Short- and long-term outcomes of patients with active cancer presenting with an acute coronary syndrome.

BACKGROUND: Management of cancer patients presenting with an acute coronary syndrome (ACS) may be challenging. In this study, we sought to examine whether and how a concomitant diagnosis of active cancer affects patients' management and outcomes following an event of ACS. METHODS: We used a retrospective cohort data analysis of patients from the Acute Coronary Syndrome Israeli Survey (ACSIS) carried out between the years 2016-2021 to compare patients with and without a concomitant diagnosis of active cancer. RESULTS: Of 4913 patients who presented with an ACS, 90 (1.8%) patients had a concomitant active cancer. Cancer patients were older, with a higher prevalence of hypertension and chronic renal failure. The rate of ST-elevation myocardial infarction (STEMI) was similar (40%) between both groups. Cancer patients were less likely to undergo coronary angiography during hospitalization; but once it was performed, the rate of percutaneous coronary intervention was similar. The presence of cancer during an ACS was associated with an increased short- and long-term mortality. In a multivariate analysis, the risk for 1-year mortality remained significantly higher in cancer patient (HR 2.72, 95% CI 1.74-4.24, p < 0.001), and was most prominent in patients presenting with STEMI (HR 5.00, 95% CI 2.40-10.39, p < 0.001). Short- and long-term death rates were also higher in cancer patients after a propensity score matching and adjustment for comorbidities other than cancer. CONCLUSION: Despite significant advances in oncologic and cardiac care, the presence of active cancer in patients with an ACS is still associated with significantly increased risk for 1-year mortality.

Percutaneous Transcatheter Edge-to-Edge MitraClip Technique: A Practical "Step-by-Step" 3-Dimensional Transesophageal Echocardiography Guide.

Recent innovations and advancements in 3-dimensional (3D) echocardiography allow for better understanding of anatomic relationships and improve communication with the interventional cardiologist for guidance of catheter-based interventions. The mitral valve lends itself best for imaging with transesophageal echocardiography (TEE). Consequently, the role of 3D TEE in guiding catheter-based mitral interventions has been evolving rapidly. Although several publications have reported on the advantages and role of 3D TEE in guiding one or more of the steps involved in percutaneous mitral valve repair using the MitraClip, none offer a comprehensive and practical user-friendly guide. This review article provides the reader with practical intraprocedural tips on use of 3D TEE to guide all relevant steps involved in the procedure including how to acquire the images needed and what to look for.

Catheter Aspiration after Every Stage during Primary Percutaneous Angioplasty; ADMIT Trial.

We assess the epicardial and microcirculation flow characteristics, and clinical outcome by using catheter aspiration after each stage of primary percutaneous coronary intervention (PPCI). Conflicting data are reported regarding early and late benefit of using aspiration catheter in the initial phase PPCI. A total of 100 patients with ST-segment elevation acute myocardial infarction (STEMI) were included: 51 underwent PPCI without using an aspiration device (SA group) and 49 underwent PPCI by activating an aspiration catheter after each stage of procedure; wiring, ballooning and stenting, respectively (MA group). Thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame counts and myocardial blush grade (MBG) were evaluated in each group during every stage of procedure. Major adverse cardiac events were evaluated in the index hospitalization and during 30 and 180 days of follow-up. A TIMI flow grade 2-3 was more prevalent in the MA group compared with the SA group only after wiring: 65.9 versus 39.1% (p = 0.01), but TIMI frame counts were lower in the MA versus SA group throughout all procedural steps. MBG 2-3 was statistically higher in the MA group compared with the SA group mainly after wiring. After stenting there were no significant changes in both epicardial and microcirculation flow parameters. There were no significant differences between the groups in early and late clinical outcomes. Improved flow parameters were noticed in the MA group only by activating the aspiration device after wiring. This early advantage disappeared after stenting. The initial better flow characteristic in the MA group was not translated into a better early or late clinical outcome.

Transradial diagnosis and intervention of supraaortic vessels.

BACKGROUND: The transradial approach (TRA) is becoming widespread, mainly for coronary interventions, but it has rarely been used for diagnosis and even less for therapeutic treatment of supraaortic arterial vessel (SAAV) atherosclerotic disease. OBJECTIVES: We report our last year's experience in both diagnostic and therapeutic endovascular procedures for SAAV atherosclerotic disease using the TRA. METHODS: The TRA was used in 20 diagnostic and 18 therapeutic procedures for SAAV atherosclerotic disease performed on 26 males and 12 females with a mean age of 65 ± 7 years. Indications for diagnostic or therapeutic procedures were: clinical findings; and symptoms related to SAAV disease. Indications for the TRA were: no option of femoral approach (9/38); hostile arch anatomy (3/38); technical failure via femoral approach (4/38); ostial vertebral disease (6/38); or patient preference (16/38). All diagnostic procedures were undertaken using 5 Fr catheters. Treated vessels were: brachiocephalic; subclavian; carotid; vertebral; extracranial segments V1 and V2; and intracranial segment V4 and basilar arteries. Technical success was achieved in 17/18 therapeutic procedures (95%). We switched to the femoral approach in 1 patient with right-sided carotid disease where the distal protection device could not be propagated cranial to the narrowed segment. No vascular or neurological complications were recorded in any of the procedures. Patients were discharged the same day after diagnostic procedure and 1 day after therapeutic procedure. At a mean 7-month follow-up exam, neither neurological symptoms nor clinical restenosis were detected. CONCLUSIONS: Diagnostic and therapeutic procedures involving SAAV can be safely and successfully performed via the TRA by experienced interventional cardiologists.