首页 > 最新文献

Cardiovascular Revascularization Medicine最新文献

英文 中文
Diagnostic performance of angiography-derived fractional flow reserve compared to pressure wire-derived fractional flow reserve: Rationale and design of MPFFR pivotal trial. 血管造影得出的分数血流储备与压力导线得出的分数血流储备的诊断性能比较:MPFFR 关键性试验的原理和设计。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.015
Hyun-Wook Chu, Chang-Hwan Yoon, Donghoon Han, Won-Woo Seo, Sang-Don Park, Joon Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Bon-Kwon Koo, In-Ho Chae, Tae-Jin Youn

Background: Cardiovascular disease remains the leading cause of death and the use of percutaneous coronary intervention (PCI) is steadily increasing. Current guidelines advocate the use of the fractional flow reserve (FFR) to assess coronary stenosis and treatment strategies; however, invasive FFR has some limitations. Angiography-derived FFR is a potential alternative for calculating FFR from two-dimensional (2D) angiographic images, thereby reducing invasiveness and complications. A novel artificial intelligence (AI)-based angiography-derived FFR, named "MPFFR," offers automated operator-independent hemodynamic calculations; this phase 3 trial aims to validate its diagnostic performance against 2D-quantitative coronary angiography (QCA).

Methods and analysis: This pivotal MPFFR trial is a prospective, multicenter, single-blind study. This trial involves patients with coronary artery disease (CAD) from eight cardiovascular centers. Invasive FFR will be performed according to standard guidelines and defined as the reference standard. Angiography-derived FFR will be computed using a proprietary method and 2D-QCA will be performed using validated software. The primary endpoint is the area under the curve for identifying physiologically significant coronary stenosis (FFR ≤0.80), with secondary endpoints including diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and correlations between angiography-derived and invasive FFR. This study is designed to demonstrate the superiority of angiography-derived FFR over 2D-QCA and is powered to achieve this with a sample size of 240 patients. Medipixel Inc. supports the trial and is not involved in the data analysis or management.

