Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.08.009
Çağrı Zorlu, Sefa Erdi Ömür
{"title":"Critique of the OPTIMIS study on magnesium-based bioresorbable scaffolds","authors":"Çağrı Zorlu, Sefa Erdi Ömür","doi":"10.1016/j.carrev.2025.08.009","DOIUrl":"10.1016/j.carrev.2025.08.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 124-125"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862538","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.05.020
Artur Dziewierz
{"title":"Refining the prognostic role of red cell distribution width in TAVR patients","authors":"Artur Dziewierz","doi":"10.1016/j.carrev.2025.05.020","DOIUrl":"10.1016/j.carrev.2025.05.020","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Page 126"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128864","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.08.015
Ezequiel J. Molina
{"title":"Editorial: Refining the hemocompatibility paradigm in AMI-cardiogenic shock: Insights from an early Impella 5+ experience with DAPT and bivalirudin","authors":"Ezequiel J. Molina","doi":"10.1016/j.carrev.2025.08.015","DOIUrl":"10.1016/j.carrev.2025.08.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 109-110"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974175","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.02.001
Francesco Amata , Massimo Ferraro , Antonio Mangieri , Damiano Regazzoli , Giuseppe Ferrante , Ottavia Cozzi , Giulio Stefanini , Bernhard Reimers , Antonio Colombo
Background
The third-generation Fantom Encore bioresorbable scaffold (BRS), made with Tyrocore polymer, features full radiopacity, 95–115 μm strut thickness, and high expansion capacity. Currently, there is a lack of real-world data on this device.
Methods and results
We conducted a retrospective, single-center study involving 28 elective patients undergoing percutaneous coronary intervention (PCI) for 43 de novo coronary lesions with implantation of the Fantom Encore BRS. Mean age was 66.6 ± 8.5 years (male 82.1 %). Number of target lesions/patient was 1.54 ± 0.99, and 89.3 % of patients had single-vessel disease; most lesions were type C (58.1 %). Number of BRS/lesion was 1.02 ± 0.15, with a mean maximum scaffold diameter/lesion of 3.39 ± 0.41 mm and a mean scaffold length/lesion of 24.8 ± 8.17 mm. Plaque debulking was necessary in 32.6 % of lesions and IVUS was employed in 74.4 % of lesions. Acute technical success was achieved in 97.7 % of cases. Clinical follow-up was available in 96.4 % of cases. At a median of 18 months (range: 9–31 months) no patient experienced major adverse cardiovascular events (MACE); notably, no scaffold thrombosis was reported. Angiographic follow-up was performed in 50 % of patients at a median of 17 months (range: 6–35), with no documented cases of target lesion failure.
Conclusion
Fantom Encore BRS shows good potential in delivering safe and effective PCI outcomes in patients with stable coronary artery disease, including those with complex coronary lesions.
