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Improving outcomes with standardized care in high-risk patients supported with a percutaneous microaxial flow pump. 使用经皮微轴血流泵为高风险患者提供支持,通过标准化护理提高疗效。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.015
Ezequiel J Molina
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引用次数: 0
Adverse outcomes with left atrial appendage occlusion device implantation in chronic and end stage kidney disease: A systemic review and meta-analysis. 慢性肾病和终末期肾病患者植入左房阑尾闭塞器的不良后果:系统回顾和荟萃分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.016
Gauravpal S Gill, Shikha Shailly, Teja Chakrala, Anirudh Palicherla, Pramod K Ponna, Venkata Mahesh Alla, Arun Kanmanthareddy

Background: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.

Methods: PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I2 test.

Results: Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).

Conclusions: This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.

背景:慢性肾脏病(CKD)和终末期肾病(ESRD)与正在接受抗凝治疗的心房颤动患者发生出血事件(包括出血性中风)、围手术期出血和消化道出血的风险增加有关。经皮左心房阑尾封堵术(LAAO)在这类患者中的安全性尚不确定,研究结果相互矛盾:方法:我们在 PubMed 和 Google Scholar 数据库中查询了对接受 LAAO 装置植入术的慢性肾脏病患者与非慢性肾脏病患者、ESRD 患者与非 ESRD 患者的疗效进行比较的研究。从所选研究中提取结果数据,并使用随机效应模型进行分析。使用I2检验评估异质性:最终分析纳入了来自11项研究、61 724名肾病和非肾病患者的数据。院内死亡风险增加(OR 2.76,95 % CI [1.15-6.64];P = 0.02),围手术期出血风险增加(1.51 [1.33-1.71];P 结论:本研究显示,肾病患者接受 LAAO 装置植入术后并发症风险增加。这些研究结果表明,有必要进行随机对照研究,专门比较肾脏疾病和 ESRD 患者接受 LAAO 与抗凝治疗的结果。
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引用次数: 0
Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE registry outcomes. 急性冠状动脉综合征右冠状动脉动脉瘤的经皮冠状动脉介入治疗:RIGHTMARE 登记结果。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.013
Giulio Piedimonte, Enrico Cerrato, Cristina Rolfo, Ivan J Nunez Gil, Lorenzo Azzalini, Riccardo Mangione, Francesco Maiellaro, Alberto Boi, Donovan Riganelli, Andrea Sardone, Francesco Bruno, Fernando Scudiero, Giampiero Vizzari, Gabriele Carciotto, Dario Calderone, Marco Borgi, Francesco Paolo Cancro, Ivan Sanchez, Massimo Leoncini, Emanuele Sagazio, Francesco Colombo, Gabriele Rosso, Tania Chechi, Simone Zecchino, Marco Pavani, Alfonso Franzè, Greca Zanda, Manuel Bosco, Jose Maria De La Torre Hernandez, Antonio Micari, Gennaro Galasso, Francesco Versaci, Corrado Tamburino, Giuseppe Patti, Alessio La Manna, Francesco Tomassini, Ferdinando Varbella

Background: The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting.

Objectives: To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS).

Methods: Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE).

Results: The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years.

Conclusions: Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.