背景:心血管疾病仍然是导致死亡的主要原因,而经皮冠状动脉介入治疗(PCI)的使用正在稳步增加。目前的指南提倡使用分数血流储备(FFR)来评估冠状动脉狭窄情况和治疗策略;然而,有创 FFR 有一些局限性。血管造影衍生 FFR 是一种从二维(2D)血管造影图像计算 FFR 的潜在替代方法,从而减少了侵入性和并发症。基于人工智能(AI)的新型血管造影衍生 FFR 被命名为 "MPFFR",可提供独立于操作者的自动血流动力学计算;该三期试验旨在验证其与二维定量冠状动脉造影(QCA)相比的诊断性能:这项关键的 MPFFR 试验是一项前瞻性、多中心、单盲研究。这项试验涉及八个心血管中心的冠状动脉疾病(CAD)患者。有创 FFR 将根据标准指南进行,并被定义为参考标准。血管造影得出的 FFR 将使用专有方法计算,2D-QCA 将使用经过验证的软件执行。主要终点是识别有生理意义的冠状动脉狭窄(FFR ≤0.80)的曲线下面积,次要终点包括诊断准确性、敏感性、特异性、阳性预测值、阴性预测值以及血管造影衍生和有创 FFR 之间的相关性。该研究旨在证明血管造影得出的 FFR 优于二维-QCA,其样本量为 240 例患者。Medipixel 公司为该试验提供支持,但不参与数据分析或管理。
{"title":"Diagnostic performance of angiography-derived fractional flow reserve compared to pressure wire-derived fractional flow reserve: Rationale and design of MPFFR pivotal trial.","authors":"Hyun-Wook Chu, Chang-Hwan Yoon, Donghoon Han, Won-Woo Seo, Sang-Don Park, Joon Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Bon-Kwon Koo, In-Ho Chae, Tae-Jin Youn","doi":"10.1016/j.carrev.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.015","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease remains the leading cause of death and the use of percutaneous coronary intervention (PCI) is steadily increasing. Current guidelines advocate the use of the fractional flow reserve (FFR) to assess coronary stenosis and treatment strategies; however, invasive FFR has some limitations. Angiography-derived FFR is a potential alternative for calculating FFR from two-dimensional (2D) angiographic images, thereby reducing invasiveness and complications. A novel artificial intelligence (AI)-based angiography-derived FFR, named \"MPFFR,\" offers automated operator-independent hemodynamic calculations; this phase 3 trial aims to validate its diagnostic performance against 2D-quantitative coronary angiography (QCA).</p><p><strong>Methods and analysis: </strong>This pivotal MPFFR trial is a prospective, multicenter, single-blind study. This trial involves patients with coronary artery disease (CAD) from eight cardiovascular centers. Invasive FFR will be performed according to standard guidelines and defined as the reference standard. Angiography-derived FFR will be computed using a proprietary method and 2D-QCA will be performed using validated software. The primary endpoint is the area under the curve for identifying physiologically significant coronary stenosis (FFR ≤0.80), with secondary endpoints including diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and correlations between angiography-derived and invasive FFR. This study is designed to demonstrate the superiority of angiography-derived FFR over 2D-QCA and is powered to achieve this with a sample size of 240 patients. Medipixel Inc. supports the trial and is not involved in the data analysis or management.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366958","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
Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation. 经导管主动脉瓣植入术中性别差异和手术环境对临床的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.014
Lis Victória Ravani, Henrique Barbosa Ribeiro, Pedro Calomeni, Fábio Sandoli de Brito, Fernando Bernardi, Pedro Lemos, Fausto Feres, Dimytri Alexandre Siqueira, Ricardo Costa, Rogério Sarmento-Leite, Fernanda Mangione, José Armando Mangione, Luiz Eduardo Koenig São Thiago, Valter Correia de Lima, Adriano Dias Dourado Oliveira, Marcos Antônio Marino, Carlos José Francisco Cardoso, Paulo Ricardo Avancini Caramori, Rogério Tadeu Tumelero, Antenor Lages Fortes Portela, Maurício Lopes Prudente, Leônidas Alvarenga Henriques, Fabio Solano de Freitas Souza, Cristiano Guedes Bezerra, Guy Fernandes de Almeida Prado Junior, Leandro Zacarias Figueiredo de Freitas, Ederlon Ferreira Nogueira, George César Ximenes Meirelle, Renato Bastos Pope, Ênio Eduardo Guérios, Pedro Beraldo de Andrade, Luciano de Moura Santos, Mauricio Felippi de Sá Marchi, Vinicius Borges Cardozo Esteves, Alexandre Abizaid

Background: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain.

Methods: The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated.

Results: We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78-87] vs. 81 [75-85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality.

Conclusions: Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.

背景:经导管主动脉瓣植入术(TAVI)是治疗有症状的主动脉瓣狭窄患者的一种行之有效的方法。然而,性别差异和公共与私人手术环境对 TAVI 结果的影响仍不确定:RIBAC-NT(巴西经导管主动脉瓣置换术结果评估登记)数据集包括2009年至2021年的3194名TAVI患者。这项回顾性分析探讨了基线特征、手术和住院结果的差异,并按性别和手术环境对患者进行了分层。同时还研究了时间趋势:我们纳入了 1551 例(49%)女性患者和 1643 例(51%)男性患者。女性年龄更大(83 [78-87] 岁 vs. 81 [75-85]岁;P 结论:女性的手术和住院率更高:与男性相比,女性在 TAVI 术后的手术死亡率和院内死亡率较高,同时危及生命的出血率和不良事件发生率也较高。虽然公立医院的死亡率高于私立医院,但手术环境与院内死亡率并无独立关联。
{"title":"Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation.","authors":"Lis Victória Ravani, Henrique Barbosa Ribeiro, Pedro Calomeni, Fábio Sandoli de Brito, Fernando Bernardi, Pedro Lemos, Fausto Feres, Dimytri Alexandre Siqueira, Ricardo Costa, Rogério Sarmento-Leite, Fernanda Mangione, José Armando Mangione, Luiz Eduardo Koenig São Thiago, Valter Correia de Lima, Adriano Dias Dourado Oliveira, Marcos Antônio Marino, Carlos José Francisco Cardoso, Paulo Ricardo Avancini Caramori, Rogério Tadeu Tumelero, Antenor Lages Fortes Portela, Maurício Lopes Prudente, Leônidas Alvarenga Henriques, Fabio Solano de Freitas Souza, Cristiano Guedes Bezerra, Guy Fernandes de Almeida Prado Junior, Leandro Zacarias Figueiredo de Freitas, Ederlon Ferreira Nogueira, George César Ximenes Meirelle, Renato Bastos Pope, Ênio Eduardo Guérios, Pedro Beraldo de Andrade, Luciano de Moura Santos, Mauricio Felippi de Sá Marchi, Vinicius Borges Cardozo Esteves, Alexandre Abizaid","doi":"10.1016/j.carrev.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.014","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain.</p><p><strong>Methods: </strong>The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated.</p><p><strong>Results: </strong>We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78-87] vs. 81 [75-85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality.</p><p><strong>Conclusions: </strong>Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373248","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
ANOCA updated: From pathophysiology to modern clinical practice. ANOCA 已更新:从病理生理学到现代临床实践。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.carrev.2024.09.010
Kyriakos Dimitriadis, Nikolaos Pyrpyris, Athanasios Sakalidis, Eirini Dri, Panagiotis Iliakis, Panagiotis Tsioufis, Fotis Tatakis, Eirini Beneki, Christos Fragkoulis, Konstantinos Aznaouridis, Konstantinos Tsioufis

