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Management of Pediatric Heart Failure. 小儿心力衰竭的处理。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 DOI: 10.4070/kcj.2024.0320
Anne I Dipchand

Heart failure (HF) in children is a complex syndrome with multiple diverse etiologies and both acute and chronic presentations. Chronic presentations can persist throughout childhood and adolescence, and require diligent management with ongoing reassessment to maximize survival and quality of life. Stages of HF are key to recognize as they guide both management and inform prognosis. In more severe cases, children can present with signs of low cardiac output and circulatory collapse with potential to transition either to a chronic HF stage or progress to a need for advanced HF therapies. Morbidity and mortality are high. Managing HF requires a multi-disciplinary approach that can adapt to the needs of the different phases of childhood and adolescence. Treatment can include medications, nutritional support, activity modifications, and potentially surgical intervention, pacemaker, respiratory or mechanical support, or even heart transplantation. Limited evidence exists for almost all medical therapies used in the management of HF in children and approaches are predominantly extrapolated from extensive adult experience. There are multiple maladaptive pathways in the failing heart; medications that modify these maladaptive pathways promote "reverse remodelling" of the myocardium and are key to the management, forming the basis for "guideline directed medical therapy". The purpose of this review is to summarize the current state of the art management of systolic HF in children.

儿童心力衰竭(HF)是一种复杂的综合征,具有多种病因和急性和慢性表现。慢性表现可以持续整个童年和青春期,需要勤奋的管理和不断的重新评估,以最大限度地提高生存和生活质量。心衰的分期是识别的关键,因为它们指导治疗和告知预后。在更严重的情况下,儿童可能出现低心输出量和循环衰竭的迹象,有可能转变为慢性心衰期或进展到需要高级心衰治疗。发病率和死亡率都很高。治疗心衰需要多学科的方法,以适应儿童和青少年不同阶段的需要。治疗包括药物治疗、营养支持、活动改变、可能的手术干预、起搏器、呼吸或机械支持,甚至心脏移植。几乎所有用于治疗儿童心衰的医学疗法都存在有限的证据,而且方法主要是从广泛的成人经验中推断出来的。衰竭的心脏存在多种不适应途径;改变这些不适应途径的药物促进心肌的“反向重塑”,是治疗的关键,形成了“指导药物治疗”的基础。本综述的目的是总结儿童收缩期心衰的治疗现状。
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引用次数: 0
2024 Korean Society of Myocardial Infarction/National Evidence-Based Healthcare Collaborating Agency Guideline for the Pharmacotherapy of Acute Coronary Syndromes. 2024 韩国心肌梗塞学会/全国循证医疗合作机构《急性冠状动脉综合征药物治疗指南》。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.4070/kcj.2024.0257
Hyun Kuk Kim, Seungeun Ryoo, Seung Hun Lee, Doyeon Hwang, Ki Hong Choi, Jungeun Park, Hyeon-Jeong Lee, Chang-Hwan Yoon, Jang Hoon Lee, Joo-Yong Hahn, Young Joon Hong, Jin Yong Hwang, Myung Ho Jeong, Dong Ah Park, Chang-Wook Nam, Weon Kim

Many countries have published clinical practice guidelines for appropriate clinical decisions, optimal treatment, and improved clinical outcomes in patients with acute coronary syndrome. Developing guidelines that are specifically tailored to the Korean environment is crucial, considering the treatment system, available medications and medical devices, racial differences, and level of language communication. In 2017, the Korean Society of Myocardial Infarction established a guideline development committee. However, at that time, it was not feasible to develop guidelines, owing to the lack of knowledge and experience in guideline development and the absence of methodology experts. In 2022, the National Evidence-Based Healthcare Collaborating Agency collaborated with a relevant academic association to develop internationally reliable guidelines, with strict adherence to the methodology for evidence-based guideline development. The first Korean acute coronary syndrome guideline starts from the 9 key questions for pharmacotherapy.

