Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Shrivastava, Abhinav; Nath, Ranjit Kumar; Mahapatra, Himansu Sekhar; Pandit, Bhagya Narayan; Raj, Ajay; Sharma, Ajay; Kumar, Tarun; Kuber, Dheerendra; Aggarwal, Puneet

doi:10.1016/j.ihj.2022.08.004

Cited by 10 publications

(9 citation statements)

References 38 publications

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“…Patient related factors are mostly non-modifiable and include diabetes mellitus and younger age. 18,19 Lesion related factors include multivessel disease, ostial and complex bifurcation PCI, longer lesion length, and smaller vessel diameter which correlated with the findings in our study as well, with ISR being present significantly more in longer SB lesions length and smaller SB vessels. In this study, a SB DRD of ≤2.8 mm was an independent predictor of ISR with a sensitivity of 83.3% and specificity of 62.5%.…”

Section: Discussionsupporting

confidence: 90%

“…Currently, ISR predictors may be classified into three categories: patient related, lesion related, and procedure related. Patient related factors are mostly non‐modifiable and include diabetes mellitus and younger age 18,19 . Lesion related factors include multivessel disease, ostial and complex bifurcation PCI, longer lesion length, and smaller vessel diameter which correlated with the findings in our study as well, with ISR being present significantly more in longer SB lesions length and smaller SB vessels.…”

Section: Discussionsupporting

confidence: 86%

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Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

Gupta,

Shrivastava,

Chhikara

et al. 2023

Cathet Cardio Intervent

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BackgroundAmong the two stent strategies, contemporary evidence favors double kissing crush technique (DKC) for complex unprotected distal left main bifurcation (UdLMB) lesions. However one of the major challenges to these lesions is side branch (SB) restenosis.AimsOur aim was to identify optical coherence tomographic (OCT) characteristics that may predict SB restenosis (SBR) after UdLMB angioplasty using DKC technique.MethodsThis was a single‐center, retrospective study that included 60 patients with complex UdLMB disease, who underwent OCT‐guided angioplasty using DKC technique. Angiographic follow‐up was performed in all patients at 1 year to identify patients with SBR. Patients with SBR group were compared with patients without SBR (NSBR group) for OCT parameters during index procedure.ResultsTwelve (20%) patients developed SBR at 1‐year follow‐up. The SBR group had longer SB lesion (18.8 ± 3.2 vs. 15.3 ± 3.7 mm, p = 0.004) and neo‐metallic carinal length (2.1 vs. 0.1 mm, p < 0.001) when compared to the NSBR group. Longer neo‐metallic carinal length was associated with the absence of the dumbbell sign, presence of hanging stent struts across the SB ostium on OCT of final MB pullback. On multivariate regression analysis, SB distal reference diameter (DRD) and SB stent expansion were identified as independent predictors of SBR with SB‐DRD of ≤2.8 mm (area under curve—0.73, sensitivity—83.3%, and specificity—62.5%) and SB stent expansion of ≤89% (area under curve—0.88, sensitivity—83.3%, and specificity‐ 81.2%) as the best cut off values to predict SBR.ConclusionsSB DRD and SB stent expansion are the OCT predictors of future SBR after UdLMB angioplasty using DKC technique.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

Gupta,

Shrivastava,

Chhikara

et al. 2023

Cathet Cardio Intervent

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“…Although there was no significant difference in the amount of contrast medium between the group with PC-AKI and the group without PC-AKI in this study, Shrivastava et al demonstrated that the ultra-low contrast PCI protocol was reasonably safe and effective in reducing the incidence of CI-AKI in a high-risk cohort compared to conventional PCI [ 29 ]. Despite the significance of the type and amount of contrast medium in the development of PC-AKI, our results suggest that the etiology of AKI in STEMI patients undergoing PCI is multifactorial, including the role of contrast medium, rather than solely attributable to contrast medium alone.…”

Section: Discussionmentioning

confidence: 61%

Baseline eGFR cutoff for increased risk of post-contrast acute kidney injury in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction in the emergency department