Lately, a large number of stable ischemic patients, with no obstructed coronary arteries are being diagnosed. Despite this condition, which is being described as angina with no obstructive coronary arteries (ANOCA), was thought to be benign, recent evidence report that it is associated with increased risk for adverse cardiovascular outcomes. ANOCA is more frequent in women and, pathophysiologically, it is predominantly related with microvascular dysfunction, while other factors, such as endothelial dysfunction, inflammation and autonomic nervous system seem to also play a major role to its development, while other studies implicate ANOCA and microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction. For establishing an ANOCA diagnosis, measurement including coronary flow reserve (CFR), microvascular resistance (IMR) and hyperemic microvascular resistance (HMR) are mostly used in clinical practice. In addition, new modalities, such as optical coherence tomography (OCT) are being tested and show promising results for future diagnostic use. Regarding management, pharmacotherapy consists of a wide selection of drugs, according to the respected pathophysiology of the disease (vasospastic angina or microvascular dysfunction), while research for new treatment options including interventional techniques, is currently ongoing. This review, therefore, aims to provide a comprehensive analysis of all aspects related to ANOCA, from pathophysiology to clinical managements, as well as clinical implications and suggestions for future research efforts, which will help advance our understanding of the syndrome and establish more, evidence-based, therapies.

最近,大量冠状动脉无阻塞的稳定型缺血性患者被确诊。尽管这种被称为无冠状动脉阻塞性心绞痛(ANOCA)的病症被认为是良性的,但最近有证据表明,它与不良心血管后果风险的增加有关。无冠状动脉阻塞性心绞痛在女性中更为常见,从病理生理学角度看,它主要与微血管功能障碍有关,而其他因素,如内皮功能障碍、炎症和自主神经系统似乎也对其发展起着重要作用,而其他研究则认为无冠状动脉阻塞性心绞痛和微血管功能障碍与射血分数保留型心力衰竭的发病机制有关。在临床实践中,为确定 ANOCA 的诊断,大多采用包括冠状动脉血流储备(CFR)、微血管阻力(IMR)和充盈微血管阻力(HMR)在内的测量方法。此外,光学相干断层扫描(OCT)等新模式正在接受测试,并显示出未来诊断使用的良好前景。在治疗方面,药物疗法包括根据疾病的病理生理学(血管痉挛性心绞痛或微血管功能障碍)选择多种药物,而包括介入技术在内的新治疗方案的研究目前正在进行中。因此,本综述旨在全面分析与 ANOCA 相关的各个方面,从病理生理学到临床管理,以及对未来研究工作的临床影响和建议,这将有助于增进我们对该综合征的了解,并建立更多循证疗法。
{"title":"ANOCA updated: From pathophysiology to modern clinical practice.","authors":"Kyriakos Dimitriadis, Nikolaos Pyrpyris, Athanasios Sakalidis, Eirini Dri, Panagiotis Iliakis, Panagiotis Tsioufis, Fotis Tatakis, Eirini Beneki, Christos Fragkoulis, Konstantinos Aznaouridis, Konstantinos Tsioufis","doi":"10.1016/j.carrev.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.010","url":null,"abstract":"<p><p>Lately, a large number of stable ischemic patients, with no obstructed coronary arteries are being diagnosed. Despite this condition, which is being described as angina with no obstructive coronary arteries (ANOCA), was thought to be benign, recent evidence report that it is associated with increased risk for adverse cardiovascular outcomes. ANOCA is more frequent in women and, pathophysiologically, it is predominantly related with microvascular dysfunction, while other factors, such as endothelial dysfunction, inflammation and autonomic nervous system seem to also play a major role to its development, while other studies implicate ANOCA and microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction. For establishing an ANOCA diagnosis, measurement including coronary flow reserve (CFR), microvascular resistance (IMR) and hyperemic microvascular resistance (HMR) are mostly used in clinical practice. In addition, new modalities, such as optical coherence tomography (OCT) are being tested and show promising results for future diagnostic use. Regarding management, pharmacotherapy consists of a wide selection of drugs, according to the respected pathophysiology of the disease (vasospastic angina or microvascular dysfunction), while research for new treatment options including interventional techniques, is currently ongoing. This review, therefore, aims to provide a comprehensive analysis of all aspects related to ANOCA, from pathophysiology to clinical managements, as well as clinical implications and suggestions for future research efforts, which will help advance our understanding of the syndrome and establish more, evidence-based, therapies.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336978","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
Characteristics and outcomes of myocardial infarction among patients with bleeding or hypercoagulable disorders: A nationwide analysis. 出血性或高凝血功能障碍患者心肌梗死的特征和预后:全国性分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.carrev.2024.09.011
Ramy Sedhom, Adeba Mohammad, Mohamed Khedr, Michael Megaly, Carly Waldman, Aditya S Bharadwaj, Ofer Kobo, Ahmed Sayed, Dmitry Abramov