背景:动脉瘤右冠状动脉(ARCA)经皮冠状动脉介入治疗(PCI动脉瘤性右冠状动脉(ARCA)经皮冠状动脉介入治疗(PCI)的最佳策略仍不确定,且从未在急性病例中进行过测试:目的:比较急性冠状动脉综合征(ACS)期间作为罪魁祸首的ARCA立即和分阶段PCI策略的院内和长期疗效:在欧洲18个中心进行的102376例PCI手术中,共有85例急性冠状动脉综合征患者接受了ARCA PCI治疗,最终纳入分析。分析收集了患者的 PCI 策略(即刻手术与分阶段手术中的支架植入)和采用的药物治疗方法。主要结果是手术成功率(技术成功且无院内MACE):结果:48.2%的病例获得了主要结果,立即PCI组和分期PCI组之间没有观察到显著差异(50.9% vs 43.3%,P = 0.504)。分期 PCI 组患者的静脉抗凝剂使用率(83.3% vs 48.1%,p = 0.002)、BARC 3 型和 5 型出血率(12.9% vs 1.9%,p = 0.037)和住院时间(7.40 ± 5.11 vs 9.5 ± 5.25 天,p = 0.049)均明显更高。经过多变量分析,两组患者均未发现手术成功的独立预测因素。靶病变失败发生率为24.1%,中位随访三年,两组间无差异:结论:在接受ARCA PCI治疗的ACS患者中,立即或分期PCI与相似的院内和长期预后相关。然而,与立即PCI策略相比,分期PCI与更高的大出血风险和更长的住院时间相关。
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引用次数: 0
Performance of balloon-expandable transcatheter bioprostheses in inoperable patients with pure aortic regurgitation of a native valve: The BE-PANTHEON international project. 球囊扩张型经导管生物瓣膜在无法手术的纯主动脉瓣反流患者中的表现:BE-PANTHEON国际项目。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.007
Enrico Poletti, Ignacio Amat-Santos, Enrico Criscione, Antonio Popolo Rubbio, Mario García-Gómez, Mateusz Orzalkiewicz, Manuel Pan, Antonio Sisinni, Mattia Squillace, Bruno García Del Blanco, Francesco Bruno, Vasileios Panoulas, Radoslaw Pracon, Ole De Backer, Maurizio Taramasso, Giuliano Costa, Marco Barbanti, Nicolas M Van Mieghem, Damiano Regazzoli, Antonio Mangieri, Andrea Scotti, Azeem Latib, Francesco Saia, Francesco Bedogni, Luca Testa

Background: The off-label utilization of transcatheter heart valve (THV) devices for the treatment of inoperable or high-surgical risk patients with pure native aortic valve regurgitation (NAVR) has demonstrated suboptimal outcomes, both with self- and balloon-expandable (BE) devices. The aim of this study is to compare the use of different BE scaffolds in treating pure NAVR.

Methods: Consecutive patients with pure severe NAVR who were deemed to be at high-risk and were treated with last-generation BE-THVs among seventeen Centers in Europe and US. Technical and device success rates were the primary objectives.

Results: Between February 2018 and July 2023, among 144 patients, 41 (28 %) received a MyVal device and 103 (72 %) were treated with a Sapien THV. Patients treated with a MyVal THV had an extra-large annulus more frequently compared to the Sapien group (49%vs.20 %, p < 0.001). Technical and device success rates were 90 % and 81 %, respectively, p > 0.1. The rate of THV migration/embolization (MyVal 4.9%vs. Sapien 11 %, p = 0.4) and second valve needed (4.9%vs.7.8 %, p = 0.7) were numerically lower in the MyVal group, whereas the rate of at least moderate paravalvular leak (15%vs.7.8 %, p = 0.2) and permanent pacemaker implantation (25%vs.18 %, p = 0.16) were numerically higher in the Myval group.

Conclusions: Off-label use of BE devices for pure NAVR represents a potential alternative in high-risk patients in the absence of dedicated devices. However, BE in NAVR is associated with suboptimal outcomes. The availability of larger THV sizes may introduce transcatheter aortic valve replacement as an effective treatment for patients traditionally deemed unsuitable.

Non-standard abbreviations and acronyms: AR = aortic regurgitation, BE = balloon-expandable, NAVR = native aortic valve regurgitation, PM = pacemaker, TAVR = transcatheter aortic valve replacement, THV = transcatheter heart valve, TVEM = transcatheter valve embolization and migration, VARC-3 = Valve Academic Research Consortium 3.

