Cardiovascular Revascularization Medicine最新文献_第9页

Procedural characteristics and outcomes of patients undergoing Impella-assisted high-risk percutaneous coronary interventions in the IMPELLA-PL registry 在IMPELLA-PL登记中，接受impella辅助的高风险经皮冠状动脉介入治疗的患者的程序特征和结果。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.06.003

Aleksandra Gąsecka , Arkadiusz Pietrasik , Tomasz Pawłowski , Jerzy Sacha , Marek Grygier , Gabriel Bielawski , Wojciech Balak , Adam Sukiennik , Paulina Burzyńska , Adam Witkowski , Mateusz Warniełło , Stanisław Bartuś , Łukasz Rzeszutko , Artur Pawlik , Mateusz Kaczyński , Robert Gil , Wiktor Kuliczkowski , Krzysztof Reczuch , Marcin Protasiewicz , Paweł Kleczyński , Janusz Kochman

Background

Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.

Methods

Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).

Results

The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4–55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38–8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06–7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02–0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08–0.89).

Conclusions

Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.

背景：Impella是一种基于导管的左心室持续血流辅助装置，用于接受高风险经皮冠状动脉介入治疗（HR PCI）的患者。我们的目的是评估接受impella辅助HR-PCI的患者的预后，并确定12个月死亡率的独立预测因素。方法：从2014年10月至2021年12月，在波兰20个介入性心脏病中心的全国性、多中心、回顾性IMPELLA-PL登记中心（n = 253）登记的连续HR-PCI患者纳入分析。主要终点是(i)手术成功（定义为所有预先计划病变的血运重建），（ii）器械相关并发症，（iii） 12个月死亡率和主要不良心血管事件（MACE）。结果：以左主干多支病变为主（63.6%）。句法评分II的中位数为43.0（32.4-55.0）。手术成功率为83.0%。器械相关并发症包括通路部位出血（14.6%）、肢体缺血（2.4%）和溶血（1.6%）。住院MACE包括心外科干预1例（0.4%），心衰加重12例（4.7%），心肌梗死11例（4.3%），急性肾损伤32例（12.6%），炎症并发症35例（13.8%），大出血并发症32例（13.4%）。住院死亡率为8.3%，12个月死亡率为18.2%，出院后MACE率为22.5%。先前存在的房颤（OR 3.50, 95% CI 1.38-8.95）和慢性肾脏疾病（OR 2.77, 95% CI 1.06-7.26）增加了12个月的死亡率，在导尿管实验室中移除Impella （OR 0.11, 95% CI 0.02-0.76）和使用RAAS抑制剂（OR 0.26, 95% CI 0.08-0.89）降低了死亡率。结论：尽管IMPELLA-PL登记的患者冠状动脉疾病解剖复杂性高，但手术成功率相对较高，死亡率相对较低。

{"title":"Procedural characteristics and outcomes of patients undergoing Impella-assisted high-risk percutaneous coronary interventions in the IMPELLA-PL registry","authors":"Aleksandra Gąsecka , Arkadiusz Pietrasik , Tomasz Pawłowski , Jerzy Sacha , Marek Grygier , Gabriel Bielawski , Wojciech Balak , Adam Sukiennik , Paulina Burzyńska , Adam Witkowski , Mateusz Warniełło , Stanisław Bartuś , Łukasz Rzeszutko , Artur Pawlik , Mateusz Kaczyński , Robert Gil , Wiktor Kuliczkowski , Krzysztof Reczuch , Marcin Protasiewicz , Paweł Kleczyński , Janusz Kochman","doi":"10.1016/j.carrev.2025.06.003","DOIUrl":"10.1016/j.carrev.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.</div></div><div><h3>Methods</h3><div>Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (<em>n</em> = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).</div></div><div><h3>Results</h3><div>The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4–55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38–8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06–7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02–0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08–0.89).</div></div><div><h3>Conclusions</h3><div>Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 103-110"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337156","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

Exploring the relationship between chronic total occlusions and mortality in coronary artery disease 探讨慢性全闭塞与冠心病死亡率的关系。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.04.038

Joakim Sundström , Mohammed Mohammed , Antros Louca , Aidin Rawshani , Dan Ioanes , Oskar Angerås , Petur Petursson , Anna Myredal , Sebastian Völz , Christian Dworeck , Jacob Odenstedt , Araz Rawshani , Truls Råmunddal

Background

Chronic total occlusions (CTOs) are common in coronary artery disease (CAD) and are known to impact survival, especially in acute myocardial infarction and cardiac arrest. However, their impact on long-term survival across the broader population with CAD remains less studied. We studied the association between the number, location, and severity of CTOs and long-term survival in a large, unselected cohort.

Methods

Patients undergoing coronary angiography in Sweden between July 2015 and December 2021 were identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Individuals with prior CABG were excluded. Patients were categorized by the number of CTOs (none, 1, or ≥ 2) and location (LAD, LCX, or RCA). Survival was assessed using Kaplan–Meier and Cox proportional hazards models.

Results

Of 202,191 patients, 88.0 % had no CTO, 9.8 % had 1 CTO, and 2.1 % had ≥2 CTOs. Survival worsened with increasing CTOs (p < 0.0001). Compared to no CTO, hazard ratios were 1.69 (95 % CI, 1.63–1.76; p < 0.001) for 1 CTO and 2.27 (95 % CI, 2.13–2.42; p < 0.001) for ≥2 CTOs. Adjusted HRs by location were 1.31 (95 % CI, 1.24–1.38; p < 0.001) for LAD, 1.59 (95 % CI, 1.52–1.66; p < 0.001) for RCA, and 1.28 (95 % CI, 1.21–1.35; p < 0.001) for LCX.

