Coronary artery disease最新文献

Background: Coronary artery disease (CAD) outcomes are influenced by social determinants, including marital status. However, research on the sex-specific effects of marital status on CAD outcomes is limited. This study aimed to evaluate the relationship between marital status and clinical outcomes of patients with CAD stratified according to sex in Korea.

Methods: A total of 3476 patients with CAD who underwent percutaneous coronary intervention (PCI) were enrolled in this retrospective observational study. Patients were categorized into married and nonmarried groups based on demographic data at the time of admission. The primary endpoint was all-cause mortality.

Results: Among the study population, 20.7% of women and 11.5% of men who underwent PCI for CAD were nonmarried. For 87.1% of nonmarried women, the cause of being nonmarried was the death of a spouse, whereas for 48.3% of unmarried men, the most common cause was being unmarried. During a median follow-up of 53.3 months, in analysis using the Cox proportional hazard regression model, nonmarried status was associated with higher all-cause [adjusted hazard ratio (HR): 2.24, 95% confidence interval (CI): 1.22-4.09, P  = 0.009] and cardiovascular (adjusted HR: 2.63, 95% CI: 19.91-5.80, P  = 0.017) deaths in men but not in women.

Conclusion: Marital status independently predicted the adverse outcomes in men with CAD but not in women, highlighting the importance of sex-specific approaches to the assessment of social determinants in cardiovascular care. Future studies should explore broader social and economic factors to inform targeted interventions.

Background: Despite advancements in percutaneous coronary intervention (PCI), stent-related complications continue to occur, emphasizing the necessity for stent optimization. This study employed optical coherence tomography (OCT) to investigate the safety and efficacy of overexpanding the biodegradable polymer everolimus-eluting stent (SYNERGY; Boston Scientific, Marlborough, Massachusetts, USA) stent in large coronary arteries.

Methods: This single-center observational study enrolled patients with ischemic heart disease requiring stent placement in large coronary arteries (≥4.5 mm). The patients underwent PCI guided by OCT using SYNERGY stents, incorporating postdilation techniques to enhance expansion. Stent parameters were evaluated through OCT imaging. The primary endpoints focused on the maximum stent diameter and the maximum percentage of overexpansion. Secondary clinical outcomes, including death, myocardial infarction (MI), revascularization, stent thrombosis, cerebrovascular accidents (CVAs), and heart failure readmissions, were monitored with follow-ups at 1, 6, and 12 months, as well as annually thereafter.

Results: A total of 12 patients (8427 struts) were analyzed after successful PCI. OCT imaging showed adequate stent expansion, maximum stent diameter was 4.5 ± 0.2 mm, with a maximum expansion of 113.2 ± 4.1%), with no definite stent fractures or major edge dissections. During follow-up, one patient experienced an MI, but no stent thrombosis, target lesion revascularization, CVA, or death were reported.

Conclusion: Application of OCT-guided PCI with SYNERGY stents is safe and effective for treating large coronary arteries. It facilitates optimal stent expansion and yields favorable long-term outcomes. These results advocate for an expanded application of OCT-guided PCI in complex anatomical situations, showcasing the performance of SYNERGY stents in cases of excess expansion.

Background: Thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients with a high thrombus burden remains an important clinical consideration. This study aimed to evaluate the impact of aspiration catheter size on thrombus removal and the slow-flow/no-reflow phenomenon.

Methods: This retrospective study included 208 STEMI patients presenting within 12 h of symptom onset with high thrombus burden. All underwent primary PCI with thrombus aspiration. Patients were divided based on catheter size: 7-French (n = 85) and 6-French (n = 123). Clinical characteristics, procedural outcomes, and angiographic results were compared. Multivariate logistic regression identified independent predictors of slow-flow/no-reflow.

Results: Patients treated with a 7-French catheter had a lower incidence of slow-flow/no-reflow after stent deployment (14.0 vs. 36.6%; P < 0.001) and postdilatation (25.0 vs. 55.2%; P = 0.003). Final thrombolysis in myocardial infarction 3 flow was more frequently achieved in the 7-French group (100 vs. 90.2%; P = 0.032). History of stroke or transient ischemic attack [odds ratio (OR): 5.16; P = 0.021] and ischemic time greater than 330 min (OR: 2.13; P = 0.032) were predictors of no-reflow, while use of a 7-French catheter was protective (OR: 0.26; P < 0.001).

Conclusion: In STEMI patients with high thrombus burden, using a 7-French aspiration catheter was associated with higher procedural success and lower incidence of slow-flow/no-reflow. Larger-caliber catheters may offer a clinical advantage in selected patients undergoing primary PCI.

Background: Percutaneous coronary intervention (PCI) in severely calcified lesions remains challenging. While orbital atherectomy is a treatment option for calcified lesions, the specific patient and lesion characteristics that predict successful debulking with orbital atherectomy remain unclear. This study aimed to identify the factors associated with a greater minimum lumen area (MLA) after orbital atherectomy.

Methods: We retrospectively identified 77 lesions in 68 patients who underwent PCI with orbital atherectomy at Tottori University Hospital from May 2020 to June 2024. Among these, 62 lesions with a measurable intraluminal area by intravascular imaging were included in the analysis. The lesions were divided into two groups on the basis of a median post-orbital atherectomy MLA of 2.5 mm2: the large group (≥2.5 mm2) and the small group (<2.5 mm2). We compared the patients' background, characteristics of the lesions, procedural details, and imaging findings between the two groups.

