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Rota-Sesame technique for chronic total occlusion percutaneous coronary intervention. 慢性全闭塞经皮冠状动脉介入治疗的 Rota-Sesame 技术。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.carrev.2024.09.009
Reza Masoomi, Lorenzo Azzalini, Kathleen E Kearney, William L Lombardi
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引用次数: 0
Hyperemic vs non-hyperemic indexes discordance: Role of epicardial and microvascular resistance (HyperDisco Study). 高血压与非高血压指数不一致:心外膜和微血管阻力的作用(HyperDisco 研究)。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.carrev.2024.09.004
A Di Molfetta, V Cusimano, M Cesario, P Mollo, G Di Ruzza, M Menichelli

Background: Literature reports a 20 % discordance between hyperemic (FFR) and non-hyperemic indexes (NHi) of coronary stenosis lesions. This work aims to develop and test clinically, a formula relating FFR and NHi (including iFR, RFR and Pd/Pa) to study their discordance.

Methods: We conducted a prospective, single-center, clinical study enrolling all patients undergoing full coronary physiology assessment with Coroventis CoroFlow Cardiovascular System (Abbott Vascular, St. Paul, Minnesota) to validate the developed formula: [Formula: see text] where IMR(BMR) is the hyperemic (basal) microvascular resistance and HSR(BSR) is the hyperemic (basal) stenosis resistance.

Results: A total of 51 patients were enrolled, 72 % male, average age 67.4 ± 8.9. Mean hemodynamic data were: FFR 0.87 ± 0.07, iFR 0.93 ± 0.05, RFR 0.91 ± 0.05, Pd/Pa 0.92 ± 0.05, BMR 76.6 ± 51.6 mmHg*s, IMR 28.4 ± 22.8 mmHg*s, BSR 5.5 ± 4.7 mmHg, HSR 3.8 ± 2.9 mmHg*s, coronary flow reserve (CFR) 2.9 ± 1.6, resistive reserve ratio (RRR) 3.3 ± 2.0. Lin's Concordance and Bland Altman analysis showed an optimal correlation between measured and estimated data. Sensitivity analysis showed that: (1) FFR can underestimate epicardial stenosis severity leading to FFR- vs NHi + discordance in case of elevated IMR, (2) NHi can overestimate epicardial stenosis severity leading to FFR- vs NHi + in the case of low BMR, (3) if BSR > HSR, FFR- vs NHi + discordance can occur, while if BSR < HSR, FFR+ vs NHi- discordance can occur.

Conclusion: (1) NHi can be more reliable in case of elevated IMR; (2) FFR-CFR combination can be more reliable for low BMR occurring to compensate an epicardial stenosis; (3) NHi-CFR combination can be more reliable when BSR > HSR, while FFR-CFR combination can be more reliable when BSR < HSR. The combination between pressure and flow indexes (FFR-CFR or NHi-CFR) is more reliable when compensatory mechanisms occur.

背景:文献报道冠状动脉狭窄病变的充盈指数(FFR)和非充盈指数(NHi)之间存在20%的不一致。这项工作的目的是开发并临床测试一个与 FFR 和 NHi(包括 iFR、RFR 和 Pd/Pa)相关的公式,以研究它们之间的不一致性:我们进行了一项前瞻性、单中心临床研究,纳入了所有使用 Coroventis CoroFlow 心血管系统(明尼苏达州圣保罗市雅培血管公司)进行全面冠状动脉生理评估的患者,以验证所开发的公式:[公式:见正文],其中 IMR(BMR) 为充盈(基础)微血管阻力,HSR(BSR) 为充盈(基础)狭窄阻力:共有 51 名患者入选,其中 72% 为男性,平均年龄(67.4 ± 8.9)岁。平均血液动力学数据为FFR 0.87 ± 0.07,iFR 0.93 ± 0.05,RFR 0.91 ± 0.05,Pd/Pa 0.92 ± 0.05,BMR 76.6 ± 51.6 mmHg*s,IMR 28.4 ± 22.8 mmHg*s,BSR 5.5 ± 4.7 mmHg,HSR 3.8 ± 2.9 mmHg*s,冠状动脉血流储备(CFR) 2.9 ± 1.6,阻力储备比(RRR) 3.3 ± 2.0。Lin's Concordance 和 Bland Altman 分析表明,测量数据和估计数据之间具有最佳相关性。敏感性分析表明(1) 在 IMR 升高的情况下,FFR 可低估心外膜狭窄的严重程度,导致 FFR- vs NHi + 不一致;(2) 在 BMR 低的情况下,NHi 可高估心外膜狭窄的严重程度,导致 FFR- vs NHi + 不一致;(3) 如果 BSR > HSR,则 FFR- vs NHi + 不一致可能发生,而如果 BSR 结论为:(1) NHi 可高估心外膜狭窄的严重程度,导致 FFR- vs NHi + 不一致;(2) 如果 BSR > HSR,则 FFR- vs NHi + 不一致可能发生:(1)在 IMR 升高的情况下,NHi 更为可靠;(2)在补偿心外膜狭窄而出现低 BMR 的情况下,FFR-CFR 组合更可靠;(3)当 BSR > HSR 时,NHi-CFR 组合更可靠,而当 BSR > HSR 时,FFR-CFR 组合更可靠。
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引用次数: 0
Abbreviated ticagrelor based dual antiplatelet therapy in acute coronary syndrome: A systematic review and meta-analysis. 急性冠状动脉综合征中基于替卡格雷的简短双联抗血小板疗法:系统综述和荟萃分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.carrev.2024.09.005
Wissam Harmouch, Ravi Thakker, Mirza Umair Khalid, Wissam Khalife, Neal Kleiman, Umamahesh Rangasetty, Waleed Tallat Kayani, Hani Jneid, Bashar Al-Hemyari, Ayman Elbadawi

