Raja Hatem

Effect of Radial-to-Femoral Access Crossover on Adverse Outcomes in Primary Percutaneous Coronary Intervention

We aimed to describe the impact of the vascular access used when patients are treated with primary percutaneous coronary intervention (PPCI) and to assess whether this translates into differences in angiographic outcomes. Patients with ST-elevation myocardial infarction who underwent PPCI were divided into 3 groups: successful radial access (RA), successful femoral access (FA), and Crossover (failed RA with need for bailout FA) groups. Vascular access-related time (VART) was defined as the delay in PPCI that can be attributed to vascular access-related issues. Study end point was the final corrected Thrombolysis In Myocardial Infarction frame count. Multivariable analysis was used to identify predictors of RA failure (RAF: FA + Crossover). We included 241 patients (RA, n = 172; FA, n = 49; Crossover, n = 20). Mean VART was longer in Crossover (10.3 [8.8 to 12.4] minutes), relative to RA (4.1 [3.2 to 5.5] minutes) and FA (4.6 [3.4 to 8.4] minutes, p <0.001). A similar situation was found for time-to-first device (Crossover 22.5 [20.3 to 32.0], RA 15.0 [12.0 to 19.8]; FA 17.9 [13.5 to 22.3] minutes, p <0.001) and total procedure time (Crossover 60.3 [51.6 to 71.5], RA 46.8 [38.1 to 59.7], FA 52.3 [41.9 to 74.7] minutes, p <0.001). No differences in corrected Thrombolysis In Myocardial Infarction frame count were observed (Crossover 26 [18 to 32] frames, RA 24 [18 to 32] frames, FA 25 [16 to 34] frames, p = 0.625). Killip class IV (odds ratio [OR] 3.628, 95% confidence interval [CI] 1.098 to 11.981, p = 0.035), cardiopulmonary resuscitation before arrival (OR 3.572, 95% CI 1.028 to 12.407, p = 0.045), and glomerular filtration rate (OR 0.861, 95% CI 0.758 to 0.978, p = 0.021) were independent predictors of RA failure. In conclusion, in the setting of PPCI, radial-to-FA crossover can lead to VART delays that do not affect angiographic outcomes, in comparison with successful RA.

Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention

This study sought to assess the impact of residual coronary artery disease (CAD), using the residual SYNTAX score (rSS), on in‐hospital outcomes after primary percutaneous intervention (PPCI). The study also aimed to determine independent predictors for high rSS. Residual CAD has been associated with worsened prognosis in patients undergoing PCI for non‐ST acute coronary syndromes. The rSS is a systematic angiographic score that measures the extent and complexity of residual CAD after PCI.

Morphological Patterns of In-Stent Chronic Total Occlusions: An Intravascular Ultrasound Study

This was a retrospective intravascular ultrasound (IVUS) study of mechanisms of in-stent restenosis (ISR) chronic total occlusions (CTOs). ISR CTOs were defined as TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 within a stented lesion (including 5-mm margins) with estimated occlusion

MORPHOLOGIC PATTERNS OF IN-STENT CHRONIC TOTAL OCCLUSIONS: AN INTRAVASCULAR ULTRASOUND STUDY

This was a retrospective intravascular ultrasound (IVUS) study of mechanisms of in-stent restenosis (ISR) chronic total occlusions (CTOs). ISR CTOs were defined as TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 within a stented lesion (including 5-mm margins) with estimated occlusion

Predictive Scores of Success in CTO PCI: There Is No Substitute for Operator Experience and Skill.

D ating back as far as 1985, many small series have reported their own predictors of primary success and failure modes in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) (1,2). Early predictors of failure included increasing age of the occlusion, presence of calcium, presence of a nontapered stump, excessive tortuosity of occluded vessels, long occlusion length, presence of side branches at the proximal cap, bridging collateral vessels, and lack of visibility of the distal bed (3). These early predictors of success and failure were reported before the development of retrograde and antegrade dissection re-entry techniques. Fast-forward to 2011: Morino et al. (4) reported on 494 native CTO lesions and developed the J-CTO (Multicenter CTO Registry in Japan) score. The objective parameter of the score was to determine the different parameters that influenced successful guidewire crossing within 30 minutes of starting the case. Independent predictors of failure to do so included calcification, vessel tortuosity, ambiguous cap, occlusion length, and prior failed procedure in the CTO territory. The score is then categorized as easy, intermediate, difficult, or very difficult. Subsequent validations of the score have demonstrated positive results pertaining to final success rates in relation to initial J-CTO score (5). In 2015, Alessandrino et al. (6) described independent predictors of CTO PCI failure that included