You,

Cho,

Shin

et al. 2023

PLoS ONE

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Acute myocardial infarction is an acute-stage disease that requires prompt diagnosis and treatment. Primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is a high-risk factor for post-contrast acute kidney injury (PC-AKI). This retrospective cohort study analyzed the data of 754 patients with STEMI who underwent pPCI and were integrated into the Fast Interrogation Rule for STEMI critical pathway program between 2015 and 2019. We aimed to determine the optimal cutoff baseline eGFR for identifying a high risk of PC-AKI after multivariable adjustment with statistically significant risk factors. We also compared the incidence rates of PC-AKI between the previous and current diagnostic criteria. The probability of PC-AKI increased when the baseline estimated glomerular filtration rate (eGFR) was ≤ 79mL/min/1.73 m2. The optimal cutoff baseline eGFR for high risk of PC-AKI was found to be an eGFR of ≤ 61 mL/min/1.73 m2 after multivariable adjustment. The current diagnostic criteria more accurately identified the patient group with impaired renal function. Our results have clinically significant implications for identifying patients at a high risk of developing PC-AKI, especially before and after the use of contrast agents in patients who require PCI for STEMI in the emergency department.

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“…Intervention by ULC-PCI with IVUS guidance is feasible and can be safely used in patients with renal dysfunction to reduce the incidence of CI-AKI. 70 Sakai, et al examined the use of IVUS-guided minimum-contrast (MINICON) PCI (n=98) compared to standard angiography-guided PCI (n=86) in patients with advanced CKD (n total= 184). The IVUS-guided MINICON PCI group showed significantly reduced contrast volume and a lower incidence of CI-AKI compared to the angiography-guided standard PCI group (CI-AKI; 2% vs. 15%; P = 0.001).…”

Section: Monitoring Plaque Morphology and Changes With Therapymentioning

confidence: 99%

Role of Intravascular Ultrasound and Optical Coherence Tomography in Intra Coronary Imaging for Coronary Artery Disease

Sarwar,

Adedokun,

Anantha Narayanan

2023

Preprint

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Coronary angiography, long considered the gold standard for coronary imaging, faces limitations in assessing coronary vessel wall anatomy and guiding percutaneous coronary intervention (PCI). Despite its prevalence, studies have demonstrated that it is suboptimal in estimating the severity of coronary disease and physiologic significance of stenosis. Intracoronary imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer promising alternatives to overcome these limitations. This review delves into the nuances of IVUS and OCT, highlighting their strengths and limitations as adjuncts to PCI. IVUS, utilizing ultrasound technology, and OCT, based on near-infrared light, each provide unique insights into coronary pathology. They differ in terms of temporal and spatial resolution, influencing their capabilities in plaque characterization and vessel assessment. The discussion navigates their historical evolution, technical specifications, and clinical utility. Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone. While IVUS has demonstrated consistent benefits in terms of clinical outcomes, the evidence supporting OCT is less robust. However, the utilization of these imaging modalities remains variable across regions, with increasing adoption in recent years, particularly in IVUS-guided PCIs. Intravascular ultrasound's journey from early motion detection to current high-resolution mechanical systems is traced, including improvements in catheter size and compatibility. On the other hand, optical coherence tomography has advanced significantly, utilizing near infrared light to achieve unparalleled resolutions, albeit requiring temporary blood clearance for optimal imaging. In conclusion, IVUS and OCT offer valuable insights into coronary pathophysiology and guide interventions with improved precision compared to traditional angiography. While IVUS remains more extensively utilized, OCT's growing potential is underscored by advancements in technology, culminating in enhanced imaging capabilities. Both modalities demonstrate comparable clinical outcomes, emphasizing the need for tailored imaging choices based on individual clinical scenarios. The continued refinement and broader integration of intravascular imaging are expected to play a pivotal role in optimizing coronary interventions and patient outcomes.

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Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Cited by 10 publications

References 38 publications

Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

Baseline eGFR cutoff for increased risk of post-contrast acute kidney injury in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction in the emergency department

Role of Intravascular Ultrasound and Optical Coherence Tomography in Intra Coronary Imaging for Coronary Artery Disease

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