Journal of interventional cardiology最新文献

Background: In patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), the benefit of complete revascularization (CR) with respect to hard endpoints (death or myocardial infarction [MI]) and the role of invasive physiological assessment remains uncertain.

Methods: This systematic review and meta-analysis included randomized trials comparing CR with culprit only revascularization (COR) or immediate versus delayed CR in patients with STEMI and MVD. Random-effects meta-analysis was performed comparing clinical outcomes in individual groups. The primary endpoint was the composite of death or MI.

Results: Sixteen trials were identified including a total of 15,160 patients. Compared to a COR strategy, CR significantly reduced the risk of death/MI (RR: 0.68, CI = 0.54–0.85). Angiography-guided CR significantly reduced the risk of death/MI compared to a COR approach (RR: 0.57, CI = 0.40–0.83, p < 0.05). Seven trials evaluated physiology-guided CR and did not demonstrate a significant difference for death/MI compared to a COR approach (RR: 0.74, CI = 0.54–1.01, p = 0.06). Meta-regression showed that age was significantly associated with death/MI (p = 0.026), and the timing of CR was associated with a reduced risk of ischemia-driven revascularization (p = 0.045).

Conclusion: CR was associated with a lower risk of death or MI compared to COR. Compared to COR, angiography-guided CR was associated with a lower incidence of death or MI; however, these benefits were not observed in the physiology-guided CR group. There is a need for further head-to-head studies investigating the role of physiology-guided risk-stratification of nonculprit stenoses.

Aims: This study aimed to compare 6-month survival and complication rates of patients undergoing high-risk percutaneous coronary intervention (PCI) supported by either iVAC2L mechanical circulatory support (MCS) or intra-aortic balloon pump (IABP).

Methods and Results: In this retrospective cohort analysis, we included 54 patients who underwent a high-risk PCI for an unprotected left main, 3-vessel disease or a last remaining vessel stenosis with temporary MCS. Patients received either iVAC2L (n = 24) or IABP (n = 30) during PCI. The primary endpoint was 6-month all-cause mortality. Secondary endpoints included vascular complications, repeat revascularization, and stroke. The groups had similar baseline characteristics, with the ejection fraction being 34.4 ± 9.5% in the iVAC2L group and 37.9 ± 9.4% in the IABP group (p = 0.177). The 6-month mortality rate was lower in the iVAC2L group (8.3%) compared to the IABP group (16.7%), though the difference was not statistically significant (p = 0.365). Access site vascular complications were numerically higher in the iVAC2L group (12.5% vs. 3.3%; p = 0.201). Repeat revascularization rates (iVAC2L 4.2% vs. IABP 6.7%, p = 0.690) and stroke rates (iVAC2L 4.2% vs. IABP 3.3%, p = 0.872) were similar in both groups.

Conclusion: Patients with iVAC2L MCS had higher 6-month survival compared to IABP in high-risk PCI, albeit without statistically significant differences. Both devices provided effective hemodynamic support during the intervention with no periprocedural mortality. Vascular complications were numerically more frequent with iVAC2L, highlighting the need for skilled vascular access management. Larger prospective studies are needed to confirm these findings and guide optimal MCS device selection for high-risk PCI.

Introduction: Plaque modifying-debulking devices are the most effective initial strategy for percutaneous coronary intervention of severely calcified lesions including left main coronary artery. There are limited data comparing the short- and long-term clinical outcomes of these devices in left main lesions.

Methods: A retrospective analysis of patients with calcified left main lesions treated with percutaneous intervention with adjunctive plaque modifying device at a large tertiary center between 2008 and 2021. The primary endpoint was long-term mortality at documented longest follow-up. Secondary endpoints included procedural complications and in-hospital clinical outcome.