背景:标示外使用经导管心脏瓣膜(THV)装置治疗无法手术或手术风险高的纯原发性主动脉瓣反流(NAVR)患者,无论是自体瓣膜装置还是球囊扩张(BE)装置,均显示出不理想的疗效。本研究旨在比较使用不同的 BE 支架治疗纯性 NAVR 的效果:方法:在欧洲和美国的 17 个中心连续收治被视为高风险的纯重度 NAVR 患者,并使用上一代 BE-THV 进行治疗。技术和设备成功率是主要目标:2018年2月至2023年7月期间,在144名患者中,41人(28%)接受了MyVal装置治疗,103人(72%)接受了Sapien THV治疗。与 Sapien 组相比,接受 MyVal THV 治疗的患者出现超大瓣环的频率更高(49%vs.20%,P 0.1。MyVal组的THV移位/栓塞率(MyVal 4.9%vs. Sapien 11%,p = 0.4)和需要二次瓣膜的比例(4.9%vs.7.8%,p = 0.7)在数字上较低,而MyVal组的至少中度瓣膜旁漏率(15%vs.7.8%,p = 0.2)和永久起搏器植入率(25%vs.18%,p = 0.16)在数字上较高:结论:标示外使用 BE 设备进行纯 NAVR 是高风险患者在没有专用设备的情况下的一种潜在选择。然而,BE 在 NAVR 中的应用与次优结果相关。更大尺寸 THV 的出现可能会使经导管主动脉瓣置换术成为传统上被认为不适合患者的一种有效治疗方法:AR=主动脉瓣反流,BE=球囊扩张,NAVR=原发性主动脉瓣反流,PM=起搏器,TAVR=经导管主动脉瓣置换术,THV=经导管心脏瓣膜,TVEM=经导管瓣膜栓塞和移位,VARC-3=瓣膜学术研究联盟 3。
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引用次数: 0
A novel functional index, aortic-valve-coefficient, for assessing aortic-stenosis in patients undergoing TAVR: A prospective-pilot study. 用于评估接受 TAVR 患者主动脉瓣狭窄的新型功能指数--主动脉瓣系数:一项前瞻性试点研究。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.006
Shreyash M Manegaonkar, Rishi Sukhija, Mohamed A Effat, Marepalli Rao, Rupak K Banerjee

Background: Evaluating the severity of aortic stenosis (AS) can be challenging, particularly in patients with low-gradient (LG, Δp < 40 mmHg) AS.

Objective: This study aims to improve the accuracy of assessing severity of AS using a novel functional index- Aortic Valve Coefficient (AVC). The AVC is defined as ratio of mean transvalvular pressure-drop (Δp) to the proximal dynamic pressure (1/2 × blood density × VLVOT2; VLVOT: left ventricular outflow tract peak velocity).

Hypothesis: AVC, developed from fundamental fluid dynamic principles, is a better index for accessing AS severity as it incorporates square of VLVOT and downstream pressure recovery.

Methods: This pilot prospective study enrolled 47 patients undergoing TAVR for AS. Using cardiac-catheterization-measured Δp and echocardiography-Doppler-derived VLVOT, AVC was evaluated. Pre- and post-TAVR pressure-velocity measurements were obtained, resulting in a dataset with 78 data points, including 32 data points specifically linked to LG AS. Linear regression analysis was performed to correlate AVC with Δp, VLVOT and aortic-valve-area. Welch 2-sample t-test was carried out to compare the means of AVC against aortic-valve-area.

Results: Moderate correlation (r = 0.85) was observed between AVC and aortic-valve-area indicating AVC could be a prospective index. However, correlation decreased (r = 0.75) in LG AS patients, indicating increased discordancy. Comparing AVC and aortic-valve-area in LG AS patients with left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 %, t-test showed that AVC values are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48).

Conclusion: AVC, a novel index, has the potential to improve assessment of AS severity and clinical decision making for treating patients with AS.

