REC Interventional Cardiology最新文献

Introduction and objectives: Ultrathin-strut stents (UTS) represent a significant advancement in percutaneous coronary intervention. This study aimed to evaluate the safety and short- to mid-term outcomes of stenting with the thinnest struts on the market (50 µm) using a biodegradable everolimus-eluting polymer (Evermine 50) in real-world patients with coronary artery disease.

Methods: A single-arm, multicenter, prospective study was conducted in real-world patients. A total of 161 patients with de novo lesions who received at least 1 UTS stent were enrolled. The primary safety endpoint was the occurrence of major adverse cardiovascular events, defined as cardiac death, target-vessel myocardial infarction, or the need for revascularization of the target lesion at 12 months. The incidence of stent thrombosis at 12 months was also analyzed.

Results: The study included 161 patients with a mean age of 64 ± 14 years; 79% were male, 34% had diabetes, and 66% had hypertension. The most common indication for intervention was non-ST-segment elevation myocardial infarction (42%), followed by ST-segment elevation myocardial infarction (22%). The procedural success rate was 100%. At 12 months of follow-up, the incidence of MACE was 2.5%, and the definite stent thrombosis rate was 1.3%.

Conclusions: The use of the 50 µm UTS stent with a biodegradable everolimus-eluting polymer demonstrated a favorable safety profile and good clinical outcomes in unselected patients at 1 year of follow-up.

Introduction and objectives: Multistate models have proven to be effective tools in survival analyses. We propose modeling disease progression in interventional cardiology studies using a multistate model.

Methods: The model was fitted to the PACO-PCI database including a total of 1057 elderly patients with atrial fibrillation revascularized with drug-eluting stents to assess the efficacy profile and prognosis of different antithrombotic therapies. The model defines a total of 4 states: treatment, myocardial infarction and/or revascularization, bleeding, and death, with significant factors for each transition, and was compared using a multivariate Cox model.

Results: Survival factors common to both analyses were the PreciseDAPT and HAS-BLED scales, anemia, diabetes mellitus, chronic kidney disease, number of vessels treated, and left ventricular function. The multistate model also shows that after a new hemorrhage the probability of myocardial infarction and/or revascularization is influenced by the treatment of left main coronary artery disease and the transition to death from previous coronary artery bypass graft. Compared with Cox models, multistate models allow us to tell which transition in the model is influenced by each predictor.

Conclusions: The results illustrate the additional advantages of multistate models in survival analyses through individual predictions for the patients based on their clinical characteristics and disease progression.

Introduction and objectives: The use of transradial access for percutaneous coronary procedures has increased due to its advantages over the femoral approach. However, this benefit comes at the expense of a higher rate of radial artery occlusion (RAO). Our objective was to assess the incidence and predictors of RAO following transradial catheterization. Additionally, we studied anatomic variations of the radial artery (RA).

Methods: This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. The forearm arteries were evaluated by ultrasound. If RAO was present, follow-up ultrasound examinations were performed at 1 and 3 months postprocedure.

Results: Our study population included 288 men (67.4%) and 139 women (32.6%). The mean age was 61.9 ± 11.1 years. RAO occurred in 48 patients (11.24%), and spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, independent predictors of RAO were younger age (OR, 0.642; 95%CI, 0.480-0.858; P = .031), low periprocedural systolic blood pressure (OR, 0.598; 95%CI, 0.415-0.862; P = .007), a small radial diameter (OR, 0.371; 95%CI, 0.323-0.618; P = .031), insufficient anticoagulation (OR, 0.287; 95%CI, 0.163-0.505; P < .001), occlusive hemostasis (OR, 0.128; 95%CI, 0.047-0.353; P < .001), and long duration of hemostasis. The overall incidence of RA anatomic variations was 14.8% (n = 63). Among these, 40 patients (63.5%) had a high radial origin, 18 (28.6%) had extreme RA tortuosity, and 5 (7.9%) had a complete radioulnar loop.

Conclusions: The main modifiable predictors of RAO are insufficient heparinization and occlusive hemostasis. Preventive strategies should focus primarily on these 2 predictive factors to reduce the risk of RAO.

Introduction and objectives: In elderly and frail patients, there is limited evidence on the therapeutic management of left main coronary artery (LM) disease. The objective of this study was to evaluate mid-term clinical outcomes in older adults undergoing percutaneous coronary intervention (PCI) of LM.

Methods: We conducted a retrospective study including all older patients (≥ 75 years) undergoing LM-PCI at a high-volume center between 2017 and 2021. The primary endpoint was a composite of major adverse cardiovascular events (MACE). Patients were grouped according to the presence of frailty based on the FRAIL scale. Inverse probability of treatment weighting was used to account for clinical differences between the 2 groups.

Results: A total of 140 patients were included in the study (median age 80 [78-84]; 36% women). Of them, 49% met the criteria for frailty. After a median follow-up of 19 [5-35] months, 40 MACE (29%) were recorded. The all-cause death rate was 32%. There were no differences in the risk of MACE between frailty groups, but patients with frailty had an increased risk of all-cause mortality (HR_adj, 1.95 [1.02-3.75]; P = .046).

Conclusions: LM-PCI in older adults with multiple associated comorbidities could be considered a feasible option in this special population. The rate of MACE at follow-up was acceptable. Frailty was associated with a worse prognosis in terms of all-cause mortality at follow-up.

Introduction and objectives: Transcatheter aortic valve implantation (TAVI) for pure aortic regurgitation is challenging due to inadequate device anchoring and increased risks of device embolization and paravalvular regurgitation (PVR). This study aimed to review the safety and efficacy of TAVI for aortic regurgitation with devices specifically designed for this indication.

Methods: A comprehensive search of PubMed, Web of Science, Cochrane Library, and major conference archives up to April 2024 identified 143 unique results based on predefined criteria.

Results: Fifteen studies (n = 788 patients) were included, with J-Valve used in 357 patients and JenaValve in 431. Men represented 51% of the cohort, with a mean age of 74.7 ± 8.8 years and an STS-PROM score of 5.8 ± 4.9%. Transapical and transfemoral access routes were used in 62.7% and 37.3% of patients, respectively. Overall, procedural success was achieved in 95.9% of cases; surgical conversion was required in 1.8%, device migration/embolization occurred in 3.2%, and a second valve (in-valve) was required in 2.0% of patients. At 30 days, 95.5% of patients were alive, and device success was reported in 93.3% of cases. Mild PVR was observed in 18.0% of patients, moderate-to-severe PVR in 1.7%, and permanent pacemaker implantation (PPI) was required in 13.0%. In studies focusing on transfemoral procedures (all using JenaValve), the pooled estimates showed a procedural success rate of 97.8% (95%CI, 94.4-100), device success of 97.0% (95%CI, 94.8-99.2), 30-day mortality of 1.96% (95%CI, 0.20-3.72), moderate-to-severe PVR of 0.47% (95%CI, 0.00-1.47), and PPI requirement of 18.7% (95%CI, 13.9-23.4).

Conclusions: This systematic review of relatively small observational studies demonstrates the safety and favorable early outcomes of TAVI using J-Valve and JenaValve in patients with pure aortic regurgitation, especially when the transfemoral approach is used. Nevertheless, the need for PPI remains frequent.