Results: A total of 302 patients with calcified left main lesions treated with rotational atherectomy (RA) (n = 240), intracoronary lithotripsy (n = 30), or excimer laser coronary atherectomy (n = 32) were included. Out of all patients, 55% presented with acute coronary syndromes. Technical success was achieved in 98.7% of the patients and procedural success was achieved in 95.4% of the patients. At a median follow-up of 42 (19–62) months, there was no difference in mortality between the 3 devices (RA 54/240 [23.4%] vs. lithotripsy 1/30 [3.3%] vs. laser 5/32 [15.6%], p = 0.128). Likewise, in-hospital clinical outcomes were similar. However, procedural complications were higher in the laser group.

Conclusions: In patients with calcified left main lesions treated with percutaneous intervention, adjunctive plaque-modifying devices appear safe with survival exceeding 80% at long-term follow-up with no difference between the devices in relation to in-hospital clinical outcomes or long-term mortality risk.

Introduction: Currently, there are 2 types of third generation bioprostheses that can be used in patients with aortic stenosis with a large aortic annulus (LAA): the 29-mm Sapien 3 (S3; Edwards Lifesciences LLC, Irvine, CA) and the 34-mm Evolut-R (ER; Medtronic, Inc, Dublin, Ireland). The objective of this trial was to compare long-term hemodynamic and clinical outcomes of these two valves in patients with LAA and to determine the effect of aortic annulus size on these two outcomes.

Method: We conducted a retrospective, monocentric study (CHU Rangueil–Toulouse) in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis between 04/01/2018 and 31/12/2020. We included all patients with severe aortic stenosis (SAS) who were diagnosed based on clinical and echocardiographic criteria. All clinical, anatomical, and procedural characteristics were recorded.

Results: We included 172 patients: 110 received a 29-mm S3 prosthesis and 62 patients a 34-mm ER prosthesis. The average area of the aortic annulus was 595 ± 67 mm². The average aortic perimeter was 87.5 ± 5.1 cm for the S3 and 584 ± 72 mm² and 86.4 ± 6.3 cm for the ER. The aortic regurgitation (AR) rate was higher with the ER than with the S3 (18.3% vs. 3.9%; p = 0.002) but the mean transvalvular gradient was lower with the ER (7.1 ± 2.8 mmHg vs. 9.9 ± 3.8 mmHg; p < 0.001). At Day 30, there were 4 deaths in the S3 group and 1 death in the ER group. The mean duration of follow-up was 22.7 months. No differences in cardiovascular mortality were observed between the two devices, with a rate of 2.7 deaths per 100 person-years for the ER vs. 3.9 deaths per person-years for the S3 group (p = 0.208). Subgroup analysis according to the LAA size showed a higher rate of AR in patients with the largest annulus dimensions.

Conclusion: In patients with a LAA who require a TAVI, the 34-mm ER and 29-mm S3 prostheses demonstrate significant differences in hemodynamics with no impact on cardiovascular mortality.

Background: Cardiovascular diseases evolve over time; this may affect treatment. We investigated angiographic trends in patients presenting with de novo left main coronary artery (LM) stenosis over a decade.

Methods: Clinical records and all consecutive coronary angiograms performed in our Institution between 2011 and 2020 were reviewed to identify subjects with newly diagnosed significant (≥ 50% lumen diameter reduction by quantitative angiography) LM stenosis. Values of the overall SYNTAX score (SS), LM lesion SS (LM-SS) and SS for lesion(s) beyond LM (non-LM-SS) were assessed as per angiographic core labolatory protocol.

Results: Out of 12,524 coronary angiograms in de novo referrals, 372 (2.97%) showed significant LM stenosis; the proportion varied from 2.30% to 3.48% annually. LM patients’ mean age was 69.12 ± 9.75 years (22.95% women). No temporal age/gender trends could be identified. Overall, SS decreased from a mean value of 35 to 27 (Spearman correlation coefficient, SC = −0.17, p = 0.001). This was driven by reduction in non-LM-SS (SC = −0.18, p < 0.001) while LM-SS was not changing in time (SC = 0.04, p = 0.40). No temporal trends were present in LM stenosis segmental location (ostial/mid/bifurcation, p > 0.05 for all), its angiographic severity (< 70% vs. ≥ 70%; p = 0.35) or in the number of LM segments affected (p = 0.19). Isolated LM stenosis presentations increased over time (Z = 2.07, p = 0.039). The reduction in non-LM-SS was associated primarily with a trend towards reduction in number of coexisting non-LM lesions requiring revascularization (SC = −0.09, p = 0.07).

