Journal of interventional cardiology最新文献

Background: It is generally accepted that for patients with multivessel disease and myocardial infarction, complete revascularization is preferable than culprit-only revascularization. However, existing studies comparing coronary physiology-guided versus angiography-guided complete revascularization percutaneous coronary intervention (PCI) present conflicting conclusions.

Methods: The investigation involved a comprehensive search of PubMed/Medline, Embase, and the Cochrane library for studies comparing coronary physiology-guided with angiography-guided PCI in patients with MI-MVD. Clinical endpoints, including major adverse cardiovascular events, all-cause mortality, recurrent MI, major adverse cardiac and cerebral event, planned revascularization, repeated revascularization, average stent number per patient, heart failure, and contrast nephropathy during any follow-up period post PCI, were considered for analysis. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated for binary and continuous variables, respectively. The analyses were conducted using Review Manager 5.1.

Results: Our analysis included a total of 2493 patients from 5 studies. The physiology-guided PCI group exhibited a lower rate of planned revascularization (OR: 0.10, 95% CIs: 0.07–0.14, p ≤ 0.001, and I² = 96.6%) and average stent number per patient (mean difference: −0.47, 95% CIs: −0.56–−0.38, p ≤ 0.001, and I² = 58.6%). However, there were no significant differences between the two groups regarding major adverse cardiac event (MACE) (OR: 0.89, 95% CIs: 0.63–1.26, p = 0.520, and I² = 67.8%), all-cause mortality (OR: 0.65, 95% CIs: 0.38–1.12, p = 0.120, and I² = 50.5%), recurrent MI (OR: 0.74, 95% CIs: 0.28–2.00, p = 0.558, and I² = 77.2%), major adverse cardiac and cerebral event (MACCE) (OR = 0.77, 95% CIs: 0.43–1.37, p = 0.378, and I² = 0%), repeated revascularization (OR = 1.47, 95% CIs: 0.54–3.99, p = 0.452, and I² = 76.5%), heart failure (OR: 1.04, 95% CIs: 0.43–2.56, p = 0.924, and I² = 0%), and contrast nephropathy (OR: 1.26, 95% CIs: 0.27–5.81, p = 0.766, and I² = 0%).

Conclusions: Among patients with MI-MVD, physiology-guided PCI appeared to reduce the need for planned revascularization without triggering repeated revascularization, leading to fewer stents compared with angiography-guided PCI. Other prespecified clinical outcomes including MACE, all-cause mortality, recurrent MI, MACCE, heart failure, and contrast nephropathy were not significantly different between these two approaches.

Background: Mitral transcatheter-edge-to-edge-repair (M-TEER) is mostly done with using general anesthesia (GA). Limited data including specific risk factors exist for a deep sedation (DS) approach.

Methods and Results: 464 M-TEER procedures were included for comparison of a DS approach versus those who required a conversion to GA. Specific predefined risk factors were analyzed to identify those patients who might not benefit from a DS strategy by the need of conversion to GA. The conversion rate from DS to GA was 6.7% (n = 433 successful DS and n = 31 conversion to GA). Mean age was 80 years. Classical surgical risk scores did not show any significant difference between the two groups. Patients with DS had a higher procedural success rate (96.1% versus 80.1%; p < 0.001). The time on the intensive care unit (ICU) (3.9 h versus 126 h; p = 0.023) was shorter for patients with DS. Patients who were in the need for a conversion to GA had a lower 30-day and 1-year survival rate. A multivariate analysis for conversion to GA showed body mass index (p = 0.023), pre-existing kidney failure (p < 0.001), obstructive sleep apnea syndrome (OSAS) (p = 0.031), systolic pulmonary pressure value (p = 0.013), and concomitant tricuspid regurgitation (p = 0.049) as risk factors.

Conclusions: Using DS in M-TEER is feasible with a low conversion rate to GA. In case of a conversion, the procedure is less successful regarding reduction of MR and more complications occurred with a lower survival rate up to 12 months. These data suggest that conversion from DS to GA is high risk. Therefore, we could identify different predictors for the need of a conversion to GA. However, our results could only be hypothesis-generated and should be evaluated in a randomized study.

