The American journal of cardiology
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Randomized Controlled Trial Multicenter Study
Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trials).
Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials-Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. ⋯ By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95% confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population.
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Randomized Controlled Trial Comparative Study
Comparison of endovascular versus epicardial lead placement for resynchronization therapy.
Cardiac resynchronization therapy (CRT) has been shown to improve survival and symptoms in patients with severe left ventricular (LV) dysfunction, congestive heart failure, and prolonged QRS duration. LV lead placement is achieved by placing the lead in the coronary sinus, an endovascular approach, or by a minimally invasive robotic-assisted thoracoscopic epicardial approach. There are no data directly comparing the 2 methods. ⋯ There were no significant differences in the secondary end points between the 2 groups. In conclusion, there were no differences in echocardiographic and clinical outcomes comparing a conventional endovascular approach versus robotic-assisted surgical epicardial LV lead placement for CRT in patients with heart failure. Surgical approaches are still a viable alternative when a transvenous procedure has failed or is not technically feasible.