Conclusions: In consecutive patients presenting with de novo LM stenosis, angiographic SS showed a statistically significant negative trend over a decade, driven primarily by a reduction in non-LM-SS. Our findings are consistent with an increase in the proportion of patients presenting with LM stenosis amenable to first-line percutaneous (rather than surgical) management (LM-EVOLUTION study).

Background: This study aimed at comparing the safety and long-term outcomes pertaining to delayed left atrial appendage closure (LAAC) after catheter ablation (CA).

Methods: The retrospective analysis in the study included 474 patients who received LAAC at our center between July 2017 and April 2024. Procedure- and device-related complications, major adverse events (MAEs), and recurrence of atrial fibrillation (AF) were compared among the CA + LAAC, Delayed-LAAC, and LAAC-only groups.

Results: The Delayed-LAAC group did not report device-related thrombus (DRT) formation, and the CA + LAAC group presented obviously lower DRT incidence versus the LAAC-only group (0.7% vs. 7.1%, p = 0.02). Both CA + LAAC and Delayed-LAAC groups exhibited obviously lower stroke events rate versus the LAAC-only group (4.6% and 2% vs. 13.7%, p = 0.02). And all three groups demonstrated low rates of bleeding events (9.8% and 6% vs. 3.4%, p = 0.25) and all-cause death (1.9% and 2% vs. 5.2%, p = 0.23). The Delayed-LAAC group showed dramatically lower AF recurrence rate relative to the CA + LAAC group (16% vs. 35.2%, p = 0.006). In the multivariate Cox regression analysis, delayed LAAC (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.20–0.93, and p = 0.03) and paroxysmal AF (HR = 0.56, 95% CI: 0.38–0.83, and p = 0.003) were protective factors. Patients with persistent AF and who once had been diagnosed with coronary heart disease (HR = 1.56, 95% CI: 1.11–2.21, and p = 0.01) were more likely to experience AF recurrence. Further subgroup analysis showed similar results.

Conclusions: The Delayed-LAAC is as safe and feasible as the combination procedure. However, Delayed-LAAC was associated with lower AF recurrence rate.

Background: Congenital heart disease (CHD) is one of the most common birth defects globally, and catheter-based interventions have become essential in its management. However, nationwide epidemiological data on CHD interventions remain limited. This study aims to analyze nationwide epidemiological trends in catheter-based CHD interventions among pediatric and adult populations in Korea.

Methods: We analyzed the National Health Insurance Service database from 2002 to 2018 to identify patients who underwent catheter-based interventions for CHD.

Results: A total of 18,800 CHD interventions were performed during the study period, with female patients accounting for 60.4% of cases. The most common intervention was atrial septal defect (ASD) device closure (35.3%), followed by patent ductus arteriosus (PDA) device closure (29.5%), balloon pulmonary valvuloplasty, and balloon pulmonary angioplasty. Intervention patterns varied by age, with PDA device closure being most frequent in infants and children, while ASD device closure dominated among adults. The overall number of CHD interventions increased significantly over the study period, with a marked rise among adults following the inclusion of ASD closure in national health insurance coverage in 2009.

Conclusions: CHD interventions in Korea have increased substantially over time, with a notable shift toward adult patients. ASD device closure was the most frequently performed procedure, especially after its inclusion in national health insurance coverage. These findings highlight the growing need for adult CHD care and underscore the critical role of healthcare policies in shaping intervention trends.

