Pub Date : 2024-12-05DOI: 10.1016/j.carrev.2024.11.015
Felice Gragnano, Dominick J Angiolillo
{"title":"Navigating the complexity of bleeding and hypercoagulable disorders in patients with acute myocardial infarction.","authors":"Felice Gragnano, Dominick J Angiolillo","doi":"10.1016/j.carrev.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814652","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 : 2024-12-05DOI: 10.1016/j.carrev.2024.11.013
Maximillian T Bourdillon, Nils P Johnson, H V Skip Anderson
Invasive coronary physiology is well-established for identifying stable lesions appropriate for revascularization with percutaneous coronary intervention (PCI). Furthermore, fractional flow reserve (FFR)-guided PCI is associated with better clinical outcomes compared with routine angiography-guided PCI. The rise of intravascular imaging-guided PCI has generated great interest in optimizing the technical results of a PCI procedure, and this has now extended to an interest in optimizing coronary physiology following PCI. In this review, we examine the relationship between post-PCI physiology and clinical outcomes, including relief from angina, a relationship which is independent of the initial FFR value. In addition, we highlight the utility of pullback coronary pressure assessment for identifying mechanisms of suboptimal final FFR, such as patient characteristics (diffuse atherosclerosis), PCI technique, and certain artifacts in pressure-wire measurements. It is our view that the final FFR value can only be modestly improved, or optimized, with respect to clinical outcomes. The most significant clinical impact is obtained from the change in FFR (ΔFFR) from before to after PCI, which can be anticipated ahead of time by operators and used to guide lesion selection, or exclusion, for PCI.
{"title":"Post-PCI coronary physiology: clinical outcomes and can we optimize?","authors":"Maximillian T Bourdillon, Nils P Johnson, H V Skip Anderson","doi":"10.1016/j.carrev.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.013","url":null,"abstract":"<p><p>Invasive coronary physiology is well-established for identifying stable lesions appropriate for revascularization with percutaneous coronary intervention (PCI). Furthermore, fractional flow reserve (FFR)-guided PCI is associated with better clinical outcomes compared with routine angiography-guided PCI. The rise of intravascular imaging-guided PCI has generated great interest in optimizing the technical results of a PCI procedure, and this has now extended to an interest in optimizing coronary physiology following PCI. In this review, we examine the relationship between post-PCI physiology and clinical outcomes, including relief from angina, a relationship which is independent of the initial FFR value. In addition, we highlight the utility of pullback coronary pressure assessment for identifying mechanisms of suboptimal final FFR, such as patient characteristics (diffuse atherosclerosis), PCI technique, and certain artifacts in pressure-wire measurements. It is our view that the final FFR value can only be modestly improved, or optimized, with respect to clinical outcomes. The most significant clinical impact is obtained from the change in FFR (ΔFFR) from before to after PCI, which can be anticipated ahead of time by operators and used to guide lesion selection, or exclusion, for PCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819728","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.05.024
James E. Harvey , Rishi Puri , Kendra J. Grubb , Steven J. Yakubov , Paul D. Mahoney , Hemal Gada , Megan Coylewright , Marie-France Poulin , Stanley J. Chetcuti , Paul Sorajja , Joshua D. Rovin , Ruth Eisenberg , Michael J. Reardon
Background
Permanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry.
Methods
Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure.
Results
From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus.
Conclusion
From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.