Background: Few randomized clinical trials have evaluated the safety and efficacy of abbreviated ticagrelor based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these trials were underpowered to detect differences in hard clinical outcomes.

Methods: A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through June 2024, for trials that compared abbreviated (≤3-months) versus standard 12-months ticagrelor based DAPT in ACS. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction, stent thrombosis, ischemic stroke, and major bleeding. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Effect measure utilized was risk ratio (RR). Heterogeneity was assessed via Chi-squared and Higgin's I2 test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis.

Results: Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7 % were women. ACS presentations included non-ST elevation myocardial infarction (40.1 %), unstable angina (35.2 %), and ST-segment elevation myocardial infarction (31.5 %). Abbreviated ticagrelor based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95 % Confidence Interval (CI) 0.62-0.98, I2 = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41-1.03, I2 = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85-1.27, I2 = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64-1.45, I2 = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62-1.30, I2 = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38-0.66, I2 = 46 %).

Conclusion: Our analysis includes the totality of randomized data evaluating the merits of abbreviated ticagrelor based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality and major bleeding with abbreviated DAPT approach.

背景:很少有随机临床试验对急性冠状动脉综合征(ACS)中基于替卡格雷的简短双联抗血小板疗法(DAPT)的安全性和有效性进行评估;然而,这些试验在检测硬性临床结果的差异方面动力不足:方法: 对MEDLINE、Cochrane和Scopus数据库进行了系统检索,检索时间截止到2024年6月,目的是比较ACS中基于替卡格雷的简短(≤3个月)DAPT与基于替卡格雷的标准12个月DAPT的试验。主要终点是全因死亡率。次要终点包括心血管死亡、心肌梗死、支架血栓、缺血性中风和大出血。终点在 DAPT 开始后 12 个月进行测量。采用随机效应模型对数据进行汇总。采用风险比 (RR) 作为效果测量指标。异质性通过Chi-squared和Higgin's I2检验进行评估。使用 RevMan 5.0(Cochrane Collaboration,英国牛津)进行统计分析:本次分析共纳入了五项试验,评估了 21,407 名患者。ULTIMATE-DAPT、T-PASS和GLOBAL LEADERS-ACS评估了1个月的DAPT持续时间,而TICO和TWILIGHT-ACS评估了3个月的DAPT持续时间。平均年龄为 62.7 岁,22.7% 为女性。ACS表现包括非ST段抬高型心肌梗死(40.1%)、不稳定型心绞痛(35.2%)和ST段抬高型心肌梗死(31.5%)。与标准疗程的DAPT相比,基于替卡格雷的简短DAPT与较低的全因死亡风险相关(RR 0.78; 95 % 置信区间 (CI) 0.62-0.98, I2 = 0 %)。在心血管死亡(RR 0.65; 95 % CI 0.41-1.03, I2 = 0 %)、心肌梗死(RR 1.04; 95 % CI 0.85-1.27, I2 = 0 %)、支架血栓形成(RR 0.97; 95 % CI 0.64-1.45, I2 = 0 %)或缺血性中风(RR 0.90; 95 % CI 0.62-1.30, I2 = 0 %)方面,组间无差异。缩短DAPT与较低的大出血风险相关(RR 0.50; 95 % CI 0.38-0.66, I2 = 46 %):我们的分析包括了评估ACS后基于替卡格雷的简短DAPT优点的全部随机数据。研究的突出发现是观察到简短DAPT方法降低了全因死亡率和大出血风险。
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引用次数: 0
Mitigating health disparities by improving access to catheter-based therapies for vulnerable patients with acute pulmonary embolism. 通过改善急性肺栓塞弱势患者获得导管疗法的机会,减少健康差距。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-18 DOI: 10.1016/j.carrev.2024.09.002
Robert S Zhang, Norma Keller, Eugene Yuriditsky, Eric Bailey, Lindsay Elbaum, Orly Leiva, Allison A Greco, Radu Postelnicu, Vincent Li, Kerry M Hena, Vikramjit Mukherjee, Sylvie F Hall, Carlos L Alviar, Sripal Bangalore