背景：第三代Fantom Encore生物可吸收支架（BRS）由Tyrocore聚合物制成，具有充分的不透光性，支撑厚度为95-115 μm，具有高膨胀能力。目前，缺乏关于该设备的真实数据。方法和结果：我们进行了一项回顾性的单中心研究，涉及28例选择性患者，他们接受了经皮冠状动脉介入治疗（PCI），治疗43例新发冠状动脉病变，植入了Fantom Encore BRS。平均年龄66.6±8.5岁，男性82.1%。靶病变数（1.54±0.99）/例，89.3%为单血管病变；多数病变为C型（58.1%）。BRS/病变数为1.02±0.15，支架直径/病变平均最大为3.39±0.41 mm，支架长度/病变平均为24.8±8.17 mm。32.6%的病变需要清除斑块，74.4%的病变采用静脉注射。97.7%的病例获得了急性技术成功。96.4%的病例有临床随访。中位时间为18个月（范围：9-31个月），无患者发生重大心血管不良事件（MACE）；值得注意的是，没有支架血栓的报道。50%的患者进行了血管造影随访，随访时间中位数为17个月（范围：6-35个月），没有记录目标病变失败的病例。结论：Fantom Encore BRS在稳定冠状动脉疾病患者（包括复杂冠状动脉病变患者）提供安全有效的PCI治疗结果方面具有良好的潜力。
{"title":"Clinical safety and performance of the third-generation Fantom Encore sirolimus-eluting bioresorbable scaffold: Insights from a single-center study","authors":"Francesco Amata , Massimo Ferraro , Antonio Mangieri , Damiano Regazzoli , Giuseppe Ferrante , Ottavia Cozzi , Giulio Stefanini , Bernhard Reimers , Antonio Colombo","doi":"10.1016/j.carrev.2025.02.001","DOIUrl":"10.1016/j.carrev.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>The third-generation Fantom Encore bioresorbable scaffold (BRS), made with Tyrocore polymer, features full radiopacity, 95–115 μm strut thickness, and high expansion capacity. Currently, there is a lack of real-world data on this device.</div></div><div><h3>Methods and results</h3><div>We conducted a retrospective, single-center study involving 28 elective patients undergoing percutaneous coronary intervention (PCI) for 43 de novo coronary lesions with implantation of the Fantom Encore BRS. Mean age was 66.6 ± 8.5 years (male 82.1 %). Number of target lesions/patient was 1.54 ± 0.99, and 89.3 % of patients had single-vessel disease; most lesions were type C (58.1 %). Number of BRS/lesion was 1.02 ± 0.15, with a mean maximum scaffold diameter/lesion of 3.39 ± 0.41 mm and a mean scaffold length/lesion of 24.8 ± 8.17 mm. Plaque debulking was necessary in 32.6 % of lesions and IVUS was employed in 74.4 % of lesions. Acute technical success was achieved in 97.7 % of cases. Clinical follow-up was available in 96.4 % of cases. At a median of 18 months (range: 9–31 months) no patient experienced major adverse cardiovascular events (MACE); notably, no scaffold thrombosis was reported. Angiographic follow-up was performed in 50 % of patients at a median of 17 months (range: 6–35), with no documented cases of target lesion failure.</div></div><div><h3>Conclusion</h3><div>Fantom Encore BRS shows good potential in delivering safe and effective PCI outcomes in patients with stable coronary artery disease, including those with complex coronary lesions.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 11-14"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400419","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}
To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction.
Background
There is a paucity of data regarding the best timing for heparin administration in STEMI.
Methods
We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.
Results
11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56–0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48–0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2–3) at first coronary angiography (OR = 1.54; 95 % CI 1.37–1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74–1.24).
Conclusion
A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.
目的：比较肝素预处理与术中给药对st段抬高型心肌梗死患者预后的影响。背景：STEMI患者肝素给药的最佳时机缺乏相关数据。方法：系统检索1980 - 2024年间肝素预处理与术中给药治疗STEMI的疗效和安全性比较研究文献。采用随机效应meta分析比较两组临床结果。结果：纳入11项观察性研究和4项临床试验，共纳入72249例患者。患者要么在诊断时接受UFH，要么在pPCI期间接受UFH。预处理方法显示30天死亡率显著降低(OR = 0.68；95% CI 0.56-0.84)以及更长时间的随访(平均随访时间14.4个月；or = 0.67；95% ci 0.48-0.94)。此外，UFH预处理增加了首次冠状动脉造影时梗死相关动脉通畅率（IRA）（定义为TIMI 2-3） (OR = 1.54；95% CI 1.37-1.74)，未显示大出血增加（OR 0.96, 95% CI 0.74-1.24）。结论：STEMI诊断时的肝素预处理策略与梗死相关动脉通畅度增加和死亡风险降低相关，且无出血并发症的安全性问题。