Conclusions

The presence, number, and location of CTOs significantly influence long-term survival. This provides long-term risk stratification for patients with CTO, which may improve patient selection for interventions.

背景：慢性全闭塞（CTOs）在冠状动脉疾病（CAD）中很常见，并且已知会影响生存，特别是在急性心肌梗死和心脏骤停时。然而，它们对冠心病患者长期生存的影响研究较少。我们研究了cto的数量、位置和严重程度与长期生存之间的关系。方法：从瑞典冠状动脉造影和血管成形术登记处（SCAAR）确定2015年7月至2021年12月在瑞典接受冠状动脉造影的患者。既往冠脉搭桥者排除在外。根据cto的数量（无、1或≥2）和位置（LAD、LCX或RCA）对患者进行分类。生存率采用Kaplan-Meier和Cox比例风险模型进行评估。结果：202191例患者中，88.0%无CTO， 9.8%有1次CTO， 2.1%有≥2次CTO。结论：cto的存在、数量和位置显著影响长期生存。这为CTO患者提供了长期的风险分层，可以改善患者对干预措施的选择。

{"title":"Exploring the relationship between chronic total occlusions and mortality in coronary artery disease","authors":"Joakim Sundström , Mohammed Mohammed , Antros Louca , Aidin Rawshani , Dan Ioanes , Oskar Angerås , Petur Petursson , Anna Myredal , Sebastian Völz , Christian Dworeck , Jacob Odenstedt , Araz Rawshani , Truls Råmunddal","doi":"10.1016/j.carrev.2025.04.038","DOIUrl":"10.1016/j.carrev.2025.04.038","url":null,"abstract":"<div><h3>Background</h3><div>Chronic total occlusions (CTOs) are common in coronary artery disease (CAD) and are known to impact survival, especially in acute myocardial infarction and cardiac arrest. However, their impact on long-term survival across the broader population with CAD remains less studied. We studied the association between the number, location, and severity of CTOs and long-term survival in a large, unselected cohort.</div></div><div><h3>Methods</h3><div>Patients undergoing coronary angiography in Sweden between July 2015 and December 2021 were identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Individuals with prior CABG were excluded. Patients were categorized by the number of CTOs (none, 1, or ≥ 2) and location (LAD, LCX, or RCA). Survival was assessed using Kaplan–Meier and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Of 202,191 patients, 88.0 % had no CTO, 9.8 % had 1 CTO, and 2.1 % had ≥2 CTOs. Survival worsened with increasing CTOs (<em>p</em> < 0.0001). Compared to no CTO, hazard ratios were 1.69 (95 % CI, 1.63–1.76; <em>p</em> < 0.001) for 1 CTO and 2.27 (95 % CI, 2.13–2.42; <em>p</em> < 0.001) for ≥2 CTOs. Adjusted HRs by location were 1.31 (95 % CI, 1.24–1.38; <em>p</em> < 0.001) for LAD, 1.59 (95 % CI, 1.52–1.66; p < 0.001) for RCA, and 1.28 (95 % CI, 1.21–1.35; p < 0.001) for LCX.</div></div><div><h3>Conclusions</h3><div>The presence, number, and location of CTOs significantly influence long-term survival. This provides long-term risk stratification for patients with CTO, which may improve patient selection for interventions.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 16-22"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217221","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

Response to the Letter to the Editor: The use of the Medina coronary bifurcation classification… 给编辑的回信：使用麦地那冠状动脉分叉分类....

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.07.006

Dimitrios Strepkos, Emmanouil S. Brilakis

引用次数: 0

Examining the relationship between monocytes and monocyte-derived ratios in post-percutaneous coronary intervention patients and their impact on coronary artery disease progression 检查经皮冠状动脉介入治疗后患者单核细胞和单核细胞来源比率的关系及其对冠状动脉疾病进展的影响。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.01.009

Ilan Merdler, Kalyan R. Chitturi, Abhishek Chaturvedi, Lior Lupu, Ryan Wallace, Matteo Cellamare, Cheng Zhang, Vaishnavi Sawant, Itsik Ben-Dor, Brian C. Case, Ron Waksman

Background

Inflammation plays a key role in the progression and instability of coronary atherosclerosis. Monocytes and their ratios with eosinophils and lymphocytes serve as valuable markers for assessing inflammation. We explored blood monocyte levels and their related ratios in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) or significant de novo lesions (DNL).

Methods and results

A total of 3912 PCI procedures were identified from a single-center retrospective registry (2013−2022) and categorized into three groups: single PCI and no subsequent intervention (control group, n = 3342), significant ISR requiring repeat PCI (ISR-PCI group, n = 219), and significant de novo lesions requiring repeat PCI (DNL-PCI group, n = 351). Monocyte counts and monocyte-related ratios were evaluated at the index procedure and follow-up (clinical or repeat PCI procedures). Comorbidities were more prevalent in the ISR-PCI and DNL-PCI groups than those in the control group. In comparison to the control group, both ISR-PCI (15.6 ± 26.7 vs. 24.4 ± 37.8, P < 0.001) and DNL-PCI groups (16.2 ± 28.5 vs. 24.4 ± 37.8, P < 0.001) exhibited a significantly lower baseline monocyte-to-eosinophil ratio. In the adjusted regression models, a lower baseline monocyte-to-eosinophil ratio (P = 0.001) and monocyte-to-lymphocyte ratio (P = 0.04) were associated with DNL, whereas no such association was observed in ISR-PCI cases (P = 0.4 for both ratios).