许多国家都发布了临床实践指南,以帮助急性冠状动脉综合征患者做出适当的临床决策、进行最佳治疗并改善临床疗效。考虑到治疗系统、可用药物和医疗设备、种族差异以及语言交流水平,制定专门针对韩国环境的指南至关重要。2017 年,韩国心肌梗死学会成立了指南制定委员会。但当时由于缺乏制定指南的知识和经验,也没有方法论专家,因此制定指南并不可行。2022 年,国家循证医疗协作机构与相关学术协会合作,严格遵守循证指南制定方法,制定了国际上可靠的指南。韩国首部急性冠脉综合征指南从药物治疗的 9 个关键问题入手。
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引用次数: 0
Insights for Tailoring Exercise Recommendations in Home-based Cardiac Rehabilitation: Patients' Perspectives. 在家庭心脏康复中定制运动建议的启示:患者的观点。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-08-22 DOI: 10.4070/kcj.2024.0265
Jinsung Jeon, Eung Ju Kim
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引用次数: 0
Pulmonary Artery Dissection: Less Is Better When You Are Blue. 肺动脉交叉青出于蓝而胜于蓝
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-08 DOI: 10.4070/kcj.2024.0212
Merna Abdou, Justin Shipman, Francois Marcotte, Clinton Jokerst, David S Majdalany
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引用次数: 0
The Efficacy and Safety of NOAC in Very Elderly Atrial Fibrillation Patients: Data From the Korean National Health Insurance Cohort Registry. NOAC对高龄心房颤动患者的疗效和安全性:韩国国民健康保险队列登记的数据。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-07-25 DOI: 10.4070/kcj.2024.0073
Seong Huan Choi, Yeong Chan Lee, Yong-Soo Baek

Background and objectives: We investigated the clinical benefit of anticoagulation with non-vitamin K antagonist oral anticoagulant (NOAC) in very elderly atrial fibrillation (AF) patients through national healthcare insurance registry.

Methods: Clinical data was acquired from the National Health Insurance Service of south Korea. Medical records of 862,935 patients who were diagnosed with AF from 2015 to 2020 were collected for analysis. Patients under the age of 85, prior history of intracranial hemorrhage, gastrointestinal bleeding and prior prescription days of aspirin, warfarin or NOAC exceeding 90 along with follow up period less than 90 days were excluded.

Results: A total of 10,625 patients were eligible for analysis. Patients with oral anticoagulant (hazard ratio [HR], 0.60, 95% confidence interval [CI], 0.53-0.69, p<0.001) showed higher efficacy regarding cerebrovascular accident (CVA) compared to aspirin (HR, 0.84, 95% CI, 0.74-0.95, p=0.008) and no treatment group. Individual comparison of NOAC and aspirin via propensity score matching showed that patients with NOAC (HR, 0.71, 95% CI, 0.61-0.85, p<0.001) showed higher event free survival regarding CVA compared to aspirin. Bleeding risk was also higher for NOAC (HR, 1.28, 95% CI, 1.07-1.56, p=0.006) group but did not result in commensurate increase in mortality (HR, 0.60, 95% CI, 0.45-0.81, p<0.001).

Conclusions: Anticoagulation with NOAC in very elderly patient showed higher event free survival regarding CVA. Despite having higher event rate of bleeding, eventual death was lower for NOAC.

背景和目的:我们通过国家医疗保险登记处调查了使用非维生素 K 拮抗剂口服抗凝剂(NOAC)对高龄心房颤动(AF)患者的临床益处:方法:从韩国国民健康保险服务机构获取临床数据。收集了 2015 年至 2020 年期间确诊为房颤的 862,935 名患者的医疗记录进行分析。85岁以下患者、既往有颅内出血史、消化道出血史、既往阿司匹林、华法林或NOAC处方天数超过90天且随访时间少于90天的患者被排除在外:共有 10625 名患者符合分析条件。使用口服抗凝剂的患者(危险比[HR],0.60,95%置信区间[CI],0.53-0.69,pConclusions:高龄患者使用 NOAC 抗凝治疗可提高 CVA 的无事件生存率。尽管NOAC的出血事件发生率较高,但最终死亡人数较少。
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引用次数: 0
Escalating Lipid Therapy After Achieving LDL-C <70 mg/dL With Moderate-Intensity Statins in High-Risk Patients. 高危患者LDL-C <70 mg/dL后使用中等强度他汀类药物进行脂质治疗。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-26 DOI: 10.4070/kcj.2024.0218
Geunhee Park, Eui-Young Choi, Sang-Hak Lee

