Ayaka Endo

Angiographic Lesion Complexity Score and In-Hospital Outcomes after Percutaneous Coronary Intervention

Objective We devised a percutaneous coronary intervention (PCI) scoring system based on angiographic lesion complexity and assessed its association with in-hospital complications. Background Although PCI is finding increasing application in patients with coronary artery disease, lesion complexity can lead to in-hospital complications. Methods Data from 3692 PCI patients were scored based on lesion complexity, defined by bifurcation, chronic total occlusion, type C, and left main lesion, along with acute thrombus in the presence of ST-segment elevation myocardial infarction (1 point assigned for each variable). Results The patients’ mean age was 67.5 +/- 10.8 years; 79.8% were male. About half of the patients (50.3%) presented with an acute coronary syndrome, and 2218 (60.1%) underwent PCI for at least one complex lesion. The patients in the higher-risk score groups were older (p < 0.001) and had present or previous heart failure (p = 0.02 and p = 0.01, respectively). Higher-risk score groups had significantly higher in-hospital event rates for death, heart failure, and cardiogenic shock (from 0 to 4 risk score; 1.7%, 4.5%, 6.3%, 7.1%, 40%, p < 0.001); bleeding with a hemoglobin decrease of >3.0 g/dL (3.1%, 11.0%, 13.1%, 10.3%, 28.6%, p < 0.001); and postoperative myocardial infarction (1.5%, 3.1%, 3.8%, 3.8%, 10%, p = 0.004), respectively. The association with adverse outcomes persisted after adjustment for known clinical predictors (odds ratio 1.72, p < 0.001). Conclusion The complexity score was cumulatively associated with in-hospital mortality and complication rate and could be used for event prediction in PCI patients.

Outcomes of intravascular ultrasound-guided percutaneous coronary intervention with drug-eluting stents versus bare metal stents for acute coronary syndrome in octogenarians

The number of percutaneous coronary interventions (PCI) performed for octogenarians with acute coronary syndrome (ACS) continue to increase. The short- and long-term outcomes of intravascular ultrasound (IVUS)-guided PCI with drug-eluting stents (DES) or bare metal stents (BMS) for ACS in octogenarians, however, remain largely unknown. We analyzed clinical outcomes of octogenarians undergoing IVUS-guided PCI for ACS with either DES or BMS. During the study period, a total of 776 patients with ACS underwent IVUS-guided PCI and 75 of them were octogenarians. In-hospital mortality tended to be lower in the DES group than in the BMS group. Between 6 months and 1 year of follow up, treatment with DES compared with BMS tended to result in fewer target lesion revascularizations. Major adverse cardiac events were similar between patients receiving DES and BMS. In octogenarians with ACS treated with IVUS-guided PCI, DES appears as safe as BMS, providing similar short- and long-term outcomes.

Impact of Acute Kidney Injury on In-Hospital Outcomes in Patients With DeBakey Type III Acute Aortic Dissection

The relation between the incidence and severity of acute kidney injury (AKI) and clinical outcomes remains unclear in patients with DeBakey type III acute aortic dissection (AAD). We retrospectively assessed 56 patients admitted to our hospital for type III AAD within 48 hours of the onset of symptoms. The presence of AKI was identified, and its severity was staged on the basis of changes in serum creatinine (SCr) levels within 7 days after admission. We investigated the relations between AKI and clinical presentations, in-hospital complications, and predischarge renal function; AKI was observed in 20 patients (36%). After adjusting for age, gender, and body mass index, the incidence of AKI was associated with a history of hypertension, electrocardiographic ST-T changes, DeBakey type IIIb, and SCr level on admission. Maximum white blood cell count and serum C-reactive protein level were higher in patients with AKI than in those without AKI. AKI was associated with a greater incidence of in-hospital complications (70% vs 39%, p = 0.03) and higher SCr levels at discharge (1.1 [range 1.0 to 2.0] vs 0.9 [range 0.7 to 1.0] mg/dl, p = 0.0001). These associations were more pronounced in patients with relatively severe AKI. Multivariate analysis revealed that SCr level on admission and DeBakey type IIIb with renal artery involvement were major predictors of AKI. In conclusion, renal function on admission and renal artery involvement were significant risk factors for AKI, which was associated with poor outcomes and enhanced inflammatory response during hospitalization in patients with type III AAD.

Successful percutaneous coil embolization of coronary–pulmonary, –carotid, and –internal mammary artery fistulas

We herein describe a 57-year-old man with coronary–pulmonary artery fistulas that had abnormal connections between the left common carotid artery and the left internal mammary artery. The patient was treated with percutaneous coil embolization using antegrade (via the coronary artery) and retrograde (via the pulmonary artery) approaches. Coronary artery fistulas have diverse anatomical variations, and it is important to thoroughly evaluate the anatomy before beginning any mode of treatment, surgical or endovascular. In the case reported herein, multislice computed tomography played a pivotal role in the preprocedure evaluation.

Shock-induced failure of a Riata lead with normal electrical lead parameters and a normal fluoroscopic appearance: A case report

An 81‐year‐old man was scheduled for an elective implantable cardioverter defibrillator (ICD) generator exchange because of battery depletion. The Atlas™+ DR ICD (St. Jude Medical, Sylmar, CA) had been implanted in February 2007 for primary prevention. The ICD lead (Riata 1570, St. Jude Medical, Sylmar, CA) had been positioned via the left cephalic vein at the right ventricular apex. Prior to the ICD generator exchange, which took place 70 months after the initial implantation, all routine device interrogations revealed normal electrical lead parameters, and cine‐fluoroscopy of the lead showed normal appearance without any apparent fracture. We attempted to conduct high‐voltage shock testing, as there was concern about the possibility of silent lead malfunction. Following delivery of the first high‐voltage shock, the device declared “possibility of output circuit damage.” Subsequent shocks could not be delivered. Nonetheless, other lead parameters remained stable, and high‐voltage lead impedance was <20 Ω. The following day, the failed generator was replaced with a new ICD generator and connected with a new ICD lead. We then tested the new device by inducing ventricular fibrillation, which was defibrillated successfully. Although electric screening in asymptomatic patients with the Riata ICD lead remains controversial, it should be remembered that there are patients with or without detected cable externalization in whom only high‐voltage shock testing can disclose lead malfunction. Issues with Riata leads have not yet been elucidated in full detail.

Fibromuscular Dysplasia of Coronary and Brachial Artery

Summary A 72-year-old woman with a chief complaint of palpitation and shortness of breath showed “string of beads” appearance in the right coronary artery and right brachial artery. The 3-D optical frequency domain imaging showed “haustra coli” like appearance in the right coronary artery, and she was diagnosed as fibromuscular dysplasia.