{"title":"Heparin pretreatment in patients with ST-segment elevation myocardial infarction: A meta-analysis","authors":"Luca Franchin , Federico Angriman , Andrea Pezzato , Luca Siega Vignut , Enrico Fabris , Gianfranco Sinagra , Arnoud W.J. van 't Hof , Massimo Imazio","doi":"10.1016/j.carrev.2025.08.004","DOIUrl":"10.1016/j.carrev.2025.08.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction.</div></div><div><h3>Background</h3><div>There is a paucity of data regarding the best timing for heparin administration in STEMI.</div></div><div><h3>Methods</h3><div>We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.</div></div><div><h3>Results</h3><div>11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56–0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48–0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2–3) at first coronary angiography (OR = 1.54; 95 % CI 1.37–1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74–1.24).</div></div><div><h3>Conclusion</h3><div>A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 136-144"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862539","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.09.014
Deven R. Rajagopal , James P. Stewart , Vinod H. Thourani , Pradeep K. Yadav
{"title":"Transcatheter tricuspid valve replacement and valve-in-valve in patient with unusually calcified tricuspid valve","authors":"Deven R. Rajagopal , James P. Stewart , Vinod H. Thourani , Pradeep K. Yadav","doi":"10.1016/j.carrev.2025.09.014","DOIUrl":"10.1016/j.carrev.2025.09.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 120-123"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259622","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.11.009
Francesco Giangiacomi , Bert Popelier , Stijn Lochy , Koenraad Nieboer , Marnix Von Kemp , Dries Belsack , Kaoru Tanaka , Bernard Cosyns , Jean-François Argacha , Johan De Mey
Background
ECG-less coronary computed tomography angiography (CCTA) is a novel and promising tool for the diagnosis of coronary artery disease (CAD). Compared to conventional ECG-gated CCTA, it is less dependent on heart rate control and gives the possibility of ruling out both pulmonary embolism and CAD using a single contrast injection. Recently, it has shown good sensitivity in detecting obstructive CAD. Given the limitations of current emergency room algorithms—primarily based on clinical presentation, ECG, and biomarkers—the triage of patients with acute chest pain or cardiac arrest may benefit from this emerging imaging modality.
Methods
We designed two prospective, single-center, double-blinded clinical studies to investigate the role of ECG-less CCTA in acute scenarios. The ECLECTIC study (ECG-LEss coronary Computed Tomography angiography in the management of patients presenting with hIgh-troponin and Chest pain, NCT07192965) will evaluate diagnostic accuracy and prognostic value in patients presenting with acute chest pain, mildly elevated troponin levels, and a high clinical suspicion of CAD. The OPEN-CCT Arrest (Optimizing Post-arrest Evaluation with Non-gated Cardiac CT) will assess the feasibility and diagnostic utility of this technique in cardiac arrest survivors. In both studies, patients will undergo ECG-less CCTA followed by ICA, considered the gold standard.
Clinical implications
ECG-less CCTA pushes the boundaries of using CCTA in acute clinical scenarios. This technique may reduce preparation time and improve workflow, especially in highly instrumented patients. If its diagnostic accuracy and prognostic value are proven, ECG-less CCTA could significantly decrease the need for unnecessary invasive procedures, the length of hospital stay, and the overall healthcare costs.