Objective: To examine the characteristics and outcomes of acute myocardial infarction (AMI) in patients with bleeding and/or hypercoagulable disorders.

Background: Studies examining the outcomes of AMI in bleeding/hypercoagulable disorders are scarce.

Methods: The Nationwide Readmissions Database was utilized to identify hospitalizations with AMI from 2016 to 2020. The study cohort was divided into 4 groups: (1) MI without bleeding or hypercoagulable disorders, (2) MI with bleeding disorders, (3) MI with hypercoagulable disorders and (4) MI with mixed disorders. The main outcome was all-cause in-hospital mortality.

Results: A total of 4,206,005 weighted hospitalizations with AMI were identified during the study period, of which 382,118 (9.1 %) had underlying bleeding or hypercoagulable disorders. The utilization of invasive strategies for the management of MI was highest in patients without bleeding or hypercoagulable disorders (62.6 %) and lowest in patients with mixed disorders (39.3 %). In-hospital mortality was higher among patients with bleeding (adjusted odds ratio [OR] 1.22; 95 % confidence interval [CI] 1.21, 1.24) and mixed disorders (aOR 3.38; 95 % CI 3.27, 3.49) compared with patients without bleeding or hypercoagulable disorders. Among patients with any bleeding or hypercoagulable disorder, those who underwent invasive strategy had lower adjusted odds of in-hospital mortality (aOR 0.28; 95 % CI 0.27, 0.30), ischemic stroke (aOR 0.60; 95 % CI 0.56, 0.64), bleeding (aOR 0.63; 95 % CI 0.61, 0.65), blood transfusion (aOR 0.95; 95 % CI 0.91, 0.99) and 30-day urgent readmissions (aOR 0.70; 95 % CI 0.68, 0.72).

Conclusions: The inpatient management and outcomes of AMI in patients with bleeding/hypercoagulable disorders differ from patients without those disorders. Revascularization in the setting of AMI was associated with lower in-hospital mortality, which suggests that patients with bleeding/hypercoagulable disorders can be evaluated for standard approaches to managing AMI; however, confounding by indication may be a concern.