Background and objectives: Guidelines recommend target levels of low-density lipoprotein cholesterol (LDL-C) and intensive lipid-lowering therapy (LLT) in high-risk patients. However, the value of escalating LLT when the LDL-C targets are achieved with moderate-intensity statins is unknown. We aimed to evaluate the benefits of LLT escalation in this population.

Methods: In this retrospective propensity score-matched study, we screened data from two university hospitals between 2006 and 2021. Of the 54,069 patients with atherosclerotic cardiovascular disease (ASCVD), 3,205 who achieved LDL-C levels <70 mg/dL with moderate-intensity statins were included. After 1:3 matching, 1,315 patients (339 with LLT escalation and 976 without) were ultimately examined. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE)1 (cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke) and all-cause death.

Results: During a median follow-up of 5.7 years, the MACCE1 rate was not significantly lower in the escalation group than in the non-escalation group (9.8 and 14.3/1,000 person-years, respectively; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.43-1.09; p=0.11). Kaplan-Meier curves showed similar results (log-rank p=0.11). The risk of all-cause death did not differ between the groups. MACCE2 rate, which additionally includes coronary/peripheral revascularization, was lower in the escalation group (24.5 and 35.4/1,000 person-years, respectively; HR, 0.70; 95% CI, 0.52-0.94; p=0.017).

Conclusions: LLT escalation did not significantly lower hard cardiovascular outcomes and all-cause death in patients with ASCVD achieving LDL-C levels <70 mg/dL with moderate-intensity statins. However, it had benefit in reducing revascularization rates in this population.

背景和目的:指南推荐高危患者的低密度脂蛋白胆固醇(LDL-C)目标水平和强化降脂治疗(LLT)。然而,当使用中等强度他汀类药物达到LDL-C目标时,LLT升高的价值尚不清楚。我们的目的是评估在这一人群中LLT升级的益处。方法:在这项回顾性倾向评分匹配研究中,我们筛选了2006年至2021年间两所大学医院的数据。在54069例动脉粥样硬化性心血管疾病(ASCVD)患者中,3205例达到LDL-C水平。结果:在5.7年的中位随访期间,MACCE1升高组的发生率并未显著低于非升高组(分别为9.8和14.3/ 1000人年;风险比[HR], 0.68;95%置信区间[CI], 0.43-1.09;p = 0.11)。Kaplan-Meier曲线显示了类似的结果(log-rank p=0.11)。两组之间全因死亡的风险没有差异。包括冠状动脉/外周血运重建术在内的MACCE2率在升级组中较低(分别为24.5和35.4 000人年);人力资源,0.70;95% ci, 0.52-0.94;p = 0.017)。结论:在达到LDL-C水平的ASCVD患者中,LLT升级并没有显著降低硬心血管结局和全因死亡
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引用次数: 0
LncRNA uc003pxg.1 Interacts With miR-339-5p Promote Vascular Endothelial Cell Proliferation, Migration and Angiogenesis. LncRNA uc003pxg.1与miR-339-5p相互作用促进血管内皮细胞增殖、迁移和血管生成。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-18 DOI: 10.4070/kcj.2024.0153
Ping Li, Feng Wang, Anna Yue, Yanling Xuan, Ying Huang, Jingyi Xu, Jiayi Weng, Yuan Li, Kangyun Sun

Background and objectives: This study aimed to investigate the roles of lncRNA uc003pxg.1 and miR-339-5p in regulating the occurrence and development of coronary heart disease.