{"title":"OPENing a new ECLECTIC approach to NSTEMI and cardiac arrest using ECG-less coronary computed tomography angiography. Study design and rationale of two prospective clinical studies","authors":"Francesco Giangiacomi , Bert Popelier , Stijn Lochy , Koenraad Nieboer , Marnix Von Kemp , Dries Belsack , Kaoru Tanaka , Bernard Cosyns , Jean-François Argacha , Johan De Mey","doi":"10.1016/j.carrev.2025.11.009","DOIUrl":"10.1016/j.carrev.2025.11.009","url":null,"abstract":"<div><h3>Background</h3><div>ECG-less coronary computed tomography angiography (CCTA) is a novel and promising tool for the diagnosis of coronary artery disease (CAD). Compared to conventional ECG-gated CCTA, it is less dependent on heart rate control and gives the possibility of ruling out both pulmonary embolism and CAD using a single contrast injection. Recently, it has shown good sensitivity in detecting obstructive CAD. Given the limitations of current emergency room algorithms—primarily based on clinical presentation, ECG, and biomarkers—the triage of patients with acute chest pain or cardiac arrest may benefit from this emerging imaging modality.</div></div><div><h3>Methods</h3><div>We designed two prospective, single-center, double-blinded clinical studies to investigate the role of ECG-less CCTA in acute scenarios. The ECLECTIC study (<em>ECG-LEss coronary Computed Tomography angiography in the management of patients presenting with hIgh-troponin and Chest pain</em>, NCT07192965) will evaluate diagnostic accuracy and prognostic value in patients presenting with acute chest pain, mildly elevated troponin levels, and a high clinical suspicion of CAD. The OPEN-CCT Arrest (<em>Optimizing Post-arrest Evaluation with Non-gated Cardiac CT</em>) will assess the feasibility and diagnostic utility of this technique in cardiac arrest survivors. In both studies, patients will undergo ECG-less CCTA followed by ICA, considered the gold standard.</div></div><div><h3>Clinical implications</h3><div>ECG-less CCTA pushes the boundaries of using CCTA in acute clinical scenarios. This technique may reduce preparation time and improve workflow, especially in highly instrumented patients. If its diagnostic accuracy and prognostic value are proven, ECG-less CCTA could significantly decrease the need for unnecessary invasive procedures, the length of hospital stay, and the overall healthcare costs.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 36-41"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641189","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}
Pub Date : 2026-01-01DOI: 10.1016/j.carrev.2025.06.017
Mohammad Zghouzi , Ahmad Jabri , Sant Kumar , Anand Maligireddy , Roshan Bista , Timir K. Paul , Mohamed Farhan Nasser , Hady Lichaa , Herbert D. Aronow , Saraschandra Vallabhajosyula , Bryan Kelly , Gillian Grafton , Rana Awdish , Mir Babar Basir , Khaldoon Alaswad , Mohammad Alqarqaz , Gerald Koenig , Vikas Aggarwal
Background
Frailty increases vulnerability to morbidity and mortality among elderly individuals, particularly those with acute pulmonary embolism (PE). Elderly patients, especially frail ones, remain underrepresented in studies evaluating advanced PE therapies, creating uncertainty regarding therapy utilization and outcomes.
Methods
Using the National Readmission Database (NRD), elderly patients (>75 years) admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were stratified based on the Hospital Frailty Risk Score (HFRS >5 defined frailty) and clinical presentation (high-risk vs. non-high-risk features). Advanced therapies analyzed included systemic thrombolysis (ST), catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE), and surgical embolectomy (SE). Logistic regression adjusted for demographics and comorbidities compared in-hospital outcomes between frail and non-frail patients.
Results
A total of 233,091 patients were included; 53.0 % without and 79.9 % with high-risk features were frail. Advanced therapy utilization did not differ significantly between frail and non-frail patients within high-risk PE. Frail patients experienced higher in-hospital mortality in both non-high-risk (7.2 % vs. 1.8 %, adjusted OR [aOR]: 2.3, 95 % confidence interval [CI]: 2.2–2.6, p < 0.001) and high-risk groups (36.2 % vs. 30.2 %, aOR: 1.2, 95 % CI: 1.0–1.3, p = 0.02). Frailty was associated with increased intracranial hemorrhage (aOR: 3.9, 95 % CI: 3.3–4.7, p < 0.001), gastrointestinal bleeding (aOR: 2.1, 95 % CI: 1.9–2.3, p < 0.001), and hematuria (aOR: 10.8, 95 % CI: 9.4–12.4, p < 0.001). Frail patients had higher 30-day readmissions compared to non-frail patients (aOR: 1.2, 95 % CI: 1.1–1.2, p < 0.001), longer lengths of stay (6.1 vs. 3.6 days, p < 0.001), and higher total charges ($61,100 vs. $36,370, p < 0.001).
