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Objectives: This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI).Background: The safety of same-day discharge has previously ...

Objectives This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background The safety profile of CTO PCI has received limited study. Methods We conducted a meta-analysis of 65 studies published between 2000 and 2011 reporting procedural complications of CTO PCI. Data on the frequency of death, emergent coronary artery bypass graft surgery, stroke, myocardial infarction, perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected. Results A total of 65 studies with 18,061 patients and 18,941 target CTO vessels were included. Pooled estimates of outcomes were as follows: angiographic success 77% (95% confidence interval [CI]: 74.3% to 79.6%); death 0.2% (95% CI: 0.1% to 0.3%); emergent coronary artery bypass graft surgery 0.1% (95% CI: 0.0% to 0.2%); stroke Conclusions CTO PCI carries low risk for procedural complications despite high success rates.

A coronary artery chronic total occlusion (CTO) represents a coronary artery that has been occluded for a long period of time, typically months. Coronary artery CTOs are common and occur in approximately one-third of patients referred for coronary angiography. Revascularization of CTO is technically challenging and has historically been associated with lower procedural success rates and higher complication rates. Technical success of CTO revascularization has significantly improved given remarkable advances in interventional cardiology over the past 3 decades. However, the decision to perform CTO revascularization remains a dilemma, given the lack of robust clinical evidence to support its use.

Background Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population. Methods and Findings Retrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline), as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065). Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p

To identify clinical, angiographic, and procedural factors associated with increased risk of periprocedural complications during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Successful CTO PCI can provide significant clinical benefit; however, procedural risks have received limited study. We sought to identify factors associated with increased CTO PCI periprocedural risk that could be utilized to guide patient and lesion selection.The clinical, angiographic, and procedural records of 336 consecutive CTO PCI procedures performed at a single center from May 2005 through 2012 were reviewed, and data on periprocedural complications were recorded. Logistic regression was performed to identify independent predictors of periprocedural complications during CTO PCI.The incidence of major and minor complications was 3.9% and 10.4%, respectively. Minor bleeding and vascular events were the most common complications (4.8%), followed by perforation (2.4%), contrast-induced nephropathy (1.8%), and transient hypotension (0.6%). Major complications were uncommon: death (0.3%); emergency coronary artery bypass grafting (0.6%); stroke (0.3%); tamponade (0.3%); clinical myocardial infarction (0.9%); donor vessel injury (0.6%); and major bleeding or vascular events (0.9%). Patients who experienced any complication had higher preprocedure troponin levels and were more likely to undergo treatment using the retrograde approach. In multivariable analysis, use of the retrograde approach was independently associated with increased risk of periprocedural complications (odds ratio, 2.057; 95% confidence interval, 1.045-4.051; P=.04).Major complications of CTO PCI are infrequent, but are more common with use of the retrograde approach.

The incidence of periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) ranges from 2% to 50%, depending on the clinical presentation, type of procedure, choice of biomarker (creatine kinase [CK]-MB or troponin), and the threshold used to qualify the diagnosis.1 Because of this heterogeneity of definition, the prognostic implications of periprocedural MI are controversial.2 However, several studies have demonstrated that periprocedural MI is associated with worse in-hospital, short-term, and long-term clinical outcomes, including death, recurrent MI, and need for revascularization.3–5 Various mechanisms can lead to periprocedural MI, such as side branch occlusion or vessel spasm; however, distal embolization of atheroma or thrombus seems to be a dominant cause.6 In a cardiac MRI (cMRI) study of patients undergoing complex native coronary PCI, elevated troponin levels post-PCI correlated with new myocardial enhancement because of side branch occlusion in 43% of cases and in the apical myocardium distal to the stent in 57% of cases, as would be expected with distal embolization.7 Numerous studies have documented the occurrence of distal embolization during both elective and urgent PCI and have characterized its histopathologic substrate. In an analysis of catheter-retrieved materials from human studies of patients undergoing PCI for acute coronary syndrome (ACS),8 those with no-reflow had significantly higher amounts of visible atheroma and microscopic components such as platelet–fibrin complexes, cholesterol crystals, and macrophages.8 In another study of 37 lesions in 35 patients undergoing elective PCI, microscopic particles were captured by embolic protection devices (EPDs) in 28 (75.6%) lesions.9 Thrombotic components (fibrin strand–entrapped platelets, leukocytes, and red cells) accounted for the majority (≈75%) of captured debris, whereas plaque components (fibrous tissue, calcium spots, acellular amorphous material, macrophages, foam cells, and cholesterol clefts) accounted for the minority (≈25%).9 Similar findings were demonstrated among 33 …

Background Transradial (TR) catheterization is gaining popularity due to its association with lower bleeding and access site complications, improved patient comfort, and lower costs compared to transfemoral (TF) catheterization; however, there is concern that TR catheterization may be associated with an increased risk of neurological complications. New randomized data has emerged since the publication of the last meta-analysis evaluating the risk of stroke between TR and TF catheterization in 2009. Methods We conducted a meta-analysis of randomized studies published until 2013 reporting risk of stroke in TR vs. TF catheterization. Results Data from 11,273 patients in 13 studies were collated. The majority of patients were men, and 8987 (79.7%) were enrolled in acute coronary syndrome trials. Very few patients had a history of prior coronary artery bypass grafting, and approximately 2/3 of patients underwent percutaneous coronary intervention. Stroke occurred in 25 of 5659 patients in the TR group, vs. 24 of 5614 patients in the TF group. There was no difference in stroke rates between the TR and TF groups (risk difference 0.00%, 95% confidence interval −0.29%–0.25%, p =0.88). Conclusions TR catheterization is not associated with a significant increase in stroke compared to TF catheterization.

This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).The safety profile of CTO PCI has received limited study.We conducted a meta-analysis of 65 studies published between 2000 and 2011 reporting procedural complications of CTO PCI. Data on the frequency of death, emergent coronary artery bypass graft surgery, stroke, myocardial infarction, perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected.A total of 65 studies with 18,061 patients and 18,941 target CTO vessels were included. Pooled estimates of outcomes were as follows: angiographic success 77% (95% confidence interval [CI]: 74.3% to 79.6%); death 0.2% (95% CI: 0.1% to 0.3%); emergent coronary artery bypass graft surgery 0.1% (95% CI: 0.0% to 0.2%); stroke0.01% (95% CI: 0.0% to 0.1%); myocardial infarction 2.5% (95% CI: 1.9% to 3.0%); Q-wave myocardial infarction 0.2% (95% CI: 0.1% to 0.3%); coronary perforation 2.9% (95% CI: 2.2% to 3.6%); tamponade 0.3% (95% CI: 0.2% to 0.5%); and contrast nephropathy 3.8% (95% CI: 2.4% to 5.3%). Compared with successful procedures, unsuccessful procedures had higher rates of death (0.42% vs. 1.54%, p0.0001), perforation (3.65% vs. 10.70%, p0.0001), and tamponade (0% vs. 1.65%, p0.0001). Among 886 lesions treated with the retrograde approach, success rate was 79.8% with no deaths and low rates of emergent coronary artery bypass graft surgery (0.17%) and tamponade (1.2%).CTO PCI carries low risk for procedural complications despite high success rates.

Objectives: To compare differences in long term outcomes in intravascular ultrasound (IVUS)-guided vs. angiography-guided percutaneous coronary interventions (PCI) of bifurcation lesions. Backgroun...

In their letter, although Dr. Bertrand and colleagues raise a number of points, their key concern appears to relate to the publication of 2 similar papers a few months apart. Our group was completely unaware of the meta-analysis by Abdelaal et al. [(1)][1] until our paper was already in revision at