JACC. Cardiovascular interventions最新文献

英文中文

Long-Term Prognosis of Coronary Aneurysms 冠状动脉瘤的长期预后

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.08.034

Iván Sánchez-Sánchez MD , Enrico Cerrato MD, PhD , Mario Bollati MD , Carolina Espejo-Paeres MD , Luis Nombela-Franco MD, PhD , Emilio Alfonso-Rodríguez MD , Santiago J. Camacho-Freire MD, PhD , Pedro A. Villablanca MD , Ignacio J. Amat-Santos MD, PhD , José M. De la Torre Hernández MD, PhD , Isaac Pascual MD, PhD , Christoph Liebetrau MD, PhD , Benjamín Camacho MD , Marco Pavani MD , Juan Albistur MD , Roberto Adriano Latini MD , Ferdinando Varbella MD , Víctor Alfonso Jiménez Díaz MD , Davide Piraino MD , Massimo Mancone MD, PhD , Iván J. Núñez-Gil MD, PhD

Background

Limited data are available to guide the management of coronary artery aneurysms (CAAs).

Objectives

The authors sought to define the clinical characteristics, identify variables that predict outcomes, and provide long-term data on CAAs.

Methods

We describe outcomes from 1,729 consecutive patients with CAAs included in an ambispective international registry (CAAR [Coronary Artery Aneurysm Registry]; NCT02563626) involving 33 hospitals across 9 countries in America and Europe.

Results

Patients were predominantly male (78.6%; 1,359/1,729) with a mean age of 66 years. Classic cardiovascular risk factors were common, as well as coronary artery disease (85.8%; 1,484/1,729), peripheral vascular disease (10.9%; 188/1,729), and chronic kidney disease (8.0%; 138/1,729). The median number of aneurysms per patient was 1.0 (Q1-Q3: 1.0-1.0), with the most affected territory being the left anterior descending artery (49.6%; 857/1,729). The majority underwent any revascularization procedure (68.5%; 1,184/1,729), mainly percutaneous coronary intervention (50.7%; 877/1,729), and were discharged on dual antiplatelet therapy (65.6%; 1,134/1,729). After a median follow-up of 44.8 months (Q1-Q3: 14.9-88.1), 379 died (21.9%), and 641 (37.1%) developed a major adverse cardiovascular event (MACE) (all-cause death, heart failure, unstable angina, and reinfarction). In a multivariable analysis, age (HR: 1.03; 95% CI: 1.02-1.04; P < 0.001), diabetes mellitus (HR: 1.47; 95% CI: 1.23-1.75; P < 0.001), renal insufficiency (HR: 1.53; 95% CI: 1.19-1.96; P = 0.010), peripheral vessel disease (HR: 1.43; 95% CI: 1.13-1.82; P = 0.003), reduced left ventricular ejection fraction (HR: 0.98; 95% CI: 0.98-0.99; P < 0.001), acute indication for the index coronary angiography (HR: 1.30; 95% CI: 1.08-1.55; P = 0.005), and the number of coronary vessels presenting severe stenosis (HR: 1.11; 95% CI: 1.02-1.20; P = 0.015) were independent predictors of MACEs. Remarkably, only 37 patients presented with local aneurysm complications during follow-up.

Conclusions

The long-term prognosis of CAAs is not favorable, with MACEs associated with the underlying risk factor profile for atherosclerotic heart disease.

背景可用于指导冠状动脉动脉瘤（CAA）管理的数据有限。目的作者试图定义冠状动脉动脉瘤的临床特征，确定预测预后的变量，并提供长期数据。方法我们描述了1729名连续的CAA患者的治疗结果，这些患者被纳入了一个前瞻性国际登记处（CAAR [Coronary Artery Aneurysm Registry]; NCT02563626），该登记处涉及美国和欧洲9个国家的33家医院。结果患者主要为男性（78.6%；1359/1729），平均年龄66岁。常见的心血管风险因素包括冠状动脉疾病（85.8%；1,484/1,729）、外周血管疾病（10.9%；188/1,729）和慢性肾脏疾病（8.0%；138/1,729）。每位患者动脉瘤数量的中位数为 1.0（Q1-Q3：1.0-1.0），受影响最大的部位是左前降支动脉（49.6%；857/1729）。大多数患者接受了血管重建手术（68.5%；1 184/1 729），主要是经皮冠状动脉介入治疗（50.7%；877/1 729），出院时接受了双重抗血小板治疗（65.6%；1 134/1 729）。中位随访44.8个月（Q1-Q3：14.9-88.1）后，379人死亡（21.9%），641人（37.1%）发生重大不良心血管事件（MACE）（全因死亡、心力衰竭、不稳定型心绞痛和再梗死）。在多变量分析中，年龄（HR：1.03；95% CI：1.02-1.04；P <；0.001）、糖尿病（HR：1.47；95% CI：1.23-1.75；P <；0.001）、肾功能不全（HR：1.53；95% CI：1.19-1.96；P = 0.010）、外周血管疾病（HR：1.43；95% CI：1.13-1.82；P = 0.003）、左室射血分数降低（HR：0.98；95% CI：0.98-0.99；P <；0.001）、急性冠状动脉造影指征（HR：1.30；95% CI：1.08-1.55；P = 0.005）和出现严重狭窄的冠状动脉血管数量（HR：1.11；95% CI：1.02-1.20；P = 0.015）是MACEs的独立预测因素。结论 CAA 的长期预后不佳，MACEs 与动脉粥样硬化性心脏病的潜在危险因素有关。