Conclusion

Our findings reinforce the role of inflammatory markers, such as monocytes and monocyte-related ratios, in identifying individuals at risk for the progression of coronary disease post-PCI.

背景：炎症在冠状动脉粥样硬化的进展和不稳定性中起关键作用。单核细胞及其与嗜酸性粒细胞和淋巴细胞的比值是评估炎症的重要指标。我们探讨了因支架内再狭窄（ISR）或重大新生病变（DNL）而接受经皮冠状动脉介入治疗（PCI）的患者血液单核细胞水平及其相关比例。方法和结果：从单中心回顾性登记（2013-2022）中共确定了3912例PCI手术，并将其分为三组：单次PCI且无后续干预（对照组，n = 3342），需要重复PCI的显著ISR （ISR-PCI组，n = 219）和需要重复PCI的显著新生病变（DNL-PCI组，n = 351）。单核细胞计数和单核细胞相关比率在指标程序和随访（临床或重复PCI程序）中进行评估。与对照组相比，ISR-PCI组和DNL-PCI组的合并症更为普遍。与对照组相比，ISR-PCI(15.6±26.7比24.4±37.8)P。结论：我们的研究结果加强了炎症标志物（如单核细胞和单核细胞相关比率）在识别pci后冠心病进展风险个体中的作用。

{"title":"Examining the relationship between monocytes and monocyte-derived ratios in post-percutaneous coronary intervention patients and their impact on coronary artery disease progression","authors":"Ilan Merdler, Kalyan R. Chitturi, Abhishek Chaturvedi, Lior Lupu, Ryan Wallace, Matteo Cellamare, Cheng Zhang, Vaishnavi Sawant, Itsik Ben-Dor, Brian C. Case, Ron Waksman","doi":"10.1016/j.carrev.2025.01.009","DOIUrl":"10.1016/j.carrev.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation plays a key role in the progression and instability of coronary atherosclerosis<span><span>. Monocytes and their ratios with </span>eosinophils and lymphocytes serve as valuable markers for assessing inflammation. We explored blood monocyte levels and their related ratios in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) or significant de novo lesions (DNL).</span></div></div><div><h3>Methods and results</h3><div>A total of 3912 PCI procedures were identified from a single-center retrospective registry (2013−2022) and categorized into three groups: single PCI and no subsequent intervention (control group, <em>n</em> = 3342), significant ISR requiring repeat PCI (ISR-PCI group, <em>n</em> = 219), and significant de novo lesions requiring repeat PCI (DNL-PCI group, <em>n</em> = 351). Monocyte counts and monocyte-related ratios were evaluated at the index procedure and follow-up (clinical or repeat PCI procedures). Comorbidities were more prevalent in the ISR-PCI and DNL-PCI groups than those in the control group. In comparison to the control group, both ISR-PCI (15.6 ± 26.7 vs. 24.4 ± 37.8, <em>P</em> < 0.001) and DNL-PCI groups (16.2 ± 28.5 vs. 24.4 ± 37.8, <em>P</em> < 0.001) exhibited a significantly lower baseline monocyte-to-eosinophil ratio. In the adjusted regression models, a lower baseline monocyte-to-eosinophil ratio (<em>P</em> = 0.001) and monocyte-to-lymphocyte ratio (<em>P</em> = 0.04) were associated with DNL, whereas no such association was observed in ISR-PCI cases (<em>P</em> = 0.4 for both ratios).</div></div><div><h3>Conclusion</h3><div>Our findings reinforce the role of inflammatory markers, such as monocytes and monocyte-related ratios, in identifying individuals at risk for the progression of coronary disease post-PCI.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 5-10"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081748","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

Racial and ethnic disparities in the prevalence, outcomes, and management of infective endocarditis in the United States 美国感染性心内膜炎的流行、结局和治疗的种族和民族差异

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.04.014

Taha Mansoor , Ali bin Abdul Jabbar , Siddharth Agarwal , Mahmoud Ismayl , Dmitry Abramov , Sachin Parikh , Austin Brubaker , Arunima Misra , Salim Virani , Vishal Gupta , Abdul Mannan Khan Minhas , Santhosh K.G. Koshy

Introduction

Racial/ethnic differences in the prevalence, outcomes, and management of infective endocarditis (IE) remain unclear.

Methods

We assessed racial/ethnic differences in the prevalence, baseline characteristics, surgical intervention (valve replacement/repair), and clinical outcomes of hospitalizations for IE from 2016 to 2021 using the National Inpatient Sample (NIS). A multivariable regression model was used to adjust for potential confounders.

Results

A total of 78,600 hospitalizations for IE were identified, of which 76.7 % included White race, 10.7 % Black race, 7.7 % Hispanic ethnicity, and 4.9 % from other races/ethnicities. The median age was 51 (Interquartile Range [IQR] 34–67), and 41.1 % were female. Black race, Hispanic ethnicity, and other races/ethnicities were not associated with a significant difference in odds of receiving cardiac valve intervention when compared to White race. Black race (aOR 1.40; CI 1.08–1.80) was associated with higher odds of in-hospital mortality compared to White race. Black race, Hispanic ethnicity, and patients of other races/ethnicities were associated with higher odds of acute kidney injury requiring dialysis compared to White patients. Black race and patients of other races/ethnicities were associated with higher odds of cardiogenic shock when compared to White race. Black race was associated with lower odds of spleen infarction when compared to White patients.