Introduction: This study explores the implementation and outcomes of catheter-based thrombectomy (CBT) for acute pulmonary embolism (PE) within a safety-net hospital (SNH), addressing a critical gap in the literature concerning CBT in underserved and vulnerable populations.

Methods: This is a retrospective study of patients undergoing CBT between October 2020 and January 2024 at a SNH. The primary outcome was 30-day all-cause mortality.

Results: A total of 107 patients (47.6 % female, mean age 58.4 years) underwent CBT for acute PE, with 23 (21.5 %) high-risk and 84 (78.5 %) intermediate-risk PE. Demographically, 64 % identified as Black, 10 % White, 19 % Hispanic or Latino, and 5 % Asian. In terms of insurance coverage, 50 % had private insurance or Medicare, 36 % had Medicaid, and 14 % were uninsured. Notably, 67 % of the patients resided in high poverty rate zip codes and 11 % were non-citizen non-residents. Over a median follow up period of 30 days, 6 (5.6 %) patients expired (all high-risk PE), 3 of whom presented with cardiac arrest. No patients who presented with intermediate-risk PE died at 30 days. There was no difference in 30-day mortality based on race, insurance type, poverty level or citizenship status.

Conclusion: Our study findings reveal no disparities in access or outcomes to CBT at our SNH, emphasizing the feasibility and success of implementing PERT and CBT at a SNH, offering a potential model to address healthcare disparities in acute PE on a broader scale.

导言:本研究探讨了在一家安全网医院(SNH)内实施导管取栓术(CBT)治疗急性肺栓塞(PE)的实施情况和结果,填补了有关在服务不足和弱势群体中实施 CBT 的文献空白:这是一项回顾性研究,研究对象是 2020 年 10 月至 2024 年 1 月期间在一家安全网医院接受 CBT 治疗的患者。主要结果是 30 天内的全因死亡率:共有 107 名急性 PE 患者(47.6% 为女性,平均年龄 58.4 岁)接受了 CBT 治疗,其中 23 人(21.5%)为高危 PE,84 人(78.5%)为中危 PE。从人口统计学角度看,64%的人是黑人,10%是白人,19%是西班牙裔或拉丁裔,5%是亚裔。在保险覆盖范围方面,50% 的患者有私人保险或医疗保险,36% 的患者有医疗补助,14% 的患者没有保险。值得注意的是,67%的患者居住在贫困率较高的邮编区,11%为非公民非居民。在 30 天的中位随访期内,有 6 名(5.6%)患者死亡(均为高危 PE),其中 3 人心跳骤停。没有中危 PE 患者在 30 天内死亡。不同种族、保险类型、贫困程度或公民身份的患者在 30 天内的死亡率没有差异:我们的研究结果表明,在我们的SNH,接受CBT治疗的机会和结果没有差异,这强调了在SNH实施PERT和CBT的可行性和成功性,为在更大范围内解决急性PE的医疗差异提供了一个潜在的模式。
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引用次数: 0
Comparison of high-risk characteristics of non-culprit plaques in relation to plaque severity in acute coronary syndrome. 比较急性冠状动脉综合征非冠状动脉斑块的高危特征与斑块严重程度的关系。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-17 DOI: 10.1016/j.carrev.2024.09.006
Mohamed M Reda Abdelaziz Morsy, Frans B Mensink, Jonathan Los, Peter Damman, Niels van Royen, Mohamed A H Abdelhafez, Hamdy Shams Eddin Mohamed, Salwa R Demitry, Tim J F Ten Cate, Robert-Jan van Geuns

Introduction: Patients with acute coronary syndrome (ACS) have high event rates related to non-culprit (NC) lesions, therefore plaque composition of these lesions is of great interest. Although marginal atherosclerotic lesions were studied extensively, more significant lesions might have more high-risk characteristics.