摘要研究出血和/或高凝状态患者急性心肌梗死(AMI)的特征和预后:研究出血/高凝状态下急性心肌梗死预后的研究很少:方法:利用全国再入院数据库来识别 2016 年至 2020 年的急性心肌梗死住院患者。研究队列分为 4 组:(1) 无出血或高凝障碍的急性心肌梗死;(2) 伴有出血障碍的急性心肌梗死;(3) 伴有高凝障碍的急性心肌梗死;(4) 伴有混合障碍的急性心肌梗死。主要结果是全因住院死亡率:研究期间共发现 4,206,005 例急性心肌梗死加权住院病例,其中 382,118 例(9.1%)有潜在的出血或高凝障碍。无出血或高凝状态的患者采用侵入性方法治疗心肌梗死的比例最高(62.6%),混合型患者的比例最低(39.3%)。与无出血或高凝状态的患者相比,有出血(调整后的几率比 [OR] 1.22;95% 置信区间 [CI] 1.21,1.24)和混合型疾病(aOR 3.38;95% CI 3.27,3.49)的患者的院内死亡率更高。在有任何出血或高凝障碍的患者中,接受侵入性策略的患者院内死亡率(aOR 0.28;95 % CI 0.27,0.30)、缺血性中风(aOR 0.60; 95 % CI 0.56, 0.64)、出血(aOR 0.63; 95 % CI 0.61, 0.65)、输血(aOR 0.95; 95 % CI 0.91, 0.99)和30天紧急再入院(aOR 0.70; 95 % CI 0.68, 0.72):有出血/高凝状态的急性心肌梗死患者与无出血/高凝状态的急性心肌梗死患者的住院管理和预后不同。在AMI的情况下进行血管重建与较低的院内死亡率相关,这表明出血/高凝状态患者可接受标准方法评估,以管理AMI;然而,适应症的混淆可能是一个问题。
{"title":"Characteristics and outcomes of myocardial infarction among patients with bleeding or hypercoagulable disorders: A nationwide analysis.","authors":"Ramy Sedhom, Adeba Mohammad, Mohamed Khedr, Michael Megaly, Carly Waldman, Aditya S Bharadwaj, Ofer Kobo, Ahmed Sayed, Dmitry Abramov","doi":"10.1016/j.carrev.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.011","url":null,"abstract":"<p><strong>Objective: </strong>To examine the characteristics and outcomes of acute myocardial infarction (AMI) in patients with bleeding and/or hypercoagulable disorders.</p><p><strong>Background: </strong>Studies examining the outcomes of AMI in bleeding/hypercoagulable disorders are scarce.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database was utilized to identify hospitalizations with AMI from 2016 to 2020. The study cohort was divided into 4 groups: (1) MI without bleeding or hypercoagulable disorders, (2) MI with bleeding disorders, (3) MI with hypercoagulable disorders and (4) MI with mixed disorders. The main outcome was all-cause in-hospital mortality.</p><p><strong>Results: </strong>A total of 4,206,005 weighted hospitalizations with AMI were identified during the study period, of which 382,118 (9.1 %) had underlying bleeding or hypercoagulable disorders. The utilization of invasive strategies for the management of MI was highest in patients without bleeding or hypercoagulable disorders (62.6 %) and lowest in patients with mixed disorders (39.3 %). In-hospital mortality was higher among patients with bleeding (adjusted odds ratio [OR] 1.22; 95 % confidence interval [CI] 1.21, 1.24) and mixed disorders (aOR 3.38; 95 % CI 3.27, 3.49) compared with patients without bleeding or hypercoagulable disorders. Among patients with any bleeding or hypercoagulable disorder, those who underwent invasive strategy had lower adjusted odds of in-hospital mortality (aOR 0.28; 95 % CI 0.27, 0.30), ischemic stroke (aOR 0.60; 95 % CI 0.56, 0.64), bleeding (aOR 0.63; 95 % CI 0.61, 0.65), blood transfusion (aOR 0.95; 95 % CI 0.91, 0.99) and 30-day urgent readmissions (aOR 0.70; 95 % CI 0.68, 0.72).</p><p><strong>Conclusions: </strong>The inpatient management and outcomes of AMI in patients with bleeding/hypercoagulable disorders differ from patients without those disorders. Revascularization in the setting of AMI was associated with lower in-hospital mortality, which suggests that patients with bleeding/hypercoagulable disorders can be evaluated for standard approaches to managing AMI; however, confounding by indication may be a concern.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336979","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
Acetylsalicylic acid alone or in combination with either enoxaparin or unfractionated heparin for postoperative thromboprophylaxis in coronary artery bypass surgery patients. A randomised clinical trial assessing surrogate outcomes. 乙酰水杨酸单独或与依诺肝素或非丝裂肝素联合用于冠状动脉搭桥术患者术后血栓预防。一项评估替代结果的随机临床试验。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.carrev.2024.09.008
Ulver Spangsberg Lorenzen, Henrik Arendrup, Pär Ingemar Johansson, Janus Christian Jakobsen

Introduction: Coronary artery bypass graft surgery has considerable effects on patient haemostasis. Heparins as thromboprophylaxis may be beneficial but may also increase the risk of bleeding complications.

