Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:An Updated Systematic Review and Meta-analysis

Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.

Fasting Blood Glucose but not TMAO is Associated with in-Stent Restenosis in Patients with Acute Coronary Syndrome

Background:The purpose of our study was to assess whether the occurrence of ISR might be associated with plasma TMAO levels in patients with ACS after DES implantation.Methods:This was a single center retrospective case-control study,in which 64 symptomatic patients with repeated coronary angiography after PCI and 15 patients with ISR were included in the ISR group,and 49 patients without ISR were included in the non-ISR group.High-performance liquid chromatography with tandem mass spectrometry was used to measure plasma TMAO levels.Results:No significant differences were observed in plasma TMAO between the ISR and non-ISR groups.Plasma TMAO levels showed no significant correlation with ISR,but were significantly positively correlated with diabetes mellitus,serum HbA1c levels and serum creatinine levels;moreover,they were significantly negatively correlated with female sex.ISR was significantly positively correlated with diabetes mellitus,fasting blood glucose levels,the neutro-phil to lymphocyte ratio and syntax score;in addition,it was significantly negatively correlated with platelets.Logistic regression analysis indicated that fasting blood glucose was the only independent predictor of ISR.Conclusion:Plasma TMAO may not be associated with ISR and plaque burden in patients with ACS after DES im-plantation,whereas FBG may predict the development of ISR in these patients.

A Novel Robotic Control System Mimics Doctor’s Operation to Assist Percutaneous Coronary Intervention

Objectives:The use of current robotic systems to assist in percutaneous coronary intervention(PCI)fundamentally differs from performing conventional PCI.To overcome this problem,we developed a novel master-slave robotic control system to assist in PCI,and evaluated its safety and feasibility in the delivery and manipulation of coronary guidewires in vitro and in vivo.Methods:The novel robotic assist PCI system is composed of three parts:1)a master actuator,which imitates the traditional torque used by surgeons in conventional PCI,2)a slave actuator,including a guidewire delivery system and force monitoring equipment,and 3)a local area network based communication system.Results:The experiment was performed in six pigs.Both robotic and manual control completed the operation with no device-or procedure-associated complications.An experienced interventional cardiologist who was afirst-time user of the novel robotic PCI system was able to advance the guidewire into a distal branch of a coronary artery within a similar time to that required with the manual procedure.Conclusion:This early in vivo experiment with the novel robotic assisted PCI control system demonstrated that its feasibility,safety,and procedural effectiveness are comparable to those of manual operation.The novel robotic-assisted PCI control system required significantly less time to learn than other currently available systems.