Aim: To compare differences in high-risk lesion characteristics between significant versus non-stenotic NC plaques in ACS and the discrepancies with chronic coronary syndrome (CCS) patients.

Methods: Non-culprit vessels of 26 ACS patients with 26 angiographically significant lesions and 37 patients (17 ACS and 20 CCS) with 48 non-stenotic lesions were investigated with intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS). Overall, 74 segments of 30 mm length were analyzed in 1 mm intervals. External elastic lamina (EEM), plaque burden (PB), minimal luminal area (MLA), percent atheroma volume (PAV) and lipid core burden index maximum 4 mm (maxLCBI4mm) were determined for each segment.

Results: Cardiovascular risk factors were similar in all groups. PB was higher and MLA smaller in significant non-culprit ACS lesions vs non-stenotic lesions: PB 73.5% (IQR 68.7-78.5) vs 59.2 (IQR 49.6-71.5), p = 0.003, MLA 3.0 mm2 (IQR 2.3-3.9) vs 4.0 mm2 (IQR 2.8-4.7). MaxLCBI4mm was similar 308.1 (±155.4) vs 287.8 (±165.7), p = 0.67. Among non-stenotic plaques, MaxLCBI4mm was comparable between ACS and CCS patients, 275.7 (±151.5) in CCS patients vs 287.8 (±165.7) in ACS patients, p = 0.79.

Conclusion: Although visually significant non-culprit lesions had a higher plaque burden compared to non-stenotic lesions, a significant relation between MaxLCBI4mm and hemodynamic significance of the plaques couldn't be established.

导言:急性冠状动脉综合征(ACS)患者的高发病率与非冠状动脉病变(NC)有关,因此这些病变的斑块组成备受关注。尽管对边缘性动脉粥样硬化病变进行了广泛研究,但更显著的病变可能具有更多的高风险特征。目的:比较急性冠状动脉综合征(ACS)患者显著与非狭窄 NC 斑块的高风险病变特征差异,以及与慢性冠状动脉综合征(CCS)患者的差异:采用血管内超声(IVUS)和近红外光谱(NIRS)对26例ACS患者的26处血管造影显着病变和37例患者(17例ACS和20例CCS)的48处非狭窄病变的非冠状动脉进行了研究。总共分析了 74 个长度为 30 毫米、间隔为 1 毫米的节段。测定了每个节段的外部弹性层(EEM)、斑块负担(PB)、最小管腔面积(MLA)、粥样斑块体积百分比(PAV)和最大 4 毫米脂质核心负担指数(maxLCBI4mm):各组的心血管风险因素相似。与非狭窄病变相比,非实质性 ACS 病变的 PB 较高,MLA 较小:PB 73.5% (IQR 68.7-78.5) vs 59.2 (IQR 49.6-71.5), p = 0.003,MLA 3.0 mm2 (IQR 2.3-3.9) vs 4.0 mm2 (IQR 2.8-4.7)。最大LCBI4mm相似,为308.1 (±155.4) vs 287.8 (±165.7),P = 0.67。在非狭窄斑块中,ACS 和 CCS 患者的 MaxLCBI4mm 值相当,CCS 患者为 275.7 (±151.5) vs ACS 患者为 287.8 (±165.7),P = 0.79:虽然与非狭窄性病变相比,视觉上有意义的非病变有更高的斑块负荷,但最大LCBI4mm与斑块的血流动力学意义之间的显著关系并不成立。
{"title":"Comparison of high-risk characteristics of non-culprit plaques in relation to plaque severity in acute coronary syndrome.","authors":"Mohamed M Reda Abdelaziz Morsy, Frans B Mensink, Jonathan Los, Peter Damman, Niels van Royen, Mohamed A H Abdelhafez, Hamdy Shams Eddin Mohamed, Salwa R Demitry, Tim J F Ten Cate, Robert-Jan van Geuns","doi":"10.1016/j.carrev.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.006","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute coronary syndrome (ACS) have high event rates related to non-culprit (NC) lesions, therefore plaque composition of these lesions is of great interest. Although marginal atherosclerotic lesions were studied extensively, more significant lesions might have more high-risk characteristics.</p><p><strong>Aim: </strong>To compare differences in high-risk lesion characteristics between significant versus non-stenotic NC plaques in ACS and the discrepancies with chronic coronary syndrome (CCS) patients.</p><p><strong>Methods: </strong>Non-culprit vessels of 26 ACS patients with 26 angiographically significant lesions and 37 patients (17 ACS and 20 CCS) with 48 non-stenotic lesions were investigated with intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS). Overall, 74 segments of 30 mm length were analyzed in 1 mm intervals. External elastic lamina (EEM), plaque burden (PB), minimal luminal area (MLA), percent atheroma volume (PAV) and lipid core burden index maximum 4 mm (maxLCBI<sub>4mm</sub>) were determined for each segment.</p><p><strong>Results: </strong>Cardiovascular risk factors were similar in all groups. PB was higher and MLA smaller in significant non-culprit ACS lesions vs non-stenotic lesions: PB 73.5% (IQR 68.7-78.5) vs 59.2 (IQR 49.6-71.5), p = 0.003, MLA 3.0 mm<sup>2</sup> (IQR 2.3-3.9) vs 4.0 mm<sup>2</sup> (IQR 2.8-4.7). MaxLCBI<sub>4mm</sub> was similar 308.1 (±155.4) vs 287.8 (±165.7), p = 0.67. Among non-stenotic plaques, MaxLCBI<sub>4mm</sub> was comparable between ACS and CCS patients, 275.7 (±151.5) in CCS patients vs 287.8 (±165.7) in ACS patients, p = 0.79.</p><p><strong>Conclusion: </strong>Although visually significant non-culprit lesions had a higher plaque burden compared to non-stenotic lesions, a significant relation between MaxLCBI<sub>4mm</sub> and hemodynamic significance of the plaques couldn't be established.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336980","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 stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction". "无支架再灌注的分层途径:选择 ST 段抬高心肌梗死的合适患者"。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-14 DOI: 10.1016/j.carrev.2024.09.001
Rafael Mila, Juan Albistur, María Valdez, Gimena Loza, Juan Torrado, Juan Bachini, Soledad Murguía, Federico Acquistapace, Natalia Nóbile, Victoria Briano, Alvaro Niggemeyer, Pedro Trujillo, Nicolás Niell, Ariel Durán, Fernando Alfonso, Victor Dayan

