facilitated PCI was performed on 178 patients divided into two groups, a group in which TIMI-3 flow was acquired before conducting PCI and another in which it was not, and their background factors and short-term outcomes were investigated. The hemoglobin concentrations, white blood cell (WBC) counts, and HbA1c values were significantly lower in the group in which TIMI-3 flow was acquired before PCI and significantly more had a history of past smoking. According to the results of logistic analysis, WBC count (odds ratio [OR], 0.865, P = 0.0077), hemoglobin concentration (OR, 0.77, P = 0.0257), and smoking history (OR, 0.266, P = 0.0021) were independent factors that predicted acquisition of TIMI-3 flow. The WBC count and hemoglobin value on arrival at the emergency room and history of smoking were shown to be independent factors for acquisition of TIMI-3 flow before PCI in facilitated PCI.

Aged↗
PubMed2001

Cost-effectiveness analysis of intravascular ultrasound guided percutaneous coronary intervention versus conventional percutaneous coronary intervention.

OBJECTIVE: Investigation of the cost-effectiveness of intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) compared to PCI guided by coronary angiography (CAG). METHODS: One hundred and eight men referred for PCI, were randomized to IVUS or CAG guided PCI. After 6 months, the patients were subjected to a study related clinical and invasive follow-up investigation by CAG, IVUS and intracoronary Doppler flow measurements. Incremental costs of IVUS guided procedures and costs of re-interventions were estimated using the Activity Based Costing (ABC) method. RESULTS: Patients randomized to IVUS guided PCI experienced an improved clinical outcome, with lower angina levels than patients in the CAG guided group. The initial cost of performing IVUS guidance was increased due to extra procedure time, IVUS catheters and slightly more balloons and stents, but fewer patients in the IVUS guided group needed re-intervention. Overall, these savings outweighed the initial cost increase. CONCLUSION: Our data suggest that when performing IVUS guided PCI, costs as well as benefits increase. The increased benefits measured as cost savings resulting from less restenosis outweigh the cost increase from performing the IVUS guided PCI as opposed to CAG guided PCI.

Adult↗
PubMed2004

Evidence for left ventricular remodeling after percutaneous coronary intervention: effect of percutaneous coronary intervention on left ventricular ejection fraction and volumes.

BACKGROUND: Post-stress ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes by gated myocardial perfusion SPECT (MPS) are well validated, reproducible and of prognostic significance. However, little is known about the impact of percutaneous coronary intervention (PCI) on left ventricular volumes and remodeling. METHODS: Thirty-eight patients who underwent MPS before and 6 months after PCI were evaluated. MPS were interpreted deriving summed stress (SSS), rest (SRS) and difference (SDS = SSS-SRS; extent of ischemia) scores. EF, EDV and ESV were generated by QGS trade mark. Pre-PCI MPS were compared to post-PCI MPS. RESULTS: Single vessel disease was present in 63% of patients. PCI of one vessel was performed in 82% of patients. After 6 months, SSS (10.6 +/- 6.3 vs. 2.8 +/- 4.3, p < 0.001) and SDS (8.2 +/- 5.6 vs. 1.4 +/- 2.3, p < 0.001) had improved; however, EF did not change significantly (55 +/- 10 vs. 57 +/- 13, p = ns). Still, EDV (105 +/- 25 ml vs. 96 +/- 25 ml, p = 0.006) and ESV (49 +/- 19 ml vs. 41 +/- 18 ml, p = 0.001) were significantly reduced. CONCLUSION: Results of MPS documented the beneficial effect of PCI on symptoms and extent of ischemia. In addition, the findings showed a significant decrease in ESV and EDV after PCI as compared to pre-PCI findings which points to a positive effect on left ventricular remodeling even in the absence of significant changes in EF.

Aged↗
PubMed2006

ST-segment recovery and prognosis in patients with ST-elevation myocardial infarction reperfused by prehospital combination fibrinolysis, prehospital initiated facilitated percutaneous coronary intervention, or primary percutaneous coronary intervention.