Conclusion
Frailty significantly increases mortality and adverse events in elderly patients hospitalized with acute PE, particularly in non-high-risk individuals. These findings highlight the necessity of frailty assessment to optimize management decisions and guide therapeutic strategies in this vulnerable population.
{"title":"Association between frailty, use of advanced therapies, in-hospital outcomes, and 30-day readmission in elderly patients admitted with acute pulmonary embolism","authors":"Mohammad Zghouzi , Ahmad Jabri , Sant Kumar , Anand Maligireddy , Roshan Bista , Timir K. Paul , Mohamed Farhan Nasser , Hady Lichaa , Herbert D. Aronow , Saraschandra Vallabhajosyula , Bryan Kelly , Gillian Grafton , Rana Awdish , Mir Babar Basir , Khaldoon Alaswad , Mohammad Alqarqaz , Gerald Koenig , Vikas Aggarwal","doi":"10.1016/j.carrev.2025.06.017","DOIUrl":"10.1016/j.carrev.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div><span>Frailty<span> increases vulnerability to morbidity and mortality among elderly individuals, particularly those with acute pulmonary embolism (PE). Elderly patients, especially frail ones, remain underrepresented in studies evaluating advanced </span></span>PE therapies, creating uncertainty regarding therapy utilization and outcomes.</div></div><div><h3>Methods</h3><div>Using the National Readmission Database (NRD), elderly patients (>75 years) admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were stratified based on the Hospital Frailty Risk Score (HFRS >5 defined frailty) and clinical presentation (high-risk vs. non-high-risk features). Advanced therapies analyzed included systemic thrombolysis<span><span> (ST), catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE), and surgical embolectomy (SE). </span>Logistic regression adjusted for demographics and comorbidities compared in-hospital outcomes between frail and non-frail patients.</span></div></div><div><h3>Results</h3><div>A total of 233,091 patients were included; 53.0 % without and 79.9 % with high-risk features were frail. Advanced therapy utilization did not differ significantly between frail and non-frail patients within high-risk PE. Frail patients experienced higher in-hospital mortality in both non-high-risk (7.2 % vs. 1.8 %, adjusted OR [aOR]: 2.3, 95 % confidence interval [CI]: 2.2–2.6, <em>p</em> < 0.001) and high-risk groups (36.2 % vs. 30.2 %, aOR: 1.2, 95 % CI: 1.0–1.3, <em>p</em><span> = 0.02). Frailty was associated with increased intracranial hemorrhage (aOR: 3.9, 95 % CI: 3.3–4.7, </span><em>p</em><span> < 0.001), gastrointestinal bleeding (aOR: 2.1, 95 % CI: 1.9–2.3, </span><em>p</em><span> < 0.001), and hematuria (aOR: 10.8, 95 % CI: 9.4–12.4, </span><em>p</em> < 0.001). Frail patients had higher 30-day readmissions compared to non-frail patients (aOR: 1.2, 95 % CI: 1.1–1.2, <em>p</em> < 0.001), longer lengths of stay (6.1 vs. 3.6 days, p < 0.001), and higher total charges ($61,100 vs. $36,370, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Frailty significantly increases mortality and adverse events in elderly patients hospitalized with acute PE, particularly in non-high-risk individuals. These findings highlight the necessity of frailty assessment to optimize management decisions and guide therapeutic strategies in this vulnerable population.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 62-69"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545485","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}
Clinically significant tricuspid regurgitation (TR) affects nearly one-third of patients with mitral valve (MV) disease and portends higher morbidity and mortality. Concomitant tricuspid valve repair (TVr) is recommended during MV surgery (MVS) for patients with severe TR or moderate TR with tricuspid annular dilation or right-sided heart failure. This study assessed the frequency, trends, and outcomes of concomitant tricuspid valve surgery (TVS) in MVS patients in the United States.
