Cardiovascular Revascularization Medicine最新文献

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.

Background: The Patient Experience in the Catheterization Laboratory (PATCATH) Questionnaire was developed by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) to evaluate patient understanding of coronary catheterization procedures. In this study, we aimed to compare patient experience after coronary catheterization using the PATCATH questionnaire following provision of standard printed patient information leaflets (PILs) and PILs supplemented by specially developed video animations to aid informed consent.

Methods: The PATCATH questionnaire was administered anonymously to patients following coronary catheterization at a single tertiary referral center over two consecutive time periods. The questionnaire comprises 17 questions, divided into 3 domains, assessing patient experience before, during, and after the procedure. During phase 1, standard PILs were provided (PIL group). In phase 2, the PILs were supplemented with videos (PIL+ video group).

Results: The PATCATH tool was administered to a total of 296 patients following cardiac catheterization (22% female, 60.5% aged >65 years). 213 patients were included in the PIL group and 83 in the PIL + video group. Overall, positive patient satisfaction was reported in each domain. Positive patient satisfaction was comparable in both the PIL and the PIL+ video group in all 3 domains (before: 96.7% versus 100%, p = 0.20; during: 96.3% versus 97.3%, p > 0.99; after: 98.6% versus 97.6%, p = 0.62).

Conclusions: The use of a video animation in addition to a PIL when performing informed consent did not result in an increase in patient satisfaction as assessed by the PATCATH questionnaire.