Ultra-Low Contrast Volume for Patients with Advanced Chronic Kidney Disease Undergoing Coronary Procedures.

BACKGROUND/AIMS: Contrast induced nephropathy (CIN) is associated with adverse clinical outcomes in patients undergoing coronary interventions, particularly in patients with advanced chronic kidney. The study was aimed to assess the real-life feasibility and safety of ultra-low volume coronary procedures in patients with advanced chronic kidney disease. METHODS: A prospective study that included patients with an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2) was conducted. Coronary procedures were performed using an ultra-low contrast volume technique. RESULTS: The 30 patients had a mean eGFR of 31.8(±8) mL/min/1.73 m2. Indications for coronary angiography were non-ST elevation myocardial infarction (63.3%), unstable (20%), and stable angina pectoris (16.7%). Median contrast volume for diagnostic coronary angiography was 13 mL (interquartile ranges [IQR] 12-14.9), and an additional 13 mL (IQR 8.8-14.3) for percutaneous coronary intervention (PCI). In 3 patients (10%), a ≥25% increase was demonstrated in serum cystatin C levels 48 h following the procedure. None of the patients demonstrated a ≥25% increase in serum creatinine levels at 48 h. Following 6 months, no patient required renal replacement therapy or unplanned coronary intervention. CONCLUSIONS: In patients with advanced chronic kidney disease, the ultra-low contrast technique is feasible and effective and can be used safely without a significant deterioration in renal function. This technique may increase the utilization of PCI in high-risk coronary patients with chronic kidney disease.

BIOFLOW-III satellite-One-year clinical outcomes of diabetic patients treated with a biodegradable polymer sirolimus-eluting stent and comprehensive medical surveillance.

BACKGROUND: Drug-eluting stents with biodegradable polymer might be particularly useful in diabetic patients who are at increased risk for target lesion/target vessel revascularization. We therefore aimed at assessing the safety and performance of a biodegradable polymer sirolimus-eluting stent (BP-SES) in combination with comprehensive optimal medical therapy following coronary interventions. METHODS: This prospective, multicenter registry was conducted at six centers in Israel. Aside of stent treatment, we aimed for an LDL-C level<70mg/dl; at one and six months post-intervention a diabetic consultancy was required, and follow-up data were collected at six and twelve months. The primary outcome measure was target vessel failure, a composite of cardiac death, target-vessel myocardial infarction and clinically driven target vessel revascularization. Secondary outcomes were target lesion failure, its individual components, and stent thrombosis. RESULTS: From August 2013 until May 2014, 120 diabetic patients with 158 lesions were treated with a BP-SES. Mean age was 63.9±9.2years, 27.5% were insulin dependent, 28.3% had a history of myocardial infarction, and 47.5% had prior coronary interventions. By visual estimation, lesions were 3.0±0.5mm in diameter and 15.2±7.4mm long; mean stent diameter and length were 3.0±0.5mm and 19.2±6.8mm. Target vessel failure and target lesion failure at 12months occurred in seven (6.4% [95% CI: 3.1-13.0]) and four patients (3.5% [95% CI: 1.3-9.2]), respectively, and definite stent thrombosis in one patient (1.0% [95% CI: 0.1-7.0]). CONCLUSION: Treatment with a BP-SES demonstrated excellent target-vessel and target-lesion revascularization rates in a high-risk diabetic patient population undergoing catheter-based revascularization followed by intensified medical care. ANNOTATED TABLE OF CONTENTS: In 120 high-risk diabetic patients with coronary artery stenosis, treatment with the Orsiro sirolimus-eluting stent with biodegradable polymer and comprehensive antidiabetic therapy resulted in excellent clinical outcomes. Target vessel revascularization occurred in 6.4% of patients and target lesion revascularization in 3.5%.

USage of chitosan for Femoral (USF) haemostasis after percutaneous procedures: a comparative open label study.

AIMS: To test the efficacy and safety of a chitosan pad for femoral haemostasis as an adjunct to manual compression. Haemostasis of the femoral artery after coronary angiography by manual compression is time consuming and uncomfortable for the patient. Closure devices are costly and do not reduce vascular complication rate. The HemCon(r) pad is used by the US army to control traumatic bleeding. It consists of chitosan, a positively charged carbohydrate that attracts the negatively charged blood cells and platelets and promotes clotting. METHODS AND RESULTS: Patients undergoing percutaneous coronary angiography were 1:1 randomised for manual compression with regular or HemCon(r) pad. All patients were catheterised with 6 Fr sheath and received 2500 u of heparin. Time to haemostasis, incidence of minor and major bleeding, haematoma size, post-procedural stay at the hospital and level of satisfaction were compared between the two groups. Seventy patients in the HemCon group and 66 patients in the regular pad groups were recruited. Activated clotting time (ACT) before manual compression was similar, 183.9 ± 43.4 and 178.3 ± 34.2 seconds in the HemCon(r) and regular pad groups respectively. Time to haemostasis was 5.6 ± 2.1 and 8.4 ± 3.5 minutes in the HemCon® and regular pad groups, respectively (p<0.001). Haematoma developed in 6% and 14.8% of patients in the HemCon(r) and regular pad group, respectively (p=0.14). CONCLUSIONS: The HemCon(r) pad significantly decreased time-to-haemostasis compared to the regular pad. The total incidence of haematoma tended to be lower in the HemCon(r) pad compared to the regular pad group.

Six- and twelve-month clinical outcomes after implantation of prokinetic BMS in patients with acute coronary syndrome.

AIMS: To evaluate the Prokinetic bare metal stent implanted in patients presenting with acute coronary syndrome (ACS). METHODS: We retrospectively studied ACS patients who underwent percutaneous coronary intervention (PCI) with a Prokinetic stent implantation. Excluded were patients presenting with cardiogenic shock, undergoing PCI to left main coronary artery (LM), or having implantation of additional stents other than Prokinetic. Six and 12 months clinical follow-up was obtained by phone. RESULTS: A total of 140 Prokinetic stents were implanted in 117 patients (age 64+/-13.0 years, 78% men). Thirty two percent of the patients had unstable angina, 36% had non ST-elevation myocardial infarction (NSTEMI) and 33% had ST-elevation myocardial infarction (STEMI). Forty two percent of lesions were categorized as B2 and 21% as C type. Procedural success was achieved in 99.1% of lesions. Clinical success was achieved in 97.4% of patients. Major adverse cardiac events (MACE) rate was 8.5% and 11.1% at 6 and 12 months follow-up, respectively. The incidence of cardiac death, MI and TLR was 2.6%, 3.4% and 2.6%, respectively at 6 months, and 4.3%, 4.3%, 2.6% respectively at 12 months. CONCLUSIONS: Clinical outcomes at 6 and 12 months after Prokinetic stent implantation are excellent and may be attributable to its unique combination of composition, design and coating.