Conclusion

Racial/ethnic disparities exist in the prevalence, outcomes, and management of patients hospitalized for IE in the US. Further studies are warranted to identify the reasons for such disparities and to guide policy initiatives to achieve equity.

感染性心内膜炎（IE）的患病率、结局和治疗方面的种族/民族差异尚不清楚。方法：我们使用全国住院患者样本（NIS）评估了2016年至2021年IE患病率、基线特征、手术干预（瓣膜置换术/修复术）和住院临床结果的种族/民族差异。采用多变量回归模型对潜在混杂因素进行调整。结果：共确定了78,600例IE住院，其中76.7%为白人，10.7%为黑人，7.7%为西班牙裔，4.9%为其他种族/民族。中位年龄为51岁（四分位间距[IQR] 34-67），女性占41.1%。与白人相比，黑人、西班牙裔和其他种族/民族与接受心脏瓣膜干预的几率没有显著差异。黑人种族(aOR 1.40；与白种人相比，CI 1.08-1.80)与更高的住院死亡率相关。与白人患者相比，黑人、西班牙裔和其他种族/民族的患者需要透析的急性肾损伤的几率更高。与白人相比，黑人和其他种族/民族的患者发生心源性休克的几率更高。与白人患者相比，黑人患者患脾梗死的几率较低。结论：在美国，IE住院患者的患病率、预后和管理存在种族/民族差异。有必要进行进一步的研究，以查明这种差异的原因，并指导实现公平的政策倡议。

{"title":"Racial and ethnic disparities in the prevalence, outcomes, and management of infective endocarditis in the United States","authors":"Taha Mansoor , Ali bin Abdul Jabbar , Siddharth Agarwal , Mahmoud Ismayl , Dmitry Abramov , Sachin Parikh , Austin Brubaker , Arunima Misra , Salim Virani , Vishal Gupta , Abdul Mannan Khan Minhas , Santhosh K.G. Koshy","doi":"10.1016/j.carrev.2025.04.014","DOIUrl":"10.1016/j.carrev.2025.04.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial/ethnic differences in the prevalence, outcomes, and management of infective endocarditis (IE) remain unclear.</div></div><div><h3>Methods</h3><div>We assessed racial/ethnic differences in the prevalence, baseline characteristics, surgical intervention (valve replacement/repair), and clinical outcomes of hospitalizations for IE from 2016 to 2021 using the National Inpatient Sample (NIS). A multivariable regression model was used to adjust for potential confounders.</div></div><div><h3>Results</h3><div><span><span>A total of 78,600 hospitalizations for IE were identified, of which 76.7 % included White race, 10.7 % Black race, 7.7 % Hispanic ethnicity, and 4.9 % from other races/ethnicities. The median age was 51 (Interquartile Range [IQR] 34–67), and 41.1 % were female. Black race, Hispanic ethnicity, and other races/ethnicities were not associated with a significant difference in odds of receiving cardiac valve<span> intervention when compared to White race. Black race (aOR 1.40; CI 1.08–1.80) was associated with higher odds of in-hospital mortality compared to White race. Black race, Hispanic ethnicity, and patients of other races/ethnicities were associated with higher odds of acute kidney injury requiring dialysis compared to White patients. Black race and patients of other races/ethnicities were associated with higher odds of </span></span>cardiogenic shock when compared to White race. Black race was associated with lower odds of </span>spleen infarction when compared to White patients.</div></div><div><h3>Conclusion</h3><div>Racial/ethnic disparities exist in the prevalence, outcomes, and management of patients hospitalized for IE in the US. Further studies are warranted to identify the reasons for such disparities and to guide policy initiatives to achieve equity.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 115-127"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054199","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

Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention 单通道技术在impella辅助下无保护左主干经皮冠状动脉介入治疗中的倾向匹配分析。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.05.024

Raef Ali Fadel , Benjamin Hofeld , Herbert D. Aronow , Ahmad Jabri , Pedro Engel , Gerald Koenig , Muhammad Memon , Mohammad Alqarqaz , Khaldoon Alaswad , Brittany Fuller , Asaad Nakhle , Vikas Aggarwal , Brian O'Neill , Tiberio Frisoli , Mir Babar Basir , Henry Kim , William O'Neill , Pedro Villablanca

Background

The single access for high-risk percutaneous coronary intervention (SHiPCI) technique is an intriguing alternative to traditional dual access Impella-assisted PCI, potentially reducing access-site complications. Current data is limited to retrospective case studies.

Objectives

To analyze procedural complications and clinical outcomes of SHiPCI.

Methods

This single-center retrospective observational study evaluated consecutively admitted patients undergoing high-risk unprotected left main PCI (UPLM-PCI) from 2018 through 2023. Patients were grouped according to index strategy of single or dual access Impella-assisted UPLM-PCI, and propensity score matching without replacement was used to match patients 1:1. The primary outcome was a composite of all-cause in-hospital mortality, major bleeding, vascular access site complications, and blood transfusion.

Results

Six-hundred patients underwent UPLM-PCI during the study period, and one hundred patients were matched (50 patients per group). There were no significant differences in baseline characteristics between the two groups. Up-front balloon tamponade assistance was higher in the dual access group (14 % vs 4.0 %, p = 0.027), and rate of successful hemostasis post-closure was lower (82 % vs 100 %, p = 0.001). The primary composite outcome occurred in 7 patients (14 %) in the single access group, compared to 16 patients (32 %) in the dual access group (p = 0.033). Patients in the dual-access group had higher rates of major bleeding (17 % vs 2 %, p = 0.014).

