Adverse outcomes following percutaneous transcatheter interventions

Advancements in the field of interventional cardiology have resulted in better survival and a shorter recovery period for patients with coronary artery and valve disease. Despite the benefits of these less invasive techniques, it is important to keep in mind the adagium “primum non nocere”. Technical refinements with smaller catheters and different access routes have resulted in less adverse outcomes. However, increased aging and improved life-expectancy will likely result in an increased number of percutaneous interventions, and also increased complexity of these procedures. This will subsequently lead to a greater number of patients being exposed to the risk of adverse outcomes. By investigating the occurrence and causes of adverse outcomes we can improve both the techniques as well as patient selection. This thesis aims to provide a further understanding of adverse outcomes following specific transcatheter percutaneous interventions.
First we investigated the thrombo-embolic and bleeding complications in both percutaneous coronary and aortic valve interventions. In this section we report the occurrence of silent cerebral infarcts following cardiac procedures, predictors and implications of gastro-intestinal bleeding in ST-segment myocardial infarct (STEMI) patients and we performed a patient pooled analysis on antiplatelet therapy following transcatheter aortic valve implantation.
Second we focused on the efficacy and safety outcomes of a novel percutaneous coronary stent, the ABSORB bioresorbable vascular scaffold®, in real world practice.
Finally we investigated adverse remodeling in ST-elevated myocardial infarction patients treated with primary percutaneous coronary intervention. We observed that left ventricular remodeling is a long-term continuing process, and identified markers of adverse left ventricular remodeling.