Background: The DANAMI-3 DEFER study demonstrated that deferring stent implantation in ST-elevation myocardial infarction (STEMI) is safe, although not superior to immediate stenting. It is possible that an individualized revascularization strategy in STEMI, achieved through appropriate patient selection, could be feasible and effective.

Methods: This prospective, non-randomized study included 198 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between October 2019 and November 2021. Patients were assigned to either the deferred stenting (DS) group (n = 19) or the control group (C) undergoing immediate stenting (n = 179) based on a multimodal approach integrating coronary angiography, intravascular imaging, physiological assessments, and clinical judgment. The primary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).

Results: The DS group showed a significantly lower rate of stent implantation (10.5 % vs. 97.7 %, p < 0.001) and a higher use of thrombus aspiration (89.5 % vs. 30.7 %, p < 0.001) and glycoprotein IIb/IIIa inhibitors (31.6 % vs. 6.7 %, p < 0.001) compared to the C group. No significant differences were observed between the groups in terms of all-cause mortality (5.3 % vs. 8.9 %, p = 0.59) or MACCE (10.5 % vs. 8.4 %, p = 0.71).

Conclusions: This study demonstrates the feasibility of implementing individualized reperfusion strategies in STEMI within a real-world clinical setting. The findings, while limited by the study design, generate valuable hypotheses that warrant further investigation to refine patient selection criteria and optimize outcomes.

