Journal of interventional cardiology最新文献

Background

Cutting balloon (CB) can reduce vascular inflammation and elastic recoil, and these findings have been verified in combination with stent implantation in patients with coronary artery disease (CAD). This study aims to compare the immediate effect of CB with conventional balloon pre-dilatation before drug-eluting balloon (DEB) angioplasty for the treatment of CAD.

Methods

Patients with CAD, diagnosed by elective coronary angiography and having either de novo lesions or in-stent restenosis (ISR) were included. All patients were randomly assigned to undergo predilatation with either a CB or a conventional balloon prior to DEB treatment. We assessed the immediate effect and the level of inflammatory factors after the operation between two groups.

Results

Eighty-five patients were enrolled. In the CB group (n = 42), all patients achieved residual stenosis  < 30% (100% procedural success), with no acute complications observed. In the conventional balloon group (n = 43), 6 patients had residual stenosis  ≥ 30% (resulting in an 86.0% procedural success rate), and two acute complications occurred (one type B dissection and one acute branch occlusion), neither requiring bail-out stenting. Moreover, serum levels of IL-6, IL-8, TNF-α, and CRP at 24 h were significantly higher than those before and immediately after the operation in the two groups. The degrees of increase in concentration of IL-6, IL-8, and TNF-α 24-h postoperatively were lower in the CB group than those in the conventional balloon group (P < 0.05).

Conclusions

In the treatment of CAD with DEB angioplasty, predilatation with CB was associated with improved immediate procedural success and a reduced inflammatory response compared with conventional balloon predilatation.

Background

Coronary artery disease (CAD) and atrial fibrillation (AF) frequently co-occur. They influence each other in terms of occurrence and aggravation, which has an impact on the prognosis. Meanwhile, there is a lack of reports on whether AF rhythm at the time of coronary revascularizations is related to long-term prognosis. We aimed to determine whether AF upon electrocardiography at the time of revascularization for CAD affects the patient’s long-term outcome.

Methods

We observed the clinical outcomes (up to 10 years) in 7733 patients who underwent coronary intervention at two centers. Patients were divided into AF and non-AF groups on the day of the procedure, and analyses were performed after validation through propensity score matching. The primary outcome was major adverse cardiac events (MACEs) defined as a composite of all-cause mortality, spontaneous myocardial infarction, stroke, and hospitalization. Subgroup analysis was performed for different causes of hospitalization.

Results

During follow-up (mean: 3.8 years), the incidence and risk of MACEs did not differ between the AF and non-AF groups (23.3% vs. 36.2%, adjusted hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.74–1.98, p = 0.443) following coronary intervention, after propensity score matching. However, the incidence of hospitalization events was higher in the AF group than that in the non-AF group (2.2% vs. 8.6%, adjusted HR: 3.28, 95% CI: 1.02–10.53, p = 0.046). Among the causes of hospitalization, the incidence of major bleeding was significantly higher in the AF group.

Conclusions

The effect of AF during coronary revascularization on the incidence of the MACEs over a mean follow-up of 3.8 years was not statistically significant. However, AF was associated with a higher incidence of hospitalization during the follow-up period.

Trial Registration: ClinicalTrials.gov identifier: NCT04650529

Background

In-stent restenosis (ISR) and recurrent ISR (Re-ISR) remain significant challenges of percutaneous coronary intervention (PCI), especially in complex lesions where conventional therapies are less effective. Rotational atherectomy (RA) combined with super high-pressure noncompliant (NC) balloons represents a potential strategy for addressing severe ISR or Re-ISR.

Objectives and Methods

This study investigated the procedural success and safety as well as clinical outcomes of RA combined with super high-pressure NC balloons in patients with severe or Re-ISR. Consecutive patients treated for severe or Re-ISR between January 2020 and September 2024 were retrospectively analyzed. The primary endpoint was major adverse cardiovascular events (MACEs) at follow-up, including target vessel myocardial infarction (TV-MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Periprocedural complications were also recorded.

