Journal of interventional cardiology最新文献

Coronary steal syndrome (CSS) is a rare but potentially serious phenomenon that can occur after coronary artery bypass grafting (CABG), where the presence of a patent large collateral arterial branch may decrease flow through the main graft toward the myocardium. This condition can result in functional incomplete revascularization and reduce the benefit of the surgical intervention. The diagnosis and management of CSS pose significant challenges, which are described in this article through three clinical cases, accompanied by a review of existent medical data regarding this rare pathology.

Background: To provide more useful information due to the lack of published results to date, we analyzed the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) using the Global Registry of Acute Coronary Events (GRACE) score and the degree of left ventricular ejection fraction (LVEF).

Methods: In total, 4558 patients were stratified into two groups: GRACE score > 140 (group A) and GRACE score ≤ 140 (Group B). Each group was further subdivided into heart failure (HF) with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF). The primary outcome was all-cause mortality, and the secondary outcomes were cardiac death (CD), non-CD, recurrent MI, and hospitalization for HF (HHF).

Results: After adjustment, in Group A, the 3-year rates of all-cause mortality (p < 0.001 for all), CD, and HHF were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups, with similar outcomes between the HFmrEF and HFpEF subgroups. In Group B, the HFrEF subgroup had higher CD (p = 0.019) and HHF rates than did the HFmrEF subgroup and higher all-cause mortality (p = 0.001), CD (p < 0.001), and HHF rates than the HFpEF subgroup. All-cause mortality rate between the HFrEF and HFmrEF subgroups was similar, whereas the HFmrEF subgroup had a higher all-cause mortality rate than did the HFpEF subgroup (p = 0.022). Group A had worse clinical outcomes than Group B across all LVEF subgroups.

Conclusion: Although the HFrEF subgroup had a higher all-cause mortality rate than did the HFpEF subgroup, all-cause mortality patterns between the HFrEF and HFmrEF subgroups and between the HFmrEF and HFpEF subgroups varied according to the GRACE score. However, broader studies with a larger number of patients are needed.

Background: Drug-coated balloons (DCBs) have emerged as an innovative technology for coronary artery disease treatment. However, bibliometric research on DCB development trends is still lacking.

Methods: We performed a bibliometric analysis of DCB-related publications from 2006 to 2023, extracted from the Web of Science Core Collection database. Analysis dimensions included temporal publication patterns, distributions of countries/regions and institutions, author and journal productivity/impact, keyword co-occurrence and bursts, collaboration networks, and seminal studies. Visualization tools such as the R package “Bibliometrix,” VOSviewer, and CiteSpace facilitated the graphical mapping of research hotspots.

Result: This bibliometric analysis of 781 DCB-related publications shows an increasing annual output since 2011, exceeding 100 in 2021. Germany, China, Italy, Japan, and the United States were dominant in DCB research, with Germany accruing the highest citation count of 6477. The Technical University of Munich published the most DCB-related papers (n = 22). Bruno Scheller had the highest author productivity (n = 45) and citations (n = 3235). Analyses of keyword co-occurrence showed prevalent foci encompassing “DCB,” “drug-eluting stent,” and “in-stent restenosis.” Newly emerging topics contain “DCB-only strategy” and intravascular imaging.

Conclusion: The research activities on DCB have greatly expanded, with significant advancements in device design and indications. Recent priorities signal a shift towards physiology/intravascular imaging–guided usage and DCB as standalone therapies for more de novo coronary lesions. Ongoing advances will consolidate DCB in guidelines and daily practice. Our analysis provides strategic insights, informing research and clinical directions.

Background: In coronary lesions characterized by bifurcation anatomies, provisional side-branch intervention is the preferred treatment approach. However, there is a well-documented discrepancy between angiographic evaluations of blood flow obstruction and the actual functional severity of bifurcation lesions. Additionally, the use of fractional flow reserve (FFR) carries notable side effects primarily associated with the necessity of adenosine administration. Given the demonstrated noninferiority of the instantaneous wave-free ratio (iFR) compared to FFR, this study aimed to assess the clinical and functional benefits of iFR-guided side-branch ballooning which involving drug-eluting balloon inflation in side branch in comparison to conventional intervention techniques for bifurcation lesions.

Methods: In this prospective cohort study, a total of 100 patients with coronary lesions characterized by bifurcation anatomies were enrolled and randomly assigned to two groups: the iFR-based intervention group, which utilized only side-branch intervention involving drug-eluting balloon inflation, and the conventional intervention group. Both groups were monitored for 12 months postintervention to assess various clinical and functional endpoints.

