• Title, Summary, Keyword: Percutaneous Coronary Intervention

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Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification

  • Yu, Mengmeng;Li, Yuehua;Li, Wenbin;Lu, Zhigang;Wei, Meng;Zhang, Jiayin
    • Korean Journal of Radiology
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    • v.18 no.5
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    • pp.753-762
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    • 2017
  • Objective: To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods: Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results: A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ${\leq}0.84$ was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion: Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ${\leq}0.84$ was the strongest independent predictor for using RA prior to stent implantation.

Multi-vessel intractable coronary spasm development in a patient with aborted sudden cardiac death: a case study with intravascular ultrasound findings

  • Cho, Sungsoo;Kang, Tae Soo
    • Yeungnam University Journal of Medicine
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    • v.35 no.1
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    • pp.121-126
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    • 2018
  • Coronary spasm generally occurs in patients with minimal atherosclerotic plaque lesion, and it has a rather favorable prognosis. However, in some cases, coronary spasm may induce myocardial infarction and even sudden cardiac death (SCD). Here, we report a case in which multi-vessel intractable coronary vasospasm suddenly occurred in a diffuse atherosclerotic lesion after percutaneous coronary intervention (PCI) in a patient with aborted SCD. We identified the characteristics of the spasm portion in intravascular ultrasound (IVUS) images and conducted percutaneous cardiopulmonary bypass support-PCI with stenting as treatment. Intima and media thickening and a large attenuated plaque burden with rupture were identified in IVUS images at the obstructive spasm portion.

Correlation Analysis of the Frequency and Death Rates in Arterial Intervention using C4.5

  • Jung, Yong Gyu;Jung, Sung-Jun;Cha, Byeong Heon
    • International journal of advanced smart convergence
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    • v.6 no.3
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    • pp.22-28
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    • 2017
  • With the recent development of technologies to manage vast amounts of data, data mining technology has had a major impact on all industries.. Data mining is the process of discovering useful correlations hidden in data, extracting executable information for the future, and using it for decision making. In other words, it is a core process of Knowledge Discovery in data base(KDD) that transforms input data and derives useful information. It extracts information that we did not know until now from a large data base. In the decision tree, c4.5 algorithm was used. In addition, the C4.5 algorithm was used in the decision tree to analyze the difference between frequency and mortality in the region. In this paper, the frequency and mortality of percutaneous coronary intervention for patients with heart disease were divided into regions.

De-Escalation of P2Y12 Receptor Inhibitor Therapy after Acute Coronary Syndromes in Patients Undergoing Percutaneous Coronary Intervention

  • Kupka, Danny;Sibbing, Dirk
    • Korean Circulation Journal
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    • v.48 no.10
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    • pp.863-872
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    • 2018
  • Dual antiplatelet therapy (DAPT) - a combination of a $P2Y_{12}$ receptor inhibitor and aspirin - has revolutionized antithrombotic treatment. Potent $P2Y_{12}$ inhibitors such as prasugrel and ticagrelor exhibit a strong and more consistent platelet inhibition when compared to clopidogrel. Therefore, ticagrelor and prasugrel significantly reduce ischemic events, but at an expense of an increased bleeding risk in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). These observations have engaged intensive clinical research in alternative DAPT regimens to achieve sufficient platelet inhibition with an acceptable bleeding risk. Our review focusses on $P2Y_{12}$ receptor therapy de-escalation defined as a switch from a potent antiplatelet agent (ticagrelor or prasugrel) to clopidogrel. Recently, both unguided (platelet function testing independent) and guided (platelet function testing dependent) DAPT de-escalation strategies have been investigated in different clinical studies and both switching strategies could be possible options to prevent bleeding complications without increasing ischemic risk. In light of the still limited data currently available, future large-scale trials should accumulate more data on various DAPT de-escalation regimens with both ticagrelor and prasugrel in unguided and guided de-escalation approaches. In the current review we aim at summarizing and discussing the current evidence on this still emerging topic in the field of antiplatelet treatment.

Retrieval of a dislodged and dismounted coronary stent; using a rendezvous and snare technique at the brachial artery level via femoral approach

  • Jeong, Min-Woong;Sohn, Chang-Bae;Kim, Su Hong;Park, Jong-Ik;Park, Se-Ryeong;Min, Jun-Sik
    • Yeungnam University Journal of Medicine
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    • v.33 no.2
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    • pp.138-141
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    • 2016
  • Coronary stent dislodgement during percutaneous coronary intervention, which occurs when the stent is passed through tortuous and calcified lesions, is not a rare complication. Without proper treatment, such as fixing with another stent in the coronary artery or removing the undeployed stent from the coronary artery or systemic artery system, this complication can cause serious problems. We experienced the unusual situation of a dismounted and dislodged coronary stent, in which retrograde retrieval to the radial artery was impossible during transradial coronary intervention. We report on use of a rendezvous and snare technique at the brachial artery level via femoral puncture, which resulted in resolution without surgery.

