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Inconsistencies with reported point estimates and adjusted odds ratios. 与报告的点估算值和调整后的几率比率不一致。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-16 DOI: 10.1016/j.carrev.2024.11.004
Jose L Diz Ferre, Eugene H Blackstone
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引用次数: 0
Effect of cardiac amyloidosis on outcomes in transcatheter aortic valve replacement in low-flow low-gradient aortic stenosis. 心脏淀粉样变性对低流量低梯度主动脉瓣狭窄患者经导管主动脉瓣置换术结果的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-13 DOI: 10.1016/j.carrev.2024.11.008
Joseph Maenza, Lakshay Chopra, Carlo Mannina, Esha Vaish, Yash Prakash, Johanna Contreras, Francesca Prandi, Ranbir Singh, Parasuram Krishnamoorthy, Sahil Khera, George Dangas, Gilbert H L Tang, Samin K Sharma, Annapoorna S Kini, Stamatios Lerakis
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引用次数: 0
Trends in surgical and transcatheter interventions for tricuspid regurgitation: A national inpatient sample analysis from 2011 to 2020. 三尖瓣反流手术和经导管介入治疗的趋势:2011年至2020年全国住院病人样本分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-13 DOI: 10.1016/j.carrev.2024.11.005
Pedro Villablanca, Ahmad Jabri, Laith Alhuneafat, Anand Maligireddy, Waqas Rasheed, Kyle Kapcin, Katie Manalo, Azeem Latib, Gennaro Gustino, Raef Fadel, Ahmad Al Abdouh, Mohammed Mhanna, Nicholas Amoroso, Dee Dee Wang, Brian O'Neill, Rodrigo Bagur, Laui Madanat, Brian Renard, Vikas Aggarwal, Mohammad Alqarqaz, Kent So, Philippe Genereux, Ivan D Hanson, Amr E Abbas, William W O'Neill

Background: Tricuspid regurgitation (TR) poses a significant health burden, with severe disease linked to poor long-term outcomes, including intractable right heart failure. Despite guidelines advocating intervention, surgical options have historically been limited due to high mortality rates. Advancements in transcatheter valve interventions (TTVI) have renewed interest in less invasive treatments.

Methods: Utilizing data from the National Inpatient Sample (NIS) spanning 2011 to 2020, this study analyzed trends, factors influencing procedure selection, and outcomes of surgical and transcatheter tricuspid valve interventions across the United States. The analysis included 98,202 interventions, examining demographic and clinical disparities among patients undergoing TTVI, surgical tricuspid valve repair (STVr), and surgical tricuspid valve replacement (STVR).

Results: Between 2011 and 2020, 98,202 TV interventions were analyzed. Over time, total TV interventions increased, with TTVI peaking in 2020 (4.8 %). STVr declined from 78.20 % (2011) to 76.80 % (2020), while STVR decreased from 21.80 % to 18.40 %. Factors influencing procedure selection included age, race, hospital size, teaching status, and comorbidities. STVR accounted for the highest proportion of TV procedure-related deaths, followed by STVr and TTVI. STVR-related deaths declined over time, while STVr-related deaths increased.

Conclusion: This study provides a helpful visual representation of mortality trends and can inform healthcare professionals about the changing landscape of TV procedure outcomes. Further analysis would be necessary to understand the underlying causes of these trends, such as changes in patient demographics, procedural volume, technology, and clinical practices over time.

