In patients with ST-elevation myocardial infarction (STEMI), current guidelines support PCI of the infarct related artery and medical management of flow-limiting lesions in non-infarct related vessels (so-called bystander disease). This paradigm is challenged in the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study. In this single-blind trial performed at five UK centres, patients presenting with […]
Tag: PCI
PCI: Bleeding events correlate with early mortality
Although bleeding following percutaneous coronary intervention (PCI) has previously been linked with short- and long-term mortality, this association was derived from highly selected randomised controlled trials. This large study used the CathPCI registry to estimate the adjusted population attributable risk of bleeding-related mortality in patients undergoing PCI in the United States. […]
SYNTAX II: Improved predictive value
The anatomical SYNTAX score is advocated in both US and European guidelines to help establish the best revascularisation approach in patients with complex coronary artery disease. The purpose of this study was to improve the SYNTAX score further by including prognostically important clinical variables, as opposed to the anatomical variables that are used for the […]
FREEDOM: CABG superior to PCI in diabetics
Diabetes is one of the principle aetiological factors for coronary artery disease with vascular disease in diabetics displaying a particularly aggressive phenotype, often resulting in multivessel disease. Current evidence suggests that CABG is particularly beneficial in these patients as compared with PCI. however, much of this evidence was either gathered in the era before modern […]
Public Reporting of PCI Outcomes
Public reporting of outcomes is designed to motivate clinicians to improve performance, and allow patients to choose high quality hospitals. However, it has also been proposed that these measures prevent physicians from undertaking high-risk cases. The purpose of this study was to determine whether public reporting for percutaneous coronary intervention (PCI) is associated with lower […]
PCI in centres without surgical backup
As percutaneous coronary intervention (PCI) has advanced, improved technology and increased collective experience have led to a marked reduction in the need for emergency coronary artery bypass surgery (CABG), with only 0.15% of patients requiring emergency surgical intervention in 2002. In fact, PCI is now commonly practiced in hospitals without on-site cardiothoracic back-up, something that […]
How appropriate is coronary intervention?
When is a PCI procedure “appropriate” and when is it not? The answer depends on how you define “appropriate”, and recently appropriate use criteria for coronary revascularisations have been jointly developed by six professional organisations, including the AHA and ACC. The aim of this study, therefore, was to assess the appropriateness of PCI in the […]
PRECOMBAT: PCI viable for unprotected left main disease
The SYNTAX study, which randomised patients with complex severe coronary disease to either CABG or PCI, found that CABG remains a superior treatment option for the majority of these patients. However, in a substudy of patients who had left main stem (LMS) disease, SYNTAX suggested equipoise between the two treatments. Since then, the debate about […]
Medical therapy underused in patients undergoing PCI
Optimal medical therapy (OMT) has previously been shown to lead to similar rates of cardiovascular events as percutaneous coronary intervention (PCI) in patients with stable coronary artery disease. Most noticeably, the COURAGE trial showed that PCI did not improve patient survival or prevent myocardial infarction. However, it is also known that the findings of important […]
CABG rates decline in USA over the last decade
Coronary revascularisation, either by coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI), is one of the most commonly performed procedures in the USA. Over the last ten years a number of technological and pharmacological improvements have changed the landscape of coronary revascularisation and led to a number of changes in guidelines and appropriateness […]