{"title":"Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves in a large real-world registry","authors":"James E. Harvey , Rishi Puri , Kendra J. Grubb , Steven J. Yakubov , Paul D. Mahoney , Hemal Gada , Megan Coylewright , Marie-France Poulin , Stanley J. Chetcuti , Paul Sorajja , Joshua D. Rovin , Ruth Eisenberg , Michael J. Reardon","doi":"10.1016/j.carrev.2024.05.024","DOIUrl":"10.1016/j.carrev.2024.05.024","url":null,"abstract":"<div><h3>Background</h3><div><span>Permanent pacemaker implantation (PPI) rates following </span>transcatheter aortic valve replacement<span> (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry.</span></div></div><div><h3>Methods</h3><div>Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure.</div></div><div><h3>Results</h3><div>From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, <em>p</em> < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (<em>p</em><span> < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus.</span></div></div><div><h3>Conclusion</h3><div>From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 1-9"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130532","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.07.015
James A. Goldstein, Simon R. Dixon, Ivan D. Hanson
{"title":"Editorial: Coronary revascularization in advanced non-cardiac conditions: Surgery is neither necessary nor wise","authors":"James A. Goldstein, Simon R. Dixon, Ivan D. Hanson","doi":"10.1016/j.carrev.2024.07.015","DOIUrl":"10.1016/j.carrev.2024.07.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 68-69"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849294","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.06.010
Pouya Nezafati , Andrew Ajani , Diem Dinh , Angela Brennan , David Clark , Christopher M. Reid , Chin Hiew , Melanie Freeman , Dion Stub , Jaya Chandrasekhar , Anand Sharma , Ernesto Oqueli
Background
The American College of Cardiology / American Heart Association (ACC/AHA) introduced a coronary lesion classification in 1988 to stratify coronary lesions for probability of procedural success and complications after coronary angioplasty. Our aim is to assess the validity of the ACC/AHA lesion classification in predicting outcomes of percutaneous coronary intervention (PCI) in a contemporary cohort of patients.
Methods
Consecutive PCI procedures performed between 2005 and 2018, were divided into three periods. At each period, the ACC/AHA lesion classification (A, B1, B2, C) was analysed with respect to procedural characteristics, in-hospital and 30-day outcomes, as well as long-term mortality by linkage to the National Death Index (NDI).
Results
In total, 21,437 lesions were included with 7399 lesions (2005–2009), 6917 lesions (2010–2014) and 7121 lesions (2015–2018). There was a progressive increase in the number of complex lesions treated over time with ACC/AHA type C (15 %, 21 % and 26 %, p < 0.01). The rate of PCI procedural success decreased with increase in the complexity of lesions treated across all three periods (p < 0.01). Further, in-hospital and 30-day major adverse cardiovascular events (MACE), major adverse cardiac and cerebrovascular events (MACCE) increased across all three time periods (all p < 0.05).
Conclusions
Our study validates the ACC/AHA lesion classification as a meaningful tool for prediction of PCI outcomes. Despite advances in PCI techniques and technology, complex lesion PCI defined by this classification continues to be associated with adverse outcomes.
{"title":"Percutaneous coronary intervention outcomes based on American College of Cardiology/American Heart Association coronary lesion classification over 14 years – Melbourne interventional group (MIG) registry","authors":"Pouya Nezafati , Andrew Ajani , Diem Dinh , Angela Brennan , David Clark , Christopher M. Reid , Chin Hiew , Melanie Freeman , Dion Stub , Jaya Chandrasekhar , Anand Sharma , Ernesto Oqueli","doi":"10.1016/j.carrev.2024.06.010","DOIUrl":"10.1016/j.carrev.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>The American College of Cardiology / American Heart Association (ACC/AHA) introduced a coronary lesion classification in 1988 to stratify coronary lesions for probability of procedural success and complications after coronary angioplasty. Our aim is to assess the validity of the ACC/AHA lesion classification in predicting outcomes of percutaneous coronary intervention (PCI) in a contemporary cohort of patients.</div></div><div><h3>Methods</h3><div>Consecutive PCI procedures performed between 2005 and 2018, were divided into three periods. At each period, the ACC/AHA lesion classification (A, B1, B2, C) was analysed with respect to procedural characteristics, in-hospital and 30-day outcomes, as well as long-term mortality by linkage to the National Death Index (NDI).