Percutaneous coronary intervention: 2017 in review

Abstract

In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

Implementation of a clinical nursing pathway for percutaneous coronary intervention

“…[ 3 ] Patients with severe or instable coronary heart disease need percutaneous coronary intervention (PCI). [ 4 , 5 ] Current treatment options suggest that patients with acute ST segment elevation myocardial infarction should be dealt with PCI. [ 6 , 7 ] With the increase of life expectancy, there will be more and more elderly patients with coronary heart disease.…”

Selection of a modern strategy for the treatment of acute coronary syndrome with elevated ST segment

“…Кандидатами к использованию ЧКВ также следует рассматривать пациентов с симптомами, которые длятся более 12 часов. Это пациенты, которые имеют клинические признаки продолжающейся ишемии, гемодинамической нестабильности, злокачественных аритмий или сердечной недостаточности [20,34].…”

“…У пациентов, получавших фибринолиз, ранний прием бета-адреноблокаторов является предпочтительным подходом из-за наблюдаемого уменьшения острой злокачественной желудочковой аритмии. У пациентов, перенесших первичную ЧКВ, доказательства относительно раннего внутривенного введения бета-адреноблокатора и полезных краткосрочных и долгосрочных эффектов являются противоречивыми; таким образом, из-за возможности неблагоприятных последствий их рутинное использование не рекомендуется [34]. Широко используемым препаратом у пациентов, проходящих фибринолиз или первичную ЧКВ, является метопролол.…”

Risk factors associated with intra‑stent restenosis after percutaneous coronary intervention

“…After performing percutaneous coronary intervention (PCI), patients are still at risk of developing new stenosis, such as intra-stent restenosis (ISR). The treatment of patients with ISR represents an important clinical problem and is still considered a challenge (2)(3)(4). Despite the proven safety and efficacy of drug-eluting stents (DES) in patients undergoing PCI, bare-metal stents (BMS) are still widely used as well, mainly because of their reduced cost and concerns about a debatable increased risk of bleeding associated with prolonged dual antiplatelet therapy after DES (5,6).…”