In collaboration with wwwCCClivecasesorg from Cardiac Cath Lab Mount Sinai Heart NY USA in Association with CME MEDI Q UEST Disclosures ID: 1041635
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1. Complex Coronary Live Case Series In collaboration with www.CCClivecases.org from Cardiac Cath Lab, Mount Sinai Heart, NY, USA in Association with CME MEDIQUEST
2. DisclosuresSamin K. Sharma, MD, MSCAI, FACC Speaker’s Bureau – BSCAnnapoorna S. Kini, MD, MRCP, FACC Nothing to discloseKarunakar Rapolu, MD, DM (Guest Faculty) K.M.K Reddy, MD, DM, FACC, FCSI, FESC (Moderator)
3. Jimmy George, MBBS, MD, DM Consultant Interventional Cardiologist Lisie Heart Institute, Lisie Hospital Kochi, KeralaDr. Jimmy George is Consultant Interventional Cardiologist at Lisie Heart Institute, Lisie Hospital. He is Treasurer & Organising Secretary of Cardiovascular Research Society, Present Executive Committee Member of CSI Kerala, ICCK Interventional Cardiology Council Kerala, Society of Coronary Imaging & Physiology-India, Cochin Cardiology Forum and Lisie Research Executive Committee member 2022. He is International Faculty in 2022 TCT - AsiaPacific Seoul.Jabir Abdullakutty, MD, DM, FRCP, FACC, FESC, FSCAI Senior Consultant CardiologistDirector, Academic Affairs and Clinical ResearchLisie Hospital, Kochi, KeralaCORRECT ONEK. M. K. Reddy, MD, DM, FACC, FCSI, FESCProf. of CardiologyHOD, Osmania Medical College, ICD Senior Consultant Cardiologist, Apollo Hospitals, HyderabadDr. Reddy is Senior Professor of Cardiology & HOD at Osmania Medical College, Hyderabad. He is also a Senior Consultant, Cardiology & Interventional Cardiology at Apollo hospitals, Hyderabad. He completed his graduation and post-graduation studies from SV Medical College,Tirupati followed by DM (Cardiology) from Andhra Medical College, Visakhapatnam. He was the President of Cardiological Society of India, Telangana Chapter, 2020-2022. He has more than 50 publications in various international and national journals. He is Principal Investigator (PI) in a Global Clinical Trial SELECT , ZEUS and many other national clinical trials. Karunakar Rapolu, MD, DM (Cardiology) Consultant CardiologistApollo Hospitals,HyderabadDr. Rapolu is Consultant Cardiologist at Apollo hospitals, Hyderabad. He completed his graduation and post-graduation studies followed by DM in Cardiology from Osmania Medical College. He is a member of Medical Council of India (MCI) and Cardiological Society of India (CSI). He has special interest in Complex Coronary Interventions, Peripheral Interventions & Device Closures. He is actively involved in research and publication and have papers published in renowned journals.
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5. Live Case #22Clinical VariablesNo prior cardiac medical history with no medical checkups. Echo revealed EF 30% with mod MR.Present Clinical PresentationPresented with NSTEMI and + high risk MPI for MV ischemia May 2022. Also noted in HFrEF.Patient Demographics 79 yrs, MCAD Risk Factors Controlled hypertension Controlled hyperlipidemia Controlled NIDDM H/o CVA with no residualsMedicationsAspirin, Clopidogrel, Metoprolol, Furosemide, Temisartan, Amlodipine, Atorvastatin, Glucophage, SitaglaptinPlan: Now planned for multivessel PCI of LCx and rotational atherectomy with multiple DES of LAD/D1 bifurcation and Impella LV support.Cath: Cardiac cath on June 9th 2022 revealed extensive diffuse 3 V CAD: 70-80% calcific mid LAD/D1 bifurcation, subtotal thrombotic LCx-OM1, 80% calcific RCA-RPDA & AV cont bifurcation, LVEF 28% and Syntax score 33. Pt underwent HFrEF GDMT optimization and referred for CABG, which was declined after heart team discussion.