Early-Onset Postcardiac Injury Syndrome after Percutaneous Coronary Intervention Recovered with Steroids (경피적 관상동맥중재술 후 급성으로 발생한 스테로이드 치료로 회복한 심근 손상 후 증후군)

  • Kim, Min-Jeong;Yoon, Seong-Bo;Lee, Myong Dong;Kim, Si-Ho;Kim, Young Woo
    • The Korean Journal of Medicine
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    • v.93 no.6
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    • pp.565-570
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    • 2018
  • Postcardiac injury syndrome (PCIS) is an inflammatory process that usually occurs within 1 to 6 weeks after an injury to the pericardium, epicardium, or myocardium. As more interventions are performed for complicated coronary artery obstructive lesions, there have been some recent reports on PCIS following percutaneous coronary intervention (PCI). The medical management of PCIS depends on nonsteroidal anti-inflammatory drugs (NSAIDs), in addition to colchicine or steroids. An 80-year-old male patient underwent a PCI. Unfortunately, the guidewire piercing failed but he showed no immediate signs of complication. However, 5 hours after the procedure, he complained of chest discomfort. An electrocardiogram showed widespread ST elevation. Chest X-ray and computed tomography showed pulmonary congestion with pleural effusion, while thoracic echocardiography showed a moderate amount of pericardial effusion. NSAIDs were initiated, but there was no improvement of symptoms. We describe an unusual case of atypical earl onset PCIS after PCI, recovered rapidly by steroids.

Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

  • Choi, Hyun-Jung;Kim, Min Chul;Sim, Doo Sun;Hong, Young Joon;Kim, Ju Han;Jeong, Myung Ho;Kim, Soo-Hyun;Shin, Myung-Geun;Ahn, Youngkeun
    • Annals of Laboratory Medicine
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    • v.38 no.6
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    • pp.538-544
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    • 2018
  • Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P =0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

Clinical Applications of Intracoronary OCT (Invited Paper) (심혈관 OCT의 임상적 응용)

  • Ha, Jinyong;Kim, Jung-Sun;Hong, Myeong-Ki
    • Korean Journal of Optics and Photonics
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    • v.26 no.1
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    • pp.1-8
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    • 2015
  • The most common cause of a heart attack is known as coronary artery disease, which narrows the arteries and reduces the blood flow to the heart. To treat coronary artery stenosis, percutaneous coronary intervention (PCI) (a nonsurgical procedure to install a stent, which holds the artery wall open) is performed. Intracoronary optical coherence tomography (OCT) is a catheter-based, invasive optical imaging system. To determine whether PCI is appropriate, and to perform stent evaluation in a catheterization laboratory, OCT examinations are carried out. This review details the fundamental principles and technological status of intracoronary OCT imaging, and discusses the ongoing clinical applications to determine the benefits of OCT-guided PCI.

The Current Status of Percutaneous Coronary Intervention in Korea -Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry-

  • Jang, Jae-Sik;Han, Kyoo-Rok;Moon, Keon-Woong;Jeon, Dong Woon;Shin, Dong-Ho;Kim, Jung-Sun;Park, Duk-Woo;Kang, Hyun-Jae;Kim, Juhan;Bae, Jang-Whan;Hur, Seung-Ho;Kim, Byung Ok;Choi, Donghoon;Gwon, Hyeon-Cheol;Kim, Hyo-Soo
    • Korean Circulation Journal
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    • v.47 no.3
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    • pp.328-340
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    • 2017
  • Background and Objectives: Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. Materials and Methods: Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. Results: A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. Conclusion: These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.

The Practice Pattern of Percutaneous Coronary Intervention in Korea -Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry-

  • Gwon, Hyeon-Cheol;Jeon, Dong Woon;Kang, Hyun-Jae;Jang, Jae-Sik;Park, Duk-Woo;Shin, Dong-Ho;Moon, Keon-Woong;Kim, Jung-Sun;Kim, Juhan;Bae, Jang-Whan;Hur, Seung-Ho;Kim, Byung Ok;Choi, Donghoon;Han, Kyoo-Rok;Kim, Hyo-Soo
    • Korean Circulation Journal
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    • v.47 no.3
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    • pp.320-327
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    • 2017
  • Background and Objectives: Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. Materials and Methods: The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. Results: The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. Conclusion: We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.