Methods: First, the expression levels of uc003pxg.1 and miR-339-5p were verified in peripheral blood mononuclear cells of clinical samples. Then, the target gene was identified using high-throughput sequencing combined with bioinformatics. Human umbilical vein endothelial cells (HUVECs) were transfected with si-uc003pxg.1, miR-339-5p mimic and miR-339-5p inhibitor, and the expression of related genes was detected by reverse transcription-quantitative polymerase chain reaction and western blotting. EdU, CCK-8, Cell scratch and Transwell assays were used to analyze the effects of uc003pxg.1 and miR-339-5p on cell proliferation and migration.

Results: The expression of uc003pxg.1 and miR-339-5p was negatively correlated in clinical samples and HUVECs. The si-uc003pxg.1 and miR-339-5p mimic decreased the proliferation and migration of HUVECs and decreased the expression of transforming growth factor (TGF)-β1 and α-smooth muscle actin (SMA). The protein expression levels of TGF-β1, α-SMA, CD31, collagen I, collagen III and endoglin were decreased, and angiogenesis was weakened. The miR-339-5p inhibitor had the opposite effect.

Conclusions: Our study revealed that upregulation of uc003pxg.1 and downregulation of miR-339-5p in vitro promote cell proliferation, cell migration and angiogenesis and upregulate the expression of TGF-β1, α-SMA, CD31, collagen I, collagen III and endoglin, which may lead to the development of vascular atherosclerosis.

背景与目的:本研究旨在探讨lncRNA uc003pxg的作用。1和miR-339-5p在调节冠心病发生发展中的作用。方法:首先观察uc003pxg的表达水平。1和miR-339-5p在临床样本外周血单个核细胞中得到验证。然后,利用高通量测序结合生物信息学技术对目标基因进行鉴定。用si-uc003px转染人脐静脉内皮细胞(HUVECs)。1、miR-339-5p mimic和miR-339-5p inhibitor,并通过逆转录-定量聚合酶链反应和western blotting检测相关基因的表达。采用EdU、CCK-8、Cell scratch和Transwell法分析uc003pxg的作用。1和miR-339-5p对细胞增殖和迁移的影响。结果:uc003pxg的表达。1与miR-339-5p在临床样本和HUVECs中呈负相关。si-uc003pxg。miR-339-5p和miR-339-5p mimic可降低huvec的增殖和迁移,降低转化生长因子(TGF)-β1和α-平滑肌肌动蛋白(SMA)的表达。TGF-β1、α-SMA、CD31、I型胶原、III型胶原、内啡肽蛋白表达水平降低,血管生成减弱。miR-339-5p抑制剂具有相反的作用。结论:我们的研究揭示了uc003pxg的上调。miR-339-5p在体外下调可促进细胞增殖、细胞迁移和血管生成,上调TGF-β1、α-SMA、CD31、I型胶原、III型胶原和内啡肽的表达,可能导致血管粥样硬化的发生。
{"title":"LncRNA uc003pxg.1 Interacts With miR-339-5p Promote Vascular Endothelial Cell Proliferation, Migration and Angiogenesis.","authors":"Ping Li, Feng Wang, Anna Yue, Yanling Xuan, Ying Huang, Jingyi Xu, Jiayi Weng, Yuan Li, Kangyun Sun","doi":"10.4070/kcj.2024.0153","DOIUrl":"https://doi.org/10.4070/kcj.2024.0153","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to investigate the roles of lncRNA uc003pxg.1 and miR-339-5p in regulating the occurrence and development of coronary heart disease.</p><p><strong>Methods: </strong>First, the expression levels of uc003pxg.1 and miR-339-5p were verified in peripheral blood mononuclear cells of clinical samples. Then, the target gene was identified using high-throughput sequencing combined with bioinformatics. Human umbilical vein endothelial cells (HUVECs) were transfected with si-uc003pxg.1, miR-339-5p mimic and miR-339-5p inhibitor, and the expression of related genes was detected by reverse transcription-quantitative polymerase chain reaction and western blotting. EdU, CCK-8, Cell scratch and Transwell assays were used to analyze the effects of uc003pxg.1 and miR-339-5p on cell proliferation and migration.</p><p><strong>Results: </strong>The expression of uc003pxg.1 and miR-339-5p was negatively correlated in clinical samples and HUVECs. The si-uc003pxg.1 and miR-339-5p mimic decreased the proliferation and migration of HUVECs and decreased the expression of transforming growth factor (TGF)-β1 and α-smooth muscle actin (SMA). The protein expression levels of TGF-β1, α-SMA, CD31, collagen I, collagen III and endoglin were decreased, and angiogenesis was weakened. The miR-339-5p inhibitor had the opposite effect.</p><p><strong>Conclusions: </strong>Our study revealed that upregulation of uc003pxg.1 and downregulation of miR-339-5p in vitro promote cell proliferation, cell migration and angiogenesis and upregulate the expression of TGF-β1, α-SMA, CD31, collagen I, collagen III and endoglin, which may lead to the development of vascular atherosclerosis.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiovascular Etiologies and Risk Factors of Survival Outcomes After Resuscitation for Out-of-Hospital Cardiac Arrest: Data From the KoCARC Registry. 院外心脏骤停复苏后生存结果的心血管病因和危险因素:来自KoCARC登记处的数据。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-18 DOI: 10.4070/kcj.2024.0243
Joo Hee Jeong, Kyongjin Min, Jong-Il Choi, Su Jin Kim, Seung-Young Roh, Kap Su Han, Juhyun Song, Sung Woo Lee, Young-Hoon Kim

