2021 Top 10

Deepak Bhatt, Editor-in-Chief, selects the 2021 Top 10

See below for the most notable articles from JIC 2021

COVID 19 in the Cath Lab

Logistical, Financial, and Psychological Impact of the COVID-19 Pandemic on Cardiac Catheterization Lab Nurses and Technologists: A U.S. National Survey

Bailey Ann Estes, BSN; Joji J. Varghese, MD; Jared Jacques, BS; Srihari S. Naidu, MD

Coronavirus 2019 (COVID-19) significantly impacted cardiac care delivery in a manner that has not been previously experienced in the United States. Attention and resources have focused on physicians, patients, and healthcare systems with little information regarding the effects on nurses and technologists in the cardiac catheterization laboratory (CCL). Therefore, a national, online survey was conducted for nurses and technologists working in the CCL in the United States. The survey was self-administered, anonymous, and included 45 questions assessing baseline demographics, logistical changes to workflow and responsibilities, staff preparedness, and mental health.

J INVASIVE CARDIOL 2021;33(1):E9-E15

Coronary Artery Disease

Prognosis of Patients With Left Circumflex Artery Acute Myocardial Infarction in Relation to ST-Segment on Admission Electrocardiogram

Ofer Kobo, MD, MHA*; Erez Marcusohn, MD*; Ariel Roguin, MD, PhD; Robert Zukermann, MD; Naama Amsalem; Eugenia Nikolsky, MD, PhD; Simcha R. Meisel, MD.  *Equally contributed.

Total thrombotic occlusion of the left circumflex (LCX) artery may present without ST-segment elevations; the clinical outcomes of such patients remain unclear. Our objective was to examine the difference in clinical outcomes between patients with acute myocardial infarction due to LCX occlusion or stenosis with and without ST-segment elevation. Our study is based on an observational, retrospective cohort comprising all patients admitted to 2 centers between 2009 and 2019 with MI due to LCX disease. Clinical outcomes included recurrent percutaneous coronary intervention, hospitalization due to acute coronary syndrome, and mortality.

J INVASIVE CARDIOL 2021;33(1):E20-E24

Chronic Total Occlusions

Intravascular Lithotripsy for the Treatment of Calcium-Mediated Coronary In-Stent Restenoses

Fabian J. Brunner, MD; Peter Moritz Becher, MD; Christoph Waldeyer, MD; Elvin Zengin-Sahm, MD; Renate B. Schnabel, MD; Peter Clemmensen, MD; Dirk Westermann, MD; Stefan Blankenberg, MD; Moritz Seiffert, MD

Coronary intravascular lithotripsy (IVL) has recently been evaluated for the treatment of severely calcified native coronary lesions. Evidence for its use in in-stent restenosis is sparse and is still an off-label indication. Therefore, we aimed to evaluate the feasibility, safety, and acute and mid-term angiographic outcomes after IVL for the treatment of calcium-mediated coronary in-stent restenosis.

J INVASIVE CARDIOL 2021;33(1):E25-E31

COVID-19

In-Hospital and 30-Day Mortality After Percutaneous Coronary Intervention in England in the Pre-COVID and COVID Eras

Mohamed O. Mohamed, MRCP(UK);  Tim Kinnaird, MD;  Nick Curzen, PhD, FRCP;  Peter Ludman, MD;  Jianhua Wu, PhD;  Muhammad Rashid, PhD;  Ahmad Shoaib, MD;  Mark de Belder, MD, FRCP;  John Deanfield, FRCP;  Chris P. Gale, PhD, FRCP;  Mamas A. Mamas, DPhil

Public reporting of percutaneous coronary intervention (PCI) outcomes is a performance metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death after PCI, and the proportion of these deaths that are attributable to cardiac causes. All patients undergoing PCI in England between January 1, 2017 and May 10, 2020 (n = 273,141) were retrospectively analyzed according to their outcome from the date of PCI: no death, in-hospital death, postdischarge death, and total 30-day death. The present study examined short-term primary causes of death after PCI in a national cohort before and during COVID-19.

J INVASIVE CARDIOL 2021;33(3):E206-E219

High-Risk PCI

Predictors of Clinical Outcome After Early Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction

Lukasz Szczanowicz, MD; Nicolas Majunke, MD; Suzanne de Waha-Thiele, MD; Franziska Tietz, MD; Stephan Schürer, MD; Katharina Kirsch, MD; Steffen

Despite increasing use of VA-ECMO in patients with CS secondary to STEMI, a paucity of adequate evidence for this therapy remains. The aim of this single-center clinical registry study was to identify predictors of survival and discern the possible optimal time to initiate VA-ECMO in this cohort.

J INVASIVE CARDIOL 2021;33(5):E329-E335

Complications / High-Risk Patients

Pregnancy-Associated Spontaneous Coronary Artery Dissection: Clinical Characteristics, Outcomes, and Risk During Subsequent Pregnancy

Stephanie Chen, MD;  Maqdooda Merchant, MD;  Kenneth N. Mahrer, MD; Andrew P. Ambrosy, MD;  Robert J. Lundstrom, MD;  Sahar Naderi, MD

Spontaneous coronary artery dissection (SCAD) is a common cause of pregnancy-associated myocardial infarction. This study compares the clinical course and longitudinal follow-up of 22 cases of pregnancy-associated SCAD (P-SCAD) with 285 cases of non-pregnancy SCAD (NP-SCAD) from Kaiser Permanente Northern California between September 2002 through June 2017.