</div></div><div><h3>Results</h3><div>In total, 21,437 lesions were included with 7399 lesions (2005–2009), 6917 lesions (2010–2014) and 7121 lesions (2015–2018). There was a progressive increase in the number of complex lesions treated over time with ACC/AHA type C (15 %, 21 % and 26 %, <em>p</em> < 0.01). The rate of PCI procedural success decreased with increase in the complexity of lesions treated across all three periods (p < 0.01). Further, in-hospital and 30-day major adverse cardiovascular events (MACE), major adverse cardiac and cerebrovascular events (MACCE) increased across all three time periods (all <em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Our study validates the ACC/AHA lesion classification as a meaningful tool for prediction of PCI outcomes. Despite advances in PCI techniques and technology, complex lesion PCI defined by this classification continues to be associated with adverse outcomes.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 52-59"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321813","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.07.014
Nauman Khalid , Haris Muhammad , Aliza Ahmed , Sarah Aftab Ahmad
{"title":"Editorial: Shedding light on the “smoker's paradox”","authors":"Nauman Khalid , Haris Muhammad , Aliza Ahmed , Sarah Aftab Ahmad","doi":"10.1016/j.carrev.2024.07.014","DOIUrl":"10.1016/j.carrev.2024.07.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 50-51"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853098","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.06.008
Roseann White , Peter Lam , Nelson Lu , Xiaolu Su , Tracy Bergemann , Terri Johnson , Dan Stephens , Andrew Farb , Michael Jaff , Alexandra Lansky , Ajay Kirtane , Jennifer Rymer , Mitchell Krucoff
In 2020, the NIH and FDA issued guidance documents that laid the foundation for human subject research during an unprecedented pandemic. To bridge these general considerations to actual applications in cardiovascular interventional device trials, the PAndemic Impact on INTErventional device ReSearch (PAIINTERS) Working Group was formed in early 2021 under the Predictable And Sustainable Implementation Of National CardioVascular Registries (PASSION CV Registries). The PAIINTER's Part I report, published by Rymer et al. [5], provided a comprehensive overview of the operational impact on interventional studies during the first year of the Pandemic. PAIINTERS Part II focused on potential statistical issues related to bias, variability, missing data, and study power when interventional studies may start and end in different pandemic phases. Importantly, the paper also offers practical mitigation strategies to adjust or minimize the impact for both SATs and RCTs, providing a valuable resource for researchers and professionals involved in cardiovascular clinical trials.
{"title":"Statistical considerations for cardiovascular clinical trials straddling the continuum of pandemic phases","authors":"Roseann White , Peter Lam , Nelson Lu , Xiaolu Su , Tracy Bergemann , Terri Johnson , Dan Stephens , Andrew Farb , Michael Jaff , Alexandra Lansky , Ajay Kirtane , Jennifer Rymer , Mitchell Krucoff","doi":"10.1016/j.carrev.2024.06.008","DOIUrl":"10.1016/j.carrev.2024.06.008","url":null,"abstract":"<div><div><span>In 2020, the NIH and FDA issued guidance documents that laid the foundation for human subject research during an unprecedented pandemic. To bridge these general considerations to actual applications in cardiovascular interventional device trials, the PAndemic Impact on INTErventional device ReSearch (PAIINTERS) Working Group was formed in early 2021 under the Predictable And Sustainable Implementation Of National CardioVascular Registries (PASSION CV Registries). The PAIINTER's Part I report, published by Rymer et al. [5], provided a comprehensive overview of the operational impact on interventional studies during the first year of the Pandemic. PAIINTERS Part II focused on potential statistical issues related to bias, variability, missing data, and study power when interventional studies may start and end in different pandemic phases. Importantly, the paper also offers practical mitigation strategies to adjust or minimize the impact for both SATs and </span>RCTs<span>, providing a valuable resource for researchers and professionals involved in cardiovascular clinical trials.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 90-97"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405640","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 : 2024-12-01DOI: 10.1016/j.carrev.2024.05.019
Ilan Merdler , Kalyan R. Chitturi , Abhishek Chaturvedi , Sana Rahman , Matteo Cellamare , Sevket Tolga Ozturk , Vaishnavi Sawant , Itsik Ben-Dor , Ron Waksman , Hayder D. Hashim , Brian C. Case
Background
The intricate relationship between mental health disorders, notably anxiety and depression, and chest pain associated with non-obstructive coronary artery disease has become a focus of investigation.
