Double-vessel verylate stent thrombosis following Resolute Onyx zotarolimus eluting stents implantation in an octogenarian

Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]

“One-man” bailout technique for high-speed rotational atherectomy——assisted percutaneous coronary intervention in an octogenarian

Heavily calcified coronary lesions continue to represent a challenge for percutaneous coronary intervention(PCI),as they are difficult to dilate,and it is difficult to deliver and implant drug-eluting stents(DES)properly.Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes.[1]Thanks to the introduction of several adjunctive PCI tools,like cutting and scoring balloons,and to the novel intravascular lithotripsy technology,the treatment of such lesions has become increasingly feasible,predictable and safe.

Percutaneous coronary intervention in octogenarians:10-year experience from a primary percutaneous coronary intervention centre with off-site cardiothoracic support

OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention(PCI)in our centre.METHODS A total of 782 consecutive octogenarians(aged 80 and above)were identified from a prospectively collected PCI database within our non-surgical,medium volume centre between 1st January 2007 and 31st December 2016.This represented 10.9%of all PCI procedures performed in our centre during this period.We evaluated the demographic and procedural character-istics of the cohort with respect to clinical outcomes(all-cause in-hospital and 1-year mortality,in-hospital complication rates,duration of hospital admission,coronary disease angiographic complexity and major co-morbidities).The cohort was further stratified into three chronological tertiles(January 2007 to July 2012,261 cases;August 2012 to May 2015,261 cases;June 2015 to December 2016,260 cases)to assess for differences over time.Predictors of mortality were identified through a multivariate re-gression analysis.RESULTS The number of octogenarians undergoing PCI increased nearly ten-fold over the studied period.Despite this,there were no significant differences in clinical outcomes or patient characteristics,except for the increased use of trans-radial vascular access[11.9%in first tertile vs.73.2%in third tertile(P<0.0001)].The all-cause in-hospital(5.8%vs.4.6%vs.3.8%,P=0.578)and 1-year mortality(12.4%vs.12.5%vs.14.4%,P=0.746)remained constant in all three tertiles respectively.Six independent predict-ors of mortality were identified-increasing age[HR=1.12(1.03−1.22),P=0.008],cardiogenic shock[HR=16.40(4.04-66.65),P<0.0001],severe left ventricular impairment[HR=3.52(1.69−7.33),P=0.001],peripheral vascular disease[HR=2.73(1.22−6.13),P=0.015],diabetes[HR=2.59(1.30−5.17),P=0.007]and low creatinine clearance[HR=0.98(0.96−1.00),P=0.031].CONCLUSION This contemporary observational study provides a useful insight into the real-world practice of PCI in octogen-arians.

Steerable microcatheters for complex percutaneous coronary interventions in octogenarians: from Venture to Swift Ninja

0ctogenarians represent the fastest growing group of patients undergoing percutaneous coronary intervention(PCI),now constituting more than one in five patients treated with PCI in real-world practice.[1,2]Comparing coronary lesion characteristics of patients aged<≥80 years to those≥80 years undergoing PCI,the octogenarians have a higher prevalence of calcified and ostial lesions,tortuous coronary anatomy,multi-vessel disease and left main stem(LMS)stenosis.⑶Furthermore,they often have greater ischemic burden than their younger counterparts,suggesting an even greater benefit following revascularization.

Prognostic value of ΔSYNTAX% score in octogenarians undergoing percutaneous coronary intervention

OBJECTIVES To verify whether incomplete revascularisation(IR),quantified using the rSYNTAX(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)score andΔSYNTAX%score,could predict short-(in-hospital mortality)and long-term outcomes(12-month mortality)in octogenarians undergoing percutaneous coronary intervention(PCI).METHODS&RESULTS A retrospective analysis of 665 consecutive octogenarian patients presenting for PCI to a UK centre was performed.The baseline SYNTAX and rSYNTAX scores were assessed from angiographic images.ΔSYNTAX%score was calculated(ΔSYNTAX%=((SYNTAX-rSYNTAX)/SYNTAX)×100%))to measure the relative completeness of revascularisation.Kaplan-Meier analysis assessed survival at 12 months by tertiles of rSYNTAX andΔSYNTAX%scores.IncreasingΔSYNTAX%score was associated with reduced in-hospital mortality(P=0.017),and improved survival benefit(log rank 14.8,P=0.001)at 12 months.CONCLUSIONS Enhancing the completeness of revascularisation in octogenarians selected to undergo PCI is associated with a lower in-hospital mortality and a survival benefit at 12 months.