Condensed abstract: Complex hemodynamics, such as paradoxical "low-flow low-gradient (LG)" Aortic stenosis (AS) can be difficult to diagnose. Currently, mean transvalvular pressure-drop and flow-derived aortic-valve-area assess AS severity. Aortic valve coefficient (AVC) is a novel index which combines both pressure-drop and flow measurements to assess the severity of AS. A total of 47 patients (72 data points) were studied undergoing TAVR. In LG AS patients, t-test comparing left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 % showed that AVC are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48). Therefore, AVC could be a better index.

背景:评估主动脉瓣狭窄(AS)的严重程度具有挑战性,尤其是在低梯度(LG,Δp)患者中:本研究旨在使用一种新型功能性指标--主动脉瓣系数(AVC)来提高评估主动脉瓣狭窄严重程度的准确性。AVC 的定义是平均跨瓣压降(Δp)与近端动态压力(1/2 × 血液密度 × VLVOT2;VLVOT:左室流出道峰值速度)之比:假设:根据流体动力学基本原理开发的AVC是评估强直性脊柱炎严重程度的更好指标,因为它包含了VLVOT的平方和下游压力恢复:这项试验性前瞻性研究招募了 47 名因 AS 而接受 TAVR 的患者。方法:这项试验性前瞻性研究共纳入了 47 名因 AS 而接受 TAVR 的患者,使用心脏导管测量的 Δp 和超声心动图-多普勒衍生的 VLVOT 对 AVC 进行了评估。TAVR前和TAVR后的压力-速度测量结果产生了一个包含78个数据点的数据集,其中包括32个与LG AS特别相关的数据点。进行了线性回归分析,将 AVC 与 Δp、VLVOT 和主动脉瓣面积相关联。对 AVC 与主动脉瓣面积的平均值进行了韦尔奇 2 样本 t 检验:结果:AVC 与主动脉瓣面积之间存在适度的相关性(r = 0.85),表明 AVC 可以作为一种前瞻性指标。然而,LG AS 患者的相关性降低(r = 0.75),表明不一致性增加。比较左心室射血分数(LVEF)的 LG AS 患者的 AVC 和主动脉瓣面积 结论:AVC作为一项新指标,有可能改善对AS严重程度的评估和治疗AS患者的临床决策。主动脉瓣狭窄(AS)很难诊断。目前,平均跨瓣压降和血流衍生的主动脉瓣面积可评估主动脉瓣狭窄的严重程度。主动脉瓣系数(AVC)是一种新型指数,它结合了压降和血流测量来评估主动脉瓣狭窄的严重程度。共对 47 名接受 TAVR 的患者(72 个数据点)进行了研究。在LG AS患者中,比较左心室射血分数(LVEF)的t检验结果为:LVEF(左心室射血分数)高于AVC(左心室射血分数)。
{"title":"A novel functional index, aortic-valve-coefficient, for assessing aortic-stenosis in patients undergoing TAVR: A prospective-pilot study.","authors":"Shreyash M Manegaonkar, Rishi Sukhija, Mohamed A Effat, Marepalli Rao, Rupak K Banerjee","doi":"10.1016/j.carrev.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the severity of aortic stenosis (AS) can be challenging, particularly in patients with low-gradient (LG, Δp < 40 mmHg) AS.</p><p><strong>Objective: </strong>This study aims to improve the accuracy of assessing severity of AS using a novel functional index- Aortic Valve Coefficient (AVC). The AVC is defined as ratio of mean transvalvular pressure-drop (Δp) to the proximal dynamic pressure (1/2 × blood density × V<sub>LVOT</sub><sup>2</sup>; V<sub>LVOT</sub>: left ventricular outflow tract peak velocity).</p><p><strong>Hypothesis: </strong>AVC, developed from fundamental fluid dynamic principles, is a better index for accessing AS severity as it incorporates square of V<sub>LVOT</sub> and downstream pressure recovery.</p><p><strong>Methods: </strong>This pilot prospective study enrolled 47 patients undergoing TAVR for AS. Using cardiac-catheterization-measured Δp and echocardiography-Doppler-derived V<sub>LVOT</sub>, AVC was evaluated. Pre- and post-TAVR pressure-velocity measurements were obtained, resulting in a dataset with 78 data points, including 32 data points specifically linked to LG AS. Linear regression analysis was performed to correlate AVC with Δp, V<sub>LVOT</sub> and aortic-valve-area. Welch 2-sample t-test was carried out to compare the means of AVC against aortic-valve-area.