背景:三尖瓣反流(TR)对健康造成极大的负担,严重的疾病会导致不良的长期预后,包括顽固性右心衰竭。尽管指南提倡进行干预,但由于死亡率较高,手术方案历来受到限制。经导管瓣膜介入治疗(TTVI)的进步重新激发了人们对微创治疗的兴趣:本研究利用 2011 年至 2020 年的全国住院患者样本(NIS)数据,分析了全美手术和经导管三尖瓣介入治疗的趋势、影响手术选择的因素和结果。分析包括 98,202 例介入治疗,研究了接受经导管三尖瓣成形术、外科三尖瓣修复术(STVr)和外科三尖瓣置换术(STVR)的患者的人口统计学和临床差异:结果:分析了 2011 年至 2020 年间的 98,202 例电视介入治疗。随着时间的推移,电视介入手术总数有所增加,TTVI 在 2020 年达到峰值(4.8%)。STVr从78.20%(2011年)下降到76.80%(2020年),而STVR从21.80%下降到18.40%。影响手术选择的因素包括年龄、种族、医院规模、教学状况和合并症。在电视手术相关死亡病例中,STVR所占比例最高,其次是STVr和TTVI。随着时间的推移,STVR相关死亡人数有所下降,而STVr相关死亡人数则有所上升:这项研究为死亡率趋势提供了一个有用的直观表述,可以让医疗专业人员了解电视手术结果的变化情况。有必要进行进一步分析,以了解这些趋势的根本原因,如随着时间的推移,患者人口统计学、手术量、技术和临床实践的变化。
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引用次数: 0
Young adults with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the Houston Methodist Young ACS-PCI Registry. 接受经皮冠状动脉介入治疗的急性冠状动脉综合征年轻患者:休斯顿卫理公会青年 ACS-PCI 登记的启示。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-13 DOI: 10.1016/j.carrev.2024.11.007
Safi U Khan, Rody G Bou Chaaya, Taha Hatab, Sahar Samimi, Fatima Qamar, Chloe Kharsa, Hassaan B Arshad, Syed Zaid, Joe Aoun, Kershaw V Patel, Khurram Nasir, Sadeer Al-Kindi, William Zoghbi, Sachin S Goel, Alpesh R Shah, Neal S Kleiman

Background: Limited data exist on the risk profile and prognosis of young patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This study sheds light on the burden of cardiovascular risk factors and outcomes in this population.

Methods: The Houston Methodist Young ACS-PCI registry is a retrospective analysis of young adults (18 to 50 years) undergoing PCI for ACS between 2010 and 2022. Outcomes of interest were major adverse cardiovascular events (MACE: all-cause mortality, myocardial infarction (MI), ischemic stroke) at one year.

Results: Among 629 patients (median age, 46 years, 23.5% women, and 65.3% White adults), 69.2% had Non-ST-Segment Elevation MI. A total of 22.7% had prior MI, 26.2% prior PCI, and 9.2% had prior coronary artery bypass graft surgery. The prevalence of active smoking, dyslipidemia, hypertension, and diabetes was 69.4%, 82.2%, 80.4%, and 39.6%, respectively. Age-adjusted diabetes rates increased over time, while dyslipidemia, hypertension, and obesity rates remained unchanged. The femoral artery was the most common arterial access (85.2%), 72.7% had one vessel disease, 44.3% had the left anterior descending artery as the culprit vessel, and 78.5% of patients received one stent. At a median of 3.8 years, all-cause mortality was 28 deaths per 1000 person-years. At one year, 11.4% experienced MACE; racial and ethnic minority (Black, Hispanic, and Others), dialysis, prior MI, and stent diameter were independent predictors of MACE.

Conclusions: The study highlights a notable burden of cardiovascular risk factors and cardiovascular outcomes in young adults with ACS undergoing PCI, underscoring the need for strategies to enhance risk assessment and guide interventions among young adults.

背景:因急性冠状动脉综合征(ACS)而接受经皮冠状动脉介入治疗(PCI)的年轻患者的风险概况和预后数据有限。本研究揭示了这一人群的心血管风险因素负担和预后:休斯敦卫理公会青年 ACS-PCI 登记是对 2010 年至 2022 年间因 ACS 接受 PCI 治疗的年轻成人(18 至 50 岁)进行的回顾性分析。研究结果为一年后的主要不良心血管事件(MACE:全因死亡率、心肌梗死(MI)、缺血性卒中):在 629 名患者中(中位年龄 46 岁,23.5% 为女性,65.3% 为白人成年人),69.2% 患有非 ST 段抬高型心肌梗死。22.7%的患者曾有过心肌梗死,26.2%的患者曾有过PCI,9.2%的患者曾有过冠状动脉旁路移植手术。主动吸烟、血脂异常、高血压和糖尿病的患病率分别为 69.4%、82.2%、80.4% 和 39.6%。年龄调整后的糖尿病患病率随时间推移而增加,而血脂异常、高血压和肥胖的患病率则保持不变。股动脉是最常见的动脉通路(85.2%),72.7%的患者为单支血管疾病,44.3%的患者的罪魁祸首是左前降支动脉,78.5%的患者接受了一种支架治疗。在中位 3.8 年的时间里,全因死亡率为每千人年 28 例死亡。一年后,11.4%的患者发生了MACE;少数种族和民族(黑人、西班牙裔和其他)、透析、既往心肌梗死和支架直径是MACE的独立预测因素:该研究强调了接受PCI治疗的ACS年轻成人的心血管风险因素和心血管结局的显著负担,突出表明需要制定战略来加强风险评估并指导年轻成人的干预措施。
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引用次数: 0
ST-elevation myocardial infarction from spontaneous coronary artery dissection with high thrombus burden. 高血栓负荷的自发性冠状动脉夹层导致 ST 段抬高型心肌梗死。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-09 DOI: 10.1016/j.carrev.2024.10.013
Hari P Sritharan, Adam C Bland, Thomas J Ford, Roberto Spina, Michael Parkinson
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引用次数: 0
Trends in coronary artery disease mortality among adults with diabetes: Insights from CDC WONDER (1999-2020). 成人糖尿病患者冠心病死亡率趋势:来自美国疾病预防控制中心 WONDER(1999-2020 年)的启示。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-09 DOI: 10.1016/j.carrev.2024.11.002
Muhammad Abdullah Naveed, Ahila Ali, Sivaram Neppala, Faizan Ahmed, Palak Patel, Bazil Azeem, Muhammad Omer Rehan, Rabia Iqbal, Manahil Mubeen, Ayman Fath, Timir Paul