Objectives: To assess the effects of heparins on haemostasis in post-coronary artery bypass graft patients.

Methods: Across one year, we randomised 60 participants scheduled for an elective coronary artery bypass graft-procedure with or without aortic valve replacement. The trial was a prospective, open-label (though blinded for the laboratory), randomised, single-centre trial with three intervention groups (n = 20 in each): group 1 received acetylsalicylic acid, group 2 received subcutaneous low molecular weight heparin and acetylsalicylic acid, and group 3 received intravenous unfractionated heparin and acetylsalicylic acid. Primary outcomes were platelet activation (Multiplate® ASPI-test) and time to clot initiation (TEG® R-time). We secondly assessed several additional Multiplate® and TEG® parameters.

Results: Group 3 (intravenous unfractionated heparin) compared with group 1 (acetylsalicylic acid alone) showed evidence of 1) increased clot initiation time (R-time + 0.9 min; 95 % CI: +0.4 to +1.4 min; P = 0.009), and 2) decreased 30-min lysis (-1.3 %; 95 % CI: -2.1 to -0.5 %; P = 0.02). The remaining analyses of primary and secondary outcomes showed no evidence of a difference between the three groups.

Discussion: Intravenous unfractionated heparins may increase the clot initiation time post-operatively after coronary artery bypass graft surgery and reduce lysis. Otherwise, there seems to be no effect of low molecular weight or unfractionated heparin on haemostatic parameters after coronary artery bypass surgery patients.

导言:冠状动脉旁路移植手术对患者的止血有相当大的影响。肝素作为血栓预防药物可能有益,但也可能增加出血并发症的风险:评估肝素对冠状动脉旁路移植术后患者止血的影响:在一年的时间里,我们随机抽取了 60 名计划接受主动脉瓣置换术或不接受主动脉瓣置换术的择期冠状动脉搭桥术患者。该试验是一项前瞻性、开放标签(但对实验室实行盲法)、随机、单中心试验,分为三个干预组(每组 20 人):第一组接受乙酰水杨酸治疗,第二组接受皮下注射低分子量肝素和乙酰水杨酸治疗,第三组接受静脉注射非分数肝素和乙酰水杨酸治疗。主要结果是血小板活化(Multiplate® ASPI-test)和凝血开始时间(TEG® R-time)。其次,我们还评估了其他几项 Multiplate® 和 TEG® 参数:结果:第 3 组(静脉注射非分叶肝素)与第 1 组(单用乙酰水杨酸)相比,有证据表明:1)凝块形成时间延长(R-时间 + 0.9 分钟;95 % CI:+0.4 至 +1.4 分钟;P = 0.009);2)30 分钟溶解度降低(-1.3%;95 % CI:-2.1 至 -0.5%;P = 0.02)。其余的主要和次要结果分析表明,没有证据表明三组之间存在差异:讨论:静脉注射非分叶肝素可能会增加冠状动脉旁路移植手术后血块的形成时间,并减少溶解。除此之外,低分子量肝素或非分数肝素似乎对冠状动脉搭桥手术后患者的止血参数没有影响。
{"title":"Acetylsalicylic acid alone or in combination with either enoxaparin or unfractionated heparin for postoperative thromboprophylaxis in coronary artery bypass surgery patients. A randomised clinical trial assessing surrogate outcomes.","authors":"Ulver Spangsberg Lorenzen, Henrik Arendrup, Pär Ingemar Johansson, Janus Christian Jakobsen","doi":"10.1016/j.carrev.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.008","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery bypass graft surgery has considerable effects on patient haemostasis. Heparins as thromboprophylaxis may be beneficial but may also increase the risk of bleeding complications.</p><p><strong>Objectives: </strong>To assess the effects of heparins on haemostasis in post-coronary artery bypass graft patients.</p><p><strong>Methods: </strong>Across one year, we randomised 60 participants scheduled for an elective coronary artery bypass graft-procedure with or without aortic valve replacement. The trial was a prospective, open-label (though blinded for the laboratory), randomised, single-centre trial with three intervention groups (n = 20 in each): group 1 received acetylsalicylic acid, group 2 received subcutaneous low molecular weight heparin and acetylsalicylic acid, and group 3 received intravenous unfractionated heparin and acetylsalicylic acid. Primary outcomes were platelet activation (Multiplate® ASPI-test) and time to clot initiation (TEG® R-time). We secondly assessed several additional Multiplate® and TEG® parameters.</p><p><strong>Results: </strong>Group 3 (intravenous unfractionated heparin) compared with group 1 (acetylsalicylic acid alone) showed evidence of 1) increased clot initiation time (R-time + 0.9 min; 95 % CI: +0.4 to +1.4 min; P = 0.009), and 2) decreased 30-min lysis (-1.3 %; 95 % CI: -2.1 to -0.5 %; P = 0.02). The remaining analyses of primary and secondary outcomes showed no evidence of a difference between the three groups.</p><p><strong>Discussion: </strong>Intravenous unfractionated heparins may increase the clot initiation time post-operatively after coronary artery bypass graft surgery and reduce lysis. Otherwise, there seems to be no effect of low molecular weight or unfractionated heparin on haemostatic parameters after coronary artery bypass surgery patients.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336977","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
Procedural characteristics of coronary angiography in patients with anomalous aortic origin of a coronary artery. 冠状动脉主动脉起源异常患者冠状动脉造影的程序特点。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.carrev.2024.09.007
Michael Yang, Grace C Bloomfield, Brian C Case, Lowell F Satler, Ron Waksman, Itsik Ben-Dor