</p><p><strong>Results: </strong>Moderate correlation (r = 0.85) was observed between AVC and aortic-valve-area indicating AVC could be a prospective index. However, correlation decreased (r = 0.75) in LG AS patients, indicating increased discordancy. Comparing AVC and aortic-valve-area in LG AS patients with left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 %, t-test showed that AVC values are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48).</p><p><strong>Conclusion: </strong>AVC, a novel index, has the potential to improve assessment of AS severity and clinical decision making for treating patients with AS.</p><p><strong>Condensed abstract: </strong>Complex hemodynamics, such as paradoxical \"low-flow low-gradient (LG)\" Aortic stenosis (AS) can be difficult to diagnose. Currently, mean transvalvular pressure-drop and flow-derived aortic-valve-area assess AS severity. Aortic valve coefficient (AVC) is a novel index which combines both pressure-drop and flow measurements to assess the severity of AS. A total of 47 patients (72 data points) were studied undergoing TAVR. In LG AS patients, t-test comparing left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 % showed that AVC are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48). Therefore, AVC could be a better index.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113444","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
C-reactive protein and TAVR: Impact of inflammation on patient outcomes. C 反应蛋白与 TAVR:炎症对患者预后的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.012
Placido Maria Mazzone, Davide Capodanno
{"title":"C-reactive protein and TAVR: Impact of inflammation on patient outcomes.","authors":"Placido Maria Mazzone, Davide Capodanno","doi":"10.1016/j.carrev.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.012","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082144","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 response to "Outcomes in transcatheter aortic valve replacement (TAVR) patients requiring red blood cell transfusion: A nationwide perspective". 对 "需要输注红细胞的经导管主动脉瓣置换术(TAVR)患者的预后:全国视角 "的编辑回复。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.carrev.2024.08.014
David Gittess, R David Anderson
{"title":"Editorial response to \"Outcomes in transcatheter aortic valve replacement (TAVR) patients requiring red blood cell transfusion: A nationwide perspective\".","authors":"David Gittess, R David Anderson","doi":"10.1016/j.carrev.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082145","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
Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization. 经桡动脉入路冠状动脉导管术中动脉内尼卡地平与维拉帕米的对比。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-20 DOI: 10.1016/j.carrev.2024.08.008
Keshav Patel, Melissa Duckett, Mladen I Vidovich, Khalil Ibrahim

