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The present article deals with the indications for revascularization of chronic total occlusions (CTO) of the coronary arteries. The introduction section briefly summarizes the history and development of CTO PCI. The main content of the paper is divided into three sections: the first one summarizes the current American and European societies of cardiology guidelines on CTO PCI; the second one provides a reflection on the most important aspects of the indication process from the most recent expert consensus; and the third one conveys the author’s personal experience with indicating patients for CTO recanalization. The paper also includes an overview of randomized trials on CTO PCI. [ABSTRACT FROM AUTHOR]

The case report presents two views on the concept of “triple combination” in treating a particular patient with coronary artery disease. The first, somewhat untraditional meaning of the two-word expression is used to describe an unusual case of three chronic total occlusions (CTO) in three different coronary territories clinically manifested by heart failure in the setting of ischaemic cardiomyopathy. All the occlusions were gradually recanalized using CTO PCI techniques with a good angiographic and clinical effect. There was a marked improvement in the original systolic left ventricular dysfunction. The individual procedures are illustrated by images and accompanied by general information on CTO PCI. A second meaning of the words “triple combination” – in a more traditional pharmacotherapeutic sense – represents a fixed combination of three antihypertensive and lipid-lowering drugs which were used in the same patient to optimize the secondary preventive therapeutic regimen. [ABSTRACT FROM AUTHOR]

PCI for chronic total occlusion (CTO) of coronary arteries is one of the most dynamically developing fields in interventional cardiology. The issue itself involves some controversy. These are very complex procedures which, on the one hand, can significantly improve the quality of life of many patients, but on the other hand, are burdened by a higher risk of periprocedural complications compared to common non-CTO PCI. The fact that, even in our conditions, dedicated CTO programmes with increasing numbers of these procedures were set up at some centres implies that it is a current issue. The review article presents an abridged version of a state-of-the-art document developed by world-renowned experts in the subject of CTO. The basic principles of a successful and safe CTO PCI programme are divided into seven general principles, ranging from indications to planning of procedures and their technical aspects to minimizing the risk of developing and/or possibly managing complications. [ABSTRACT FROM AUTHOR]

Cangrelor is the only intravenous platelet P2Y12 receptor inhibitor with proven clinical efficacy for the reduction of PCI - related ischemic complications. Cangrelor pharmacology, clinical studies, and off-label indications are disscused in this review article. [ABSTRACT FROM AUTHOR]

The contemporary treatment following percutaneous coronary intervention (PCI) in patients with atrial fibrillation is based on the results of randomized trials. Non-vitamin K oral anticoagulants (NOAC) are associated with a better safety profile. The optimal antithrombotic therapy considering ischemic events is still a matter of debate but omitting aspirin (dual therapy) in a few weeks after PCI and standard dose of NOAC seems to be the optimal choice for most of the patients. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the study was to assess psychometric properties, validity and internal consistency of the Slovak version of the Proactive Coping Inventory (PCI). The article deals with: a) factorial structure of the PCI, b) item analysis and internal consistency of its scales, c) discriminant validity. Subjects and settings. The sample consisted of employed adult people from all main regions in Slovakia, 22% were men and 78% women. Their age ranged from 20 to 60 years, with mean age 38.62 (SD=10.78). Statistical analysis. Confirmatory factor analysis was used to test the models, Maximum Likelihood (ML) method, the goodness of fit indexes: χ2 test, χ2/df, RMSEA, 90% CI for RMSEA, CFI, GFI, and information criteria AIC, BIC. Item analysis was conducted by descriptive characteristics and popularity index p. Internal consistency was assessed by coefficients α and ω, statistical relationships were tested using Pearson's correlation coefficient. Results. None of the presented models (seven, three and one factor models) fits the data well. Modified one-factor models fit the data well. Internal consistency is low in all scales (α=ω=.55-.78). Item analysis identified several problematic items. There are significant relationships between the PCI scales. The results open the space for discussion, whether the problem is affected mainly by translation or if it corresponds with the original scale construction. The current studied Slovak version of the PCI does not meet required psychometric properties and several further modifications are needed: to improve the fit of multifactor models of the PCI and significantly increase the internal consistency of the PCI. Study limitations. The sample is not representative due to nonprobabilistic sampling method and higher percentage of women. The exploratory character of the PCI models modifications is also considered as a study limit. [ABSTRACT FROM AUTHOR]