Results

Out of 13 treated patients, 6 (46%) patients experienced periprocedural events, including 3 (23%) Type A dissections, 2 (15%) Type B dissections, and 1 (8%) Ellis Grade I perforation. 9 (70%) patients were treated with drug-coated balloons (DCBs), 1 (8%) of which had crossover to stenting and 2 (15%) had hybrid strategy with DCB and stenting combined. At a median follow-up of 13 months, 4 (31%) patients had MACE, comprising 1 (8%) TV-MI by TLR, 2 (15%) clinically driven TLR, and 1 (8%) TVR. Secondary outcomes included 1 (8%) case of hospitalization for heart failure (HF) and 1 (8%) COVID-19–related death.

Conclusions

RA combined with super high-pressure NC balloons for the treatment of severe ISR or Re-ISR is associated with a significant risk of periprocedural complications. However, the midterm outcomes suggest this strategy might be effective in managing severe or Re-ISR.

Trail Registration

ClinicalTrials.gov identifier: NCT06075602

Background

Percutaneous endocardial septal radiofrequency ablation (PESA) is a novel interventional treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, further research is required to confirm its safety and efficacy. Currently, there are no studies reporting the use of Ablation Index (AI) for energy guidance during PESA.

Methods

A total of 20 patients with drug-resistant HOCM were enrolled. All patients had previously received the maximum tolerated doses of beta-blockers and/or calcium channel blockers. All patients underwent PESA guided by AI with the assistance of intracardiac echocardiography. The primary efficacy endpoint was the change in left ventricular outflow tract gradient (LVOTG) from baseline to 1 month postoperation.

Results

The mean age of the patients was 55.75 ± 14.28 years, with an equal distribution of females and males. All patients completed a 1-month postoperative follow-up evaluation. Additionally, some patients underwent longer-term follow-up. The overall median follow-up duration was 94 days (IQR: 361.3 days). Regarding the primary efficacy endpoint, LVOTG significantly decreased to 44.15 ± 25.80 mmHg at 1 month postoperation (p < 0.0001). As for secondary endpoints, LVOTG decreased from 68.75 ± 24.92 mmHg to 45.70 ± 26.55 mmHg (p = 0.0003), and the maximum interventricular septum thickness at end-diastole decreased from 19.77 ± 5.38 mm to 18.25 ± 5.41 mm (p = 0.0104). The average distance covered in the six-minute walk test increased from 180.00 ± 76.44 m to 317.50 ± 98.38 m (p < 0.0001). Complete relief from chest pain symptoms was observed in 12 patients (60%, p < 0.001), and 19 patients (95%) showed at least a one-class improvement in the New York Heart Association functional class (p < 0.0001).

Conclusion

This study is the first to incorporate AI guidance into PESA, demonstrating that this approach offers favorable safety and efficacy in the treatment of drug-resistant HOCM. It effectively reduces left ventricular outflow tract obstruction and alleviates chest pain symptoms.

Objectives

Assessing fractional flow reserve (FFR) with a pressure wire is frequently underused due to the invasiveness of guide wire insertion and the necessity for a hyperemic agent. This study aimed to assess the diagnostic accuracy of the CAAS-vessel FFR (vFFR) software tool compared to pressure wire (pw) FFR in evaluating coronary stenotic lesions.

Methods

A single-center, prospective study was conducted at Clinique Saint Clotilde, Reunion Island, from August 2023 to March 2024. All patients undergoing coronary angiograms with pwFFR assessment of lesion severity of 40%–70% were included. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of vFFR were calculated using pwFFR as the reference standard. The cutoff value of 0.80 was used for both modalities.

