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Percutaneous Coronary Interventions in Acute Coronary Syndromes

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 18940

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Special Issue Editors

Prof. Dr. Jose P.S. Henriques

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Guest Editor

Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
Interests: ST-segment elevation myocardial infarction; cardiogenic shock; chronic total occlusions; acute coronary syndromes; drug-eluting stents; bioresorbable vascular scaffolds; drug-eluting balloons

Dr. Bimmer Claessen

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Co-Guest Editor

Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Interests: complex PCI; vulnerable plaque imaging and treatment; antiplatelet strategies
Special Issues, Collections and Topics in MDPI journals

Dr. Wouter Kikkert

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Co-Guest Editor

Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Interests: bleeding; acute coronary syndromes; risk scores; antiplatelet therapy; ST-segment elevation myocardial infarction

Special Issue Information

Dear Colleagues,

Few areas within the broad field of cardiology receive as much attention as Acute Coronary Syndromes, which include unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, given its broad range of clinical presentations, diagnostic modalities, medical and invasive treatment options, and primary- and secondary prevention. The incidence of Acute Coronary Syndromes is expected to continue to increase in the near future, as life expectancy rises across the globe and the advent of high-sensitivity troponin assays and rapid rule-out protocols allow for a swift and accurate diagnosis of myocardial infarction. Therefore, great effort is being made by researchers around the world to advance both the prevention and the treatment of Acute Coronary Syndromes. The field of percutaneous coronary intervention for Acute Coronary Syndromes is developing at a particularly high pace. To name just a few examples, attention has been focused on outcomes in women and minorities, the optimal intensity and duration of antithrombotic therapy, and the timing and completeness of coronary revascularization. Therefore, we invite researchers and clinicians to submit their works, including original clinical research studies, meta-analyses, systematic reviews and narrative reviews, related to percutaneous coronary intervention in the setting of Acute Coronary Syndromes in this Special Issue.

Prof. Dr. José P.S. Henriques
Guest Editor
Dr. Bimmer Claessen
Dr. Wouter Kikkert
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

acute coronary syndromes
ST-segment elevation myocardial infarction
non-ST-segment elevation myocardial infarction
unstable angina
antithrombotic therapy
minorities
complete revascularization
risk scores

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Published Papers (6 papers)

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Research

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10 pages, 1779 KiB

Open AccessArticle

Prognostic Analysis of Patients with Acute Myocardial Infarction Undergoing Implantation of Different Stents for the First Time

by Cheng-Chung Cheng, Fang-Han Yu, Pi-Shao Ko, Hsiao-Ting Lin, Wei-Shiang Lin, Shu-Meng Cheng and Sui-Lung Su

J. Clin. Med. 2021, 10(21), 5093; https://doi.org/10.3390/jcm10215093 - 29 Oct 2021

Cited by 2 | Viewed by 1581

Abstract

For patients with acute myocardial infarction scheduled to undergo percutaneous coronary stent implantation, in most cases a drug-eluting stent is recommended as the first choice for treatment. However, there is a lack of research on the effectiveness of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction. Our objective was to explore the effects of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction in terms of major cardiovascular incidents. This retrospective cohort study included 934 patients with myocardial infarction undergoing coronary artery stent implantation for the first time at the cardiac catheter room of the Tri-Service General Hospital in the Neihu District between 2014 and 2018. Patients’ information, including demographic data, laboratory data, cardiac echocardiography results, and angiocardiography results, was collected by reviewing medical records. Cox proportional hazards regression was used to adjust the potential confounding factors, and the adjusted data were then used to compare the correlation between different types of stents and major cardiovascular incidents in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. After the confounding factors were adjusted, in patients with ST-elevation myocardial infarction receiving a drug-eluting stent compared with those receiving a bare-metal stent, it was found that the mortality risk was lower in terms of all causes of death (Adj-HR = 0.26, 95% CI = 0.14–0.48, p < 0.001) and cardiogenic death (Adj-HR = 0.20, 95% CI = 0.08–0.55, p = 0.002), the risk of non-fatal myocardial infarction was lower (Adj-HR = 0.17, 95% CI = 0.04–0.73, p = 0.017), and there was no difference in the risk of revascularization at the lesion site (Adj-HR = 0.59, 95% CI = 0.24–1.43, p = 0.243). It terms of the findings in patients with non-ST-elevation myocardial infarction, those receiving a drug-eluting stent had a lower risk of revascularization at the lesion site (Adj-HR = 0.48, 95% CI = 0.24–0.97, p = 0.04); however, there was no difference in the mortality risk in terms of all causes of death (Adj-HR = 0.71, 95% CI = 0.37–1.35, p = 0.296) or cardiogenic death (Adj-HR = 0.59, 95% CI = 0.18–1.90, p = 0.379),or in the risk of non-fatal myocardial infarction (Adj-HR = 0.27, 95% CI = 0.06–1.25, p = 0.093). Compared with bare-metal stents, drug-eluting stents provide better protection against death to receivers with ST-elevation myocardial infarction; however, this protection is decreased in receivers with non-ST-elevation myocardial infarction. It is recommended that for patients with non-ST-elevation myocardial infarction who are indicated to receive a drug-eluting stent, the clinical effectiveness of the treatment must be considered. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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11 pages, 1526 KiB