Background: Coronary artery disease (CAD) in diabetes mellitus (DM) is a significant cause of mortality among US adults. This study investigates trends in CAD-related mortality in adults aged 25 and older with DM, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020.

Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

Results: CAD in DM accounted for 1,462,279 deaths among US adults aged 25+. Most deaths occurred in medical facilities (44.2 %) and at home (29.3 %). The overall AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95 % CI: -1.29 to -0.77, p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in metropolitan areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).

Conclusion: The notable increase in mortality rates associated with CAD among patients with DM from 2018 to 2020 presents a substantial concern that necessitates targeted public health interventions to ensure equitable access to cardiovascular care.

背景:糖尿病(DM)并发冠状动脉疾病(CAD)是导致美国成年人死亡的一个重要原因。本研究调查了 1999 年至 2020 年 25 岁及以上患有糖尿病的成年人中与冠状动脉疾病相关的死亡率趋势,重点关注地域、性别和种族/民族差异:方法: 使用疾病预防控制中心 WONDER 数据库中 1999 年至 2020 年的死亡证明数据进行了回顾性分析。按年份、性别、种族/人种和地理区域分层,计算每 10 万人的年龄调整死亡率 (AAMRs)、年百分比变化 (APC) 和年平均百分比变化 (AAPC):在美国 25 岁以上的成年人中,因糖尿病引发的 CAD 死亡人数为 1,462,279 人。大多数死亡发生在医疗机构(44.2%)和家中(29.3%)。与糖尿病相关的 CAD 死亡的总体 AAMR 从 1999 年的 36.3 降至 2020 年的 31.7,AAPC 为-0.96(95 % CI:-1.29 至-0.77,p 结论):从 2018 年到 2020 年,DM 患者中与 CAD 相关的死亡率明显上升,这引起了人们的极大关注,有必要采取有针对性的公共卫生干预措施,以确保公平地获得心血管护理。
{"title":"Trends in coronary artery disease mortality among adults with diabetes: Insights from CDC WONDER (1999-2020).","authors":"Muhammad Abdullah Naveed, Ahila Ali, Sivaram Neppala, Faizan Ahmed, Palak Patel, Bazil Azeem, Muhammad Omer Rehan, Rabia Iqbal, Manahil Mubeen, Ayman Fath, Timir Paul","doi":"10.1016/j.carrev.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) in diabetes mellitus (DM) is a significant cause of mortality among US adults. This study investigates trends in CAD-related mortality in adults aged 25 and older with DM, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.</p><p><strong>Results: </strong>CAD in DM accounted for 1,462,279 deaths among US adults aged 25+. Most deaths occurred in medical facilities (44.2 %) and at home (29.3 %). The overall AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95 % CI: -1.29 to -0.77, p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in metropolitan areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).</p><p><strong>Conclusion: </strong>The notable increase in mortality rates associated with CAD among patients with DM from 2018 to 2020 presents a substantial concern that necessitates targeted public health interventions to ensure equitable access to cardiovascular care.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding long-term risk in Percutaneous Coronary Intervention (PCI) in the Australian contemporary era with a focus on defining Complex Revascularisation in High-Risk Indicated Patients (CHIP). 了解澳大利亚当代经皮冠状动脉介入治疗(PCI)的长期风险,重点关注高危适应症患者复杂血管重建术(CHIP)的定义。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-08 DOI: 10.1016/j.carrev.2024.11.001
Julian Yeoh, Garry W Hamilton, Diem Dinh, Angela Brennan, Christopher M Reid, Dion Stub, Melaine Freeman, Martin Sebastian, Ernesto Oqueli, Andrew Ajani, Tim Scully, Liam Toner, Sandra Picardo, Mark Horrigan, Matias B Yudi, Omar Farouque, Siven Seevanayagam, David J Clark