Complete ST-segment recovery (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients presenting soon after symptom onset is still a matter of debate. STR for patients treated by prehospital combination fibrinolysis or prehospital initiated facilitated percutaneous coronary intervention (PCI) compared with primary PCI has not been assessed. In the Leipzig Prehospital Fibrinolysis Study, patients with STEMI (symptoms <6 hours) were randomized to prehospital combination fibrinolysis (1/2 dose reteplase + abciximab; n = 82, group A) or prehospital initiated facilitated PCI (n = 82, group B). Further, a control group of patients with primary PCI (n = 136, group C) was prospectively assessed. STR at 90 minutes was analyzed by blinded observers as percent resolution. Categorization was performed as complete resolution (>70%), intermediate resolution (70% to 30%), or no resolution (<30%). The percentage of patients with complete STR was highest in group B with 80% versus 52% in group A and 52% in group C (p <0.001, B vs A and C, p = NS; A vs C). Complete STR resulted in lower event rates for the combined clinical end point of death, myocardial reinfarction, and stroke compared with intermediate and no STR in groups A (complete 9.8%, intermediate 23.8%, no STR 36.8%, p = 0.04), B (7.7%, 18.2%, and 50.0%, p = 0.01), and C (8.6%, 18.4%, and 42.9%, p <0.001). In conclusion, prehospital initiated facilitated PCI results in the highest percentage of complete STR compared with prehospital combination fibrinolysis or primary PCI. In addition, STR has been confirmed to predict prognosis in timely optimized reperfusion strategies.

Abciximab↗
PubMed2006

Effectiveness and cost-effectiveness of facilitated percutaneous coronary intervention compared with primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction transferred from community hospitals.

BACKGROUND: Primary percutaneous coronary intervention ([PCI], percutaneous transluminal coronary angioplasty+stenting) for ST-segment elevation myocardial infarction (STEMI) is regarded as superior to fibrinolysis even if it means that patients need to be transferred from one center to another to undergo the procedure. However, this inevitable delay between symptom onset and PCI, caused by the time required to travel, might increase the occurrence of cardiac events. A hybrid method called facilitated PCI uses fibrinolysis and/or glycoprotein (GP) IIb/IIIa inhibitors before transfer to a tertiary medical center where urgent PCI might be performed. This approach, however, has not been systematically evaluated. OBJECTIVE: The purpose of this study was to compare the effectiveness (combined end point of in-hospital mortality, reinfarction, stroke, or emergency revascularization) and cost-effectiveness of utilizing a bolus thrombolytic agent with GP IIb/IIIa inhibitor followed by transfer to a tertiary institution for facilitated PCI or standard of care transfer without primary PCI drugs among patients presenting to a community hospital with STEMI. METHODS: This was a prospective, single-center, cohort study comprising data from STEMI patients transferred from community hospitals to Hartford Hospital, Hartford, Connecticut, from the years 2000 to 2003. At the time of analysis, patients receiving primary PCI were matched (1:1) with those receiving facilitated PCI, utilizing propensity scores to assure similar demographics. The combined incidence of major adverse cardiac end points (MACE) and total hospital costs was compared between groups. Non-parametric bootstrapping was conducted to calculate CIs for the incremental cost-effectiveness ratio and generate a quadrant analysis. RESULTS: Based on 254 propensity score-matched patients (127 facilitated PCI and 127 primary PCI), in-hospital MACE and total hospital costs were reduced by 61.3% and US 4563 dollars (2005), respectively, in patients receiving facilitated compared with primary PCI (P=0.021 and P=NS, respectively). Patients receiving facilitated PCI were more likely to have target lesion Thrombolysis in Myocardial Infarction (TIMI) III (normal) blood flow on cardiac catheterization than those receiving primary PCI (49.6% vs 30.7%; P=0.002). However, the rate of TIMI bleeding was similar in both groups (21.3% in the facilitated PCI group vs 18.9% in the primary PCI group). Nonsignificant reductions were observed in both intensive care unit (ICU) and total length of stay (LOS) (0.8 day and 1.0 day, respectively) compared with the primary PCI group. Bootstrap analysis revealed that of 25,000 samplings, facilitated PCI would likely be both more effective and less costly 94.6% of the time. CONCLUSIONS: The use of facilitated PCI in STEMI patients who initially presented to community hospitals and were transferred for PCI appeared to significantly reduce the incidence of MACE, and increase the likelihood of having baseline TIMI III blood flow at time of catheterization. Nonsignificant reductions were observed in total ICU and hospital LOS. However, there did not appear to be a significant effect on the incidence of bleeding in patients receiving facilitated PCI. Bootstrap analysis confirmed that facilitated PCI would be both a more effective and less costly strategy.

Adolescent↗
PubMed2005

Randomized, blinded trial comparing fondaparinux with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention: Arixtra Study in Percutaneous Coronary Intervention: a Randomized Evaluation (ASPIRE) Pilot Trial.

