The year in cardiology: coronary interventions

Figures

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  Figure 1. Summary of the findings of the three randomized control trials comparing percutaneous coronary intervention and medical therapy in patients with a total chronic occlusion. Image was Reprinted from Galassi et al.15 Percutaneous recanalization of chronic total occlusions: 2019 consensus document from the EuroCTO Club. Pages no. 198–208, Copyright 2019, with permission from Europa Digital & Publishing. CMR, cardiac magnetic resonance; CTO, chronic total occlusion; EQ-5D, EuroQol 5 dimensions questionnaire; J-CTO, Japanese chronic total occlusion; LAD, left anterior descending; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; OMT, optimal medical therapy; PCI, percutaneous coronary intervention; QoL, quality of life; RCA, right coronary artery; RCT, randomized control trial; SAQ, Seattle Angina Questionnaire; SCAD, stable coronary artery disease; STEMI, ST-segment elevation myocardial infarction; ΔMIB, decrease in myocardial ischaemia burden. This content is not covered by the terms of the CC BY-NC 4.0 Open Access agreement. Please refer to the original rightsholder.

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  Figure 2. Summary of the efficacy of paclitaxel-coated balloon angioplasty vs. drug-eluting stent implantation for the treatment of patients with in stent restenosis. Image obtained with permission from Giacoppo et al.20aPrimary efficacy endpoint: target lesion revascularization. bPrimary safety endpoint: the composite of death, myocardial infarction, or target lesion thrombosis. cNet composite endpoint: the composite of death, myocardial infarction, target lesion thrombosis, or target lesion revascularization. dNet composite endpoint: the composite of death, myocardial infarction, target lesion thrombosis, or target vessel revascularization. This content is covered by the terms of the CC BY-NC 4.0 Open Access agreement.

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  Figure 3. Value of intravascular imaging in guiding treatment in patients admitted with an acute coronary syndrome. Intravascular imaging (intravascular ultrasound or optical coherence tomography) can be considered in patients with obstructive coronary artery disease in case of a low-risk profile, atypical presentation or complex lesion morphology. In case of multivessel disease, hazy lesions or tortuosity/eccentricity intravascular imaging can be used to identify the culprit lesion while in the absence of obstructive coronary artery disease or in the presence of normal coronary angiogram when there are regional wall motion abnormalities and electrocardiographic changes invasive imaging can be used to exclude a plaque event. Optical coherence tomography can be used to differentiate plaque rupture, plaque erosion identify an erupted calcific nodule, spontaneous coronary dissection, or thromboembolic event; in the absence of a culprit lesion magnetic resonance imaging can be considered to identify other causes such Tako-tsubo cardiomyopathy or myocardial infarction with non-obstructive coronary arteries. Figure was obtained with permission from Johnson et al.46This content is not covered by…

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  Figure 4. Summary of the studies investigating the efficacy of intravascular imaging in detecting high-risk plaques and patients. The studies’ endpoints, the imaging predictors and the hazard ratio and the confidence interval of the imaging biomarkers are summarized, while the positive and negative predictive values are shown only for large scale studies with more than one imaging biomarkers as independent predictor. ACS, acute coronary syndrome; CI, confidence interval; DS, diameter stenosis; ESS, endothelial shear stress; FCT, fibrous cap thickness; LCBI, lipid core burden index; MI, myocardial infarction; MLA, minimum lumen area; NPV, negative predictive value; PB, plaque burden; PCI, percutaneous coronary intervention; PPV, positive predictive value; RI, remodelling index; TCFA, thin cap fibroatheroma.