Results

A total of 116 patients with 146 lesions were included. The mean age was 67 ± 9 years old, with 19% being female. Patients had an average of 1.3 ± 0.4 lesions each, with a mean pwFFR of 0.79 ± 0.09 and a mean vFFR of 0.79 ± 0.28. The overall diagnostic accuracy of vFFR was 77%, with sensitivity/specificity of 85%/71% and PPV/NPV of 67%/87%. For the left anterior descending coronary artery, the accuracy was 78%, with a sensitivity/specificity of 81%/78%. In the grey zone (invasive FFR 0.75–0.85), the accuracy dropped to 70%.

Conclusion

vFFR is a reliable noninvasive alternative to pwFFR, showing acceptable diagnostic accuracy in line with current literature.

Background

Cryoballoon ablation (CbA) for pulmonary vein isolation (PVI) is increasingly used in the treatment of paroxysmal atrial fibrillation (PAF). We aimed to assess the relationship between pulmonary vein ostium (PVO) morphology and procedural outcomes after CbA for PAF.

Methods

A total of 463 patients with PAF were enrolled. PVO morphology was evaluated using preprocedural computed tomography (CT). Intraoperative cryoablation parameters and adverse events were recorded. Patients were followed up for at least 1 year.

Results

The superior PVs exhibited the longest long-axis diameter at PVO (left, 21.85 ± 3.22 mm; right, 21.55 ± 3.71 mm, all p < 0.05), while the right superior PVs had the largest short-axis diameter (18.46 ± 3.56 mm, all p < 0.05). The left superior PVO showed the greatest ellipticity (difference between long-axis and short-axis diameters: 6.60 ± 3.35 mm, all p < 0.05), whereas the right superior PVO had the largest mean diameter (20.00 ± 3.42 mm, all p < 0.05). Left-sided PVOs demonstrated the highest ellipticity. The size of the left superior PVO was negatively correlated with the nadir freezing temperature and positively correlated with rewarming time (both p < 0.05). The long-axis diameter of PVO was positively associated with the additional radiofrequency ablation (p < 0.05). Multivariate analysis identified left superior PVO morphology as an independent predictor of late recurrence (β = 2.703, p = 0.010).

Conclusions

Large PVO dimensions, particularly in the left superior PV, are associated with intraoperative difficulty during second-generation CbA for PAF. Additionally, left superior PVO ellipticity predicts late recurrence. Preprocedural PV CT imaging may be valuable for a quick clinical predict for PAF.

Background

The optimal temperature strategy during cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG) remains debated. We compared perioperative outcomes between normothermic and hypothermic CPB in a single-center cohort in Iran.

Methods

A retrospective cohort of 98 consecutive adults were undergoing isolated, on-pump CABG at Razi Hospital (March 2020–March 2021). Patients were grouped by intraoperative temperature strategy (normothermia 35°C–37°C without topical cooling vs. hypothermia 28°C–32°C with topical cooling as used). Data were abstracted from charts using a predefined checklist (demographics/comorbidities, operative details, intra-/postoperative transfusion and fluid balance, electrolytes/renal indices, complete blood count, ICU/ward length of stay, 12 h core temperature, mortality, and neurological events). Two-sided tests were used with α = 0.05.

Results

Groups were balanced in baseline characteristics. Compared to normothermia, hypothermia required more intraoperative packed cells (mean: 476 vs. 191 mL; p < 0.001), while postoperative transfusion until discharge was similar (636 vs. 560 mL; p = 0.42). ICU (2.2 vs. 1.9 days; p < 0.001) and ward stay (5.4 vs. 3.8 days; p < 0.001) were longer with hypothermia. Postoperative sodium increased in normothermia (p < 0.001) but not in hypothermia (p = 0.173); both groups showed increased urea/creatinine and decreased RBC/Hb/Hct postoperatively. Serum intake and urine output were higher intra- and postoperatively in hypothermia (all p < 0.001). Ejection fraction and 12-h core temperature did not differ; mortality and CVA were rare and comparable.

Conclusion

In this cohort, normothermic CPB for isolated CABG was associated with fewer intraoperative transfusions and shorter ICU/ward stays than hypothermia, with otherwise similar short-term safety signals. Prospective studies should test long-term and patient-reported outcomes.