Temporary mechanical circulatory support (tMCS) devices are a critical component for treating patients with cardiogenic shock (CS). We analyzed use of Impella 5.5 device for efficacy and safety in a single-center CS population from February 2022 and April 2023. Thirty-six CS patients received Impella 5.5 support for a median duration of 16 (2, 63) days, during a median hospital stay of 40 (4, 97) days, with an overall survival (OS) of 69%. While 18 patients received Impella 5.5 only, 11 patients received Impella 5.5 as part of a de-escalation strategy, and 7 patients escalated from Impella CP only to Impella 5.5. At the time of implant, creatinine was 1.5 (0.6, 5.2) mg/dL and normalized to 1.1 (0.6, 7.7) mg/dL at discharge. In a subset of CS transfer patients (n = 12), median duration of support was 16 (1, 31) days, duration of hospital stay was 43 (8, 88) days, and OS was 67% (8/12). Collectively, these data demonstrate that Impella 5.5 support is safe and effectively improves laboratory values and survival outcomes in both transfer and in-house patients with CS.

Background: Despite the enormous impact of heart failure (HF) in China, there is a relative lack of research on its epidemiologic trends and burden. Therefore, there is an urgent need for a comprehensive and in-depth analysis of the epidemiologic patterns, underlying etiology, and overall burden of HF.

Objective: This study aimed to elucidate the epidemiology, etiology, and burden of HF in China and provided a comprehensive and up-to-date analysis, including temporal trends from 1900 to 2019.

Methods: The data for this study were derived from the Global Burden of Disease (GBD) study 2019. Descriptive analyses were conducted to examine the prevalence and years lived with disability (YLD) rates in China from 1990 to 2019, with variables including year, sex, and age. To illustrate the temporal trend spanning 1990 to 2019, estimated average annual percentage changes (AAPC) were calculated.

Results: In 2019, the number of prevalent HF cases in China was 18.51 million (95% uncertainty interval [UI]: 14.97 to 23.02 million), representing 32.9% of the global prevalence. Between 1990 and 2019, the number of cases and the prevalence rates of HF in China showed an increasing trend. The age-standardized prevalence rates (ASPRs) demonstrated an overall declining trend (AAPC = −0.16, 95% confidence interval [CI]: −0.19 to −0.13, p < 0.01), as did the age-standardized YLD rates (AAPC = −0.13, 95% CI: −0.16 to −0.1, p < 0.01). However, from 2017 to 2019, a gradual increase was observed (AAPC = 1.72, 95% CI: 1.47 to 1.96, p < 0.01). In the age-based analysis, individuals aged 55 years and older accounted for 88.3% of the prevalent cases. Women exhibited higher case numbers and ASPR compared to men. In the cause-based analysis, hypertensive heart disease emerged as the primary etiology of HF in China.

Conclusion: From 1990 to 2019, the ASPR and age-standardized YLD rates for HF in China demonstrated an overall decreasing trend. Nevertheless, the trend increased from 2017 to 2019, with significant variations observed by gender and age. Therefore, continued attention to the disease burden of HF in China remains essential. Healthy lifestyles are important for minimizing the prevalence of HF. In addition, it is necessary to address and reduce the incidence of hypertension from all causes to mitigate the disease burden further.

Objective: To compare the efficiency and safety of primary and bailout antegrade dissection and re-entry (ADR) during percutaneous coronary intervention (PCI) for chronic total occluded (CTO) lesions.

Methods: Patients who underwent ADR procedures for CTO lesions were enrolled in this study and were divided into two groups (primary ADR and bailout ADR) based on the initiation of ADR during PCI. The success rate and major adverse cardiovascular and cerebrovascular events (MACCE) during hospitalization were assessed as the primary endpoints. Procedure time, fluoroscopy time, wire crossing time, radiation dose, and contrast volume were considered as secondary endpoints.

Results: A total of 243 patients were enrolled in this study, with 127 patients receiving primary ADR and 116 receiving bailout ADR. No differences were found in baseline parameters between the two groups. The success rate was significantly higher in the primary ADR group compared to the bailout ADR group (89.0% versus 77.6%, respectively; p = 0.017). The incidence of in-hospital MACCE was low in both groups, with no significant differences observed between them. Procedure time, radiation dose, and contrast volume were lower in the primary ADR group compared to the bailout ADR group. Cox regression analysis revealed that primary ADR and J-CTO score ≥ 3 were independent predictors of technical success in CTO-PCI.

Conclusions: Both primary and bailout ADR are safe strategies for CTO-PCI. Primary ADR significantly improves the success rate of PCI for CTO compared to bailout ADR, with shorter operation time, lower radiation dose, and reduced contrast volume.