背景:DANAMI-3 DEFER研究表明,ST段抬高型心肌梗死(STEMI)患者推迟支架植入是安全的,尽管并不比立即植入支架更有优势。在 STEMI 中,通过适当选择患者而实现的个体化血管再通策略可能是可行且有效的:这项前瞻性非随机研究纳入了 198 名 STEMI 患者,他们在 2019 年 10 月至 2021 年 11 月期间接受了一次经皮冠状动脉介入治疗(PCI)。根据综合冠状动脉造影、血管内成像、生理评估和临床判断的多模式方法,患者被分配到延迟支架植入组(DS)(n = 19)或立即支架植入对照组(C)(n = 179)。主要终点包括全因死亡率和主要不良心脑血管事件(MACCE):结果:DS 组的支架植入率明显较低(10.5% 对 97.7%,P 结论:DS 组的支架植入率明显较高:这项研究证明了在实际临床环境中对 STEMI 实施个体化再灌注策略的可行性。研究结果虽然受到研究设计的限制,但提出了有价值的假设,值得进一步研究,以完善患者选择标准,优化治疗效果。
{"title":"\"A stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction\".","authors":"Rafael Mila, Juan Albistur, María Valdez, Gimena Loza, Juan Torrado, Juan Bachini, Soledad Murguía, Federico Acquistapace, Natalia Nóbile, Victoria Briano, Alvaro Niggemeyer, Pedro Trujillo, Nicolás Niell, Ariel Durán, Fernando Alfonso, Victor Dayan","doi":"10.1016/j.carrev.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>The DANAMI-3 DEFER study demonstrated that deferring stent implantation in ST-elevation myocardial infarction (STEMI) is safe, although not superior to immediate stenting. It is possible that an individualized revascularization strategy in STEMI, achieved through appropriate patient selection, could be feasible and effective.</p><p><strong>Methods: </strong>This prospective, non-randomized study included 198 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between October 2019 and November 2021. Patients were assigned to either the deferred stenting (DS) group (n = 19) or the control group (C) undergoing immediate stenting (n = 179) based on a multimodal approach integrating coronary angiography, intravascular imaging, physiological assessments, and clinical judgment. The primary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>The DS group showed a significantly lower rate of stent implantation (10.5 % vs. 97.7 %, p < 0.001) and a higher use of thrombus aspiration (89.5 % vs. 30.7 %, p < 0.001) and glycoprotein IIb/IIIa inhibitors (31.6 % vs. 6.7 %, p < 0.001) compared to the C group. No significant differences were observed between the groups in terms of all-cause mortality (5.3 % vs. 8.9 %, p = 0.59) or MACCE (10.5 % vs. 8.4 %, p = 0.71).</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of implementing individualized reperfusion strategies in STEMI within a real-world clinical setting. The findings, while limited by the study design, generate valuable hypotheses that warrant further investigation to refine patient selection criteria and optimize outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298649","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
Editorial: Evolution of cardiovascular technology – Necessary but not sufficient 社论:心血管技术的发展--必要但不充分。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-30 DOI: 10.1016/j.carrev.2024.08.020
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引用次数: 0
Coronary bifurcation lesion treatment with the BioMime™ Branch sirolimus-eluting coronary side-branch stent system: A single-center experience. 使用 BioMime™ 支西罗莫司洗脱冠状动脉侧支支架系统治疗冠状动脉分叉病变:单中心经验。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1016/j.carrev.2024.08.018
Antonio L Bartorelli, Giovanni Monizzi, Luca Grancini, Emanuele Gallinoro, Angelo Mastrangelo, Vincenzo Mallia, Franco Fabbiocchi

Background: Coronary bifurcation lesions (CBL) comprise 15 %-20 % of percutaneous coronary procedures and remain a challenge despite advances in stent and interventional techniques. The BioMime™ Branch sirolimus-eluting coronary side-branch stent (BBSES) is specifically designed for CBL treatment in conjunction with a standard drug-eluting stent (DES). We report the first single-center experience of treating complex CBL with the novel BBSES.

Methods: This is a retrospective, single-center study involving consecutive prospectively identified patients who underwent treatment of true CBL with the BBSES. The protocol included BBSES+DES implantation in the CBL and simultaneous final kissing balloon inflation.

Results: Fifty-eight CBL were treated in 58 consecutive patients (89.6 % men, mean age 69.0 ± 9.5 years) presenting primarily with stable angina (84.4 %) and true (Medina 1,1,1,) CBL. Procedural success was 100 % without major adverse cardiac events (MACE). At a median follow-up of 18 months, one sudden death was reported that was accounted as possible late stent thrombosis. One patient had spontaneous myocardial infarction due to subacute thrombosis of a DES implanted in the main vessel proximally to the BBSES before the index procedure. Another patient was hospitalized for atrial fibrillation.

Conclusions: This is the first clinical experience to date of true CBL treatment with the BBSES demonstrating high procedural success, no in-hospital MACE and sustained clinical results at a median follow-up of 18 months.

