REC Interventional Cardiology最新文献

Introduction and objectives: The early administration of unfractionated heparin (UFH) for ST-segment elevation myocardial infarction (STEMI) is still a matter of discussion, and clinical practice guidelines leave the timing of administration prior to angioplasty at the physician's discretion.

Methods: We conducted a systematic search across PubMed/Cochrane databases for studies comparing pre-treatment with UFH with a comparative untreated group (non-UFH) of patients with STEMI undergoing primary angioplasty and including TIMI flow and 30-day mortality targets from June 2024 through September 2024. We conducted a randomized meta-analysis and assessed the risk of publication bias to detect asymmetry in the included studies.

Results: We included a total of 7 studies published from 2002 through 2022 (6 retrospective trials and 1 substudy of a randomized trial) for a total of 36 831 patients: 17 751 in the UFH pre-treatment group and 19 080 in the non-UFH control group. A total of 6202 patients (31.6%) on UFH had TIMI grade-II/III flow vs 5106 (23.0%) on non-NFH while 490 (3.9%) on UFH died within 30 days vs 673 (5.1%) on non-NFH. Meta-analysis demonstrated a higher probability of TIMI grade-II/III flow (HR, 1.35; 95%CI, 1.25-1.45; P < .0001) and a lower 30-day mortality rate in patients on UFH pretreatment (HR, 0.80; 95%CI, 0.72-0.90; P = .0002), with no differences being reported in bleeding complications (HR, 0.87; 95%CI, 0.72-1.05; P = .150).

Conclusions: Meta-analysis of studies shows that pretreatment with UFH in STEMI patients undergoing primary angioplasty is associated with a higher probability of TIMI grade-II/III flow and a lower risk of early mortality. Meta-analysis registered in PROSPERO (CRD420250655362).

Introduction and objectives: Transcatheter treatment for tricuspid regurgitation (TR) has grown exponentially in recent years. The Edwards EVOQUE system (Edwards Lifesciences, United States), which obtained CE marking in 2023, is a transcatheter tricuspid valve designed to address severe cases of TR that are not amenable to repair using other transcatheter techniques. This study presents the initial experience at our center with the implantation of the EVOQUE tricuspid valve in 10 patients with symptomatic TR. Our objective was to analyze the initial clinical and 30-day imaging follow-up.

Methods: We conducted a prospective, single-center observational study. A total of 10 patients with severe TR who underwent EVOQUE tricuspid valve implantation were included. The 30-day early outcomes were evaluated using clinical parameters and echocardiographic findings. We assessed the reduction of TR, right ventricular function, and potential postoperative complications.

Results: Ten patients with symptomatic severe TR were included. The median follow-up was 80 days, and the patients' mean age, 77.2 years. The mean TRISCORE was 4.6, and the mean EuroSCORE II, 3.9%. Pacemaker dependance was observed in 40% of patients. The rate of procedural success was 100% according to the Tricuspid Valve Academic Research Consortium criteria. The maximum transprosthetic gradient was 4.8 mmHg. Significant complications included 1 case of severe mitral regurgitation following implantation, 1 complete atrioventricular block, 2 transient right ventricular failures, and 2 prosthetic valve thromboses. The median length of stay was 7 days.

Conclusions: The early outcomes of the EVOQUE tricuspid valve implantation are promising, with significant TR reduction and few complications. Further studies are needed to confirm the safety and efficacy profile of the device in the routine clinical practice.

Introduction and objectives: The prevalence of atrial fibrillation and the number of patients experiencing ischemic strokes despite oral anticoagulation (OAC) are both on the rise, which presents a significant challenge due to the absence of clear and uniform treatment recommendations for these patients. To date, there is no formal combination merging into a high anticoagulant efficacy profile while keeping a low bleeding risk. Transcatheter left atrial appendage occlusion (LAAO) in combination with OAC might provide a balance between safety and efficacy. The objective of this study is to evaluate whether, in ischemic stroke patients, despite anticoagulation, the combination of LAAO plus long-term anticoagulation-direct oral anticoagulants or vitamin K antagonist when indicated-is associated with a lower rate of recurrent cardioembolic events at 12 months vs the optimal medical therapy recommended by the neurologist.

Methods: A total of 380 patients with ischemic stroke despite OAC will be included. Patients will be randomized on a 1:1 ratio to receive the optimal medical therapy (control) or the combination of LAAO plus OAC or OAC. The primary endpoint of the study will be the occurrence of a cardioembolic event-ischemic stroke or arterial peripheral embolism-within the first 12 months after inclusion.

Conclusions: This study is one of the first randomized clinical trials to compare the LAAO plus OAC combination and optimal medical therapy in patients who have experienced ischemic strokes despite being on OAC. If results confirm the superiority of LAAO plus OAC, it could lead to a paradigm shift in treatment guidelines for these patients.