Acute coronary syndrome as an acute form of coronary artery disease is one of the most important causes of patient morbidity and mortality. Its most effective treatment method is percutaneous coronary intervention (PCI) routinely using angiographic imaging. Currently, the most accurate assessment of coronary artery morphology is provided by optical coherence tomography (OCT), an intravascular imaging technique. The main application of OCT has been shifting from mostly scientific use to almost routine practice in recent years, particularly in patients with acute coronary syndrome. Optical coherence tomography is, except for a few limitations, one of unbeatable imaging methods with respect to image resolution and the amount of information obtained. First data have been available suggesting a patient benefit from the use of OCT in interventional treatment of patients with acute myocardial infarction. The paper provides an overview of the use of OCT, especially in patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Aim: Percutaneous coronary intervention (PCI) for coronary artery chronic total occlusion (CTO) has been a rapidly evolving branch of interventional cardiology in recent years. The article presents our two-year experience with the development of a dedicated CTO programme, while focusing on stratification of CTO difficulty depending on the J-CTO scoring system and the role of the proctor in the learning curve. Material and methods: The study cohort comprised consecutive patients who underwent PCI for CTO at our centre during the period from 08/2016 to 10/2018. The following aspects were studied: the basic patient characteristics and technical aspects of the procedure; the estimated difficulty depending on the J-CTO score; the proportions of various recanalization techniques; whether or not a proctor was present during the procedure; and the rates of complications. Procedures with a J-CTO score ≥ 2 were graded as difficult in consistency with the authors of the scoring system. Results: The overall success rate of CTO PCI in the follow-up period was 84.4 %. The mean fluorocopic time per procedure was 30:17 minutes, the irradiation dose 2 660 mGy, and contrast medium consumption 262 ml. In successful procedures, the final strategy that resulted in CTO recanalization was antegrade wire escalation in 65.6 %, retrograde dissection-reentry technique in 11.1 %, and retrograde wire escalation in 6.7 %. In one case, we succeeded with antegrade dissection-reentry technique. While the success rate of CTO PCI for J-CTO scores of 0-1 reached 94.9%, in difficult cases (J-CTO ≥ 2) the success rate was only 76.5%. Proctored procedures versus unproctored ones had a higher mean J-CTO score (2.3 vs. 1.7), a higher proportion of difficult findings with a J-CTO ≥ 2 (66.7 % vs. 52.4 %), a higher percentage of retrograde procedures (55.6 % vs. 19.1 %), and a higher success rate was achieved with them (92.6 % vs. 81.0 %). Clinically severe complications occurred in 4.5%, and there was no periprocedural death or tamponade. Conclusion: The present cohort represents the first two years of the CTO PCI learning curve showing that, when certain rules are followed, it is possible to master the CTO PCI techniques and introduce them into normal operation of a catheterization room as an effective and safe treatment method for patients with a specific, and not rare, type of coronary disease. [ABSTRACT FROM AUTHOR]

The purpose of the present study is twofold. First is to carry out item and scale analysis of the Czech version of the Proactive Coping Inventory (PCI) on a selected sample of university students in helping professions (n = 176). Second is to identify the use of proactive coping strategies by gender, age, specialization and year of study. The PCI scales reached satisfactory item-total correlations, besides the items presented (8, 39 and 48). Internal consistency of the PCI scales ranged from .71 to .8, except low α for Strategic Planning. Students reached the highest use of emotional and instrumental support seeking with no overall socio-demographic differences. Further, interrelationships among the PCI scales and correlations within a subjective well-being, depression and social support are presented.

