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Planning Coronary Intervention: The “Golden Rules”—Patient Checklist and Troubleshooting

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Abstract

Several clinical and hemodynamic variables potentially factor in the immediate post-procedural and long-term outcome following percutaneous coronary intervention. The proper identification and definition of risk is a crucial prerequisite to implement adequate supportive measures and potentially avoid procedural complications. Discriminating coronary lesions based on their complexity has important implications for procedural planning and to predict (and prevent) the onset of procedural complications. However, the characteristics of a coronary lesion should be contextualized with the clinical presentation and patients’ risk profile to get a 360° vision of PCI complexity.

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References

  1. Kastrati A, Schömig A, Elezi S, Dirschinger J, Mehilli J, Schühlen H, Blasini R, Neumann FJ. Prognostic value of the modified American college of Cardiology/American heart association stenosis morphology classification for long-term angiographic and clinical outcome after coronary stent placement. Circulation. 1999;100(12):1285–90.

    Article  CAS  Google Scholar 

  2. Nakazawa G, Yazdani SK, Finn AV, Vorpahl M, Kolodgie FD, Virmani R. Pathological findings at bifurcation lesions: the impact of flow distribution on atherosclerosis and arterial healing after stent implantation. J Am Coll Cardiol. 2010;55(16):1679–87. https://doi.org/10.1016/j.jacc.2010.01.021.

    Article  PubMed  Google Scholar 

  3. Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59(2):183.

    Article  Google Scholar 

  4. Popma J, Leon M, Topol EJ. Atlas of interventional cardiology. Philadelphia, PA: Saunders; 1994.

    Google Scholar 

  5. Strauss BH, Shuvy M, Wijeysundera HC. Revascularization of chronic total occlusions: time to reconsider? J Am Coll Cardiol. 2014;64(12):1281–9. https://doi.org/10.1016/j.jacc.2014.06.1181.

    Article  PubMed  Google Scholar 

  6. Hamburger JN, Serruys PW, Scabra-Gomes R, Simon R, Koolen JJ, Fleck E, Mathey D, Sievert H, Rutsch W, Buchwald A, Marco J, Al-Kasab SM, Pizulli L, Hamm C, Corcos T, Reifart N, Hanrath P, Taeymans Y. Recanalization of total coronary occlusions using a laser guide wire (the European TOTAL Surveillance Study). Am J Cardiol. 1997;80(11):1419–23.

    Article  CAS  Google Scholar 

  7. Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Hinohara T, Tanaka H, Mitsudo K, J-CTO Registry Investigators. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4(2):213–21. https://doi.org/10.1016/j.jcin.2010.09.024.

    Article  PubMed  Google Scholar 

  8. Sinclair H, Veerasamy M, Bourantas C, Egred M, Nair A, Calvert PA, Brugaletta S, Mintz GS, Kunadian V. The role of virtual histology intravascular ultrasound in the identification of coronary artery plaque vulnerability in acute coronary syndromes. Cardiol Rev. 2016;24(6):303–9.

    Article  Google Scholar 

  9. Koskinas KC, Ughi GJ, Windecker S, Tearney GJ, Räber L. Intracoronary imaging of coronary atherosclerosis: validation for diagnosis, prognosis and treatment. Eur Heart J. 2016;37(6):524–35a-c. https://doi.org/10.1093/eurheartj/ehv642.

    Article  PubMed  Google Scholar 

  10. Guagliumi G, Capodanno D, Saia F, Musumeci G, Tarantini G, Garbo R, Tumminello G, Sirbu V, Coccato M, Fineschi M, Trani C, De Benedictis M, Limbruno U, De Luca L, Niccoli G, Bezerra H, Ladich E, Costa M, Biondi Zoccai G, Virmani R, Trial Investigators OCTAVIA. Mechanisms of atherothrombosis and vascular response to primary percutaneous coronary intervention in women versus men with acute myocardial infarction: results of the OCTAVIA study. JACC Cardiovasc Interv. 2014;7(9):958–68. https://doi.org/10.1016/j.jcin.2014.05.011.