Background: Anomalous coronary arteries (ACA) are seen in 1-5 % of patients undergoing coronary angiography, and their presence may increase procedural difficulty. We aimed to compare procedural outcomes of coronary angiography in ACA patients by anatomy and prior knowledge of the ACA.

Methods: This was a single-center review of ACA patients undergoing coronary angiography between October 2013 and February 2022. Primary endpoints were contrast volume, fluoroscopy dose, time, and dose-area product (DAP). Comparisons were made between groups based on ACA anatomy and based on prior knowledge of the ACA.

Results: We found 176 diagnostic coronary angiograms among ACA patients. Anomalies of the right coronary artery (RCA) comprised 77 %, followed by left circumflex (LCX) at 16 % and left main or left anterior descending (LMCA/LAD) at 7 %. There was significantly more contrast use among patients with RCA (mean 110.5 mL) or LMCA/LAD (115.6 mL) anomalies than LCX (76.2 mL; p = 0.01). There was no difference in fluoroscopy dose, time, or DAP. Prior knowledge of the anomaly was recorded in 61 (35 %) cases. Contrast volume (mean difference 27.1 mL, 95 % confidence interval: 12.5-41.8) and all fluoroscopy measures decreased if the ACA was previously known to the operators.

Conclusion: Different types of ACAs are associated with increased contrast use but not fluoroscopy exposure. Prior knowledge of ACA is associated with decreased contrast use and fluoroscopy exposure. Thorough review of prior catheterizations and knowledge of catheter selection is important for reducing contrast use and fluoroscopy exposure in patients with ACA.