背景:冠状动脉分叉病变(CBL)占经皮冠状动脉手术的 15%-20%,尽管支架和介入技术不断进步,但它仍然是一项挑战。BioMime™ 支西罗莫司洗脱冠状动脉侧支支架(BBSES)是专为结合标准药物洗脱支架(DES)治疗 CBL 而设计的。我们报告了首个使用新型 BBSES 治疗复杂 CBL 的单中心经验:这是一项回顾性单中心研究,涉及连续接受 BBSES 治疗真正 CBL 的前瞻性患者。研究方案包括在 CBL 中植入 BBSES+DES 并同时进行最后的接吻球囊充气:58 名连续患者(89.6% 为男性,平均年龄为 69.0 ± 9.5 岁)接受了 58 例 CBL 治疗,这些患者主要表现为稳定型心绞痛(84.4%)和真性(Medina 1,1,1,)CBL。手术成功率为 100%,无重大心脏不良事件 (MACE)。中位随访时间为 18 个月,有一例猝死被认为可能是晚期支架血栓形成。一名患者在指数手术前因植入 BBSES 近端主血管的 DES 出现亚急性血栓而自发心肌梗死。另一名患者因心房颤动住院:这是迄今为止首次使用 BBSES 进行真正 CBL 治疗的临床经验,表明手术成功率高,无院内 MACE,并且在中位随访 18 个月后仍能保持临床效果。
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引用次数: 0
Editorial: Improving outcomes in High Risk PE - a glimpse of the future? 社论:改善高风险 PE 的治疗效果--未来的曙光?
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1016/j.carrev.2024.08.019
Andrew Sharp, Sripal Bangalore
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引用次数: 0
In vivo biocompatibility of a new hydrophobic coated Al/Al2O3 nanowire surface on stents. 支架上新型疏水涂层 Al/Al2O3 纳米线表面的体内生物相容性。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-24 DOI: 10.1016/j.carrev.2024.08.017
Axel Rentzsch, Eva Metz, Ruben Mühl-Benninghaus, Alexander Maßmann, Stephanie Bettink, Bruno Scheller, Lilia Lemke, Ali Awadelkareem, Toshiki Tomori, Ayman Haidar, Matthias W Laschke, Michael D Menger, Cenk Aktas, Matthias Hannig, Norbert Pütz, Thomas Büttner, David Scheschkewitz, Michael Veith, Hashim Abdul-Khaliq

Background: Intima proliferation and in-stent restenosis is a challenging situation in interventional treatment of small vessel obstruction. Al/Al2O3 nanowires have been shown to accelerate vascular endothelial cell proliferation and migration in vitro, while suppressing vascular smooth muscle cell growth. Moreover, surface modification of Al/Al2O3 nanowires with poly[bis(2,2,2-trifluoromethoxy)phosphazene (PTFEP) coating enables further advantages such as reduced platelet adhesion. Therefore, the study's goal was to compare the biocompatibility of novel Al/Al2O3 + PTFEP coated nanowire bare-metal stents to uncoated control stents in vivo using optical coherence tomography (OCT), quantitative angiography and histomorphometric assessment.

Methods: 15 Al/Al2O3 + PTFEP coated and 19 control stents were implanted in the cervical arteries of 9 Aachen minipigs. After 90 days, in-stent stenosis, thrombogenicity, and inflammatory response were assessed. Scanning electron microscopy was used to analyse the stent surface.

Results: OCT analysis revealed that neointimal proliferation in Al/Al2O3 + PTFEP coated stents was significantly reduced compared to control stents. The neointimal area was 1.16 ± 0.77 mm2 in Al/Al2O3 + PTFEP coated stents vs. 1.98 ± 1.04 mm2 in control stents (p = 0.004), and the neointimal thickness was 0.28 ± 0.20 vs. 0.47 ± 0.10 (p = 0.003). Quantitative angiography showed a tendency to less neointimal growth in coated stents. Histomorphometry showed no significant difference between the two groups and revealed an apparent inflammatory reaction surrounding the stent struts.

Conclusions: At long-term follow-up, Al/Al2O3 + PTFEP coated stents placed in peripheral arteries demonstrated good tolerance with no treatment-associated vascular obstruction and reduced in-stent restenosis in OCT. These preliminary in vivo findings indicate that Al/Al2O3 + PTFEP coated nanowire stents may have translational potential to be used for the prevention of in-stent restenosis.