    Article  PubMed  Google Scholar 

  11. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW, PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011 Jan 20;364(3):226–35. https://doi.org/10.1056/NEJMoa1002358.

    Article  CAS  Google Scholar 

  12. Garrone P, Biondi-Zoccai G, Salvetti I, Sina N, Sheiban I, Stella PR, Agostoni P. Quantitative coronary angiography in the current era: principles and applications. J Interv Cardiol. 2009;22(6):527–36. https://doi.org/10.1111/j.1540-8183.2009.00491.x.

    Article  PubMed  Google Scholar 

  13. Pantos I, Efstathopoulos EP, Katritsis DG. Two and three-dimensional quantitative coronary angiography. Cardiol Clin. 2009;27(3):491–502. https://doi.org/10.1016/j.ccl.2009.03.008.

    Article  PubMed  Google Scholar 

  14. Tomasello SD, Costanzo L, Galassi AR. Quantitative coronary angiography in the interventional cardiology. In: Kiraç SF, editor. Chapter book in “Advances in the Diagnosis of Coronary Atherosclerosis”. London: InTech; 2011. ISBN 978-953-307-286-9.

    Google Scholar 

  15. Capodanno D. Beyond the SYNTAX score—advantages and limitations of other risk assessment systems in left main percutaneous coronary intervention. Circ J. 2013;77(5):1131–8.

    Article  Google Scholar 

  16. Graham MM, Faris PD, Ghali WA, Galbraith PD, Norris CM, Badry JT, Mitchell LB, Curtis MJ, Knudtson ML, APPROACH Investigators (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease. Validation of three myocardial jeopardy scores in a population-based cardiac catheterization cohort. Am Heart J. 2001;142(2):254–61.

    Article  CAS  Google Scholar 

  17. Ortiz-Pérez JT, Meyers SN, Lee DC, Kansal P, Klocke FJ, Holly TA, Davidson CJ, Bonow RO, Wu E. Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging. Eur Heart J. 2007;28(14):1750–8.

    Article  Google Scholar 

  18. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999 Jul;16(1):9–13.

    Article  CAS  Google Scholar 

  19. Roques F, Michel P, Goldstone AR, Nashef SA. The logistic EuroSCORE. Eur Heart J. 2003;24(9):882–3.

    Article  Google Scholar 

  20. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–44.; discussion 744-5. https://doi.org/10.1093/ejcts/ezs043.

    Article  PubMed  Google Scholar 

  21. Romagnoli E, Burzotta F, Trani C, Siviglia M, Biondi-Zoccai GG, Niccoli G, Leone AM, Porto I, Mazzari MA, Mongiardo R, Rebuzzi AG, Schiavoni G, Crea F. EuroSCORE as predictor of in-hospital mortality after percutaneous coronary intervention. Heart. 2009;95(1):43–8. https://doi.org/10.1136/hrt.2007.134114.

    Article  CAS  PubMed  Google Scholar 

  22. Schwietz T, Spyridopoulos I, Pfeiffer S, Laskowski R, Palm S, DE Rosa S, Jens K, Zeiher AM, Schächinger V, Fichtlscherer S, Lehmann R. Risk stratification following complex PCI: clinical versus anatomical risk stratification including “post PCI residual SYNTAX-score” as quantification of incomplete revascularization. J Interv Cardiol. 2013;26(1):29–37. https://doi.org/10.1111/j.1540-8183.2013.12014.x.

    Article  PubMed  Google Scholar 

  23. Capodanno D, Dipasqua F, Marcantoni C, Ministeri M, Zanoli L, Rastelli S, Romano G, Sanfilippo M, Tamburino C. EuroSCORE II versus additive and logistic EuroSCORE in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2013;112(3):323–9. https://doi.org/10.1016/j.amjcard.2013.03.032.

    Article  PubMed  Google Scholar 

  24. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW, Investigators SYNTAX. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961–72. https://doi.org/10.1056/NEJMoa0804626.

