Jeroen Wilschut

A case-vignette based assessment of patient's perspective on coronary revascularization strategies, the OPINION study

BACKGROUND AND AIMS Significant left main (LM) stem disease is potentially life-threatening and mandates revascularization. This study aimed to assess how patients rate the importance of particular features of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), how this determines their preference for a particular treatment strategy, and whether particular personality characteristics influence this preference. METHODS AND RESULTS In total, 1145 patients who visited the outpatient clinic of the Erasmus Medical Center for stable coronary artery disease were asked to complete a case vignette-questionnaire on a hypothetical significant LM stenosis amenable to PCI or CABG. To assess the individuals personality disposition and general distress level, each patient had to complete a set of 3 standardized, validated questionnaires with satisfactory psychometric properties. Overall 89% of patients preferred PCI to CABG. PCI was the preferred strategy despite a higher risk for repeat revascularization and need for more medication. Remarkably, the fact that a risk for repeat revascularization is more common in the PCI group is less important for the patients who opt for PCI. Risk for stroke and bleeding were the most important arguments to opt for PCI over CABG. Type D personality, depression, and anxiety were all associated with a relatively higher preference for CABG as revascularization strategy. CONCLUSION Overall, when given the choice patients seem to have a clear preference for PCI over CABG and consider stroke and bleeding important procedure-related complications. Patients with Type D personality, depression, or anxiety favor CABG.

Coronary lithoplasty: a novel treatment for stent underexpansion

A 74-year old man with history of hypertension and dyslipidaemia, presented with Class III angina. Coronary angiography showed a right dominant system with a heavily calcified stenotic lesion in the proximal left anterior descending (LAD) coronary artery with a minimal lumen diameter of 1.15mm and diameter stenosis of 63% by quantitative coronary angiography. [...]

References for left main stem dimensions: A cross sectional intravascular ultrasound analysis: References for left main stem dimensions: A cross sectional intravascular ultrasound analysis

Angiographic assessment of left main coronary artery (LMCA) lesions remains challenging and limited data is available on reference diameters and length of nonobstructive LMCA dimensions. Our aim was to provide insights in the dimensions of nonobstructive LMCA and to find a possible correlation with gender and patient habitus.

TCT-536 Routine Fractional Flow Reserve Measurement after Percutaneous Coronary Intervention with a Novel FFR Micro Catheter, Insights from the FFR-SEARCH Registry - FFR Stent Evaluated at Rotterdam Cardiology Hospital.

Fractional Flow Reserve (FFR) after Percutaneous Coronary Intervention (PCI) is a predictor of adverse cardiovascular events during follow-up. Most studies so far only included patients with stable coronary lesions and used a dedicated pressure wire (PW) for pre- and post-PCI FFR measurements. The