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Purpose of Review: Over the last decade, there has been a plethora of evidence to support the utilization of intravascular coronary imaging and physiological assessment to guide percutaneous coronary interventions (PCI). While there is a class I recommendation for the use of coronary physiology to guide PCI, the use of intravascular coronary imaging remains a class IIa recommendation. Herein, we aimed to review the recent scientific evidence from major trials highlighting the consideration for a future class I guideline recommendation for the use of intracoronary imaging. Recent Findings: The benefits of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to guide and optimize PCI have been demonstrated in several large trials. These trials have demonstrated that IVUS reduces major adverse cardiovascular events. Similarly, intracoronary physiology has been demonstrated to be an important tool to guide revascularization decision-making and been associated with a lower incidence of death, non-fatal myocardial infarction, and repeat revascularization compared with angiography alone. Summary: With existing clinical outcomes data on the benefit of intracoronary physiology and imaging-guided PCI as well as forthcoming data from ongoing trials regarding the use of these modalities, the interventional cardiology community is bound to transition from routine PCI to precision-, image-, and physiology-guided PCI. [ABSTRACT FROM AUTHOR]

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Background: There are limited contemporary data on the impact of success vs. failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We conducted a systematic review and a meta-analysis of contemporary studies that compared the outcomes in patients who underwent successful vs. failed contemporary (2010 onwards) CTO PCI. We performed a sensitivity analysis limited to studies that started enrollment after the publication of the hybrid algorithm in 2012. Results: We included five studies with a total of 6,084 patients (successful CTO PCI n = 4,861, failed CTO PCI n = 1,223). During a median follow-up time of 12 months (range 6–60 months), successful CTO PCI was associated with a lower risk of major adverse cardiovascular events [OR: 0.61, 95% CI (0.41, 0.92), p = 0.02, I2 = 63%] and all-cause death [OR: 0.57, 95% CI (0.33, 0.99), p = 0.05, I2 = 60%]. Both groups had similar risk of myocardial infarction (MI) [OR 0.69, 95% CI (0.43, 1.10), p = 0.38, I2 = 80%], target vessel revascularization (TVR) [OR: 0.56, 95% CI (0.25, 1.27), p = 0.17, I2 = 80%], and stroke [OR: 0.52, 95% CI (0.14, 1.91), p = 0.33, I2 = 0%]. Conclusion: In contemporary practice, successful CTO PCI was associated with a lower incidence of MACE driven by lower all-cause mortality compared with failed CTO PCI at a median follow-up of 1 year. [ABSTRACT FROM AUTHOR]

Peri-stent contrast staining (PSS), defined as contrast staining around the stent struts, has been identified as an indicator of future stent failure in first generation, sirolimus-eluting coronary stents. 1 PSS has been associated with in-stent restenosis, stent thrombosis, stent fracture, and the development of coronary aneurysm. As the frequency of patients with first generation sirolimus-eluting coronary stents becomes infrequent; PSS may go unrecognized. Herein, we present a patient with a decade of longitudinal follow-up, who developed PSS identified on coronary angiogram with recurrent stent failure. [ABSTRACT FROM AUTHOR]

The introduction of stents has led to significant improvement in the management of coronary artery disease. In-stent thrombosis, target lesion revascularization, and stent fracture (SF) have been identified as causes of in-stent restenosis. Peri-contrast staining (PSS) has been associated with in-stent restenosis, stent thrombosis, stent fracture, and the development of coronary aneurysm. As the frequency of patients with first generation sirolimus-eluting coronary stents becomes infrequent; PSS may go unrecognized. Herein, we present a patient with a decade of longitudinal follow-up, who developed PSS identified on coronary angiogram with recurrent stent failure. [ABSTRACT FROM AUTHOR]

Background: Selection of an appropriate antithrombotic regimen in patients requiring oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) still remains a challenge. An ideal 9–2regimen should balance the risk of bleeding against ischemic benefit. Methods: A comprehensive literature search for studies comparing triple antithrombotic therapy (TAT) vs double antithrombotic therapy (DAT) in patients requiring OAC undergoing PCI was performed in clinicalTrials.gov, PubMed, Web of Science, EBSCO Services, Cochrane Central Register of Controlled Trials, Google Scholar, and various scientific conference sessions from inception to May 1st, 2019. A meta‐analysis was performed using random‐effects model to calculate risk ratio (RR) and 95% confidence interval (CI). Results: Fifteen studies were eligible and included 13 967 patients, of which 7349 received TAT and 6618 received DAT. Compared with DAT, TAT was associated with lower risk of myocardial infarction (RR, 0.82; 95%CI, 0.69–0.98; P = .03) and stent thrombosis (RR, 0.66; 95%CI, 0.46–0.96; P = .03). There was no difference in risk of trial defined major adverse cardiac events, all‐cause mortality, and stroke between two groups. Compared with DAT, TAT was associated with higher risk of trial defined major bleeding (RR, 1.67; 95%CI, 1.38–2.01; P < .00001), including thrombolysis in myocardial infarction major bleeding (RR, 1.81; 95%CI, 1.47–2.24; P < .00001) but no significant difference in risk of intracranial bleeding. Conclusion: In patients requiring OAC undergoing PCI, TAT was associated with a lower risk of myocardial infarction but with a significantly higher risk of major bleeding when compared with DAT. [ABSTRACT FROM AUTHOR]

Keywords: Ventricular tachycardia; Ablation; Mechanical circulatory support; Impella; Heart failure; Cardiogenic shock EN Ventricular tachycardia Ablation Mechanical circulatory support Impella Heart failure Cardiogenic shock 431 433 3 08/02/21 20210801 NES 210801 Commentary The prevalence, socioeconomic and clinical burden of chronic heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) is exponentially growing [[1]]. Ventricular tachycardia (VT) frequently occurs in patients with HFrEF, and is not only a phenotype of structural heart disease [[2]] but may indicate progression of heart failure and risk of decompensation. It would further be useful to know how patients were sedated, as the use of general anesthesia poses a risk of deterioration and shock for patients with HFrEF, as well as when patients were extubated?. [Extracted from the article]

Background: Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Methods: We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. Results: Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min. [ABSTRACT FROM AUTHOR]