Methods
We analyzed index hospitalizations of patients undergoing MVS from the 2016–2020 Nationwide Readmissions Database (NRD), stratified by whether concomitant TVS was performed. Outcomes included inpatient mortality, length of stay (LOS), post-operative complications, and 30-day and 90-day all-cause readmissions. Inverse probability of treatment weighting (IPTW) controlled for selection bias. Outcomes were assessed using logistic regression and lognormal models.
Results
Out of 63,047 weighted hospitalizations for MVS, 2627 (4.17 %) underwent concomitant TVS. TVS was associated with 67 % higher adjusted odds of in-hospital mortality (8.29 % vs. 5.14 %, aOR 1.67; 95 % CI: 1.33–2.10; p < 0.001) and 61 % higher odds of complications (40.94 % vs. 30.08 %, aOR 1.61; 95 % CI: 1.42–1.83; p < 0.001) compared to MVS alone. TVS was associated with 18 % longer hospital stay (12.17 days vs. 10.27 days, aOR 1.18; 95 % CI: 1.13–1.24) and higher odds of 90-day readmission (30.26 % vs. 25.58 %, aOR:1.26;95 % CI: 1.06–1.50).
Conclusions
Concomitant tricuspid valve surgery in patients undergoing mitral valve surgery is associated with higher in-hospital mortality, complications, and readmissions. This early excess risk has to be weighed against potential long-term benefits.
{"title":"Trends and outcomes of concomitant tricuspid valve surgery with mitral valve surgery: A National Readmission Database study","authors":"Anirudh Palicherla , Athillesh Sivapatham , Monty Khela , Danielle B. Dilsaver , Sriharsha Dadana , Abhishek Thandra , Venkata Mahesh Alla","doi":"10.1016/j.carrev.2025.03.011","DOIUrl":"10.1016/j.carrev.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div><span>Clinically significant tricuspid regurgitation (TR) affects nearly one-third of patients with mitral valve (MV) disease and portends higher morbidity and mortality. Concomitant </span>tricuspid valve repair<span><span> (TVr) is recommended during MV surgery (MVS) for patients with severe TR or moderate TR with tricuspid annular dilation or right-sided heart failure. This study assessed the frequency, trends, and outcomes of concomitant </span>tricuspid valve surgery (TVS) in MVS patients in the United States.</span></div></div><div><h3>Methods</h3><div>We analyzed index hospitalizations of patients undergoing MVS from the 2016–2020 Nationwide Readmissions Database (NRD), stratified by whether concomitant TVS was performed. Outcomes included inpatient mortality, length of stay (LOS), post-operative complications, and 30-day and 90-day all-cause readmissions. Inverse probability of treatment weighting (IPTW) controlled for selection bias. Outcomes were assessed using logistic regression and lognormal models.</div></div><div><h3>Results</h3><div>Out of 63,047 weighted hospitalizations for MVS, 2627 (4.17 %) underwent concomitant TVS. TVS was associated with 67 % higher adjusted odds of in-hospital mortality (8.29 % vs. 5.14 %, aOR 1.67; 95 % CI: 1.33–2.10; <em>p</em> < 0.001) and 61 % higher odds of complications (40.94 % vs. 30.08 %, aOR 1.61; 95 % CI: 1.42–1.83; p < 0.001) compared to MVS alone. TVS was associated with 18 % longer hospital stay (12.17 days vs. 10.27 days, aOR 1.18; 95 % CI: 1.13–1.24) and higher odds of 90-day readmission (30.26 % vs. 25.58 %, aOR:1.26;95 % CI: 1.06–1.50).</div></div><div><h3>Conclusions</h3><div>Concomitant tricuspid valve surgery in patients undergoing mitral valve surgery is associated with higher in-hospital mortality, complications, and readmissions. This early excess risk has to be weighed against potential long-term benefits.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"82 ","pages":"Pages 72-77"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711583","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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