Aim: Absorb BVS™ (Abbott Vascular, Santa Monica, CA, USA) is the longest clinically available biodegradable stent (bioresorbable vascular scaffold, BVS). Despite promising results, pitfalls associated with treatment with this type of coronary implants have emerged. This were the registries at first, some meta-analyses subsequently, the three-year results of the ABSORB II randomized trial in autumn 2016 that suggested an increased risk of thrombosis of the BVS stent compared with the newest-generation DES. The aim of our study was to evaluate the clinical outcomes of a real population of patients with implanted BVS with an emphasis on the incidence of definite/probable BVS thrombosis. Patients and methods: The group consisted of consecutive patients who had received an Absorb BVS implant at our centre between 09/2013 and 12/2015. As of 30 April 2017, we retrospectively evaluated, in collaboration with the Institute of Health Information and Statistics of the Czech Republic, the incidence of the device-oriented composite endpoint (DOCE) and that of the patient-oriented composite endpoint (POCE), with a particular focus on BVS thrombosis. Results: During the follow-up period, a total of 210 Absorb BVSs were implanted in 178 patients during 196 PCIs. The median follow-up was 772 days. The indication for implantation was acute coronary syndrome in 47% of the cases and stable forms of IHD in the remaining cases. At one year, the incidence of DOCE was 4.5%, with an estimated incidence at two years being 6.8% on the basis of Kaplan-Meier analysis. Death from cardiovascular causes occurred in 3.9% of the patients in the first year. A total of six cases of definite and two cases of probable BVS thrombosis were encountered. The incidence of definite/probable BVS thrombosis thus reached 2.8% by 30 days and 3.9% by 1 year. Conclusion: We present data on the use of Absorb BVS in real clinical practice of a single centre with a focus on BVS thrombosis. Our results confirm the concern about higher rates of this complication that, according to the data available so far, appears to be the major and most serious problem in treating IHD with biodegradable stents of this type. [ABSTRACT FROM AUTHOR]

The AUGUSTUS trial showed superiority of non-vitamin K oral anticoagulant (NOAC) over warfarin for PCI treatment of patients with atrial fibrillation as well as defined the real position of aspirin in the treatment of these patients. Apixaban and clopidogrel have been shown to be the best choice for most of the patients, with aspirin being considered only for a minority with a very high ischaemic risk. [ABSTRACT FROM AUTHOR]

Rapid development of antithrombotic treatment has significantly improved the quality of care of patients with ischemic heart disease as well as contributed to the development of cardiovascular medicine and interventional cardiology, in particular. In this paper, individualized therapy based on risk stratifications, treatment strategy, algorithms for dual antiplatelet therapy and its combination with oral anticoagulation will be discussed. [ABSTRACT FROM AUTHOR]

The authors report a case of very late thrombosis in a patient with a bioresorbable scaffold. In the discussion are considered possible etiological factors of this event, the results of clinical trials and current recommendations for long-term antiplatelet therapy. [ABSTRACT FROM AUTHOR]

ABSORB III, a prospective, randomized, multicenter trial, evaluated the safety and efficacy of the Absorb® (Abbott, USA) everolimus- eluting poly-L-lactic acid based bioresorbable vascular scaffold (BVS) compared to the Xience® (Abbott, USA) everolimus-eluting cobalt-chromium stent (DES) during one year after implantation. One-year occurrence of the primary endpoint a composite of cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization) demonstrated noninferiority of BVS compared to DES, however with a tendency to higher rates of adverse events in the BVS group. Three-year follow-up results demonstrated an additional increase in adverse events occurence which was statistically, significant with respect to scaffold thrombosis and target vessel myocardial infarction in the BVS group. [ABSTRACT FROM AUTHOR]