Introduction: Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.

Methods: We conducted a prospective, single-blinded randomized clinical trial comparing the discomfort experienced by patients receiving either 400 μg of IA nicardipine (n = 26) or 5 mg of IA verapamil (n = 29). Patient discomfort and/or pain was assessed using the Visual Analogue Scale (VAS) both before and after IA administration of nicardipine or verapamil.

Results: There was a statistically significant difference in mean change in VAS scores between the 2 groups, with an average increase in VAS score of 0.88 in the nicardipine group and 4.81 in the verapamil group (p < 0.0001). The overall rate of RAS was low in our study (5.5 %) with no significant difference in RAS incidence between the 2 groups (p = 0.465). The nicardipine group had 2 RAS cases (7.7 %), with 1 requiring a change in strategy (3.8 %). The verapamil group had 1 RAS case (3.4 %) that did not require a change in strategy.

Conclusion: In this trial, we showed that nicardipine causes significantly less discomfort and pain compared to verapamil during IA administration for TRA cardiac catheterization.

导言:建议在经桡动脉入路(TRA)时使用动脉内(IA)血管扩张剂,以防止桡动脉痉挛(RAS)。美国心脏协会(AHA)建议使用维拉帕米、地尔硫卓、尼卡地平或硝酸甘油来预防 RAS。据我们所知,维拉帕米和尼卡地平对 RAS 的预防效果和患者耐受性还没有进行过直接的随机比较:我们进行了一项前瞻性、单盲随机临床试验,比较了接受 400 μg 体内注射尼卡地平(26 人)或 5 mg 体内注射维拉帕米(29 人)的患者的不适感。在服用尼卡地平或维拉帕米前后,均使用视觉模拟量表(VAS)对患者的不适和/或疼痛进行评估:结果:两组 VAS 评分的平均变化差异有统计学意义,尼卡地平组 VAS 评分平均增加 0.88 分,维拉帕米组则平均增加 4.81 分(p 结论:尼卡地平和维拉帕米的疗效均优于尼卡地平:本试验表明,与维拉帕米相比,尼卡地平在 TRA 心导管植入术中引起的不适和疼痛明显更少。
{"title":"Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization.","authors":"Keshav Patel, Melissa Duckett, Mladen I Vidovich, Khalil Ibrahim","doi":"10.1016/j.carrev.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.008","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.</p><p><strong>Methods: </strong>We conducted a prospective, single-blinded randomized clinical trial comparing the discomfort experienced by patients receiving either 400 μg of IA nicardipine (n = 26) or 5 mg of IA verapamil (n = 29). Patient discomfort and/or pain was assessed using the Visual Analogue Scale (VAS) both before and after IA administration of nicardipine or verapamil.</p><p><strong>Results: </strong>There was a statistically significant difference in mean change in VAS scores between the 2 groups, with an average increase in VAS score of 0.88 in the nicardipine group and 4.81 in the verapamil group (p < 0.0001). The overall rate of RAS was low in our study (5.5 %) with no significant difference in RAS incidence between the 2 groups (p = 0.465). The nicardipine group had 2 RAS cases (7.7 %), with 1 requiring a change in strategy (3.8 %). The verapamil group had 1 RAS case (3.4 %) that did not require a change in strategy.</p><p><strong>Conclusion: </strong>In this trial, we showed that nicardipine causes significantly less discomfort and pain compared to verapamil during IA administration for TRA cardiac catheterization.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082146","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
Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis. 心源性休克患者进行 TAVR 后的疗效:系统回顾和荟萃分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-17 DOI: 10.1016/j.carrev.2024.08.002
Ahmad Jabri, Mohammed Ayyad, Maram Albandak, Ahmad Al-Abdouh, Luai Madanat, Basma Badrawy Khalefa, Laith Alhuneafat, Asem Ayyad, Alejandro Lemor, Mohammed Mhanna, Zaid Al Jebaje, Raef Fadel, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Ivan D Hanson, Amr E Abbas, Tiberio Frisoli, James Lee, Dee Dee Wang, Vikas Aggarwal, Khaldoon Alaswad, William W O'Neill, Herbert D Aronow, Mohammad AlQarqaz, Pedro Villablanca

Background: While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored.

Methods: We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I2).

Results: Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts.

Conclusion: Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.

