Compared with unexposed controls, ICs and cath-lab staff had a higher prevalence of lens changes that may be attributable to ionizing radiation exposure. While most of these changes were subclinical, they are important due to the potential to progress to clinical symptoms, highlighting the importance of minimizing staff radiation exposure.

As compared with wire escalation, upfront use of the CrossBoss catheter for antegrade crossing of coronary chronic total occlusions was associated with similar crossing time, similar success and complication rates, and similar equipment use and cost.

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Aim To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. Methods We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. Results The participants' mean ± SD age was 66±10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P=0.006), and to have had previous heart failure (35 vs 22%; P=0.0001) and peripheral arterial disease (19 vs 13%; P=0.002). They also had a higher BMI (31±6 kg/m2 vs 29±6 kg/m2; P=0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P=0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P=0.66), retrograde (30 vs 28%; P=0.66) and antegrade dissection re-entry (24 vs 25%; P=0.66). Technical (91 vs 90%; P=0.80) and procedural (89 vs 89%; P=0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P=0.61). Conclusions In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes.

Objectives We sought to examine near-infrared spectroscopy (NIRS) imaging findings of aortocoronary saphenous vein grafts (SVGs). Background SVGs are prone to develop atherosclerosis similar to native coronary arteries. They have received little study using NIRS. Methods We examined the clinical characteristics and imaging findings from 43 patients who underwent NIRS imaging of 45 SVGs at our institution between 2009 and 2016. Results The mean patient age was 67 ± 7 years and 98% were men, with high prevalence of diabetes mellitus (56%), hypertension (95%), and dyslipidemia (95%). Mean SVG age was 7 ± 7 years, mean SVG lipid core burden index (LCBI) was 53 ± 60 and mean maxLCBI4mm was 194 ± 234. Twelve SVGs (27%) had lipid core plaques (2 yellow blocks on the block chemogram), with a higher prevalence in SVGs older than 5 years (46% vs. 5%, p=0.002). Older SVG age was associated with higher LCBI (r=0.480, p<0.001) and higher maxLCBI4mm (r=0.567, p<0.001). On univariate analysis, greater annual total cholesterol exposure was associated with higher SVG LCBI (r=0.30, p=0.042) and annual LDL-cholesterol and triglyceride exposure were associated with higher SVG maxLCBI4mm (LDL-C: r=0.41, p=0.020; triglycerides: r=0.36, p=0.043). On multivariate analysis, the only independent predictor of SVG LCBI and maxLCBI4mm was SVG age. SVG percutaneous coronary intervention was performed in 63% of the patients. An embolic protection device was used in 96% of SVG PCIs. Periprocedural myocardial infarction occurred in one patient. Conclusions Older SVG age and greater lipid exposure are associated with higher SVG lipid burden.