Background: Complex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures.

Methods: Patients undergoing PCI from Melbourne Intervention Group registry between 2005 and 2018 were analysed. Patients were stratified based on the number of high-risk features defined as 1)presence of ≥3 patient factors including age > 75yo, COPD, diabetes, renal impairment (eGFR<60 mL/min/1.73 m2), PVD, and 2)LVEF<30 %, and/or 3)having one complex coronary anatomical feature such as LMCA PCI, ACC/AHA B2/C lesion PCI, presence of multi-vessel disease or CTO PCI. National Death Index linkage was performed for long-term mortality analysis. Outcomes were analysed according to 4 risk categories - low risk(score 0), intermediate risk(score 1), high-risk(score 2), and very high-risk(score 3).

Results: 20,973patients were analysed. Majority of patients underwent intermediate-risk procedures(71.7 %), with low rates of high-risk(6.6 %), and very high-risk(0.2 %). Lesion success inversely correlates with risk; low-risk(99.4 %), intermediate-risk(95.1 %), high-risk(94.3 %), very high-risk(92.5 %),p < 0.001. In-hospital and 30-day death correlates with risk; low-risk(0.0 %/0.1 %), intermediate-risk(0.3 %/0.5 %), high-risk(1.5 %/2.9 %), very high-risk(2.4 %/7.1 %),p < 0.001. Long-term mortality correlates with risk; low-risk(12.3 %), intermediate-risk(15.8 %), high-risk(49.3 %), very high-risk(76.2 %),p < 0.001. On multivariate analysis, increasing risk correlates with long-term mortality; intermediate-risk(HR1.41), high-risk(HR6.42), and very high-risk(14.05).

Conclusion: In the Australian practice, proportion of patients undergoing high and very high-risk PCI procedures are low. Despite good procedural success and in-hospital outcomes, long-term mortality is poor. Further research into appropriate patient selection, and direct comparison of CHIP PCI to those treated medically and surgically should be considered.