Background and objectives: The outcomes and characteristics of out-of-hospital cardiac arrest (OHCA) vary across geographic regions. The etiologies and prognoses of OHCA in Asian populations remain less established. This study aimed to investigate the etiologies and clinical characteristics of patients successfully resuscitated after OHCA and to identify predictors of survival outcomes.

Methods: Data were extracted from a South Korean multicenter prospective registry of OHCA that included 64 tertiary hospitals from 2015 to 2018 (n=7,577). The primary outcome was in-hospital mortality, and the secondary outcome was a Cerebral Performance Category (CPC) score of grade 1 at discharge.

Results: Of the 7,577 patients, 2,066 achieved return of spontaneous circulation (ROSC) and were hospitalized. A total of 915 (44.2%) presented with ventricular arrhythmia (VA) as their initial rhythm or on admission. The leading cause was obstructive coronary artery disease (n=413; 20.0%). Sudden unexplained death syndrome (SUDS) accounted for 67.5% of survivors and was significantly less common in patients with VA (82.7% vs. 48.3%, p<0.001). VA was an independent predictor of in-hospital mortality (adjusted hazard ratio, 0.774; 95% confidence interval [CI], 0.633-0.946; p=0.012) and the grade-1 CPC score at discharge (odds ratio, 2.822; 95% CI, 1.909-4.172; p<0.001). Other predictors of in-hospital mortality included age, diabetes mellitus, witnessed cardiac arrest, ROSC on arrival, total arrest time, alertness on admission, extracorporeal membrane oxygenation use, targeted temperature management, and coronary reperfusion.

Conclusions: SUDS was common in patients with ROSC after OHCA. VA was independently associated with favorable survival outcomes at discharge. Prompt clinical intervention may improve clinical outcomes in patients with OHCA, particularly those with VA.

