Cardiovascular Revascularization Medicine最新文献

Background: Coronary artery bypass grafting (CABG) ineligibility is associated with increased mortality in patients undergoing PCI. Limited data exist about CABG-eligible patients who decline surgery and opt for PCI.

Methods: National Cardiovascular Data Repository CathPCI data from 2018 to 2024 at two high-volume PCI centers was used to identify patients that had surgical consultation prior to PCI. Baseline characteristics and in-hospital outcomes were compared between patients who were turned down for surgery (CABG-ineligible) and those who were offered surgery but declined (CABG-eligible).

Results: The cohort included 388 patients (313 CABG-ineligible and 75 CABG-eligible). CABG-ineligible patients were younger (70.4 vs 73.4 years; p = 0.01) and had higher rates of chronic lung disease, diabetes, and frailty, but with no difference in lesion complexity between the groups. PCI in the CABG-ineligible group was more likely urgent, emergent, or salvage, including STEMI and NSTEMI. Overall, PCI technical success was high, 92.9%, and in-hospital mortality was 4.8% in CABG-ineligible versus 2.7% in the CABG-eligible group (p = 0.54). There was no difference in bleeding, myocardial infarction, cardiogenic shock, cardiac arrest, or new-onset dialysis.

Conclusions: Among patients who underwent PCI after referral for CABG, technical success was high and in-hospital mortality was acceptable in patients who were deemed eligible or ineligible for CABG. Further study is warranted to examine long-term outcomes of PCI in CABG-ineligible patients versus those who decline CABG.

Background: Wire-based fractional flow reserve (wbFFR) is the gold standard for physiologic assessment of coronary artery disease (CAD). Recently, angiogram-based FFRangio have shown good diagnostic performance against wbFFR. Limited outcome data is available for FFRangio. The present study aimed to investigate the clinical outcomes of FFRangio-guided treatment for CAD in real-world practice.

Methods: In an international multicentre registry, CAD patients assessed using FFRangio underwent angiography/revascularisation at 7 centres. The primary endpoint was 1-year cumulative incidence of cardiovascular death/myocardial infarction (MI)/unplanned revascularisation (UR).

Results: Our cohort included 2129 lesions from 1579 patients. In 1951 lesions (91.6%) and 1435 patients (90.9%), treatment was concordant with FFRangio results. Mean age was 70.3 years and 30.6% were female. Mean FFRangio was 0.86 (0.66 and 0.95 in the revascularised and deferred lesions, respectively). After a median follow up of 365 (Q1-Q3: 326-365) days, the primary endpoint for the revascularisation and deferral groups was 6.8% and 1.6% (cardiovascular death 0% and 0.4%, MI 1.0% and 0.1%, UR 6.8% and 1.2%). Risk for the primary endpoint was 3.6% and 8.7% in the concordant and discordant groups, respectively (adjusted HR 0.38 [95%CI: 0.19-0.88], p = 0.006), driven by lower incidence of event in the concordant revascularisation vs. discordant deferral groups (6.8 vs. 12.3%, HR 0.43 [95%CI: 0.19-0.95], p = 0.038).

Conclusions: In real-world setting, FFRangio-guided treatment yields excellent one-year outcomes for both revascularisation and deferred lesion, which are comparable with current data for wbFFR-guided treatment. FFRangio-concordant revascularisation was associated with better prognosis than FFRangio-discordant deferral for patients with FFRangio ≤ 0.8.

Trial registration: NCT05648396.

Acute mitral regurgitation (MR) is a critical condition arising from diverse etiologies, including infective endocarditis, ischemic heart disease, stress-induced cardiomyopathy, and iatrogenic injury. While surgical repair or replacement has traditionally served as the standard of care, particularly in emergent cases, the evolution of transcatheter mitral valve therapies offers viable alternatives for patients deemed high-risk for conventional surgery. This review examines the pathophysiological mechanisms underlying acute MR in specific clinical contexts, and explores the expanding role of transcatheter edge-to-edge repair.

Background: Transcatheter mitral edge-to-edge repair (M-TEER) has transformed the management of patients with severe mitral regurgitation (MR) at high or prohibitive surgical risk. However, data on long-term survival and causes of death after M-TEER remain limited.

Methods and results: This single-center registry included consecutive patients undergoing M-TEER with the MitraClip device for severe MR between February 2016 and June 2020. The primary objective was long-term mortality trends and causes of death. Over a median follow-up of 3.3 years (IQR 1.3-5.1; maximum 8.5 years), 130 of 218 patients (59.6%) died, with 55.4% due to cardiovascular (CV) causes, mainly heart failure (HF, 34.6%). Non-CV deaths were attributed to sepsis (15.4%), malignancy (10.8%), trauma (3.8%), and multi-organ failure (1.5%). CV mortality accounted for 55% of deaths within 1 year and 68.4% beyond 5 years, with no significant change in the CV/non-CV mortality ratio over time. Among 88 survivors, non-fatal CV events were infrequent: 12.5% were rehospitalized for HF and 2.3% underwent repeat M-TEER. Non-CV hospitalizations occurred in 9.1%, mainly due to fractures or pneumonia. Independent predictors of all-cause mortality included ischemic secondary MR etiology, prior HF, TAPSE/sPAP ≤0.36, and ≥moderate tricuspid regurgitation, while a low MitraScore predicted better survival. A low MitraScore risk was associated with a significantly lower all-cause and CV mortality compared to a high Mitrascore risk (48.6% vs 83.9%, p < 0.001; 21.0% vs 64.4%, p ≤ 0.001).

Conclusion: Long-term mortality after M-TEER remains influenced by extra-mitral cardiac involvement and non-cardiac comorbidities. The MitraScore preserves its prognostic accuracy during extended follow-up.

Background: Reperfusion therapy is the cornerstone of treatment for acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, older adults with AMI and CS face higher risks of adverse outcomes and procedure-related complications. Since this population is under-represented in clinical trials, the efficacy of reperfusion therapy remains unclear. We performed a meta-analysis to evaluate the impact of reperfusion therapy on mortality in older adults with AMI and CS.

Methods: We searched PUBMED and EMBASE through 4/1/2025 for studies comparing reperfusion therapy with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) and non-reperfusion therapy for AMI and CS in patients aged ≥75 years. We included prospective and retrospective observational trials reporting clinical outcomes. The primary outcome was set as short-term mortality, and the secondary outcome was long-term mortality. We performed subgroup analysis of the primary outcome for patients with ST-segment elevation myocardial infarction and those without.

Results: Our search identified 14 eligible studies in a total of 4583 patients. Reperfusion therapy was associated with significantly reduced short-term mortality, compared with non-reperfusion therapy with high heterogeneity (odds ratio (OR): 0.47; 95% confidence interval (CI): 0.30-0.73, I² = 76.8%). There was no significant difference in long-term all-cause mortality between reperfusion and non-reperfusion therapy (OR: 0.66; 95% CI: 0.34-1.26, I² = 79.7%). The subgroup analyses were largely consistent with the main findings.

Conclusions: Reperfusion therapy was associated with reduced short-term mortality, compared to non-reperfusion therapy for older patients with AMI and CS. Reperfusion therapy showed a tendency towards reduced long-term mortality.