Results: In the iFR-guided group, only 2 patients (4%) met the primary endpoint (a composite of target bifurcation-related nonfatal myocardial infarction, target bifurcation revascularization, and any unplanned revascularization) compared to 10 patients (20%) in the conventional group (p = 0.01). The study also demonstrated the superiority of iFR-guided drug-eluting balloon inflation in side branches over conventional interventional procedures for bifurcation lesions, as evidenced by a reduction in fluoroscopy time (mean difference [MD] = −8.9 min, 95% confidence interval [CI] = −15.6 to −2.1, p = 0.01), intervention duration (MD = −11.6 min, 95% CI = −20.5 to −2.8, p = 0.01), and length of hospital stay (MD = −1 day, 95% CI = −1.2 to −0.80, p < 0.0001). Additionally, the amount of contrast media used in the iFR-guided intervention group was significantly lower than that in the conventional treatment group (p < 0.0001).

Conclusions: iFR-guided side-branch intervention involving drug-eluting balloon inflation in bifurcation lesions was significantly better when compared to conventional interventions in terms of clinical and functional outcomes in patients with coronary lesions characterized by bifurcation anatomies.

Assessing the preprocedural risk of mortality following percutaneous coronary intervention (PCI) is crucial for clinical decision-making, quality registries, and performance monitoring. This systematic review aims to summarize preprocedural factors associated with in-hospital mortality post-PCI. A systematic search of MEDLINE, EMBASE, CINAHL, and Web of Science was conducted up to April 2024, without language restrictions, to identify preprocedural factors associated with in-hospital mortality post-PCI. The information was systematically evaluated and descriptively summarized following the CHhecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies (CHARMS) checklist. The search initially identified 9552 studies, with 28 articles ultimately included in the final analysis. The pooled prevalence of in-hospital mortality post-PCI was 1.63%, whereas it was 6.40% for patients with acute coronary syndrome (ACS). A total of 77 independent preprocedural factors were found to be significantly associated with in-hospital mortality, of which 22 were consistently reported across multiple studies and identified as potential key factors. Factors most frequently reported in various studies included, but not limited to, ACS (n = 27, 96.4%), renal failure (n = 24, 85.7%), age (n = 19, 67.9%), gender (n = 16, 57.1%), cardiac events (n = 15, 53.6%), ejection fraction (n = 15, 53.6%), vascular disease (n = 12, 42.9%), heart failure (n = 12, 42.9%), body mass index (n = 10, 35.7%), lesion location (n = 9, 32.1%), diabetes (n = 8, 28.6%), and vessel disease (n = 8, 28.6%). Eleven articles (39.2%) used imputation methods to handle missing data. Logistic regression was used by 19 articles (67.9%), and five articles (18.6%) used the machine learning (ML) method. Nineteen articles (67.9%) reported the discriminatory performance of the models using receiver operating characteristic (ROC) score ranging from 0.776 to 0.960. Incorporating the 22 preprocedural factors identified in this study can aid clinicians in decision-making for high-risk cases. To improve risk adjustment models, these factors should be integrated, missing data carefully managed, models validated, and ML techniques utilized.

Objective: The aim of this study was to investigate the therapeutic effects and 1-year outcomes of RA in patients with severe calcified coronary artery CTO.

Methods: Data were collected from 395 individuals with severe calcified CTO who received treatment at Liaoning Provincial People’s Hospital. These patients were categorized into two groups: those receiving RA and those receiving non-RA. The association between RA and the incidence of MACCEs within the 1-year postoperative period was evaluated via the Cox proportional hazards model.

Results: In patients with CTO exhibiting severe calcification, we compared various factors, including age, BMI, history of diabetes, left ventricular ejection fraction, low-density lipoprotein levels, hemoglobin, creatinine, the glomerular filtration rate, and family history of coronary heart disease, between those who underwent RA and those who did not. In addition, we assessed medical history, cardiac bypass surgery, cerebrovascular disease, coronary interventions, the number of CTO lesions, operation time, irradiation time, contrast agent usage, and the incidence rates of MACCEs, all of which were found to be statistically significant (p < 0.05). These significant indicators and the occurrence of MACCEs within 1 year were incorporated into the Cox survival regression analysis, which revealed that the use of RA (p = 0.010, HR: 0.457, 95% CI: 0.251–0.830) was independently correlated with a lower MACCE rate. Furthermore, the survival curve of the non-RA group was significantly lower than that of the RA group.

Conclusion: Intervention with RA is associated with a lower MACCE rate in patients with severely calcified CTO. These findings imply that the potential of RA could be an alternative treatment modality in these patients. However, more evidence and further randomized controlled studies are needed to verify these findings.