{"title":"Long-Term Prognosis of Coronary Aneurysms","authors":"Iván Sánchez-Sánchez MD , Enrico Cerrato MD, PhD , Mario Bollati MD , Carolina Espejo-Paeres MD , Luis Nombela-Franco MD, PhD , Emilio Alfonso-Rodríguez MD , Santiago J. Camacho-Freire MD, PhD , Pedro A. Villablanca MD , Ignacio J. Amat-Santos MD, PhD , José M. De la Torre Hernández MD, PhD , Isaac Pascual MD, PhD , Christoph Liebetrau MD, PhD , Benjamín Camacho MD , Marco Pavani MD , Juan Albistur MD , Roberto Adriano Latini MD , Ferdinando Varbella MD , Víctor Alfonso Jiménez Díaz MD , Davide Piraino MD , Massimo Mancone MD, PhD , Iván J. Núñez-Gil MD, PhD","doi":"10.1016/j.jcin.2024.08.034","DOIUrl":"10.1016/j.jcin.2024.08.034","url":null,"abstract":"<div><h3>Background</h3><div>Limited data are available to guide the management of coronary artery aneurysms (CAAs).</div></div><div><h3>Objectives</h3><div>The authors sought to define the clinical characteristics, identify variables that predict outcomes, and provide long-term data on CAAs.</div></div><div><h3>Methods</h3><div>We describe outcomes from 1,729 consecutive patients with CAAs included in an ambispective international registry (CAAR [Coronary Artery Aneurysm Registry]; <span><span>NCT02563626</span><svg><path></path></svg></span>) involving 33 hospitals across 9 countries in America and Europe.</div></div><div><h3>Results</h3><div>Patients were predominantly male (78.6%; 1,359/1,729) with a mean age of 66 years. Classic cardiovascular risk factors were common, as well as coronary artery disease (85.8%; 1,484/1,729), peripheral vascular disease (10.9%; 188/1,729), and chronic kidney disease (8.0%; 138/1,729). The median number of aneurysms per patient was 1.0 (Q1-Q3: 1.0-1.0), with the most affected territory being the left anterior descending artery (49.6%; 857/1,729). The majority underwent any revascularization procedure (68.5%; 1,184/1,729), mainly percutaneous coronary intervention (50.7%; 877/1,729), and were discharged on dual antiplatelet therapy (65.6%; 1,134/1,729). After a median follow-up of 44.8 months (Q1-Q3: 14.9-88.1), 379 died (21.9%), and 641 (37.1%) developed a major adverse cardiovascular event (MACE) (all-cause death, heart failure, unstable angina, and reinfarction). In a multivariable analysis, age (HR: 1.03; 95% CI: 1.02-1.04; <em>P</em> < 0.001), diabetes mellitus (HR: 1.47; 95% CI: 1.23-1.75; <em>P</em> < 0.001), renal insufficiency (HR: 1.53; 95% CI: 1.19-1.96; <em>P</em> = 0.010), peripheral vessel disease (HR: 1.43; 95% CI: 1.13-1.82; <em>P</em> = 0.003), reduced left ventricular ejection fraction (HR: 0.98; 95% CI: 0.98-0.99; <em>P</em> < 0.001), acute indication for the index coronary angiography (HR: 1.30; 95% CI: 1.08-1.55; <em>P</em> = 0.005), and the number of coronary vessels presenting severe stenosis (HR: 1.11; 95% CI: 1.02-1.20; <em>P</em> = 0.015) were independent predictors of MACEs. Remarkably, only 37 patients presented with local aneurysm complications during follow-up.</div></div><div><h3>Conclusions</h3><div>The long-term prognosis of CAAs is not favorable, with MACEs associated with the underlying risk factor profile for atherosclerotic heart disease.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"17 22","pages":"Pages 2681-2691"},"PeriodicalIF":11.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Era of Head-to-Head Comparisons of Transcatheter Heart Valves Has Begun 经导管心脏瓣膜的正面比较时代已经来临