Background: Coronary lesions with significant angulation or tortuosity pose unique challenges during intervention due to limited access and maneuverability. The SuperCross microcatheter (SCM) is specifically designed to navigate through these angulated vessels and facilitate the successful crossing of side branches.

Objectives: The objective of this article is to formulate and discuss recommendations for the primary use of SCM in coronary intervention involving complex coronary anatomy.

Methods: From January 2021 to December 2023, a total of 43 patients underwent treatment at our single center utilizing SCM techniques. The duration of the treatment period was categorized into two distinct phases: primary use and secondary use of SCM.

Results: The average age of the patients was 68.5 ± 10.6 years, with a predominance of male patients. The primary diagnosis consisted of unstable angina. Due to limited accessibility and maneuverability, there were frequent attempts made at the ostium of the left circumflex artery (30.2%), diagonal branch ostium (27.9%), and obtuse marginal branch ostium (14.0%). However, three cases failed to successfully navigate through highly angulated lesions.

Conclusions: The utilization of SCM techniques offers distinct advantages in managing complex coronary anatomies, particularly when dealing with highly angulated vessels observed in bifurcation or chronic total occlusion scenarios, as well as facilitating antegrade dissection for re-entry into the true lumen.

Background and Aims: Breast cancer (BC) is the leading cause of cancer in women. Female interventional cardiologists are potentially at a higher risk of developing BC due to occupational radiation exposure. This survey aimed at understanding radiation safety and awareness in current clinical practice, and the occurrence of BC, among female interventional cardiologists.

Methods: A survey was conducted worldwide among 64 cardiac laboratories from September 2022 to December 2022.

Results: 195 physicians (mean age 41.0 ± 7.4 years) completed the survey: 33 (16.9%) reported being exposed to X-ray for less than five years, 78 (40%) between five and ten years and 84 (43.1%) for more than ten years; 13 (6.7%) reported performing less than 50 interventional procedures/year, 52 (26.7%) between 50 and 100 and 130 (66.6%) more than 100 procedures/year. 126 physicians reported wearing three or more radiation dosimeters; 72 reported not using tableside X-ray shielding to protect themselves from direct and scattered radiation. BC occurred in four (2.1%) physicians, all of whom worked in the electrophysiology laboratory for a relatively long time (one with 5–10 years of exposure and three with more than ten years; mean age at cancer presentation was 46.5 ± 3.7 years). All tumours were left-sided BC.

Conclusions: This survey provides a snapshot of occupational radiation exposure of female interventional cardiologists. BC is a possible professional threat in addition to its real-life epidemiology, with a negative impact on women’s lives in interventional laboratories. All possible efforts should be made to eliminate radiation exposure among interventional laboratory workers.

Introduction and Objectives: Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Although its management is well-studied in tertiary care settings, little is known about the incidence and treatment patterns at district general hospitals (DGHs), which this study explored.

Materials and Methods: A single-centre analysis of all PCI procedures in a DGH between January 2011 and December 2023 was performed. Patients’ records were examined for procedure details and endpoints, which included pericardiocentesis, emergency cardiac surgery and secondary coronary artery bypass grafting. The endpoints also included in-hospital and one-year mortalities.

Results: During the study period, there were 13,480 PCIs, of which 31 (0.23%) were complicated by CAP. Males composed 65%, and the mean age was 69.9 ± 10 years. The most common perforation type was Ellis II in 45% of patients, and the left anterior ascending artery (LAD) was most affected in 55% of patients. An echocardiogram was done in all patients and showed tamponade physiology in 16%, in all of whom pericardiocentesis was performed. Other CAP treatments included balloon tamponade in 65%, covered stent in 42%, fat embolisation in 10% and emergency surgery and coiling in 6% each. Inpatient mortality occurred in three patients (10%), with no one-year mortalities. Long-term complications were not observed in the study.

Conclusion: CAP remains a rare, potentially lethal complication of PCI in a DGH setting, with an incidence, pattern and treatments similar to those of high-volume PCI teaching centres. Early recognition and proper management are crucial.