背景:内膜增生和支架内再狭窄是小血管阻塞介入治疗中的一个难题。研究表明,Al/Al2O3 纳米线可在体外加速血管内皮细胞的增殖和迁移,同时抑制血管平滑肌细胞的生长。此外,用聚[双(2,2,2-三氟甲氧基)磷苯(PTFEP)涂层]对 Al/Al2O3 纳米线进行表面修饰还能进一步发挥其优势,如降低血小板粘附性。因此,本研究的目标是利用光学相干断层扫描(OCT)、定量血管造影术和组织形态学评估,比较新型 Al/Al2O3 + PTFEP 涂层纳米线裸金属支架与未涂层对照支架在体内的生物相容性。90 天后,对支架内狭窄、血栓形成和炎症反应进行评估。扫描电子显微镜用于分析支架表面:OCT分析显示,与对照支架相比,Al/Al2O3 + PTFEP涂层支架的新内膜增生明显减少。Al/Al2O3 + PTFEP涂层支架的新生内膜面积为1.16 ± 0.77 mm2,而对照支架为1.98 ± 1.04 mm2(p = 0.004);新生内膜厚度为0.28 ± 0.20,而对照支架为0.47 ± 0.10(p = 0.003)。定量血管造影显示,涂层支架的新生内膜生长较少。组织形态学显示两组间无明显差异,并显示支架支柱周围有明显的炎症反应:在长期随访中,置入外周动脉的铝/Al2O3 + PTFEP涂层支架表现出良好的耐受性,没有治疗相关的血管阻塞,OCT显示支架内再狭窄减少。这些初步的体内研究结果表明,Al/Al2O3 + PTFEP涂层纳米线支架可能具有用于预防支架内再狭窄的转化潜力。
{"title":"In vivo biocompatibility of a new hydrophobic coated Al/Al<sub>2</sub>O<sub>3</sub> nanowire surface on stents.","authors":"Axel Rentzsch, Eva Metz, Ruben Mühl-Benninghaus, Alexander Maßmann, Stephanie Bettink, Bruno Scheller, Lilia Lemke, Ali Awadelkareem, Toshiki Tomori, Ayman Haidar, Matthias W Laschke, Michael D Menger, Cenk Aktas, Matthias Hannig, Norbert Pütz, Thomas Büttner, David Scheschkewitz, Michael Veith, Hashim Abdul-Khaliq","doi":"10.1016/j.carrev.2024.08.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.017","url":null,"abstract":"<p><strong>Background: </strong>Intima proliferation and in-stent restenosis is a challenging situation in interventional treatment of small vessel obstruction. Al/Al<sub>2</sub>O<sub>3</sub> nanowires have been shown to accelerate vascular endothelial cell proliferation and migration in vitro, while suppressing vascular smooth muscle cell growth. Moreover, surface modification of Al/Al<sub>2</sub>O<sub>3</sub> nanowires with poly[bis(2,2,2-trifluoromethoxy)phosphazene (PTFEP) coating enables further advantages such as reduced platelet adhesion. Therefore, the study's goal was to compare the biocompatibility of novel Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated nanowire bare-metal stents to uncoated control stents in vivo using optical coherence tomography (OCT), quantitative angiography and histomorphometric assessment.</p><p><strong>Methods: </strong>15 Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated and 19 control stents were implanted in the cervical arteries of 9 Aachen minipigs. After 90 days, in-stent stenosis, thrombogenicity, and inflammatory response were assessed. Scanning electron microscopy was used to analyse the stent surface.</p><p><strong>Results: </strong>OCT analysis revealed that neointimal proliferation in Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated stents was significantly reduced compared to control stents. The neointimal area was 1.16 ± 0.77 mm<sup>2</sup> in Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated stents vs. 1.98 ± 1.04 mm<sup>2</sup> in control stents (p = 0.004), and the neointimal thickness was 0.28 ± 0.20 vs. 0.47 ± 0.10 (p = 0.003). Quantitative angiography showed a tendency to less neointimal growth in coated stents. Histomorphometry showed no significant difference between the two groups and revealed an apparent inflammatory reaction surrounding the stent struts.</p><p><strong>Conclusions: </strong>At long-term follow-up, Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated stents placed in peripheral arteries demonstrated good tolerance with no treatment-associated vascular obstruction and reduced in-stent restenosis in OCT. These preliminary in vivo findings indicate that Al/Al<sub>2</sub>O<sub>3</sub> + PTFEP coated nanowire stents may have translational potential to be used for the prevention of in-stent restenosis.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113447","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}
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Cardiovascular Revascularization Medicine
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