背景:经皮冠状动脉介入治疗(PCI)中出现了高危适应症患者复杂血管重建术(CHIP)。我们记录了澳大利亚人群中CHIP PCI的频率和结果,以了解风险并指导临床决策。我们提出了一个评分系统来定义CHIP手术:分析了 2005 年至 2018 年期间墨尔本干预小组登记处接受 PCI 治疗的患者。根据高危特征的数量对患者进行分层,高危特征定义为:1)存在≥3个患者因素,包括年龄大于75岁、慢性阻塞性肺病、糖尿病、肾功能损害(eGFRR结果:分析了20973名患者。大多数患者接受了中危手术(71.7%),高危(6.6%)和极高危(0.2%)比例较低。病变成功率与风险成反比:低风险(99.4%)、中度风险(95.1%)、高风险(94.3%)和极高风险(92.5%):在澳大利亚,接受高风险和极高风险 PCI 手术的患者比例较低。尽管手术成功率和院内疗效良好,但长期死亡率较低。应考虑进一步研究如何选择合适的患者,并将CHIP PCI与药物和手术治疗的患者进行直接比较。
{"title":"Understanding long-term risk in Percutaneous Coronary Intervention (PCI) in the Australian contemporary era with a focus on defining Complex Revascularisation in High-Risk Indicated Patients (CHIP).","authors":"Julian Yeoh, Garry W Hamilton, Diem Dinh, Angela Brennan, Christopher M Reid, Dion Stub, Melaine Freeman, Martin Sebastian, Ernesto Oqueli, Andrew Ajani, Tim Scully, Liam Toner, Sandra Picardo, Mark Horrigan, Matias B Yudi, Omar Farouque, Siven Seevanayagam, David J Clark","doi":"10.1016/j.carrev.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.001","url":null,"abstract":"<p><strong>Background: </strong>Complex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures.</p><p><strong>Methods: </strong>Patients undergoing PCI from Melbourne Intervention Group registry between 2005 and 2018 were analysed. Patients were stratified based on the number of high-risk features defined as 1)presence of ≥3 patient factors including age > 75yo, COPD, diabetes, renal impairment (eGFR<60 mL/min/1.73 m2), PVD, and 2)LVEF<30 %, and/or 3)having one complex coronary anatomical feature such as LMCA PCI, ACC/AHA B2/C lesion PCI, presence of multi-vessel disease or CTO PCI. National Death Index linkage was performed for long-term mortality analysis. Outcomes were analysed according to 4 risk categories - low risk(score 0), intermediate risk(score 1), high-risk(score 2), and very high-risk(score 3).</p><p><strong>Results: </strong>20,973patients were analysed. Majority of patients underwent intermediate-risk procedures(71.7 %), with low rates of high-risk(6.6 %), and very high-risk(0.2 %). Lesion success inversely correlates with risk; low-risk(99.4 %), intermediate-risk(95.1 %), high-risk(94.3 %), very high-risk(92.5 %),p < 0.001. In-hospital and 30-day death correlates with risk; low-risk(0.0 %/0.1 %), intermediate-risk(0.3 %/0.5 %), high-risk(1.5 %/2.9 %), very high-risk(2.4 %/7.1 %),p < 0.001. Long-term mortality correlates with risk; low-risk(12.3 %), intermediate-risk(15.8 %), high-risk(49.3 %), very high-risk(76.2 %),p < 0.001. On multivariate analysis, increasing risk correlates with long-term mortality; intermediate-risk(HR1.41), high-risk(HR6.42), and very high-risk(14.05).</p><p><strong>Conclusion: </strong>In the Australian practice, proportion of patients undergoing high and very high-risk PCI procedures are low. Despite good procedural success and in-hospital outcomes, long-term mortality is poor. Further research into appropriate patient selection, and direct comparison of CHIP PCI to those treated medically and surgically should be considered.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Five-year clinical outcomes of STEMI patients treated with a pre-specified bioresorbable vascular scaffold implantation technique: Final results of the BVS STEMI STRATEGY-IT. 采用预先指定的生物可吸收血管支架植入技术治疗 STEMI 患者的五年临床疗效:BVS STEMI STRATEGY-IT 的最终结果。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-07 DOI: 10.1016/j.carrev.2024.11.003
Elisabetta Moscarella, Gianluca Campo, Massimo Leoncini, Salvatore Geraci, Elisa Nicolini, Bernardo Cortese, Bruno Loi, Vincenzo Guiducci, Salvatore Saccà, Attilio Varricchio, Paolo Vicinelli, Gianfranco De Candia, Davide Personeni, Paolo Calabrò, Salvatore Brugaletta, Azeem Latib, Maurizio Tespili, Alfonso Ielasi

Background: Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT).

Methods: The BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (NCT02601781). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter).

Results: 502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1-0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007).

Conclusions: This study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.