Background: The safety of new-generation mobile phones using 5G networks in patients with modern-generation pacemakers has not been studied.

Objectives: This study aimed to compare the risk of electromagnetic interference (EMI) generated by a new-generation mobile phone with 5G networks when positioned at the pacemaker pocket or the contralateral ear and assess the incidence of EMI with telemetry interrogation in patients with permanent pacemakers.

Methods: We enrolled 489 patients with pacemakers from three different manufacturers. The pacemaker mode was programmed for overdrive pacing and sensing mode if an intrinsic rhythm was present. A smartphone (Samsung S21 + 5G) was placed directly over the pulse generator and right ear. The phone was tested under standby mode, 5G internet connection, and incoming and outgoing calls for each location. Real-time electrocardiography (ECG) monitoring and patient symptoms were recorded to determine the occurrence of EMI. The possibility of EMI with interrogation telemetry was also investigated.

Results: A total of 4824 tests were performed on 489 patients. Most pacemakers were dual-chamber (82%) or magnetic resonance imaging (MRI)-compatible systems (83%). EMI was not detected with both mobile phone positions. Interference with telemetry was demonstrated in 11.5% of patients. Almost all incidences of interference (98.2%) occurred during incoming calls. Single-chamber pacemakers, non-MRI-compatible systems, older pulse generators, older leads, and unipolar settings were significantly related to a higher incidence of interference with interrogation telemetry.

Conclusions: The risk of EMI between modern smartphones with 5G networks and pacemakers is low. Nevertheless, interference with the interrogation telemetry may still occur.

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs).

Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834.

Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross-over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p < 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all-cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06).

Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique’s long-term outcomes and complications.

The DynamX Bioadaptor is a novel implant with uncaging elements that disengage after polymer resorption and permits restoration of vessel function, thereby potentially reducing late adverse cardiac events. We evaluated the safety and efficacy of this novel implant with imaging follow-up at 6-months, the time point when the bioadaptor starts to uncage. This prospective study enrolled 44 patients with up to two de novo lesions at seven centers in New Zealand treated with the DynamX Bioadaptor. Follow-up was planned out to 12-months. The primary safety and efficacy endpoints were 6-month target lesion failure (TLF) and late lumen loss. Patients presented with non-ST elevation myocardial infarction in 49%. Lesions (n = 45) were 16.0 ± 6.7 mm long, and 2.81 ± 0.41 mm in diameter. Device and procedure success were 100%, and acute lumen gain was 1.93 ± 0.35 mm. At 6-months, median in-device late lumen loss was 0.09 mm (IQR:0.05–0.16). Measured by intravascular ultrasound, the vessel, lumen, and device area remained constant. By optical coherence tomography, 96.4% ± 5.9% of struts per lesion were covered. Out to 12-months, no TLF and no definite or probable device thrombosis were reported. In conclusion, this study provides evidence of the safety and performance of the DynamX Bioadaptor with excellent 12-month clinical and 6-month imaging outcomes comparable to best-in-class drug-eluting stents (DES).

Trial Registration: ClinicalTrials.gov identifier: NCT03634020, NCT05464147, NCT04562805, and NCT04192747.

Background: Percutaneous (PC) access has become the first-line strategy for transfemoral (TF) transcatheter aortic valve replacement (TAVR), but surgical cutdown (SC) may be required in selected and usually challenging cases. We aimed to compare the efficacy and safety of SC versus echo-guided PC approach in TF TAVR.

Methods: Between November 2019 and December 2020, all patients undergoing TF TAVR were included in a prospective study. The choice of PC or SC strategy was left at operators’ discretion, according to predictable access site difficulties. The primary endpoint included all vascular complications (VCs) and all bleeding at 1-month follow-up according to Valve Academic Research Consortium-2 criteria.

Results: Among 225 patients, 166 (73.8%) and 59 (26.2%) underwent PC or SC approach, respectively. Median age was 82 years, EuroSCORE 2 was higher (p = 0.02), and peripheral arterial disease (p < 0.001) was more common in the SC group. Femoral access was successful in 100% in the SC group vs 97.6% in the PC group (p = 0.2). The primary endpoint was reached in 32 patients (14.2%), 5 (8.4%) in the SC group and 27 (16.2%) in the PC group (p = 0.1) with low incidence of major VC in both groups (1.7% vs 3% in the SC and PC groups respectively, p = 0.6).

Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study.

Trial Registration: ClinicalTrials.gov identifier: NCT03865043