Comparison of Mortality Prediction by the GRACE Score, Multiple Biomarkers, and Their Combination in All-comer Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Objective This study examined the ability of a combination of biomarkers, including N-terminal pro-B-type natriuretic peptide (N-BNP) and high-sensitivity C-reactive protein (hs-CRP), to better predict mortality than the Global Registry of Acute Coronary Events (GRACE) score in acute myocardial infarction (AMI) patients who received primary percutaneous coronary intervention (PPCI). Methods The in-hospital mortality in 754 all-comer patients with AMI who underwent successful PPCI over 8 years was examined. A receiver operating characteristic (ROC) analysis was performed to determine the in-hospital mortality in a single center. A logistic regression analysis was used to compare the predictive accuracy of the GRACE score and biomarkers. The incremental predictive value of those biomarkers beyond the GRACE score was also examined. Results The mean age was 66±13 years old, and 609 patients with ST-elevated AMI (80.8%) were included. The in-hospital mortality was 6.8%. The GRACE score (in-hospital survivor/non-survivor: 106±33/161±32; p<0.05,) and N-BNP (in-hospital survivor/non-survivor: 2,458±7,058/8,880±1,1331 pg/mL; p<0.05) were significantly lower in survivors than in non-survivors. The area under the ROC curve (AUC) of in-hospital mortality of the GRACE score was significantly higher than that of the dual-biomarker combination (0.868/0.720; p<0.05). The AUC of the combination of the GRACE score and dual-biomarkers was not significantly higher than that of the GRACE score alone (0.870/0.868; p=0.747). Conclusion The measurement of representative cardiovascular biomarkers did not provide any additional benefit for mortality prediction beyond the GRACE score in AMI patients who received PPCI.

Simple percutaneous coronary intervention strategy with a novel guide extension catheter through a 5-Fr guiding catheter for a tortuous coronary artery.

A 78-year-old female diagnosed with effort angina underwent coronary angiography. The findings revealed subtotal occlusion in the tortuous circumflex. The lesion was initially treated with a drug-coated balloon alone; however, restenosis occurred after 2 months. Thus, percutaneous coronary intervention was performed again using a drug-eluting stent (DES) through a 5-Fr guiding catheter to minimize invasiveness. However, it was not possible to pass the lesion with the DES; thus, a novel guide extension catheter with a rapid exchange system was passed under balloon anchoring against the tortuous artery. The use of this guide extension catheter resulted in the successful delivery and implantation of the DES. This approach, using a novel guide extension catheter with a rapid exchange system through a 5-Fr guiding catheter, may facilitate the implantation of devices. Learning objective: Smaller guiding catheter (GC) using a 5-Fr contributes less invasive percutaneous coronary intervention (PCI) procedure for patients. However, sometimes GC stability and device pushability become insufficient in using 5-Fr GC. Hence, we report a case of PCI procedure through a 5-Fr GC with novel guide extension catheter, and it may be an alternative option when GC stability and device pushability are insufficient. It is meaningful to share this method of PCI procedure for all physicians.

Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina.

Conventional radial access (cRA) for percutaneous coronary intervention (PCI) has become the current standard due to low bleeding complications, although recently, distal radial access (dRA) has attracted attention as an alternative. Here, the usefulness of dRA is shown in a case in whom neither side could be used for cRA. The patient was a woman in her 70 s diagnosed with unstable angina pectoris at another hospital. Although ad hoc PCI was attempted via her right forearm radial artery, her hemodynamics deteriorated and the procedure was abandoned. After an intra-aortic balloon pumping device was inserted via the left femoral approach and hemostasis was established with a dedicated device, the patient was transferred to our hospital. Her right radial artery was being used for hemostasis and her left radial artery was poorly palpable. Because her right distal radial artery was palpable, access via that location was attempted after confirming sufficient blood vessel diameter and blood flow by ultrasound. A 6Fr sheath was inserted and PCI was safely accomplished. Hemostasis on dRA was completed without complications using a hemostasis device. Thus, dRA may be an option as an alternative access site in an emergency. .

Coronary orbital atherectomy using a five-French guiding catheter.

Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI). The safety and feasibility of OAS application through a 5-Fr guiding catheter (GC) which is less invasive and reduces access site complications were validated. This sequential, retrospective, observational study was conducted in a single center from September 2018 to May 2020. The primary endpoint was a successful PCI with the OAS. Secondary endpoints were major adverse complications related to PCI with the OAS, including coronary dissection, perforation, side branch loss, need for an unexpected cardiac assist device, access site complications, and major adverse cardiac and cerebrovascular events. 33 PCIs in 30 patients (mean age 72 ± 11 years; male, 83.3%) were surveyed. All PCIs were successfully completed with OAS application through a 5-Fr GC. Coronary perforation after the OAS procedure occurred in one case (3.0%). Severe coronary dissection occurred in three cases (9.1%), and procedural myocardial infarction in two cases (6.1%). Regarding PCIs performed with the 5-Fr GC, the OAS is a safe and feasible strategy for calcified plaque modification.

First Reported Use of a Visualization Device for the Radial Artery With Near-Infrared Rays Through the Transradial Approach.

OBJECTIVES: The transradial approach (TRA) is recommended in coronary catheterization due to the lower rate of bleeding complications compared with the transfemoral approach. However, a disadvantage of TRA is difficulty in puncturing under palpation of the radial pulse alone without arterial visibility. To overcome this limitation, a vessel visualization device using near-infrared rays, Art View (Forte Grow Medical Company), was used in the puncture of the radial artery (RA). METHODS: Patients who underwent coronary angiography via the right RA with Art View were retrospectively surveyed. According to the quality of RA visibility, the performance of the Art View was rated as follows: 5 = excellent; 4 = good; 3 = fair; 2 = not good; and 1 = poor. The primary endpoint was the procedural success of TRA using the Art View device. The secondary endpoints were procedural time (from injection of local anesthesia to successful crossing of the guidewire attached to the sheath), number of RA punctures, and change of puncture method or approach site. RESULTS: The Art View device was used in 38 patients (mean age, 71 ± 11 years). Puncturing of the visualized RA was successful in 30 patients (79.0%). Among successful cases, the mean procedural time was 142 ± 87 seconds. The success rates of each visualization evaluation were 100%, 100%, 84.6%, 33.3%, and 0% from grades 5 to 1, respectively (P<.01). The mean procedural times were 92 ± 18 seconds, 102 ± 58 seconds, 180 ± 75 seconds, 306 ± 80 seconds, and not available from grades 5 to 1, respectively (P<.01). CONCLUSION: The Art View RA visualization device is useful for RA puncture.