Cardiovascular Revascularization Medicine最新文献

Background: Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo left atrial appendage closure. SCAI/HRS consensus recommends routine post-procedure transthoracic echocardiography (TTE) before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.

Methods: We performed a retrospective observational study using the data from our institutional LAAC registry. We compared patients discharged on the same day after the procedure who underwent a TTE vs patients who were discharged without a TTE. The primary outcome studied was 45-day readmission for any given reason from the day of discharge.

Results: In a cohort of patients who were discharged on the same day, 350 did not undergo post-procedure TTE, and 60 underwent TTE. 33 patients were readmitted in the TTE group, and 4 patients were readmitted in the No TTE group. The RR for readmission without vs. with pre-discharge TTE was 1.41 (95 % CI 0.52-3.85, p = 0.25). No 45-day mortality occurred in either study group.

Conclusion: For patients undergoing LAAC with same-day discharge, routine TTE before discharge did not significantly influence 45-day readmission rates. Given the absence of clinical benefit but the presence of TTE costs and resource use, a more selective approach to post-procedural imaging should be considered.

Background: Ischaemic heart disease is the most prevalent form of cardiovascular disease (CVD) worldwide and imposes a substantial burden on healthcare systems. Identification of patients at high risk of events in a tailored primary prevention strategy is hindered by relatively blunt risk assessment tools. A novel scoring model that allows for rapid calculation of atheroma and ischaemia burden may facilitate earlier identification of high risk individuals. Our aim was to validate the ability of a novel candidate scoring model (Functional FFR Score 2, FFS2) to predict adverse clinical events, as a proof of concept, by applying it in a cohort of patients in whom coronary artery disease was assessed by means of invasive coronary angiography (ICA) and intracoronary pressure wire.

Methods: We retrospectively applied the novel FFS2 to a population of patients in whom there was comprehensive anatomical and physiological data from ICA plus intracoronary measurement of fractional flow reserve (FFR), the 3V-FFR FRIENDS study. The FFS2 includes an anatomical and physiological component, each used to score severity. Receiver operating characteristics (ROC) analysis and area under curve (AUC) were performed for the total FFS2 score, and for its components. The best cut-off value was then used to classify patients into high and low score groups to assess association with updated 5-year major adverse cardiac events (MACE).

Results: The FFS2 was applied on 616 patients from the 3V-FFR FRIENDS population, and was associated with MACE up to 5-years follow up (4.9 % Ischaemia-driven revascularisation, 1.6 % myocardial infarction (MI), and 1.3 % cardiac death), when patients were classified into "high" and "low" risk groups according to the best cut-off value of 11.5 following the initial ROC analysis of the total FFS2 score. The calculated hazard ratio (HR) was 2.87 (95 % CI 1.50-5.49, P = 0.002) for MACE and 3.75 (95 % CI 1.79-7.89, P < 0.001) for the ischaemia-driven revascularisation in the high risk group of patients.

Conclusion: The novel FFS2 score, incorporating an assessment of total atheroma and ischaemia burden, is associated with the rate of MACE and ischaemia-driven revascularisation. Further testing of this scoring tool to primary prevention populations is now warranted.

Background: Catheter-based drug delivery systems have evolved in percutaneous coronary interventions (PCI). Drug-coated balloons (DCBs) deliver agents to obstructive atherosclerotic lesions without permanent implants, but their pharmacokinetic profiles vary and may affect efficacy and safety.

Method: Twenty-seven Yucatan Miniature Swine underwent treatment with SEL-SEB (SELUTION SLR™), MT-SCB (MagicTouch™), or EES (XIENCE™) in the right coronary or left circumflex arteries. Drug levels were measured in treated arteries and downstream myocardium at 7, 60, and 90 days. MT-SCB samples were extracted with ZnSO₄/methanol, whereas SEL-SEB samples underwent two-step extraction (ZnSO₄/methanol followed by acetonitrile/acetone).

Result: A total of 54 arteries underwent pharmacokinetic evaluation (n = 6 treated arteries per time point) from 27 swine. At 7 days, the mean of arterial drug levels was 1767.5 ng/g for SEL-SEB, 1136.5 ng/g for MT-SCB, and 1057.4 ng/g for EES (p = 0.94). By 60 days, SEL-SEB and EES maintained high levels (1146.3 and 837.3 ng/g), while MT-SCB fell sharply to 5.8 ng/g (p < 0.05). At 90 days, SEL-SEB and EES remained stable (360.7 ng/g and 916.5 ng/g, respectively), although MT-SCB was negligible, 2.0 ng/g (p < 0.05). Drug levels in the downstream myocardium at 7 days were lowest with EES (0.1 ng/g), higher with SEL-SEB (11.3 ng/g), and highest with MT-SCB (281.5 ng/g) (p < 0.05).