6. Assessment and Predicting Patient RiskRecommendation to Predicting Patient Risk of Death with CABG: STS RiskAssessment of Risk Factors Not Qualified in the STS ScoreRecommendation for Defining Coronary Artery Lesion Complexity: SYNTAX ScoreRecommendation for the Heart TeamLawton et al., J Am Coll Cardiol 2022:79;e21-129Syntax score 33; STS score 3.1
7. Use of Coronary Physiology to Guide Revascularization with PCILawton et al., J Am Coll Cardiol 2022:79;e21-129Recommendations for the Use of Coronary Physiology to Guide Revascularization Recommendations for Intravascular Ultrasound to Assess Lesion Severity
8. AUC 2017: Left Main + 2/3 V CADPatel et al., J Am Coll Cardiol 2017;69:2212
9. Revascularization to Improve Survival in SIHD Compared to Medical TherapyLawton et al., J Am Coll Cardiol 2022:79;e21-129
10. Percutaneous LV Assist DevicesIABPPTVA:TandemHeartIMPELLA:Recovers 2.5/CP
11. LV Support during High-risk PCI:LVEF + Lesion ComplexityLVEF >40%LVEF 20-40%LVEF <20%Simple PCIComplex PCINo supportNone ?IABP/?ImpellaImpella/PTVASimple or Complex:Inoperable casesNone or IABPImpella/IABP (if Impella is CI)Simple PCIComplex PCI: High Syntax score >32/ STS>5Extensive revascularization
12. LV Support during High-risk PCI:LVEF + Lesion ComplexityLVEF >40%LVEF 20-40%LVEF <20%Simple PCIComplex PCINo supportNone Impella is okImpella/PTVASimple or Complex:Inoperable casesNone or IABPImpella/IABP (if Impella is CI)Simple PCIComplex PCI: High Syntax score >32/ STS>5Extensive revascularization
13. Cath LabAppsComplicAIDBifurcAIDTranseptAIDCalcificAIDGuidewireAIDBifurcAID 3DOCTAIDTAVRcathAIDMobile AppComing soon…
14. > 60,000 unique downloads and counting!BifurcAIDCath Lab Apps CardiologyApps.comData Updated on Jun 9 2022*iOS ★ 5/512,703 downloadsAndroid ★ 5/510,536 downloadsReleased sept 2017OCTAIDiOS ★ 5/58,731 downloadsAndroid ★ 4.7/55,242 downloadsReleased June 2018 TranseptAIDiOS ★ 5/52,277 downloadsAndroid ★ 4.6/51,298 downloadsReleased Sept 2018 TAVRcathAIDiOS ★ 5/54,546 downloadsAndroid ★ 5/52,017 downloadsReleased March 2019 CalcificAIDiOS ★ 5/52,805 downloadsAndroid ★ 5/51,918 downloadsReleased June 2019ComplicAID30,248 page viewswww.cardiologyapps.com/ComplicAIDReleased August 2020BifurcAID 3DiOS ★ 5/52,932 downloadsAndroid ★ 4.9/51,847 downloadsReleased June 2021STEMIcathAIDClinical Care Application For Heart Attack patient transfers 555 downloadsReleased Aug 2020GuidewireAIDiOS ★ 5/51,678 downloadsAndroid ★ 5/51,302 downloadsReleased Nov 2021Apple ® and App Store® are registered trademarks of Apple Inc.And 5 more in development…DeviceAIDWebApp Out Now!Mobile App isComing Soon
15. Revascularization to Improve Survival in SIHD Compared to Medical TherapyRecommendations for Revasc to Improve Survival in SIHD Compared with Medical TherapyLawton et al., J Am Coll Cardiol 2022:79;e21-129
16. Specific Indications for PCIRecommendations for Radial and Femoral Approach for PCIRecommendations for Use of Intravascular ImagingLawton et al., J Am Coll Cardiol 2022:79;e21-129
17. Patients with Complex Disease & DiabetesRecommendations for Patients with Complex DiseaseRecommendations for Patients with DiabetesLawton et al., J Am Coll Cardiol 2022:79;e21-129
18. Revascularization to Improve Survival in SIHD Compared to Medical TherapyLawton et al., J Am Coll Cardiol 2022:79;e21-129
19. AUC 2017: Revascularization to Improve Survival Compared with Medical TherapySyntax score 48; STS score 5.1Patel et al., J Am Coll Cardiol 2017;69:2212
20. www.ccclivecases.org
21. CCClivecases: Total Page Views per Month (Past 2 Years) Number of views
22. Protocol for Management of Calcific LesionsModerate-severe calcificationCoronary AngiographyStent and OCT/IVUS optimizationRA or OA ?ELCASuboptimal balloon expansionOptimal balloon expansionNC balloon/CBDoes not crossLithotripsy IVLSuboptimal result- High-pressure NC balloons- Cutting/scoring balloonLithotripsy IVL (RA/OA for Ca 360°)Optimal balloon expansionIVUS/OCT assessment: Calcium arc 180-270° (2points) Calcium arc >270° (3 points) Calcium length >5 mm (1 point) Thickness >0.5 mm (1 point)1-2 points3-5 pointsCalcific Nodule≈50%Un-crossable lesion/CTOAngulated lesionTortuous lesionLong lesionIVUS/OCT/balloon did not cross≈50%ELCA, if no Rota/OA Wire could be crossed