Introduction and objectives: Several tools have been implemented to assess the functional significance of coronary lesions. Their reliability in the management of acute coronary syndrome (ACS) might be affected by alterations in the acute phase that go beyond the affected area. Our main objective was to evaluate the reliability of invasive physiological indices for non-culprit lesions (NCL) in patients with ACS.

Methods: We conducted a systematic review across ClinicalTrials.gov, Embase, Google Scholar, PubMed, and Web of Science from inception through 5 December 2024. Additionally, a citation analysis and web searches were conducted.

Results: A total of 20 articles, with 4379 patients were included in the analysis. The main study design is a cohort study. The following methods were compared between acute and staged interventions: a) angiography-derived; b) hyperemic; and c) non-hyperemic indices. A significant difference in fractional flow reserve, instantaneous wave-free ratio, and quantitative flow ratio was found in one or more articles. There were no articles reporting any important changes in the Murray law-based quantitative flow ratio, resting distal-to-aortic coronary pressure ratio, or vessel fractional flow reserve. However, these indices rely on retrospective and/or limited data. All significant variations were observed in cohorts of ST-segment elevation myocardial infarction. Unlike quantitative flow ratio, the fractional flow reserve and instantaneous wave-free ratio demonstrated consistent directions of change towards lower and higher values, respectively. Prospective cohorts and randomized controlled trials including non-ST-segment elevation acute coronary syndrome did not prove the existence of significant differences between acute and follow-up fractional flow reserve.

Conclusions: Physiological methods lack complete reliability for evaluating NCL during acute ST-segment elevation myocardial infarction. However, considering directions of change, fractional flow reserve is suitable for guiding the revascularization of acute positive NCL. Conversely, instantaneous wave-free ratio can be used to defer the revascularization of negative NCL. In non-ST-segment elevation acute coronary syndrome, fractional flow reserve is appropriate for assessing NCL within the acute phase.

The gender gap in interventional subspecialties is largely due to concerns about occupational radiation exposure. The belief that it is not possible to continue working in cath labs during pregnancy is perceived by many female physicians as a barrier to develop their career or fulfill their motherhood wishes. Many physicians are unaware of the doses of ionizing radiation that are harmful for the fetus, which is the dose received by women who continue to work in cath labs throughout their pregnancies, or do not know the existing regulations. The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), the Heart Rhythm Association of the Spanish Society of Cardiology (ARC-SEC), the Spanish Society of Vascular and Interventional Radiology (SERVEI), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Medical Radiology (SERAM), and the Society of the Spanish Group of Interventional Neuroradiology (GeNI) consider it necessary to draft this informative document and joint position paper to provide female physicians with the necessary knowledge to make fully informed decisions on whether to choose an interventional subspecialty or work exposed to ionizing radiation during their pregnancy.

Introduction and objectives: Complete and secure venous access closure is essential at the end of large-bore catheter-based procedures. The aim of this study is to evaluate the safety and efficacy profile of a new simplified purse-string suture with 3-way stopcock to improve venous hemostasis in structural heart procedures (the SUTURE-3 study).

Methods: We conducted a multicenter, non-randomized and prospective study including all consecutive patients undergoing any interventional procedures with a ≥ 10-Fr femoral venous access in whom a simplified purse-string suture with 3-way stopcock for venous hemostasis was used. Exclusion criteria were < 10-Fr diameters or ipsilateral artery access. We evaluate the safety profile according to the Valve Academic Research Consortium-3 criteria, efficacy (correct hemostasis), a pain-score (visual analog scale [VAS]) and a clinical 1 month-follow up.

Results: A total 222 patients were included. Mean age was 73.6 ± 9.7 years (58%, men; 85%, hypertensive; 44%, diabetics; 91%, had a past medical history of atrial fibrillation). We found significantly high CHA₂DS₂-VA (4.1 ± 1.8) and HAS-BLED (3.5 ± 1.6) scores with a higher proportion of previous major bleeding (62%). A total of 54% of patients were on oral anticoagulation and 25%/6% on single/dual antiplatelet therapy, respectively. The most common procedure was left atrial appendage closure (n = 154, 69%) and mitral valve transcatheter edge-to-edge repair (n = 41, 18%). Mean diameter access was 15.6 ± 5-Fr; 91%, echo-guided; compression time, 4 ± 1.7 h; pain in VAS, 0.6 ± 1.5. Hemostasis was instantaneous with a 100% success rate, and only 2 minor bleeding events being reported (0.9%). No access complications (including infections) were recorded after discharge at the 1-month follow-up.

Conclusions: The simplified purse string suture with 3-way stopcock to improve venous hemostasis in structural heart procedures is a simple, inexpensive, safe and effective procedure.