Journal of Cardiovascular Medicine最新文献

Background: Takotsubo cardiomyopathy (TCM) is an acute form of left-ventricular systolic dysfunction triggered by emotional or physical stress, which can lead to refractory cardiogenic shock. In such cases, mechanical cardiovascular support, such as extracorporeal membrane oxygenation (ECMO), may be beneficial. However, the outcomes of ECMO in this population remain unclear.

Objective: To evaluate the association between ECMO and in-hospital outcomes in patients hospitalized with TCM and cardiogenic shock.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2022 to evaluate outcomes in adult patients hospitalized with TCM and cardiogenic shock. ECMO use was identified using ICD-10 procedure codes. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), total hospital charges (THCs), acute kidney injury, and bleeding complications. Propensity score matching with double adjustment using survey-weighted logistic and linear regression was used to adjust for confounders.

Results: A total of 20 350 weighted hospitalizations were included, with 300 patients (1.5%) receiving ECMO. In the unadjusted analysis, ECMO was associated with higher in-hospital mortality (35.0 vs. 27.7%), longer LOS (19.4 vs. 12.1 days), and higher THCs ($761 206 vs. $254 690). After matching, 270 patients were identified in each group. ECMO was still associated with higher THCs ($630 317 vs. $372 195). In-hospital mortality remained higher in the ECMO group (32.5% vs. 26.7%), although not statistically significantly (P  = 0.49).

Conclusion: Among patients with TCM complicated by cardiogenic shock, ECMO was not associated with a significant reduction in mortality. Further studies are warranted to improve patient risk stratification and clarify the clinical value of ECMO in this population.

Background: The correct antithrombotic strategy after the MitraClip system needs to be clarified.

Objectives: This study aimed to compare the clinical outcomes of single antiplatelet therapy (SAPT) vs. dual antiplatelet therapy (DAPT) following transcatheter edge-to-edge repair (TEER) using the MitraClip system. The objective was to evaluate their relative safety and efficacy in a real-world cohort, offering preliminary evidence to inform future prospective studies.

Methods: The study retrospectively analysed patients who underwent MitraClip implantation at a high-volume tertiary care centre in Rome, Italy. Patients treated with oral anticoagulant therapy (OAC) were excluded. The primary outcome was to determine SAPT vs. DAPT in terms of all-cause mortality, cardiac mortality, hospitalization for heart failure, myocardial infarction, and bleeding complications.

Results: Among 199 patients, 114 met the inclusion criteria. Baseline mitral regurgitation was 3+ or 4+ in both groups. The acute success of the procedure was 100%. All patients were monitored for 12 months following treatment. Complications were uncommon and, in most cases, unrelated to antiplatelet therapy. Patients in the DAPT group had significantly poorer outcomes than those in the SAPT group, with 12-month survival freedom from all-cause mortality of 78.7% and 94% ( P  = 0.014) and survival freedom from cardiac mortality of 89.4% and 98.5% ( P  = 0.031).We observed no significant difference in major and minor bleeding between the two groups, although the incidence was higher in the DAPT group.

Conclusions: SAPT was associated with improved 12-month survival and a lower rate of bleeding events compared with DAPT in patients undergoing TEER. While individual rates of major and minor bleeding were not significantly different, the overall bleeding burden was reduced in the SAPT group. These findings suggest a potential association between SAPT and lower mortality rates and support its consideration in patients at high bleeding risk. Further prospective studies are warranted to confirm these observations.

Background and objective: Microcirculatory dysfunction is a known cause of myocardial infarction with nonobstructive coronary arteries (MINOCA). Angiography-derived microcirculatory resistance (AMR), a wire-free and adenosine-free index, offers a potential method for early assessment of microvascular function in these patients at the time of angiography. This study aimed to evaluate the prognostic impact of the Angiographic Microvascular Resistance (AMR) Index in patients with MINOCA.

Methods: A retrospective study was conducted on patients with acute MINOCA who underwent coronary angiography between January 2017 and March 2024. AMR was computed from coronary angiography. The primary endpoint of our investigation was the occurrence of major adverse cardiovascular events (MACE), specifically defined as encompassing cardiovascular death, stroke, heart failure, nonfatal myocardial infarction, and angina rehospitalization. Kaplan-Meier, Cox regression, and receiver-operating characteristic (ROC) analyses were performed. The best cutoff of AMR was derived from ROC analysis based on the MACE prediction.

Results: Overall, 205 MINOCA patients were included in the final analysis of this study. During a median follow-up of 38 months, a total of 63 (30.7%) patients developed MACE. The area under the curve for AMR to predict MACE was 0.702 [95% confidence interval (CI) 0.617-0.786], with an optimal cutoff value of 35 mmHg s/dm. AMR, whether as a continuous [per 1SD increase in the AMR Index, hazard ratio, 1.72 (95% CI 1.36-2.17); P  < 0.001] or categorical [AMR >35; hazard ratio, 3.32 (95% CI 1.99-5.52); P  < 0.001] variable, was independently associated with MACE after adjusting for traditional risk factors. Incorporating AMR into the Thrombolysis In Myocardial Infarction (TIMI) score resulted in a significant improvement in discrimination for MACE [net reclassification improvement (NRI) 0.211; P  = 0.006].

Conclusion: In conclusion, increased AMR was independently associated with poor prognosis following MINOCA. These findings suggest that AMR may play a potential role in the cardiovascular risk stratification of the MINOCA population.

Background: Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality. This meta-analysis aimed to compare clinical outcomes of intravascular imaging-guided percutaneous coronary intervention (PCI) versus angiography - or fractional flow reserve (FFR)-guided PCI.

Methods: We systematically searched six databases through October 2024 for randomized controlled trials (RCTs) comparing intravascular ultrasound (IVUS)-guided or optical coherence tomography (OCT)-guided PCI versus angiography-guided or FFR-guided PCI. Primary outcomes included target-vessel failure (TVF), myocardial infarction (MI), mortality, stent thrombosis, repeat revascularization, and contrast-induced nephropathy. Risk ratios (RRs) were pooled using a random-effects model.

Results: Eighteen RCTs including 21 812 patients (11 215 imaging-guided; 10 597 angiography/FFR-guided) were analyzed. Imaging-guided PCI was associated with lower risks of TVF (RR: 0.66; 95% CI: 0.58-0.74), cardiac death (RR: 0.56; 95% CI: 0.44-0.71), all-cause mortality (RR: 0.77; 95% CI: 0.64-0.93), MI (RR: 0.84; 95% CI: 0.71-0.99), and definite stent thrombosis (RR: 0.41; 95% CI: 0.27-0.62). No significant differences were observed in repeat revascularization (RR: 0.99; 95% CI: 0.75-1.31) or contrast-induced nephropathy (RR: 1.08; 95% CI: 0.64-1.83). Although relative risk reductions were significant, absolute event rates were low, resulting in modest absolute risk reductions.

Conclusion: Intravascular imaging-guided PCI significantly improves key clinical outcomes, including mortality, MI, and stent thrombosis, compared with angiography-guided or FFR-guided PCI. These findings support broader implementation of IVUS and OCT in contemporary PCI, especially in patients with complex coronary disease.