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Background: Evidence regarding the clinical outcomes of rotational atherectomy (RA) in middle-income countries is limited. We analyzed the clinical outcomes of patients with heavily calcified coronary lesions who underwent RA-assisted percutaneous coronary intervention (PCI) and explored the risks for developing major adverse cardiovascular and cerebrovascular events (MACCE).Methods: This is a single-center, retrospective cohort analysis that enrolled consecutive patients who underwent RA-assisted PCI at the largest tertiary hospital in Thailand. The primary endpoint is the incidence of MACCE during the first-year follow-up. MACCE consists of cardiac death, ischemic stroke, definite stent thrombosis, target lesion revascularization, and target vessel revascularization.Results: From January 2015 to December 2018, 616 patients (663 lesions) were enrolled. The mean age was 72.8 ± 9.7 years, 292 (47.4%) patients were female and 523 (84.9%) completed one-year follow-up. Drug-eluting stents were deployed in 606 (91.4%) lesions. The RA success rate – defined as when the operator successfully passed the burr across the target lesion – was 99.4% and the angiographic success rate was 94.8%. 130 (21.4%) procedures developed periprocedural complications. The cumulative MACCE rate at 30-days was 1.5% and at 1-year was 6.3%. The in-hospital mortality rate was 1.1% and the cardiac death rate was 1.6%. Independent risk factors for developing MACCE included the use of an intra-aortic balloon pump (hazard ratio [HR] 3.96, 95% confidence interval [CI] 1.54–10.21; P = 0.004), a history coronary artery bypass graft (HR 2.30, 95% CI 1.01–5.25; P = 0.048), and increased serum creatinine (HR 1.16, 95% CI 1.04–1.30; P = 0.008).Conclusions: RA is an effective revascularization technique for heavily calcified lesions. This study demonstrates a high success rate and good short- to intermediate-term results of RA-assisted PCI in middle-income countries which are similar to high-income countries. Nevertheless, the rate of periprocedural complications remains high.

The prevalence of dyslipidaemia has been increasing in the Asia-Pacific region and this is attributed to dietary changes and decreasing physical activity. While there has been substantial progress in dyslipidaemia therapy, its management in the region is hindered by limitations in awareness, adherence and healthcare costs. The Asian Pacific Society of Cardiology (APSC) developed these consensus recommendations to address the need for a unified approach to managing dyslipidaemia. These recommendations are intended to guide general cardiologists and internists in the assessment and treatment of dyslipidaemia and are hoped to pave the way for improving screening, early diagnosis and treatment. The APSC expert panel reviewed and appraised the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. The resulting consensus recommendations tackle contemporary issues in the management of dyslipidaemia, familial hypercholesterolaemia and lipoprotein(a) in the Asia-Pacific region.

Objectives: This study aimed to investigate the incidence of 1-year major adverse cardiac events (MACE) compared between intravascular imaging guidance and angiographic guidance in patients undergoing rotablator atherectomy (RA)-assisted percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation.Methods: This retrospective analysis included 265 consecutive patients with heavy calcified lesion who underwent RA-assisted PCI with DES implantation at our institution during the January 2016-December 2018 study period. This study was approved by the Siriraj Institutional Review Board. Patients were divided into either the angiographic guidance PCI group or the imaging guidance PCI group, which was defined as intravascular ultrasound or optical coherence tomography. The primary endpoint was 1-year MACE.Results: Two hundred and sixty-five patients were enrolled, including 188 patients in the intravascular imaging guidance group, and 77 patients in the angiographic guidance group. One-year MACE was significantly lower in the imaging guidance group compared to the angiographic guidance group (4.3 vs. 28.9%, respectively; odds ratio (OR): 9.06, 95% CI: 3.82–21.52; p < 0.001). The 1-year rates of all-cause death (OR: 8.19, 95% CI: 2.15–31.18; p = 0.002), myocardial infarction (MI) (OR: 6.13, 95% CI: 2.05–18.3; p = 0.001), and target vessel revascularization (TVR) (OR: 3.67, 95% CI: 1.13–11.96; p = 0.031) were also significantly lower in the imaging guidance group compared with the angiographic guidance group. The rate of stroke was non-significantly different between groups.Conclusion: In patients with heavy calcified lesion undergoing RA-assisted DES implantation, the intravascular imaging guidance significantly reduced the incidence of 1-year MACE, all-cause death, MI, and TVR compared to the angiographic guidance.

Background Coronary perforation (CP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). Although several variables are associated with the risk of coronary perforation, a cumulative risk predictive model has not been established yet. Purpose To assess an incidence, risk factors and to develop risk predictive model for coronary perforation following PCI. Methods A single center, retrospective study of patients who underwent PCI from March 2010 to December 2019. Multivariate regression analysis was performed to identify independent predictors of CP. A risk predictive model was constructed with incremental weights attributed to each component variable according to their beta coefficients. Results 10,671 PCI procedures were enrolled. The incidence of CP was 0.94%. Adverse in-hospital outcomes were significant higher in CP group, including death (odds ratio [OR]: 3.58), mechanical circulatory support; including IABP and ECMO (OR: 3.79) and urgent revascularization (OR: 7.35). Multivariable analysis identified seven independent risk factors for CP, which were age (OR: 1.02), insulin-treated diabetes (OR: 2.50), prior CABG (OR: 2.03), hydrophilic guidewire (OR: 1.62), rotational atherectomy (OR: 2.60), excimer laser coronary atherectomy (ELCA) (OR: 3.39) and chronic total occlusion PCI (OR: 4.21). Risk predictive model (APOLLO-XI score) was calculated from the total points of each variables as follows: age (1 point per 10-year increase), hydrophilic guidewire (2 points), prior CABG (3 points), insulin-treated diabetes or rotational atherectomy (4 points), ELCA (5 points) and chronic total occlusion PCI (6 points). Cumulative risk score more than 11 points had increased risk for coronary perforation more than 1%. The validation of the risk predictive model (C-statistic) was 0.75 (95% CI: 0.70–0.80). Conclusions Coronary perforation is a rare but lethal complication. Our study demonstrates the risk predictive model which could enhance cardiovascular team to precisely estimate risk of coronary perforation before complex PCI procedure. Funding Acknowledgement Type of funding sources: None. Baseline charecteristicsAPOLLO-XI score