BACKGROUND: Factor Xa plays a central role in the generation of thrombin, making it a novel target for treatment of arterial thrombosis. Fondaparinux is a synthetic factor Xa inhibitor that has been shown to be superior to standard therapies for the prevention of venous thrombosis. We performed a randomized trial to determine the safety and feasibility of fondaparinux in the percutaneous coronary intervention (PCI) setting. METHODS AND RESULTS: A total of 350 patients undergoing elective or urgent PCI were randomized in a blinded manner to receive unfractionated heparin (UFH), 2.5 mg fondaparinux IV, or 5.0 mg fondaparinux IV. Randomization was stratified for planned or no planned use of glycoprotein (GP) IIb/IIIa antagonists. The primary safety outcome was total bleeding, which was a combination of major and minor bleeding events. The incidence of total bleeding was 7.7% in the UFH group and 6.4% in the combined fondaparinux groups (hazard ratio, 0.81; 95% confidence interval, 0.35 to 1.84; P=0.61). Bleeding was less common in the 2.5-mg fondaparinux group compared with the 5-mg fondaparinux group (3.4% versus 9.6%, P=0.06). The composite efficacy outcome of all-cause mortality, myocardial infarction, urgent revascularization, or need for a bailout GPIIb/IIIa antagonist was 6.0% in the UFH group and 6.0% in the fondaparinux group, with no significant difference in efficacy among the fondaparinux doses compared with UFH. Coagulation marker analysis at 6 and 12 hours after PCI demonstrated that fondaparinux was superior to UFH in inducing a sustained reduction in markers of thrombin generation, as measured by prothrombin fragment F1.2 (P=0.02). CONCLUSIONS: In this pilot study of patients undergoing contemporary PCI, factor Xa inhibition with the synthetic anticoagulant fondaparinux in doses of 2.5 and 5.0 mg was comparable to UFH for clinical safety and efficacy outcomes. These data form the basis for further evaluation of fondaparinux in arterial thrombosis.

Aged↗
PubMed2005

Expressed preferences for health education of patients after percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention patients may require further education to increase their uptake of lifestyle change. Little is known, however, about their preferences for health education. This study aimed to investigate percutaneous coronary intervention patients' preferences regarding information provision and to identify patient characteristics associated with specific preferences. DESIGN AND METHODS: A consecutive series of eligible patients was recruited from three metropolitan hospitals in Melbourne, Australia after their first percutaneous coronary intervention. Structured telephone interviews were conducted with 218 patients shortly after discharge from hospital. Patient preferences for source and format of information about both heart disease and lifestyle change were ascertained. Data regarding demographic characteristics and rehabilitation attendance were also collected. RESULTS: Cardiac rehabilitation programme staff were the most frequently nominated preferred source for information delivery. Cardiac rehabilitation was also the most frequently nominated preferred format for information delivery. Half the patients nominated alternative formats, most commonly individual consultation with a health professional and self-education. Not surprisingly, patients who preferred alternatives to group cardiac rehabilitation were significantly less likely to attend rehabilitation. CONCLUSIONS: It is important to cater for patients who express a desire for alternative information formats. A flexible model of cardiac rehabilitation delivery which incorporates non-group alternatives would meet the needs of these patients.

Adult↗
PubMed2006

Combined therapy with percutaneous coronary intervention and percutaneous aortic valvuloplasty under mechanical support for an elderly patient with cardiogenic shock.

Percutaneous aortic valvuloplasty is reportedly a useful tool for the management of critical and severe aortic stenosis with cardiogenic shock. However, early percutaneous coronary intervention for cardiogenic shock is beneficial for elderly patients with acute myocardial infarction. We describe a patient with critical aortic stenosis who presented with severe coronary stenosis of the left main trunk and the ostium of the right coronary artery. We performed percutaneous coronary intervention and percutaneous aortic valvuloplasty under intra-aortic balloon pump and percutaneous cardiopulmonary support. After these procedures, the cardiogenic shock was reversed, and the patient could be weaned from both intra-aortic balloon pump support and percutaneous cardiopulmonary support.

Aged, 80 and over↗
PubMed2004

Evaluation of routine functional testing after percutaneous coronary intervention.

Following percutaneous coronary intervention, 348 patients were randomized to either routine or selective functional testing strategies. For the primary end point of maximal exercise endurance on a treadmill at 9 months, achievement was similar in the routine and selective groups. For the secondary end points measuring functional status and quality of life, scores were also similar. There was little difference in the rates of invasive cardiac procedures for the 2 groups at 9 months.

Angioplasty, Balloon, Coronary↗