Conclusions

SHiPCI compared to standard dual access for Impella-assisted UPLM-PCI demonstrated a lower rate lower rate of the composite outcome, driven primarily by a lower rate of major bleeding. Prospective randomized controlled trials are needed to delineate the efficacy and safety of SHiPCI.

背景：单通道高风险经皮冠状动脉介入治疗（SHiPCI）技术是传统双通道impella辅助PCI的一个有趣的替代方案，潜在地减少了通道部位的并发症。目前的数据仅限于回顾性的案例研究。目的：分析SHiPCI的手术并发症及临床结果。方法：本单中心回顾性观察性研究对2018年至2023年接受高危无保护左主干PCI （UPLM-PCI）的患者进行连续评估。根据单路或双路impela辅助UPLM-PCI的指标策略对患者进行分组，采用倾向评分匹配无置换，1:1匹配患者。主要结局是全因住院死亡率、大出血、血管通路并发症和输血的综合结果。结果：600例患者在研究期间行UPLM-PCI，匹配100例患者（每组50例）。两组患者的基线特征无显著差异。双通道组正面球囊填塞辅助率较高（14%比4.0%,p = 0.027），闭合后成功止血率较低（82%比100%，p = 0.001）。单通道组有7例（14%）患者出现主要复合结局，双通道组有16例（32%）患者出现主要复合结局（p = 0.033）。双通道组患者大出血发生率较高（17% vs 2%, p = 0.014）。结论：SHiPCI与标准双通道impella辅助UPLM-PCI相比，复合结果的发生率更低，主要是由于大出血发生率更低。需要前瞻性随机对照试验来描述SHiPCI的有效性和安全性。

{"title":"Propensity matched analysis of single access technique for Impella-assisted unprotected left main percutaneous coronary intervention","authors":"Raef Ali Fadel , Benjamin Hofeld , Herbert D. Aronow , Ahmad Jabri , Pedro Engel , Gerald Koenig , Muhammad Memon , Mohammad Alqarqaz , Khaldoon Alaswad , Brittany Fuller , Asaad Nakhle , Vikas Aggarwal , Brian O'Neill , Tiberio Frisoli , Mir Babar Basir , Henry Kim , William O'Neill , Pedro Villablanca","doi":"10.1016/j.carrev.2025.05.024","DOIUrl":"10.1016/j.carrev.2025.05.024","url":null,"abstract":"<div><h3>Background</h3><div>The single access for high-risk percutaneous coronary intervention (SHiPCI) technique is an intriguing alternative to traditional dual access Impella-assisted PCI, potentially reducing access-site complications. Current data is limited to retrospective case studies.</div></div><div><h3>Objectives</h3><div>To analyze procedural complications and clinical outcomes of SHiPCI.</div></div><div><h3>Methods</h3><div>This single-center retrospective observational study evaluated consecutively admitted patients undergoing high-risk unprotected left main PCI (UPLM-PCI) from 2018 through 2023. Patients were grouped according to index strategy of single or dual access Impella-assisted UPLM-PCI, and propensity score matching<span><span> without replacement was used to match patients 1:1. The primary outcome was a composite of all-cause in-hospital mortality, major bleeding, </span>vascular access<span> site complications, and blood transfusion.</span></span></div></div><div><h3>Results</h3><div><span>Six-hundred patients underwent UPLM-PCI during the study period, and one hundred patients were matched (50 patients per group). There were no significant differences in baseline characteristics between the two groups. Up-front balloon tamponade assistance was higher in the dual access group (14 % vs 4.0 %, </span><em>p</em><span> = 0.027), and rate of successful hemostasis post-closure was lower (82 % vs 100 %, </span><em>p</em> = 0.001). The primary composite outcome occurred in 7 patients (14 %) in the single access group, compared to 16 patients (32 %) in the dual access group (<em>p</em> = 0.033). Patients in the dual-access group had higher rates of major bleeding (17 % vs 2 %, <em>p</em> = 0.014).</div></div><div><h3>Conclusions</h3><div>SHiPCI compared to standard dual access for Impella-assisted UPLM-PCI demonstrated a lower rate lower rate of the composite outcome, driven primarily by a lower rate of major bleeding. Prospective randomized controlled trials are needed to delineate the efficacy and safety of SHiPCI.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 80-85"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174905","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

Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry 既往冠状动脉搭桥手术患者经皮冠状动脉介入治疗的分叉：来自PROGRESS-BIFURCATION注册表的分析。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.05.018

Dimitrios Strepkos , Michaella Alexandrou , Deniz Mutlu , Pedro E.P. Carvalho , Ozgur S. Ser , Jaskanwal Deep Singh Sara , Oleg Krestyaninov , Dimitri Khelimskii , Barkin Kultursay , Ali Karagoz , Ufuk Yildirim , Korhan Soylu , Mahmut Uluganyan , Olga Mastrodemos , Bavana V. Rangan , Sandeep Jalli , Konstantinos Voudris , M. Nicholas Burke , Yader Sandoval , Emmanouil S. Brilakis

Background

Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).

Objectives

We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.

Methods

We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.

Results

Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion (SBO) after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.

Conclusions

Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.