    Article  CAS  PubMed  Google Scholar 

  25. Authors/Task Force members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619. https://doi.org/10.1093/eurheartj/ehu278.

    Article  Google Scholar 

  26. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44-122. doi: https://doi.org/10.1016/j.jacc.2011.08.007.

  27. Capodanno D. Lost in calculation: the clinical SYNTAX score goes logistic. Eur Heart J. 2012;33(24):3008–10. https://doi.org/10.1093/eurheartj/ehs346.

    Article  PubMed  Google Scholar 

  28. Nam CW, Mangiacapra F, Entjes R, Chung IS, Sels JW, Tonino PA, De Bruyne B, Pijls NH, Fearon WF, Study Investigators FAME. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol. 2011;58(12):1211–8. https://doi.org/10.1016/j.jacc.2011.06.020.

    Article  PubMed  Google Scholar 

  29. Capodanno D, Caggegi A, Miano M, et al. Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization. J Am Coll Cardiol Intv. 2011;4:287–97.

    Article  Google Scholar 

  30. Serruys PW, Farooq V, Vranckx P, et al. A global risk approach to identify patients with left main or 3-vessel disease who could safely and efficaciously be treated with percutaneous coronary intervention: the SYNTAX Trial at 3 years. JACC Cardiovasc Interv. 2012;5:606–17.

    Article  Google Scholar 

  31. Farooq V, Vergouwe Y, Raber L, et al. Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the logistic clinical SYNTAX Score. Eur Heart J. 2012;33:3098–104.

    Article  Google Scholar 

  32. Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX Score II. Lancet. 2013;381:639–50.

    Article  Google Scholar 

  33. Myat A, Patel N, Tehrani S, Banning AP, Redwood SR, Bhatt DL. Percutaneous circulatory assist devices for high-risk coronary intervention. JACC Cardiovasc Interv. 2015;8(2):229–44. https://doi.org/10.1016/j.jcin.2014.07.030.

    Article  PubMed  Google Scholar 

  34. O’Neill WW. What is high-risk PCI, and how do you safely perform it? J Invasive Cardiol. 2011;23(10):425–6.

    PubMed  Google Scholar 

  35. Brennan JM, Curtis JP, Dai D, Fitzgerald S, Khandelwal AK, Spertus JA, Rao SV, Singh M, Shaw RE, Ho KK, Krone RJ, Weintraub WS, Weaver WD, Peterson ED, National Cardiovascular Data Registry. Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2013;6(8):790–9. https://doi.org/10.1016/j.jcin.2013.03.020.

    Article  PubMed  Google Scholar 

  36. Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D, de Belder A, Redwood S, BCIS-1 Investigators. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA. 2010;304(8):867–74. https://doi.org/10.1001/jama.2010.1190.

    Article  CAS  PubMed  Google Scholar 

  37. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G, Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–45. https://doi.org/10.1016/S0140-6736(13)61783-3.

    Article  PubMed  Google Scholar 

  38. Seyfarth M, Sibbing D, Bauer I, Fröhlich G, Bott-Flügel L, Byrne R, Dirschinger J, Kastrati A, Schömig A. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8. https://doi.org/10.1016/j.jacc.2008.05.065.

    Article  PubMed  Google Scholar 

  39. O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717–27. https://doi.org/10.1161/CIRCULATIONAHA.112.098194.

    Article  PubMed  Google Scholar 

  40. Thiele H, Sick P, Boudriot E, Diederich KW, Hambrecht R, Niebauer J, Schuler G. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26(13):1276–83.

    Article  Google Scholar 

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Buccheri, S., Capodanno, D. (2018). Planning Coronary Intervention: The “Golden Rules”—Patient Checklist and Troubleshooting. In: Myat, A., Clarke, S., Curzen, N., Windecker, S., Gurbel, P.A. (eds) The Interventional Cardiology Training Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-71635-0_8

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  • DOI: https://doi.org/10.1007/978-3-319-71635-0_8

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