背景和目的:院外心脏骤停(OHCA)的结局和特征因地理区域而异。亚洲人群OHCA的病因和预后仍然不太确定。本研究旨在探讨OHCA后成功复苏患者的病因和临床特征,并确定生存结果的预测因素。方法:数据提取自韩国OHCA多中心前瞻性注册表,其中包括2015年至2018年的64家三级医院(n= 7577)。主要结局是住院死亡率,次要结局是出院时脑功能分类(CPC)评分为1级。结果:在7577例患者中,2066例患者恢复了自然循环(ROSC)并住院治疗。共有915例(44.2%)患者以室性心律失常(VA)作为其初始节律或入院时的表现。主要原因为阻塞性冠状动脉疾病(n=413;20.0%)。不明原因猝死综合征(SUDS)占幸存者的67.5%,在VA患者中明显较少见(82.7%对48.3%)。结论:SUDS在OHCA后ROSC患者中很常见。VA与出院时良好的生存结果独立相关。及时的临床干预可以改善OHCA患者的临床结果,特别是那些VA患者。
{"title":"Cardiovascular Etiologies and Risk Factors of Survival Outcomes After Resuscitation for Out-of-Hospital Cardiac Arrest: Data From the KoCARC Registry.","authors":"Joo Hee Jeong, Kyongjin Min, Jong-Il Choi, Su Jin Kim, Seung-Young Roh, Kap Su Han, Juhyun Song, Sung Woo Lee, Young-Hoon Kim","doi":"10.4070/kcj.2024.0243","DOIUrl":"https://doi.org/10.4070/kcj.2024.0243","url":null,"abstract":"<p><strong>Background and objectives: </strong>The outcomes and characteristics of out-of-hospital cardiac arrest (OHCA) vary across geographic regions. The etiologies and prognoses of OHCA in Asian populations remain less established. This study aimed to investigate the etiologies and clinical characteristics of patients successfully resuscitated after OHCA and to identify predictors of survival outcomes.</p><p><strong>Methods: </strong>Data were extracted from a South Korean multicenter prospective registry of OHCA that included 64 tertiary hospitals from 2015 to 2018 (n=7,577). The primary outcome was in-hospital mortality, and the secondary outcome was a Cerebral Performance Category (CPC) score of grade 1 at discharge.</p><p><strong>Results: </strong>Of the 7,577 patients, 2,066 achieved return of spontaneous circulation (ROSC) and were hospitalized. A total of 915 (44.2%) presented with ventricular arrhythmia (VA) as their initial rhythm or on admission. The leading cause was obstructive coronary artery disease (n=413; 20.0%). Sudden unexplained death syndrome (SUDS) accounted for 67.5% of survivors and was significantly less common in patients with VA (82.7% vs. 48.3%, p<0.001). VA was an independent predictor of in-hospital mortality (adjusted hazard ratio, 0.774; 95% confidence interval [CI], 0.633-0.946; p=0.012) and the grade-1 CPC score at discharge (odds ratio, 2.822; 95% CI, 1.909-4.172; p<0.001). Other predictors of in-hospital mortality included age, diabetes mellitus, witnessed cardiac arrest, ROSC on arrival, total arrest time, alertness on admission, extracorporeal membrane oxygenation use, targeted temperature management, and coronary reperfusion.</p><p><strong>Conclusions: </strong>SUDS was common in patients with ROSC after OHCA. VA was independently associated with favorable survival outcomes at discharge. Prompt clinical intervention may improve clinical outcomes in patients with OHCA, particularly those with VA.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feasibility of Distal Radial Access in High Bleeding Risk Patients Who Underwent Percutaneous Coronary Intervention. 经皮冠状动脉介入治疗高危出血患者桡动脉远端通路的可行性。
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-14 DOI: 10.4070/kcj.2024.0239
In Tae Jin, Ji Woong Roh, Oh-Hyun Lee, Eui Im, Deok-Kyu Cho, Jun-Won Lee, Bong-Ki Lee, Sang-Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Han-Young Jin, Jin Sup Park, Jung Ho Heo, Do Hoi Kim, Jin Bae Lee, Dong-Kie Kim, Jun Ho Bae, Sung-Yun Lee, Seung-Hwan Lee, Yongcheol Kim

Backgrounds and objectives: The distal radial access (DRA), a potential alternative to the trans-radial approach (TRA), may offer advantages in terms of access site complications due to its smaller vessel diameter, especially for high bleeding risk (HBR) patients. This study aims to investigate the feasibility of DRA in HBR patients.