背景：分叉经皮冠状动脉介入治疗（PCI）在既往冠状动脉搭桥手术（CABG）患者中的应用研究尚不充分。目的：我们试图评估有CABG和没有CABG的患者的临床和程序特征以及分岔PCI的结果。方法：我们比较了2014年至2024年间在5个中心接受了1496例分岔pci的1305例CABG患者的技术、程序特征和预后。结果：既往CABG患者占研究人群的14.4%，年龄较大，心血管危险因素较多，血管造影复杂性较高，包括中度或重度主血管近端扭曲和钙化的发生率较高。技术成功率（95.0% vs 94.8%, p=0.942）和手术成功率（91.5% vs 91.1%, p=0.875）在有和没有CABG的患者中相似；先前CABG患者使用临时支架的频率较低（60.6% vs 68.0%, p = 0.031）。在调整混杂因素后，既往CABG患者侧支闭塞率较低（调整优势比[OR]: 0.27, 95%可信区间[CI]: 0.08, 0.72, p = 0.018），院内类似的主要不良心血管事件（3.7% vs 4.1%, p = 0.800）。在中位随访1095天期间，既往CABG患者靶血管重建术发生率较高（校正风险比[HR]: 1.71, 95% CI: 1.01, 2.89, p = 0.004）。在既往冠脉搭桥的患者中，接受PCI的患者冠状动脉解剖结构更复杂，但技术上的成功和短期和长期的结果相似。结论：既往CABG患者行分岔PCI术后发生SBO的风险较低，随访TVR较高。在先前的CABG患者中，介入搭桥术的住院和随访结果与自体血管介入相似。

{"title":"Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry","authors":"Dimitrios Strepkos , Michaella Alexandrou , Deniz Mutlu , Pedro E.P. Carvalho , Ozgur S. Ser , Jaskanwal Deep Singh Sara , Oleg Krestyaninov , Dimitri Khelimskii , Barkin Kultursay , Ali Karagoz , Ufuk Yildirim , Korhan Soylu , Mahmut Uluganyan , Olga Mastrodemos , Bavana V. Rangan , Sandeep Jalli , Konstantinos Voudris , M. Nicholas Burke , Yader Sandoval , Emmanouil S. Brilakis","doi":"10.1016/j.carrev.2025.05.018","DOIUrl":"10.1016/j.carrev.2025.05.018","url":null,"abstract":"<div><h3>Background</h3><div>Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).</div></div><div><h3>Objectives</h3><div>We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.</div></div><div><h3>Methods</h3><div>We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.</div></div><div><h3>Results</h3><div>Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, <em>p</em>=0.942) and procedural (91.5% vs 91.1%, <em>p</em>=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, <em>p</em> = 0.031). Prior CABG patients had lower rates of side branch occlusion (SBO) after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, <em>p</em> = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, <em>p</em> = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, <em>p</em> = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.</div></div><div><h3>Conclusions</h3><div>Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 25-31"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182261","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

Early readmissions after percutaneous mechanical circulatory support–assisted percutaneous coronary intervention: Insights from the nationwide readmissions database 经皮机械循环支持辅助经皮冠状动脉介入治疗后的早期再入院：来自全国再入院数据库的见解。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.06.002

Sean DeAngelo , Badri Aryal , Gianfranco Bittar-Carlini , Rohan Gajjar , Jeremiah Bello , Sharan Malkani , Ufuk Vardar , Abhimanyu Saini

<div><h3>Background</h3><div><span>The use of percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) has seen an increase in use over the past five years. It remains unclear how the increased prevalence has affected the rate of readmissions and what clinical predictors may play a role in a patient's readmission. We aimed to assess the cardiovascular causes, </span>mortality rate, and clinical predictors of patients readmitted after experiencing pMCS-assisted PCI.</div></div><div><h3>Methods</h3><div><span>Patients who underwent pMCS (intra-aortic balloon pump, Impella, or percutaneous left ventricular assist device) and PCI between January 2016 and November 2020 were selected from the nationwide readmission database. The frequency and underlying causes of cardiovascular-related 30-day readmissions were assessed, as delineated by the International Classification of Diseases, Tenth Revision (ICD-10) codes. Additionally, readmission mortality rates, mean hospital stay length, cumulative hospital charges, and independent factors predictive of 30-day all-cause readmissions were analyzed. A secondary analysis of mortality and readmission rate in patients with </span>cardiogenic shock who underwent pMCS were compared to those with pMCS-assisted PCI.</div></div><div><h3>Results</h3><div><span><span>Of the 77,099 patients discharged alive after receiving pMCS-assisted PCI, 12,072 (15.6%) had a readmission within 30 days. Among the readmissions, the all-cause mortality was 876 (7.26%). The most common cardiovascular causes for readmission were hypertensive heart disease with heart failure (8.6%), hypertensive heart and </span>chronic kidney disease stage 1–4 (8.3%), and non-ST elevation myocardial infarction (4.1 %). Readmitted patients exhibited a shorter mean length of stay in contrast to their index admission (5.9 vs 9.9 days, </span><em>p</em><span><span> < 0.0001). Patients who were readmitted incurred total hospital charges of $1.01 billion US. Factors independently associated with 30-day readmissions were female sex, leaving against medical advice, renal insufficiency, congestive heart failure, prior valve replacement, and length of stay > 10 days. Index mortality was significantly higher in the pMCS-assisted </span>cardiogenic shock cohort compared the pMCS-assisted PCI group (32.6% vs 26.4%; CI: 5.8–6.6, </span><em>p</em> < 0.001). Readmission rate was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (16.4% vs 15.7 %; CI: 0.4–1.1, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Our study revealed that 15.6% of patients discharged after receiving pMCS-assisted PCI were readmitted within 30 days, with an all-cause mortality rate of 7.26% among these readmissions. The most common causes of readmission were related to hypertensive heart disease and NSTEMI. These findings underscore the need for targeted interventions to reduce