背景:在ST段抬高型心肌梗死(STEMI)患者中使用Absorb生物可吸收血管支架(BVS)的数据有限。此外,包括 STEMI 患者在内的 Absorb 研究缺乏用于优化 BVS 部署的预设植入技术。本研究探讨了 STEMI 患者使用优化植入策略的 BVS 5 年疗效以及延长双联抗血小板疗法(DAPT)的影响:BVS STEMI STRATEGY-IT 研究是一项前瞻性、非随机、单臂多中心试验(NCT02601781)。505 名 STEMI 患者接受了预定义 BVS 植入方案的经皮冠状动脉介入治疗。关键终点是心源性死亡、靶血管心肌梗死(TV-MI)和缺血驱动靶病变血运重建(ID-TLR)的5年设备导向复合终点(DOCE)。研究还比较了 DAPT 持续时间(36 个月与更短)的结果:502名患者(99.4%)完成了5年随访。DOCE率为2.4%。ID-TLR、TV-MI和心源性死亡发生率分别为1.6%、0.8%和0.6%。三至五年内未发生 DOCE。支架血栓 (ScT) 发生率为 1%,均发生在 24 个月内。与短期DAPT相比,长期DAPT可显著降低DOCE(1.3% vs. 4.3%;HR:0.29;95 % CI:0.1-0.9;p = 0.03),原因是TV-MI(0% vs. 2.2%;p = 0.018)和ScT(0% vs. 2.7%,p = 0.007)发生率较低:本研究显示,在选定的 STEMI 患者中,采用优化植入策略进行 BVS 治疗的 5 年预后良好。延长 DAPT 进一步改善了预后,强调了其在减少支架再吸收期间不良事件方面的作用。评估新一代生物可吸收装置还需要进一步的研究。
{"title":"Five-year clinical outcomes of STEMI patients treated with a pre-specified bioresorbable vascular scaffold implantation technique: Final results of the BVS STEMI STRATEGY-IT.","authors":"Elisabetta Moscarella, Gianluca Campo, Massimo Leoncini, Salvatore Geraci, Elisa Nicolini, Bernardo Cortese, Bruno Loi, Vincenzo Guiducci, Salvatore Saccà, Attilio Varricchio, Paolo Vicinelli, Gianfranco De Candia, Davide Personeni, Paolo Calabrò, Salvatore Brugaletta, Azeem Latib, Maurizio Tespili, Alfonso Ielasi","doi":"10.1016/j.carrev.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT).</p><p><strong>Methods: </strong>The BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (NCT02601781). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter).</p><p><strong>Results: </strong>502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1-0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007).</p><p><strong>Conclusions: </strong>This study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Conduction disorders following transcatheter aortic valve replacement using acurate Neo2 transcatheter heart valve: A propensity matched analysis 使用 Acurate Neo2 经导管主动脉瓣置换术后的传导障碍:倾向匹配分析
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.002
Itamar Loewenstein , Ariel Finkelstein , Shmuel Banai , Amir Halkin , Maayan Konigstein , Jeremy Ben-Shoshan , Yaron Arbel , Israel Barbash , Amit Segev , Planner David , Gabby Elbaz-Greener , Hana Assa-Vaknin , Ran Kornowski , Danny Dvir , Elad Asher , Arie Steinvil

Background

The ACURATE neo2 transcatheter aortic valve was developed to improve paravalvular leak (PVL) rates while maintaining low rates of conduction disturbances and permanent pacemaker implantation (PPMI) seen with its predecessor. We aimed to compare conduction disturbances rates of transcatheter aortic valve replacement (TAVR) using ACURATE Neo2 with other commonly used valves.

Methods

A retrospective analysis of the Israeli TAVR registry between the years 2014–2023 was performed to compare conduction disturbances and PVL rates, and procedural outcomes, among patients treated with ACURATE neo2, Edwards Sapien 3 (S3), and Evolut PRO valves. Propensity score matching was performed to compare groups with similar characteristics.

Results

Following exclusion of patients with non-femoral access, unknown valve type, older-generation valves, and less commonly used valves or (n = 4387), our analysis included 3208 patients undergoing TAVR using ACURATE neo2, Edwards S3, and Evolut PRO valves. Propensity matched groups comprised 169 patients each. Rates of any conduction disturbances [left bundle branch block (LBBB), atrioventricular block, or PPMI] were lower in the ACURATE neo2 group compared to both other valves [15.8 %, S3–37.5 % (p < 0.001), Evolut PRO-27.5 % (p = 0.02)] as were LBBB rates [9.0 %, S3–31.3 % (p < 0.001); Evolut PRO-20.1 % (p = 0.01). Atrioventricular block and PPMI rates were lower without statistical significance, as were rates of above-moderate PVL.