Results: The large group more frequently had prior rotational atherectomy use (35.5 vs. 3.2%; P = 0.004) and had a greater pre-orbital atherectomy MLA [2.36 (2.01-3.10) vs. 1.37 mm2 (0.99-1.76); P < 0.001] than the small group. No significant differences in major complications or 1-year outcomes were observed between the two groups.

Conclusion: Optimal lumen gain following orbital atherectomy was associated with a greater pre-orbital atherectomy MLA and prior rotational atherectomy. Pretreatment with rotational atherectomy may establish a sufficient lumen, subsequently enhancing the efficacy of orbital atherectomy. These results suggest the effectiveness of a strategy of using rotational atherectomy before orbital atherectomy.

Background: Historically, the elderly population was underrepresented in clinical trials evaluating the optimal treatment for non-ST-segment elevation myocardial infarction (NSTEMI). Therefore, we aimed to compare invasive versus noninvasive strategies for the management of NSTEMI in older adults.

Methods: PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were screened for studies evaluating medical therapy or invasive revascularization in elderly patients with NSTEMI. Following outcomes were extracted: all-cause mortality, cardiovascular death, fatal or nonfatal MI, repeat coronary revascularization, major adverse cardiovascular events (MACE), bleeding, stroke, noncardiovascular death, and repeat hospitalization for heart failure. Data were pooled using random-effects model to evaluate weighted mean differences and risk ratios with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42024622236.

Results: Seven studies (n = 2997 patients) were included. Patients treated with medical versus invasive therapies showed no significant difference in all-cause mortality (risk ratio: 1.05, 95% CI: 0.94-1.18, P = 0.37); however, invasive therapies significantly decreased the risk of fatal or nonfatal MI (risk ratio: 0.75, 95% CI: 0.59-0.96, P = 0.02), repeat coronary revascularizations (risk ratio: 0.29, 95% CI: 0.21-0.40, P < 0.00001), and risk of MACE (risk ratio: 0.74, 95% CI: 0.61-0.89, P = 0.002). Lastly, invasive therapies were associated with increased risk of bleeding.

Conclusion: Invasive therapy, in comparison to medical management, has reduced incidence of fatal or nonfatal MI, MACE, and the need for revascularization; however, no benefit was noted for all-cause and cardiovascular mortality. Age-specific guidelines must be established for the management of NSTEMI among older adults.

Background: Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults.

Methods: Cochrane, PubMed, and Scopus were searched for RCTs comparing intravascular imaging (IVUS or OCT) vs. angiography alone in adults aged ≥65 years. The outcome of interest was major adverse cardiovascular events (MACE) at the longest follow-up, as defined by each trial. Subgroup analyses were performed based on intravascular imaging modality, age group, and lesion complexity. Data were pooled using random-effects models, and heterogeneity was assessed using Higgins' I² statistic.

Results: Nine RCTs (n = 7164, intravascular imaging = 3703, angiography alone = 3461) met the inclusion criteria. Intravascular imaging significantly reduced MACE compared with angiography alone [relative risk (RR) 0.66, 95% confidence interval (CI) 0.56-0.77; P < 0.001; I² = 0%]. IVUS demonstrated superiority over angiography alone (RR 0.55, 95% CI 0.43-0.72; P < 0.001; I² = 0%), while OCT demonstrated only a trend toward MACE reduction (RR 0.80, 95% CI 0.62-1.02). Subgroup analyses indicated consistent benefits with intravascular imaging for adults aged ≥65 and ≥70 years, respectively, and among those with complex coronary lesions (RR 0.65, 95% CI 0.53-0.79; P < 0.001).

Conclusion: Intravascular imaging guidance, especially IVUS, reduces MACE in older adults undergoing PCI compared with angiography alone.

Background: Timely restoration of blood flow is critical for ST-segment elevation myocardial infarction (STEMI) management. We evaluate the effects of time intervals - total ischemic time, time from symptom onset to first medical contact, delay within the healthcare system, and time from hospital arrival to balloon inflation and from arrival at the catheterization laboratory to balloon inflation - on in-hospital mortality among patients with STEMI undergoing primary percutaneous coronary intervention.

Methods: We analyzed data from 315 patients with STEMI who underwent primary percutaneous coronary intervention in a hospital between 2020 and 2021. A random forest model was used to assess the predictive importance of time delay components for in-hospital mortality.

Results: Of the total sample, 35 patients died. The median (interquartile range) for total ischemic time was 310.0 (215.0-547.5) min. Univariate analysis showed significant differences between the two groups in time to first medical contact [120.0 (60.0-245.0) vs. 210.0 (120.0-272.5); P = 0.007] and total ischemic time [300.0 (210.0-531.2) vs. 370.0 (320.0-720.0); P = 0.001]; however, the multivariable model (accuracy = 0.971, sensitivity = 0.800, specificity = 0.999, and an area under the curve = 0.93) identified total ischemic time as the most important time-based predictor of mortality, followed by system delay, time from hospital arrival to balloon inflation, from symptom onset to first medical contact, and from arrival at the catheterization laboratory to balloon inflation.

Conclusion: Each delay component in STEMI management carries distinct clinical consequences that necessitate targeted intervention.