Conclusions: SEL-SEB shows sustained arterial drug retention, more closely resembling the gold-standard EES. This data suggests that SEL-SEB should produce durable outcomes without the need for a permanent implant.

Background: Angina with non-obstructive coronary arteries (ANOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) are increasingly recognized as manifestations of coronary vasomotor dysfunction. Intracoronary acetylcholine (ACh) testing remains the gold standard for diagnosing endothelial-dependent coronary dysfunction, epicardial spasm, and microvascular spasm; however, variability in protocols and safety concerns has limited broader adoption.

Objectives: To provide a contemporary, practice-oriented review of the indications, mechanisms, protocols, safety profile, and clinical utility of ACh provocation testing, integrating emerging multicenter registry data and recent mechanistic insights.

Methods and results: We review standardized ACh dosing strategies (bolus and continuous infusion), diagnostic endotypes, and integration with wire-based hemodynamic assessment. Building upon prior state-of-the-art reviews, this article incorporates new data from abstracts presented in 2025 from the DISCOVER-INOCA registry and recent prospective multicenter endotype studies demonstrating (1) high diagnostic yield, (2) quantitative differentiation of epicardial spasm, microvascular spasm, isolated endothelial dysfunction, and enhanced nociception, and (3) a very low incidence of major complications (<1%). Contemporary meta-analysis further clarifies the safety profile of ACh relative to ergonovine. We also provide updated contraindications aligned with 2024 ESC chronic coronary syndrome guidance and MINOCA recommendations. Importantly, emerging data support a shift from purely qualitative spasm provocation toward mechanism-guided, endotype-specific therapy.

Conclusions: This review advances the field by integrating prospective North American registry validation, contemporary safety meta-analyses, and quantitative endotype phenotyping frameworks. ACh testing is repositioned not only as a diagnostic tool but as a platform for precision medicine in ANOCA and MINOCA, enabling tailored therapy and improved patient-centered outcomes.

Background: Since their creation in 2002, drug-eluting stents (DES) have proven their superiority over their bare-metal counterparts and significantly evolved. Efforts are now concentrated on improving the DES platform, particularly by integrating thinner stent design. We aimed to compare outcomes between a broad range of current generation DES to evaluate the impact of thinner strut design in a real-world setting.

Methods: We analysed data from 3092 patients who underwent percutaneous coronary intervention (PCI) with thin (≤80 μm) or thick (>80 μm) DES in the Cardio-FR database. Of these, 2551 (1567 thick DES and 984 thin DES) met the inclusion and exclusion criteria and completed a two-year follow-up: The primary outcome was the device-oriented composite endpoint (DOCE) of cardiac death, non-fatal target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR).

Results: The mean age was 67 years, and 75% were male. After multivariable adjustment, thick-strut DES were associated with higher 2-year DOCE compared with thin-strut DES (adjusted OR for thick vs thin: 1.298; 95% CI: 1.006-1.674; p = 0.045). In contrast, stroke was less frequent with thick-strut DES (2.0% vs 3.4%; p = 0.041). All other event rates were similar between the groups.

Conclusion: Clinical follow-up up to two years shows treatment with thin strut DES significantly lowers DOCE rates compared with thick strut DES. More research is needed to assess the impact of thinner strut design on performance.

Ostial coronary lesions present significant technical challenges during percutaneous coronary intervention (PCI), where imprecise stent positioning can result in geographic miss, stent protrusion, or compromised future access. Angiographic guidance alone is often limited by vessel foreshortening, overlapping structures, and variable aortic root anatomy. Although intravascular ultrasound (IVUS) provides high-resolution visualization of the coronary ostium and plaque morphology, its integration into real-time ostial stent deployment has been inconsistent, partly due to equipment and technical constraints. The Fluoroscopic IVUS X-mark IT (FIX-IT) technique offers a simple, reproducible solution by using IVUS to identify the true anatomical ostium and translate this landmark precisely onto fluoroscopy. This facilitates accurate stent placement while minimizing contrast use and reducing the risk of geographic miss. We describe the application of FIX-IT for ostial left anterior descending (LAD) artery stenting across three different IVUS platforms, demonstrating its adaptability, procedural reliability, and potential to improve technical success and long-term outcomes in ostial PCI.