背景:虽然经导管主动脉瓣置换术(TAVR)拓宽了重症患者的治疗选择,但对伴有心源性休克(CS)的患者的治疗效果还没有进行深入研究:我们对主要数据库进行了全面检索,比较了自 TAVR 开始至 2023 年 10 月 31 日期间有无 CS 患者的治疗效果。我们的荟萃分析包括五项非随机观察性研究。采用曼特尔-海恩泽尔法(风险比、95% CI)评估二分法结果,采用反方差法评估均值差异和95% CI,评估连续性结果。统计异质性采用不一致性检验(I2)确定:在五项研究的26283名患者中,CS组(7267名患者;27.6%)的30天死亡率高于无CS组(OR 3.41,95% CI [2.01,5.76],P 结论:在接受TAVR的患者中,CS组的短期死亡率高于无CS组:在接受 TAVR 的患者中,有 CS 和没有 CS 的患者短期死亡率较高,但一年后的结果相似。未来的研究应探讨当手术延迟以优化 CS 时,TAVR 的预后是否会得到改善;当无法延迟时,特定的管理策略是否会带来更有利的围手术期预后。
{"title":"Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis.","authors":"Ahmad Jabri, Mohammed Ayyad, Maram Albandak, Ahmad Al-Abdouh, Luai Madanat, Basma Badrawy Khalefa, Laith Alhuneafat, Asem Ayyad, Alejandro Lemor, Mohammed Mhanna, Zaid Al Jebaje, Raef Fadel, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Ivan D Hanson, Amr E Abbas, Tiberio Frisoli, James Lee, Dee Dee Wang, Vikas Aggarwal, Khaldoon Alaswad, William W O'Neill, Herbert D Aronow, Mohammad AlQarqaz, Pedro Villablanca","doi":"10.1016/j.carrev.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.002","url":null,"abstract":"<p><strong>Background: </strong>While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored.</p><p><strong>Methods: </strong>We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I<sup>2</sup>).</p><p><strong>Results: </strong>Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts.</p><p><strong>Conclusion: </strong>Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113458","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
Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs. 院外心脏骤停住院患者的姑息治疗咨询:对侵入性程序、拒绝复苏指令和医疗成本的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-17 DOI: 10.1016/j.carrev.2024.08.003
Abdilahi Mohamoud, Nadhem Abdallah, Abdirahman Wardhere, Mahmoud Ismayl

Background: The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.

Method: This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.

Results: Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.

Conclusion: Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.

背景:姑息关怀咨询对院外心脏骤停(OHCA)住院患者的管理和预后的影响仍鲜为人知。本研究探讨了姑息治疗咨询与OHCA住院患者的院内预后之间的关系,并根据生存状况进行了分层:这项横断面研究使用了全国住院病人抽样调查(2016-2021 年)的数据。研究纳入了接受心肺复苏的 OHCA 住院成人患者。多变量分析评估了姑息治疗咨询与非终末期和终末期 OHCA 住院治疗结果之间的关联,并对人口统计学、医院特征和合并症进行了调整:在 488,700 例 OHCA 住院患者中,姑息关怀咨询与非终末期住院患者较低的侵入性程序几率相关,包括经皮冠状动脉介入治疗(PCI)(aOR 0.30,95 % CI 0.25-0.36)、机械循环支持(aOR 0.54,95 % CI 0.44-0.68)、永久起搏器(aOR 0.27,95 % CI 0.20-0.37)、植入式心律转复除颤器(aOR 0.22,95 % CI 0.16-0.31)和心脏复律(aOR 0.62,95 % CI 0.55-0.70)。在末期住院治疗中,姑息治疗与较低的 PCI(aOR 0.78,95 % CI 0.70-0.87)和心脏电复律(aOR 0.91,95 % CI 0.85-0.97)几率相关,但与较高的治疗性低温(aOR 3.12,95 % CI 2.72-3.59)、胃造瘘(aOR 1.22,95 % CI 1.05-1.41)和肾脏替代治疗(aOR 1.19,95 % CI 1.12-1.26)几率相关。姑息治疗与两个亚组中较高的DNR使用率和较低的非终末期住院费用相关,但与较高的终末期住院费用相关:结论:在 OHCA 患者中,姑息治疗咨询与侵入性手术、DNR 使用率和住院费用的差异有关,这些差异因存活状况而异。
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Cardiovascular Revascularization Medicine
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