Methods: Based on data from the KODRA registry, a prospective, multicenter cohort, this study analyzed 1,586 patients who underwent successful percutaneous coronary intervention (PCI) via DRA. Patients were categorized into HBR and non-HBR groups. The primary endpoint of the study is DRA-related bleeding, and the secondary endpoints of the study are overall access site complications and each component of the access site complications. To reduce the effect of potential confounders, a multivariable adjustment analysis was performed.

Results: The mean age of the total population was 71.1±10.8 years, and 40.3% of patients were female. Both DRA-related bleeding (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67-1.97; p=0.616) and overall access site complications (OR, 1.08; 95% CI, 0.67-1.72; p=0.761) were not significantly different between the HBR group and non-HBR group after multivariable adjustment. No major bleeding before discharge was observed in both groups. Furthermore, the incidence of distal and conventional radial artery occlusion was less than 1% at 1-month follow-up in both groups.

Conclusions: Our study results showed the safety of DRA for both DRA-related bleeding and access site complications among HBR patients who underwent PCI.

Trial registration: ClinicalTrials.gov Identifier: NCT04080700.

背景和目的:桡骨远端入路(DRA)是经桡骨入路(TRA)的潜在替代方案,由于其血管直径较小,在入路并发症方面可能具有优势,特别是对于高危出血(HBR)患者。本研究旨在探讨DRA在HBR患者中的可行性。方法:基于前瞻性、多中心队列KODRA登记的数据,本研究分析了1586例经DRA成功行经皮冠状动脉介入治疗(PCI)的患者。患者分为HBR组和非HBR组。研究的主要终点是dra相关出血,次要终点是总体通路部位并发症和通路部位各组成部分并发症。为了减少潜在混杂因素的影响,进行了多变量调整分析。结果:患者平均年龄为71.1±10.8岁,女性占40.3%。均为dra相关出血(优势比[OR], 1.15;95%置信区间[CI], 0.67-1.97;p=0.616)和总体通路并发症(OR, 1.08;95% ci, 0.67-1.72;p=0.761),经多变量校正,HBR组与非HBR组间无显著差异。两组患者出院前均未见大出血。此外,在1个月的随访中,两组远端和常规桡动脉闭塞的发生率均小于1%。结论:我们的研究结果表明,在接受PCI治疗的HBR患者中,DRA对于DRA相关出血和通路并发症都是安全的。试验注册:ClinicalTrials.gov标识符:NCT04080700。
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引用次数: 0
Safety and Feasibility of Robot-Assisted Percutaneous Coronary Intervention Using the AVIAR 2.0 System: A Prospective, Multi-Center, Single-Arm, Open, Investigator-Initiated, Post-Approval Clinical Trial. 使用AVIAR 2.0系统的机器人辅助经皮冠状动脉介入治疗的安全性和可行性:一项前瞻性、多中心、单臂、开放、研究者发起、批准后的临床试验
IF 3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-05 DOI: 10.4070/kcj.2024.0226
Junghoon Lee, Tae Oh Kim, Pil Hyung Lee, Young-Hak Kim, Osung Kwon, Seung-Whan Lee

Background and objectives: Traditional manual percutaneous coronary intervention (PCI) exposes operators to significant radiation and physical stress. The recently developed Advanced Vascular Intervention Assist Robot (AVIAR) 2.0 system in South Korea aimed to overcome these issues by evaluating its safety and feasibility in a clinical setting.

Methods: The study enrolled patients with stable angina from 2 medical centers. Single-vessel de novo lesions were treated using the AVIAR 2.0 system. The primary endpoints were technical success (using the AVIAR system for PCI devices, including guidewires, balloon catheters, and stents, without switching to manual) and clinical success (<30% residual stenosis in the treated lesion and no major cardiovascular events within 48 hours or before discharge). Secondary endpoints included operator radiation exposure and procedural time. Safety was assessed using treatment-emergent adverse events.

Results: Twenty patients (mean age, 63.9±8.5 years, 70% male) underwent robot-assisted PCI for lesions mainly in the left anterior descending artery and right coronary artery, with 95% (19/20) classified as B2/C lesions. The average robotic procedural time was 23:06±05:55 minutes. Technical success was 100%, with no need for manual conversion. Clinical success was 100%, with no major complications until discharge. Operator effective radiation dose was reduced by 84% compared to table effective doses.