Open AccessArticle

The Effect of the Timing of Invasive Management on Cardiac Function in Patients with NSTE-ACS, Insights from the OPTIMA-2 Randomized Controlled Trial

by Nick D. Fagel, Stefan G. J. Leuven, Wouter J. Kikkert, Michelle M. de Leau, Loek van Heerebeek and Robert K. Riezebos

J. Clin. Med. 2021, 10(16), 3636; https://doi.org/10.3390/jcm10163636 - 17 Aug 2021

Cited by 2 | Viewed by 1674

Abstract

The timing of coronary angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) remains a matter of debate. The relationship between the timing of invasive management and left ventricular function (LVF) is largely unknown. The An Immediate or Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome trial (OPTIMA-2) was a randomized controlled prospective open-label multicenter trial that randomized 249 NSTE-ACS patients to either an immediate (<3 h) invasive treatment strategy or an early strategy (12–24 h). Patients were pre-treated with a combination of aspirin, ticagrelor and fondaparinux. The aim of this prespecified sub-analysis was to assess (the recovery of) left ventricular function by analysing echocardiography data obtained <72 h after admission and at 30-day follow-up, for patients with a confirmed diagnosis of acute coronary syndrome. LVF was determined using ejection fraction (EF) and global longitudinal strain (GLS). Inter-observer variability was tested. No difference in the recovery of EF was found between an immediate and early strategy if the follow-up echocardiograms were compared to baseline: 2.5% (standard deviation (SD): 7.9) and 3.3% (SD: 8.5), p = 0.51, nor was there any difference in GLS recovery between the study groups: −0.8% (SD: 2.5) vs. −0.7% (SD 2.8) p = 0.82. If baseline and follow-up echocardiograms were compared, there was a similar but significant improvement in both EF and GLS in both separate study groups. An immediate invasive strategy in NSTE-ACS patients did not result in an improved left ventricular EF or GLS recovery compared with an early strategy. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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16 pages, 2622 KiB

Open AccessArticle

Clinical Scoring for Prediction of Acute Kidney Injury in Patients with Acute ST-Segment Elevation Myocardial Infarction after Emergency Primary Percutaneous Coronary Intervention

by Akaphol Kaladee, Phichayut Phinyo, Thamarath Chantadansuwan, Jayanton Patumanond and Boonying Siribumrungwong