背景：在过去的五年中，经皮机械循环支持（pMCS）辅助经皮冠状动脉介入治疗（PCI）的使用有所增加。目前尚不清楚患病率的增加是如何影响再入院率的，以及哪些临床预测因素可能在患者再入院中发挥作用。我们的目的是评估pmcs辅助PCI后再入院患者的心血管原因、死亡率和临床预测因素。方法：从全国再入院数据库中选择2016年1月至2020年11月期间接受pMCS（主动脉内球囊泵、Impella或经皮左心室辅助装置）和PCI治疗的患者。根据国际疾病分类第十版（ICD-10）代码，评估了心血管相关的30天再入院的频率和潜在原因。此外，还分析了再入院死亡率、平均住院时间、累计住院费用和预测30天全因再入院的独立因素。对经pMCS辅助PCI与经pMCS辅助PCI的心源性休克患者的死亡率和再入院率进行了二次分析。结果：77,099例患者在接受pmcs辅助PCI治疗后存活出院，其中12,072例（15.6%）在30天内再次入院。再入院患者全因死亡率为876例（7.26%）。再入院最常见的心血管原因是高血压心脏病合并心力衰竭（8.6%）、高血压心脏和慢性肾脏疾病1-4期（8.3%）和非st段抬高型心肌梗死（4.1%）。再入院患者的平均住院时间比首次入院患者短（5.9天vs 9.9天，p 10天）。与pmcs辅助PCI组相比，pmcs辅助心源性休克组的指数死亡率显著高于pmcs辅助PCI组(32.6% vs 26.4%；结论：我们的研究显示，15.6%接受pmcs辅助PCI术后出院的患者在30天内再次入院，其中全因死亡率为7.26%。再入院最常见的原因与高血压心脏病和非stemi有关。这些发现强调了有针对性的干预措施的必要性，以减少再入院和相关的医疗保健费用，以及识别高风险患者，在pmcs辅助PCI出院后进行更深入的随访和管理的重要性。

{"title":"Early readmissions after percutaneous mechanical circulatory support–assisted percutaneous coronary intervention: Insights from the nationwide readmissions database","authors":"Sean DeAngelo , Badri Aryal , Gianfranco Bittar-Carlini , Rohan Gajjar , Jeremiah Bello , Sharan Malkani , Ufuk Vardar , Abhimanyu Saini","doi":"10.1016/j.carrev.2025.06.002","DOIUrl":"10.1016/j.carrev.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div><span>The use of percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) has seen an increase in use over the past five years. It remains unclear how the increased prevalence has affected the rate of readmissions and what clinical predictors may play a role in a patient's readmission. We aimed to assess the cardiovascular causes, </span>mortality rate, and clinical predictors of patients readmitted after experiencing pMCS-assisted PCI.</div></div><div><h3>Methods</h3><div><span>Patients who underwent pMCS (intra-aortic balloon pump, Impella, or percutaneous left ventricular assist device) and PCI between January 2016 and November 2020 were selected from the nationwide readmission database. The frequency and underlying causes of cardiovascular-related 30-day readmissions were assessed, as delineated by the International Classification of Diseases, Tenth Revision (ICD-10) codes. Additionally, readmission mortality rates, mean hospital stay length, cumulative hospital charges, and independent factors predictive of 30-day all-cause readmissions were analyzed. A secondary analysis of mortality and readmission rate in patients with </span>cardiogenic shock who underwent pMCS were compared to those with pMCS-assisted PCI.</div></div><div><h3>Results</h3><div><span><span>Of the 77,099 patients discharged alive after receiving pMCS-assisted PCI, 12,072 (15.6%) had a readmission within 30 days. Among the readmissions, the all-cause mortality was 876 (7.26%). The most common cardiovascular causes for readmission were hypertensive heart disease with heart failure (8.6%), hypertensive heart and </span>chronic kidney disease stage 1–4 (8.3%), and non-ST elevation myocardial infarction (4.1 %). Readmitted patients exhibited a shorter mean length of stay in contrast to their index admission (5.9 vs 9.9 days, </span><em>p</em><span><span> < 0.0001). Patients who were readmitted incurred total hospital charges of $1.01 billion US. Factors independently associated with 30-day readmissions were female sex, leaving against medical advice, renal insufficiency, congestive heart failure, prior valve replacement, and length of stay > 10 days. Index mortality was significantly higher in the pMCS-assisted </span>cardiogenic shock cohort compared the pMCS-assisted PCI group (32.6% vs 26.4%; CI: 5.8–6.6, </span><em>p</em> < 0.001). Readmission rate was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (16.4% vs 15.7 %; CI: 0.4–1.1, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Our study revealed that 15.6% of patients discharged after receiving pMCS-assisted PCI were readmitted within 30 days, with an all-cause mortality rate of 7.26% among these readmissions. The most common causes of readmission were related to hypertensive heart disease and NSTEMI. These findings underscore the need for targeted interventions to reduce ","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 97-102"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327273","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

Sex-related differences in hospital outcomes after balloon aortic valvuloplasty 主动脉瓣球囊成形术后住院结果的性别差异

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.02.003

Fatima Lakhani , Bertrand Ebner , Chetan Yarlagadda , Polydoros Kampaktsis , Nikolaos Spilias

Background

Sex differences in the prevalence and characteristics of cardiac pathologies, including aortic stenosis (AS), are well-documented. For instance, females with severe AS exhibit lower degrees of calcification but higher levels of fibrosis compared to males. This study aims to evaluate sex-based differences in in-hospital outcomes among patients with AS undergoing balloon aortic valvuloplasty (BAV).