Conclusions: The AVIAR 2.0 system appears to be a safe and effective adjunct to manual PCI, enhancing procedural efficiency and reducing operator radiation exposure. These findings support the use of robotics in coronary interventions and suggest a promising future for minimally invasive cardiac procedures.

Trial registration: ClinicalTrials.gov Identifier: NCT05981859.

背景和目的:传统的人工经皮冠状动脉介入治疗(PCI)使操作者暴露在明显的辐射和身体压力下。韩国最近开发的先进血管介入辅助机器人(AVIAR) 2.0系统旨在通过评估其在临床环境中的安全性和可行性来克服这些问题。方法:研究纳入了来自2个医疗中心的稳定型心绞痛患者。使用AVIAR 2.0系统治疗单血管新生病变。主要终点是技术成功(使用AVIAR系统进行PCI设备,包括导丝、球囊导管和支架,无需手动)和临床成功(结果:20例患者(平均年龄63.9±8.5岁,70%男性)接受机器人辅助PCI治疗,病变主要位于左前降支和右冠状动脉,95%(19/20)分为B2/C病变。机器人平均手术时间为23:06±05:55分钟。技术成功率为100%,无需人工转换。临床成功率100%,出院前无重大并发症。操作者有效辐射剂量与表有效剂量相比降低了84%。结论:AVIAR 2.0系统似乎是一种安全有效的辅助人工PCI,提高了程序效率并减少了操作员的辐射暴露。这些发现支持了机器人技术在冠状动脉介入治疗中的应用,并表明微创心脏手术的前景广阔。试验注册:ClinicalTrials.gov标识符:NCT05981859。
{"title":"Safety and Feasibility of Robot-Assisted Percutaneous Coronary Intervention Using the AVIAR 2.0 System: A Prospective, Multi-Center, Single-Arm, Open, Investigator-Initiated, Post-Approval Clinical Trial.","authors":"Junghoon Lee, Tae Oh Kim, Pil Hyung Lee, Young-Hak Kim, Osung Kwon, Seung-Whan Lee","doi":"10.4070/kcj.2024.0226","DOIUrl":"https://doi.org/10.4070/kcj.2024.0226","url":null,"abstract":"<p><strong>Background and objectives: </strong>Traditional manual percutaneous coronary intervention (PCI) exposes operators to significant radiation and physical stress. The recently developed Advanced Vascular Intervention Assist Robot (AVIAR) 2.0 system in South Korea aimed to overcome these issues by evaluating its safety and feasibility in a clinical setting.</p><p><strong>Methods: </strong>The study enrolled patients with stable angina from 2 medical centers. Single-vessel de novo lesions were treated using the AVIAR 2.0 system. The primary endpoints were technical success (using the AVIAR system for PCI devices, including guidewires, balloon catheters, and stents, without switching to manual) and clinical success (<30% residual stenosis in the treated lesion and no major cardiovascular events within 48 hours or before discharge). Secondary endpoints included operator radiation exposure and procedural time. Safety was assessed using treatment-emergent adverse events.</p><p><strong>Results: </strong>Twenty patients (mean age, 63.9±8.5 years, 70% male) underwent robot-assisted PCI for lesions mainly in the left anterior descending artery and right coronary artery, with 95% (19/20) classified as B2/C lesions. The average robotic procedural time was 23:06±05:55 minutes. Technical success was 100%, with no need for manual conversion. Clinical success was 100%, with no major complications until discharge. Operator effective radiation dose was reduced by 84% compared to table effective doses.</p><p><strong>Conclusions: </strong>The AVIAR 2.0 system appears to be a safe and effective adjunct to manual PCI, enhancing procedural efficiency and reducing operator radiation exposure. These findings support the use of robotics in coronary interventions and suggest a promising future for minimally invasive cardiac procedures.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05981859.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Korean Circulation Journal
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