Methods
This study from the Coronary Microvascular Disease Registry (CMDR) evaluated the association of mental health disorders and coronary microvascular dysfunction (CMD) among patients with angina with no obstructive coronary artery disease (ANOCA) who had undergone comprehensive invasive physiological testing for CMD. Clinical data regarding baseline characteristics, comorbidities, and noninvasive cardiac testing were obtained from chart review. The primary outcome of interest was the potential relationship between mental health diagnoses and the presence of CMD.
Results
Of patients included in the CMDR, 27 % (41/152) had at least one documented mental health disorder diagnosis (International Classification of Diseases, Tenth Revision codes) and CMD. There was no difference in mental health diagnosis prevalence between CMD-positive and CMD-negative patients (21.1 % vs. 28.9 %, p = 0.34). The most common mental health diagnoses were depression (15.8 %) and anxiety (15.8 %). Furthermore, 46.3 % (19/41) of patients with mental health disorders were prescribed psychiatric medications, with the most common being benzodiazepines (26.8 %).
Conclusion
Patients with chest pain not due to CMD did not have an increased prevalence of mental health disorders compared with patients with ANOCA due to CMD, challenging the notion of a psychosomatic component in the pathogenesis of ANOCA.
{"title":"Exploring the interplay between coronary microvascular dysfunction and mental health","authors":"Ilan Merdler , Kalyan R. Chitturi , Abhishek Chaturvedi , Sana Rahman , Matteo Cellamare , Sevket Tolga Ozturk , Vaishnavi Sawant , Itsik Ben-Dor , Ron Waksman , Hayder D. Hashim , Brian C. Case","doi":"10.1016/j.carrev.2024.05.019","DOIUrl":"10.1016/j.carrev.2024.05.019","url":null,"abstract":"<div><h3>Background</h3><div><span><span>The intricate relationship between mental health disorders, notably anxiety and depression, and </span>chest pain associated with non-obstructive </span>coronary artery disease has become a focus of investigation.</div></div><div><h3>Methods</h3><div><span><span>This study from the Coronary Microvascular Disease Registry (CMDR) evaluated the association of mental health disorders and </span>coronary microvascular dysfunction (CMD) among patients with angina with no obstructive coronary artery disease (ANOCA) who had undergone comprehensive invasive physiological testing for CMD. Clinical data regarding baseline characteristics, comorbidities, and noninvasive </span>cardiac testing were obtained from chart review. The primary outcome of interest was the potential relationship between mental health diagnoses and the presence of CMD.</div></div><div><h3>Results</h3><div>Of patients included in the CMDR, 27 % (41/152) had at least one documented mental health disorder diagnosis (International Classification of Diseases, Tenth Revision codes) and CMD. There was no difference in mental health diagnosis prevalence between CMD-positive and CMD-negative patients (21.1 % vs. 28.9 %, <em>p</em><span> = 0.34). The most common mental health diagnoses were depression (15.8 %) and anxiety (15.8 %). Furthermore, 46.3 % (19/41) of patients with mental health disorders were prescribed psychiatric medications, with the most common being benzodiazepines (26.8 %).</span></div></div><div><h3>Conclusion</h3><div>Patients with chest pain not due to CMD did not have an increased prevalence of mental health disorders compared with patients with ANOCA due to CMD, challenging the notion of a psychosomatic component in the pathogenesis of ANOCA.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"69 ","pages":"Pages 25-29"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049745","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号