J INVASIVE CARDIOL 2021;33(6):E457-E466

High-Risk PCI

Outcomes of Vascular Closure Device Use After Transfemoral Coronary Intervention: Insights from the EXCEL Trial  

Toshiki Kuno, MD, PhD^1,2;  Bimmer E. Claessen, MD, PhD¹;  Paul Guedeney, MD¹; Patrick W. Serruys, MD, PhD^3,4;  Joseph F. Sabik III, MD⁵;  Charles A. Simonton, MD⁶; David E. Kandzari, MD⁷;  Marie-Claude Morice, MD⁸;  Zixuan Zhang, MS⁹; Ovidiu Dressler, MD⁹;  Roxana Mehran, MD^1,9;  Ori Ben-Yehuda, MD^9,10; Arie Pieter Kappetein, MD, PhD¹¹;  Gregg W. Stone, MD^1,9

VCDs provide rapid hemostasis for patients undergoing PCI with transfemoral access (TFA); however, the safety and efficacy of VCDs continues to be debated. Our objectives were to assess the safety and efficacy of using vascular closure devices (VCDs) in percutaneous coronary intervention (PCI) for left main coronary artery disease (LM-CAD). In this study, we found that in the EXCEL trial, LM-CAD PCI via TFA using VCD was associated with similar 30-day rates of bleeding and comparable early and late major adverse cardiovascular events compared with manual compression.

J INVASIVE CARDIOL 2021;33(8):E619-E627

Access-Site Complications

Comparison of Vascular Closure Devices vs Manual Compression After Femoral Artery Puncture in Patients on Oral Anticoagulation — Post Hoc Analysis of the ISAR-CLOSURE Trial

Katharina Mayer, MD;  Senta Gewalt, MD;  Tanja Morath, MD;  Christopher Emmer, MD;  Raphaela Hilz, MD;  Maryam Linhardt, MD; Katharina Hoppe, MD;  Roland Schmidt, MD;  Lorenz Bott-Flügel, MD;  Karl Ludwig Laugwitz, MD;  Heribert Schunkert, MD;  Adnan Kastrati, MD;  Stefanie Schüpke, MD;  Nikolaus Sarafoff, MD

Our objective was to compare vascular closure devices (VCDs) with manual compression (MC) in patients on chronic oral anticoagulation (OAC) who undergo diagnostic coronary angiography in terms of vascular access-site complications. This is a subanalysis of 604 patients who underwent transfemoral diagnostic coronary angiography and were randomly assigned to arteriotomy closure with either VCDs (intravascular FemoSeal VCD or extravascular Exoseal VCD) or MC within the large-scale, randomized ISAR-CLOSURE trial. The primary endpoint was the composite of access-site related vascular complications at 30 days. Secondary endpoints were time to hemostasis and repeat MC.

J INVASIVE CARDIOL 2021;33(9):E709-E715

Transcatheter Aortic Valve Replacement

Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement

Hani Jneid, MD;  Douglas Farmer, MD;  Riyad Y. Kherallah, MD;  David Paniagua, MD;  Ali Denktas, MD;  Biswajit Kar, MD;  Lorraine Cornwell, MD;  Alvin Blaustein, MD;  Ourania Preventza, MD;  Ernesto Jimenez, MD

Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population. We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease, were assessed with multivariable regression and competing-risk analyses. Long-term survival of veterans after TAVR is comparable to that of their non-veteran counterparts. Significant coronary artery disease, along with age and select comorbidities, was associated with poorer survival.

J INVASIVE CARDIOL 2021;33(9):E730-E737

Coronary Imaging

Coronary Plaque Rupture in Stable Coronary Artery Disease and Non-ST Segment Elevation Myocardial Infarction: An Optical Coherence Tomography Study

Luca Mariani, MD, PhD;  Francesco Burzotta, MD, PhD;  Cristina Aurigemma, MD, PhD;  Giancarla Scalone, MD, PhD;  Francesco Fracassi, MD;  Giampaolo Niccoli, MD, PhD;  Rocco Vergallo, MD;  Andrea Romano, MD; Alessandro Aimi, MD;  Luca Di Vito, MD, PhD;  Simona Silenzi, MD;  Pierfrancesco Grossi, MD;  Carlo Trani, MD;  Filippo Crea, MD

Plaque rupture is the main cause of coronary thrombosis in non-ST segment elevation myocardial infarction (NSTEMI), but can be found in stable coronary artery disease (CAD). Our study compared the morphology and local inflammatory activity of ruptured plaques between stable CAD and NSTEMI patients using frequency-domain optical coherence tomography (FD-OCT). We retrospectively evaluated 70 plaques with plaque rupture at the FD-OCT (25 in stable CAD patients and 45 in NSTEMI patients). Main clinical, angiographic, and morphological features were compared.

J INVASIVE CARDIOL 2021;33(11):E843-E850