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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Predictors of periprocedural complications in patients undergoing percutaneous coronary interventions within coronary
Rafał A Januszek1, Artur Dziewierz2, Zbigniew Siudak3
12nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland. jaanraf@interia.pl.
Insights
Percutaneous coronary interventions (PCI) in saphenous vein grafts (SVG) lead to higher complication rates. Acute coronary syndromes, slow blood flow, and thrombectomy increase these risks in SVG PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary bypass grafting requires interventions for graft failure in at least 10% of patients within a decade.
- Saphenous vein grafts (SVG) carry a higher risk of periprocedural complications during interventions.
- Predictors of periprocedural complications in PCI within coronary artery bypass grafts require investigation.
Purpose of the Study:
- To investigate predictors of periprocedural complications in PCI within coronary artery bypass grafts.
- To compare periprocedural complication rates between SVG, internal mammary artery (IMA), and non-IMA/SVG groups.
- To identify factors influencing complications in SVG interventions.
Main Methods:
- Analysis of data from the Polish National Registry (ORPKI) between January 2015 and December 2016.
- Inclusion of 2,616 patients undergoing PCI of SVG and 442 patients undergoing PCI of IMA.
- Investigation of dissimilarities in periprocedural complications and their predictors among different graft types.
Main Results:
- SVG patients were older with higher comorbidity burden and higher rates of restenosis.
- The SVG group exhibited higher rates of no-reflows, perforations, and overall periprocedural complications.
- Predictors for no-reflows included acute coronary syndromes (ACS), thrombectomy, and prior stroke; complications involved hypertension, pre-PCI TIMI flow, and thrombectomy.
Conclusions:
- PCI of SVG is linked to an elevated risk of specific periprocedural complications.
- ACS, diminished TIMI flow before PCI, and thrombectomy significantly elevate periprocedural complication rates in SVG PCI.
- Understanding these predictors can guide strategies to mitigate risks during SVG interventions.
Background:
During the first decade following the coronary bypass grafting, at least ten percent of the patients require percutaneous coronary interventions (PCI) due to graft failure. Saphenous vein grafts (SVG) are innately at a higher risk of periprocedural complications. The present study aimed to investigate predictors of periprocedural complications of PCI within coronary artery bypass grafts.
Methods:
This study analyzed data gathered in the Polish National Registry (ORPKI) between January 2015 and December 2016. Of the 221,195 patients undergoing PCI, data on 2,616 patients after PCI of SVG and 442 patients after internal mammary artery (IMA) were extracted. The dissimilarities in periprocedural complications between the SVG, IMA and non-IMA/SVG groups and their predictors were investigated.
Results:
Patients in the SVG group were older (p < 0.001), with a higher burden of concomitant disease and differing clinical presentation. The rate of de-novo lesions was lower, while restenosis was higher at baseline in the SVG (p < 0.001). The rate of no-reflows (p < 0.001), perforations (p = 0.01) and all periprocedural complications (p < 0.01) was higher in the SVG group, while deaths were lower (p < 0.001). Among the predictors of no-reflows, it was found that acute coronary syndromes (ACS), thrombectomy and past cerebral stroke, while the complications included arterial hypertension, Thrombolysis in Myocardial Infarction (TIMI) flow before PCI and thrombectomy.
Conclusions:
Percutaneous coronary interventions of SVG is associated with increased risk of specific periprocedural complications. The ACS, slower TIMI flow before PCI and thrombectomy significantly increase the periprocedural complication rate in patients undergoing PCI of SVG.
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