Background Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs). Methods Consecutive patients who underwent TAVR during December 2009–March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University—Thailand’s largest national tertiary referral center—were enrolled. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively. Results A total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. Multivariate analysis revealed MS length ≤ 6.43 mm (adjusted odds ratio [aOR] 9.54; 95% CI 2.56–35.47; p = 0.001) and ∆MSID p = Conclusion This study identified MS length ≤ 6.43 mm and ∆MSID Trial registration: TCTR, TCTR20210818002. Registered 17 August 2021—Retrospectively registered, http://www.thaiclinicaltrials.org/show/TCTR 20210818002.

‐Aortic dissection of descending aorta was detected by intraoperative TEE in a case of 67‐year‐old man with symptomatic severe aortic stenosis after TAVR. ‐Transesophageal echocardiogram after TAVR procedure is helpful to detect this rare complication., ‐Aortic dissection of descending aorta was detected by intraoperative TEE in a case of 67‐year‐old man with symptomatic severe aortic stenosis after TAVR.‐Transesophageal echocardiogram after TAVR procedure is helpful to detect this rare complication.

The unique characteristics of patients with chronic coronary syndrome (CCS) in the Asia-Pacific region, heterogeneous approaches because of differences in accesses and resources and low number of patients from the Asia-Pacific region in pivotal studies, mean that international guidelines cannot be routinely applied to these populations. The Asian Pacific Society of Cardiology developed these consensus recommendations to summarise current evidence on the management of CCS and provide recommendations to assist clinicians treat patients from the region. The consensus recommendations were developed by an expert consensus panel who reviewed and appraised the available literature, with focus on data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting recommendations provide guidance on the assessment and management of bleeding and ischaemic risks in Asian CCS patients. Furthermore, the selection of long-term antithrombotic therapy is discussed, including the role of single antiplatelet therapy, dual antiplatelet therapy and dual pathway inhibition therapy.

Transcatheter aortic valve replacement (TAVR) is a treatment of choice for treating symptomatic severe aortic stenosis patient whose condition is considered the high and intermediate operative risk for surgical aortic valve replacement. Here, we present a case of 67-year-old man with symptomatic severe aortic stenosis, triple vessels disease, type 2 diabetes mellitus and end-stage renal disease who was treated with TAVR. After the valve was deployed, we found the abnormal leakage at descending aorta by transesophageal echocardiogram (TEE). Under intraoperative close monitoring, the dissection was slowly expanding so we decided to perform thoracic endovascular repair (TEVAR). In conclusion, TEE after TAVR procedure is helpful to detect this rare complication. Reported cases of AD status post TAVR Author Sex/Age Comorbidity Detection time of AD Site of AD Detection of AD Treatment for AD Result Route access of TAVR This case 2018 M/67 DM, ESRD Immediate after implant Ds TEE TEVAR Recovery Femoral Losmanova et al. 2018 F/81 NA 3 yrs As Autopsy Conservative Died NR Kratimenos et al. 2016 F/81 COPD, renal dysfunction, angiodysplasia 12 days Ds CT TEVAR Recovery Femoral Nagasawa et al. 2016 F/86 Heart failure During the procedure Ds TEE Conservative Recovery Femoral Yashima et al. 2015(14) F/88 NA 3 days As CT Conservative Recovery Femoral Van Mieghem et al. 2013 F/86 Coronary artery disease, post total knee prosthesis 1-2 hours As Angiogram TEVAR Recovery Femoral Loeser et al. 2013 F/89 NA 2-5 hours As Autopsy NA Cardiogenic shock and died Femoral Bibombe et al. 2013 M/83 Previous CBG, HT, DLP During the procedure As and Ds TEE, CTA, angiogram Open surgery Recovery Femoral Al-Attar et al. 2013 F/84 HT, thrombophlebitis 8 months 2 weeks As CT Open surgery Arrest and died Femoral D"Onofrio et al. 2012 F/79 RA, pulmonary edema, cerebral hemorrhage Immediate after implant As TEE Open surgery Died 32 day later due to septic shock Aortic Ong et al. 2011 M/90 HT, CA prostate, CKD, gastric and duodenal ulcer Immediate after implant As TEE Conservative Recovery Femoral Gerber et al. 2010 F/83 DM, LE 22 days As Autopsy NA Cardiac arrest and died Femoral Abbreviations M Male; F Female; DM Diabetes mellitus; ESRD End-stage renal disease; NA Not available; COPD Chronic obstructive pulmonary disease; CBG Coronary bypass graft; HT hypertension; DLP Dyslipidemia; RA Rheumatoid arthritis; CA cancer; CKD Chronic kidney disease; LE Lupus erythematosus; AD Aortic dissection; As Ascending; Ds Descending; TEVAR Thoracic endovascular aortic repair. Abstract P861 Figure. Intraoperative TEE after TAVR