背景:在接受冠状动脉造影术的患者中,1%-5%的患者存在异常冠状动脉(ACA),而异常冠状动脉的存在可能会增加手术难度。我们的目的是根据解剖结构和先前对 ACA 的了解,比较 ACA 患者冠状动脉造影术的疗效:这是一项对 2013 年 10 月至 2022 年 2 月期间接受冠状动脉造影术的 ACA 患者进行的单中心回顾性研究。主要终点是对比剂用量、透视剂量、时间和剂量-面积乘积(DAP)。根据冠状动脉解剖结构和事先对冠状动脉的了解情况进行组间比较:我们在 ACA 患者中发现了 176 例诊断性冠状动脉造影。右冠状动脉 (RCA) 异常占 77%,其次是左侧环状动脉 (LCX),占 16%,左主干或左前降支 (LMCA/LAD) 异常占 7%。RCA(平均 110.5 毫升)或 LMCA/LAD (115.6 毫升)异常患者使用的造影剂明显多于 LCX(76.2 毫升;P = 0.01)。透视剂量、时间或 DAP 均无差异。有 61 例(35%)患者事先知道异常。如果操作者之前就知道 ACA,则对比剂用量(平均差异为 27.1 毫升,95% 置信区间:12.5-41.8)和所有透视测量值都会减少:结论:不同类型的ACA与造影剂用量增加有关,但与透视暴露无关。结论:不同类型的 ACA 与造影剂用量增加有关,但与透视暴露无关;事先了解 ACA 与造影剂用量和透视暴露减少有关。彻底审查之前的导管检查并了解导管的选择对于减少ACA患者的造影剂使用和透视暴露非常重要。
{"title":"Procedural characteristics of coronary angiography in patients with anomalous aortic origin of a coronary artery.","authors":"Michael Yang, Grace C Bloomfield, Brian C Case, Lowell F Satler, Ron Waksman, Itsik Ben-Dor","doi":"10.1016/j.carrev.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.007","url":null,"abstract":"<p><strong>Background: </strong>Anomalous coronary arteries (ACA) are seen in 1-5 % of patients undergoing coronary angiography, and their presence may increase procedural difficulty. We aimed to compare procedural outcomes of coronary angiography in ACA patients by anatomy and prior knowledge of the ACA.</p><p><strong>Methods: </strong>This was a single-center review of ACA patients undergoing coronary angiography between October 2013 and February 2022. Primary endpoints were contrast volume, fluoroscopy dose, time, and dose-area product (DAP). Comparisons were made between groups based on ACA anatomy and based on prior knowledge of the ACA.</p><p><strong>Results: </strong>We found 176 diagnostic coronary angiograms among ACA patients. Anomalies of the right coronary artery (RCA) comprised 77 %, followed by left circumflex (LCX) at 16 % and left main or left anterior descending (LMCA/LAD) at 7 %. There was significantly more contrast use among patients with RCA (mean 110.5 mL) or LMCA/LAD (115.6 mL) anomalies than LCX (76.2 mL; p = 0.01). There was no difference in fluoroscopy dose, time, or DAP. Prior knowledge of the anomaly was recorded in 61 (35 %) cases. Contrast volume (mean difference 27.1 mL, 95 % confidence interval: 12.5-41.8) and all fluoroscopy measures decreased if the ACA was previously known to the operators.</p><p><strong>Conclusion: </strong>Different types of ACAs are associated with increased contrast use but not fluoroscopy exposure. Prior knowledge of ACA is associated with decreased contrast use and fluoroscopy exposure. Thorough review of prior catheterizations and knowledge of catheter selection is important for reducing contrast use and fluoroscopy exposure in patients with ACA.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336996","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
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
{"title":"Rota-Sesame technique for chronic total occlusion percutaneous coronary intervention.","authors":"Reza Masoomi, Lorenzo Azzalini, Kathleen E Kearney, William L Lombardi","doi":"10.1016/j.carrev.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336997","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
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。
{"title":"Hyperemic vs non-hyperemic indexes discordance: Role of epicardial and microvascular resistance (HyperDisco Study).","authors":"A Di Molfetta, V Cusimano, M Cesario, P Mollo, G Di Ruzza, M Menichelli","doi":"10.1016/j.carrev.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>(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.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336994","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
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。
{"title":"Abbreviated ticagrelor based dual antiplatelet therapy in acute coronary syndrome: A systematic review and meta-analysis.","authors":"Wissam Harmouch, Ravi Thakker, Mirza Umair Khalid, Wissam Khalife, Neal Kleiman, Umamahesh Rangasetty, Waleed Tallat Kayani, Hani Jneid, Bashar Al-Hemyari, Ayman Elbadawi","doi":"10.1016/j.carrev.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 I<sup>2</sup> test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis.</p><p><strong>Results: </strong>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, I<sup>2</sup> = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41-1.03, I<sup>2</sup> = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85-1.27, I<sup>2</sup> = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64-1.45, I<sup>2</sup> = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62-1.30, I<sup>2</sup> = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38-0.66, I<sup>2</sup> = 46 %).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336976","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
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。
{"title":"Mitigating health disparities by improving access to catheter-based therapies for vulnerable patients with acute pulmonary embolism.","authors":"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","doi":"10.1016/j.carrev.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.09.002","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366959","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
期刊
Cardiovascular Revascularization Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1