Conclusions

In this analysis, TAVR using ACURATE neo2 was associated with a lower composite rate of conduction disturbances in comparison to the Evolut PRO and Edwards S3 valves, mainly due to lower left bundle branch block rates, with non-significantly lower rates of PPMI and PVL.
背景:ACURATE neo2经导管主动脉瓣的开发旨在提高腔旁漏(PVL)率,同时保持其前身所具有的低传导障碍率和永久起搏器植入率(PPMI)。我们旨在比较使用 ACURATE Neo2 的经导管主动脉瓣置换术(TAVR)与其他常用瓣膜的传导干扰率:我们对 2014-2023 年间的以色列 TAVR 登记进行了回顾性分析,以比较 ACURATE neo2、Edwards Sapien 3 (S3) 和 Evolut PRO 瓣膜治疗患者的传导障碍和 PVL 发生率以及手术结果。为比较具有相似特征的组别,进行了倾向评分匹配:在排除非股动脉入路、瓣膜类型未知、老一代瓣膜和不常用瓣膜的患者(n = 4387)后,我们的分析包括3208名使用ACURATE neo2、Edwards S3和Evolut PRO瓣膜进行TAVR的患者。倾向匹配组各由 169 名患者组成。与其他两种瓣膜相比,ACURATE neo2 组出现任何传导障碍[左束支传导阻滞 (LBBB)、房室传导阻滞或 PPMI]的比例较低[15.8%,S3-37.5% (p 结论:ACURATE neo2 组出现传导障碍的比例较低,S3-37.5% (p 结论:ACURATE neo2 组出现传导障碍的比例较高]:在这项分析中,与Evolut PRO和Edwards S3瓣膜相比,使用ACURATE neo2进行TAVR的传导障碍综合发生率较低,这主要是由于左束支传导阻滞发生率较低,而PPMI和PVL的发生率则无显著性差异。
{"title":"Conduction disorders following transcatheter aortic valve replacement using acurate Neo2 transcatheter heart valve: A propensity matched analysis","authors":"Itamar Loewenstein ,&nbsp;Ariel Finkelstein ,&nbsp;Shmuel Banai ,&nbsp;Amir Halkin ,&nbsp;Maayan Konigstein ,&nbsp;Jeremy Ben-Shoshan ,&nbsp;Yaron Arbel ,&nbsp;Israel Barbash ,&nbsp;Amit Segev ,&nbsp;Planner David ,&nbsp;Gabby Elbaz-Greener ,&nbsp;Hana Assa-Vaknin ,&nbsp;Ran Kornowski ,&nbsp;Danny Dvir ,&nbsp;Elad Asher ,&nbsp;Arie Steinvil","doi":"10.1016/j.carrev.2024.05.002","DOIUrl":"10.1016/j.carrev.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><div>The ACURATE neo2 transcatheter aortic valve<span><span><span> was developed to improve paravalvular leak (PVL) rates while maintaining low rates of </span>conduction disturbances<span> and permanent pacemaker implantation (PPMI) seen with its predecessor. We aimed to compare conduction disturbances rates of </span></span>transcatheter aortic valve replacement (TAVR) using ACURATE Neo2 with other commonly used valves.</span></div></div><div><h3>Methods</h3><div><span>A retrospective analysis of the Israeli TAVR registry between the years 2014–2023 was performed to compare conduction disturbances and PVL rates, and procedural outcomes, among patients treated with ACURATE neo2, Edwards Sapien 3 (S3), and Evolut PRO valves. </span>Propensity score matching was performed to compare groups with similar characteristics.</div></div><div><h3>Results</h3><div>Following exclusion of patients with non-femoral access, unknown valve type, older-generation valves, and less commonly used valves or (<em>n</em><span> = 4387), our analysis included 3208 patients undergoing TAVR using ACURATE neo2, Edwards S3, and Evolut PRO valves. Propensity matched groups comprised 169 patients each. Rates of any conduction disturbances [left bundle branch block (LBBB), atrioventricular block, or PPMI] were lower in the ACURATE neo2 group compared to both other valves [15.8 %, S3–37.5 % (</span><em>p</em> &lt; 0.001), Evolut PRO-27.5 % (<em>p</em> = 0.02)] as were LBBB rates [9.0 %, S3–31.3 % (p &lt; 0.001); Evolut PRO-20.1 % (<em>p</em> = 0.01). Atrioventricular block and PPMI rates were lower without statistical significance, as were rates of above-moderate PVL.</div></div><div><h3>Conclusions</h3><div>In this analysis, TAVR using ACURATE neo2 was associated with a lower composite rate of conduction disturbances in comparison to the Evolut PRO and Edwards S3 valves, mainly due to lower left bundle branch block rates, with non-significantly lower rates of PPMI and PVL.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 17-22"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A question about what coronary angiography teaches about occlusion and thrombosis in STEMI 关于冠状动脉造影对 STEMI 闭塞和血栓形成的启示的问题。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.10.001
Spencer B. King III
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引用次数: 0
期刊
Cardiovascular Revascularization Medicine
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