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.09.053

Nicolas M. Van Mieghem MD, PhD

引用次数: 0

Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后假体与患者不匹配的问题

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.09.025

Julien Ternacle MD, PhD , Alexis Theron MD, PhD , Philippe Pibarot DVM, PhD

引用次数: 0

Transcatheter Valves for Bicuspid Aortic Stenosis 治疗双尖瓣主动脉瓣狭窄的经导管瓣膜：驾驭解剖学挑战，应对各种风险。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.08.012

Thomas Pilgrim MD, MSc, Annette Maznyczka MD, PhD, MSc

引用次数: 0

Rethinking the Functional SYNTAX Score Threshold 重新思考功能性 SYNTAX 分数阈值

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.10.001

Haotai Xie MD

引用次数: 0

Neurologic Events After TAVR TAVR 术后神经系统事件

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.09.055

Brahim Harbaoui MD, PhD, Ahmad Hayek MD, MSc, Pierre Lantelme MD, PhD

引用次数: 0

Outcomes and Impact of Device Iterations in Mitral Valve Transcatheter Edge-to-Edge Repair: The REPAIR Study.

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.11.016

Philipp von Stein, Lukas Stolz, Jean Marc Haurand, Matthias Gröger, Felix Rudolph, Donika Mustafa, Jannik Jobst, Christoph Alexander Mues, Amir Abbas Mahabadi, Isabel A Hörbrand, Carl Schulz, Atsushi Sugiura, Tobias Ruf, Philipp Lurz, Muhammed Gerçek, Patrick Horn, Mirjam Kessler, Tienush Rassaf, Marcel Weber, Tobias Kister, Niklas Schofer, Mathias Konstandin, Florian Schindhelm, Helge Möllmann, Bernhard Unsöld, Stephan Baldus, Wolfgang Rottbauer, Volker Rudolph, Jörg Hausleiter, Roman Pfister, Victor Mauri

Background: The PASCAL P10 system for mitral valve transcatheter edge-to-edge repair has undergone iterations, including introduction of the narrower Ace implant and the Precision delivery system.

Objectives: The study sought to evaluate outcomes and the impact of PASCAL mitral valve transcatheter edge-to-edge repair device iterations.

Methods: The REPAIR (REgistry of PAscal for mltral Regurgitation) study is an investigator-initiated, multicenter registry including consecutive patients with mitral regurgitation (MR) treated from 2019 to 2024. Patients were stratified by device iteration: P10_only, P10/Ace_Gen1 (introduction of Ace), and P10/Ace_Prec (introduction of Precision). The primary endpoint was MR ≤1+ at discharge; secondary endpoints included technical success and MR durability (discharge vs 30 days, 1 year, and 2 years).

Results: A total of 2,165 patients (mean age 78 ± 10 years, 44% female, 85% in NYHA functional class ≥III, EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 4.9% [Q1-Q3: 3.0% to 8.1%]) were included: 660 P10_only, 945 P10/Ace_Gen1, and 560 P10/Ace_Prec. Median follow-up was 510 days (Q1-Q3: 369-874 days). Primary (47% [n = 1,019 of 2,142]) and secondary (52% [n = 1,123 of 2,142]) MR etiology did not change across device iterations (P = 0.547). Technical success was achieved in 97.0% (n = 2,099 of 2,165) with similar rates across device iterations (P = 0.290). MR ≤1+ was achieved in 72% (n = 1,397 of 2,085), improving with device iterations (P10_only: 66% [n = 422 of 638], P10/Ace_Gen1: 73% [n = 661 of 906], P10/Ace_Prec: 77% [n = 414 of 541]; P < 0.001). MR grades of ≤1+ and ≤2+ slightly worsened at 30 days, 1 year, and 2 years, primarily in patients with primary MR, with no differences across iterations.

Conclusions: Device iterations of the PASCAL system resulted in increasing rates of achieving MR reduction to ≤1+ at discharge, with stable and high technical success rates. A slight deterioration of the initial result warrants further investigation.

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Coronary Artery Aneurysms 冠状动脉动脉瘤

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.09.026

Ehtisham Mahmud MD

引用次数: 0

Full Issue PDF 全期 PDF

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/S1936-8798(24)01552-8

引用次数: 0

Automated Assessment of Left Ventricular Filling Pressures From Coronary Angiograms With Video-Based Deep Learning Algorithms 利用基于视频的深度学习算法从冠状动脉血管造影自动评估左心室充盈压

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-11-25 DOI: 10.1016/j.jcin.2024.07.047

Behrouz Rostami PhD, Mohammad Sarraf MD, Eunjung Lee PhD, Zachi Attia PhD, Kenneth Fetterly PhD, Shih-Sheng Chang MD, Rajiv Gulati MD, PhD, Paul A. Friedman MD, Jae Oh MD, Mohamad Alkhouli MD, MBA

引用次数: 0

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