Risk-scoring model to predict one-year major adverse cardiac events after percutaneous coronary intervention

Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events [MACE], including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention [PCI]

Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 [n= 2875] were included as a validation data set

Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score [R[²] = 0.795]. The models had adequate goodness of fit [Hosmer-Lemeshow statistic; p value = 0.601] and acceptable ability of discrimination [c-statistics = 0.63]. The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks

Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care

Evaluation of in-hospital NT-proBNP changes in heart failure patients to identify the six-month clinical response following cardiac resynchronization therapy

N-terminal pro beta-type natriuretic peptide [NT-proBNP] is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy [CRT], we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients' response at six months. In this prospective study, 21 consecutive patients with severe heart failure [New York Heart Association class 3.19 +/- 0.40] who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NTproBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months' follow-up, 16 [76.2%] patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients [Delta NT-proBNP was 40.94 +/- 135.74 vs. 54.80 +/- 88.98]; however, at six months' follow-up, the NT-proBNP changes statistically differed across the two groups of patients [P=0.005]. According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients' clinical response after six months, which was incongruent to the patients' clinical improvement after CRT

Retrograde trans-femoral approach for successful percutaneous angioplasty in a diabetic patient with ischemic hand ulcer: a case report

Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient's finger was warm with a well-healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm. The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation

One-year clinical outcomes of ultra long apollo polymer-based paclitaxel-eluting stents in patients with complex, long coronary artery lesions

For all the wealth of research comparing the efficacy of the different types of the drug-eluting stent [DES] such as sirolimus-, paclitaxel-, and zotarolimus-eluting stents, there is still a dearth of data on the different brands of each DES type. We aimed to investigate the one-year clinical outcomes, including major adverse cardiac events [MACE], of the use of the ultra long Apollo paclitaxel-eluting stent in patients with long atherosclerotic coronary artery lesions. According to a retrospective review of the Tehran Heart Center Registry of Interventional Cardiology, a single-center nonrandomized computerized data registry in which all adult patients who undergo single or multi-vessel percutaneous coronary intervention [PCI] are enrolled without any specific exclusion criteria, the mixed use of long Apollo paclitaxel-eluting stents and other types of the DES as well as myocardial infarction within forty-eight hours prior to the procedure was excluded. In total, 122 patients were enrolled in the study, and their baseline clinical, angiographic, and procedural characteristics were obtained. In addition, the patients' follow-up data and, most importantly, MACE during a one-year period after intervention were recorded. The mean follow-up duration was 14.1 +/- 3.8 months. The one-year clinical follow-up data were obtained in 95.9% of all the patients. The incidence of MACE was 5.7% during the entire study period. There was 1 death, which occurred during the initial days after PCI. The incidence of non-fatal myocardial infarction was 2.5% [3 cases], including one patient who underwent target vessel revascularization seven months later. Also, 3 patients with single-vessel disease and in-stent restenosis underwent coronary artery bypass grafting between five to ten months later. Our results showed that the Apollo paclitaxel-eluting stent might be regarded as a safe and effective treatment for long coronary lesions