Methods

National Inpatient Sample database was queried from 2015 to 2019, identifying adult patients with severe nonrheumatic AS undergoing BAV using ICD-10 codes. Statistical analyses included Chi-Squared tests for initial comparisons followed by logistic regression to adjust for covariates.

Results

The study included 19,510 patients: 10,556 males (54.1 %) and 8954 females (45.9 %). Females demonstrated lower rates of post-procedural in-hospital mortality, acute kidney injury, infection, ventricular arrhythmias, and pneumothorax, however higher incidence of stroke or transient ischemic attack (TIA), red blood cell transfusions, vascular complications, and pericardial effusion. Adjusted analysis revealed female patients had lower mortality rates (OR 0.89; 95 % CI [0.79–1.0]; p = 0.042), but higher rates of red blood cell transfusions (OR 1.6; 95 % CI [1.4–1.8]; p < 0.001) and vascular complications (OR 1.5; 95 % CI [1.3–1.8]; p < 0.001), without significant difference in stroke (OR 1.1; 95 % CI [0.91–1.3]; p = 0.309).

Conclusions

Females undergoing BAV for severe AS experienced lower in-hospital mortality but higher rates of vascular complications and red blood cell transfusions compared to males. These findings underscore the importance of a sex-specific approach in the management of AS to reduce adverse outcomes and optimize patient care.

背景：包括主动脉瓣狭窄（AS）在内的心脏疾病的患病率和特征的性别差异已经得到了充分的证明。例如，与男性相比，患有严重AS的女性表现出较低程度的钙化，但较高水平的纤维化。本研究旨在评估接受球囊主动脉瓣成形术（BAV）的AS患者住院结果的性别差异。方法：查询2015 - 2019年全国住院患者样本数据库，使用ICD-10编码识别成人重症非风湿性AS BAV患者。统计分析包括对初始比较进行卡方检验，然后进行逻辑回归以调整协变量。结果：共纳入19510例患者，其中男性10556例（54.1%），女性8954例（45.9%）。女性手术后住院死亡率、急性肾损伤、感染、室性心律失常和气胸的发生率较低，但卒中或短暂性脑缺血发作（TIA）、红细胞输注、血管并发症和心包积液的发生率较高。调整后的分析显示，女性患者的死亡率较低(OR 0.89；95% ci [0.79-1.0]；p = 0.042)，但红细胞输注率较高(OR 1.6；95% ci [1.4 ~ 1.8]；结论：与男性相比，接受BAV治疗严重AS的女性住院死亡率较低，但血管并发症和红细胞输注率较高。这些发现强调了在AS管理中采用性别特异性方法以减少不良后果和优化患者护理的重要性。

{"title":"Sex-related differences in hospital outcomes after balloon aortic valvuloplasty","authors":"Fatima Lakhani , Bertrand Ebner , Chetan Yarlagadda , Polydoros Kampaktsis , Nikolaos Spilias","doi":"10.1016/j.carrev.2025.02.003","DOIUrl":"10.1016/j.carrev.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Sex differences in the prevalence and characteristics of cardiac pathologies, including aortic stenosis (AS), are well-documented. For instance, females with severe AS exhibit lower degrees of calcification but higher levels of fibrosis compared to males. This study aims to evaluate sex-based differences in in-hospital outcomes among patients with AS undergoing balloon aortic valvuloplasty (BAV).</div></div><div><h3>Methods</h3><div>National Inpatient Sample database was queried from 2015 to 2019, identifying adult patients with severe nonrheumatic AS undergoing BAV using ICD-10 codes. Statistical analyses included Chi-Squared tests for initial comparisons followed by logistic regression to adjust for covariates.</div></div><div><h3>Results</h3><div>The study included 19,510 patients: 10,556 males (54.1 %) and 8954 females (45.9 %). Females demonstrated lower rates of post-procedural in-hospital mortality, acute kidney injury, infection, ventricular arrhythmias, and pneumothorax, however higher incidence of stroke or transient ischemic attack (TIA), red blood cell transfusions, vascular complications, and pericardial effusion. Adjusted analysis revealed female patients had lower mortality rates (OR 0.89; 95 % CI [0.79–1.0]; p = 0.042), but higher rates of red blood cell transfusions (OR 1.6; 95 % CI [1.4–1.8]; p < 0.001) and vascular complications (OR 1.5; 95 % CI [1.3–1.8]; p < 0.001), without significant difference in stroke (OR 1.1; 95 % CI [0.91–1.3]; p = 0.309).</div></div><div><h3>Conclusions</h3><div>Females undergoing BAV for severe AS experienced lower in-hospital mortality but higher rates of vascular complications and red blood cell transfusions compared to males. These findings underscore the importance of a sex-specific approach in the management of AS to reduce adverse outcomes and optimize patient care.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"81 ","pages":"Pages 111-114"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial: Chronic total occlusion and survival: The never-ending debate 社论：慢性全闭塞和生存：永无止境的争论。

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.carrev.2025.08.006

Sant Kumar , Lorenzo Azzalini

引用次数: 0