J. Clin. Med. 2021, 10(15), 3402; https://doi.org/10.3390/jcm10153402 - 30 Jul 2021

Cited by 2 | Viewed by 2519

Abstract

Acute kidney injury (AKI) after a coronary intervention is common in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with significant morbidity and mortality. Several scores have been developed to predict post-procedural AKI over the years. However, the AKI definitions have also evolved, which causes the definitions used in the past to be obsolete. We aimed to develop a prediction score for AKI in patients with STEMI requiring emergency primary percutaneous coronary intervention (pPCI). This study was based on a retrospective cohort of Thai patients with STEMI who underwent pPCI at the Central Chest Institute of Thailand from December 2014 to September 2019. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL from baseline within 48 h after pPCI. Logistic regression was used for modeling. A total of 1617 patients were included. Of these, 195 patients had AKI (12.1%). Eight significant predictors were identified: age, baseline creatinine, left ventricular ejection fraction (LVEF) < 40%, multi-vessel pPCI, treated with thrombus aspiration, inserted intra-aortic balloon pump (IABP), pre- and intra-procedural cardiogenic shock, and congestive heart failure. The score showed an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75, 0.82) and was well-calibrated. The pPCI-AKI score showed an acceptable predictive performance and was potentially useful to help interventionists stratify the patients and provide optimal preventive management. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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11 pages, 726 KiB

Open AccessArticle

Cangrelor Use in Routine Practice: A Two-Center Experience

by Niels M. R. van der Sangen, Ho Yee Cheung, Niels J. W. Verouden, Yolande Appelman, Marcel A. M. Beijk, Bimmer E. P. M. Claessen, Ronak Delewi, Paul Knaapen, Jorrit S. Lemkes, Alexander Nap, M. Marije Vis, Wouter J. Kikkert and José P. S. Henriques

J. Clin. Med. 2021, 10(13), 2829; https://doi.org/10.3390/jcm10132829 - 26 Jun 2021

Cited by 3 | Viewed by 2544

Abstract

Cangrelor is the first and only intravenous P2Y₁₂-inhibitor and is indicated when (timely) administration of an oral P2Y₁₂ inhibitor is not feasible in patients undergoing percutaneous coronary intervention (PCI). Our study evaluated the first years of cangrelor use in two Dutch tertiary care centers. Cangrelor-treated patients were identified using a data-mining algorithm. The cumulative incidences of all-cause death, myocardial infarction, definite stent thrombosis and major bleeding at 48 h and 30 days were assessed using Kaplan–Meier estimates. Predictors of 30-day mortality were identified using uni- and multivariable Cox regression models. Between March 2015 and April 2021, 146 patients (median age 63.7 years, 75.3% men) were treated with cangrelor. Cangrelor was primarily used in ST-segment elevation myocardial infarction (STEMI) patients (84.2%). Approximately half required cardiopulmonary resuscitation (54.8%) or mechanical ventilation (48.6%). The cumulative incidence of all-cause death was 11.0% and 25.3% at 48 h and 30 days, respectively. Two cases (1.7%) of definite stent thrombosis, both resulting in myocardial infarction, occurred within 30 days, but after 48 h. No other cases of recurrent myocardial infarction transpired within 30 days. Major bleeding occurred in 5.6% and 12.5% of patients within 48 h and 30 days, respectively. Cardiac arrest at presentation was an independent predictor of 30-day mortality (adjusted hazard ratio 5.20, 95%-CI: 2.10–12.9, p < 0.01). Conclusively, cangrelor was used almost exclusively in STEMI patients undergoing PCI. Even though cangrelor was used in high-risk patients, its use was associated with a low rate of stent thrombosis. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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10 pages, 973 KiB

Open AccessArticle

Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience

by Vassili Panagides, Henrik Vase, Sachin P. Shah, Mir B. Basir, Julien Mancini, Hayaan Kamran, Supria Batra, Marc Laine, Hans Eiskjær, Steffen Christensen, Mina Karami, Franck Paganelli, Jose P. S. Henriques and Laurent Bonello

J. Clin. Med. 2021, 10(2), 339; https://doi.org/10.3390/jcm10020339 - 18 Jan 2021

Cited by 10 | Viewed by 3220

Abstract

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. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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Review

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25 pages, 3517 KiB

Open AccessReview

Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities

by Anna van Veelen, Niels M. R. van der Sangen, Ronak Delewi, Marcel A. M. Beijk, Jose P. S. Henriques and Bimmer E. P. M. Claessen

J. Clin. Med. 2022, 11(5), 1361; https://doi.org/10.3390/jcm11051361 - 1 Mar 2022

Cited by 22 | Viewed by 6417

Abstract

Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction. Full article

(This article belongs to the Special Issue Percutaneous Coronary Interventions in Acute Coronary Syndromes)

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