Journal of Invasive Cardiology最新文献

Objectives: An early invasive strategy is recommended for patients with acute myocardial infarction-related cardiogenic shock (AMICS). However, data on outcomes of patients undergoing early coronary angiography (CA) without subsequent percutaneous coronary intervention (PCI) are limited. The authors examined the characteristics and outcomes of patients with AMICS who underwent early CA and were treated with or without acute PCI.

Methods: The authors analyzed data from the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) CA registry. Patient characteristics, indications for CA, treatments, and in-hospital outcomes were collected and analyzed. All patients who underwent CA for AMICS were included.

Results: Between January 2009 and December 2020, 4290 patients with AMICS underwent CA within 24 hours after symptom onset. Patients referred to urgent coronary artery bypass grafting (CABG) were excluded. Among the remaining 4075 patients, 3249 (79.7%) underwent acute PCI, 428 (10.5%) had significant coronary artery disease (CAD) but were not treated with PCI, and 398 (9.8%) had no significant CAD. Patients who did not undergo PCI were older and more likely to have a history of prior PCI or CABG. The in-hospital mortality rate was 47.2% among patients without PCI, 41.9% among those treated with PCI, and 36.5% among those without significant CAD.

Conclusions: In this large, contemporary CA registry, approximately 10% of AMICS patients had significant CAD but did not undergo acute PCI; this subgroup exhibited high in-hospital mortality. Another 10% of patients had no significant CAD, with one-third dying during hospitalization. Further studies are needed to identify strategies to improve outcomes in these populations.

Objectives: There are limited data on the use of excimer laser coronary atherectomy (ELCA) in conjunction with other calcium modification devices (intravascular lithotripsy [IVL], rotational/orbital atherectomy [RA/OA]). The aim of this analysis was to compare the use of ELCA as a sole device for coronary intervention with ELCA in combination with additional calcium modification devices.

Methods: This was a retrospective analysis of all patients treated with ELCA (either as a sole modification device or in conjunction with another calcium modification device) at a single high-volume center. Data and comparisons between ELCA alone and each of the combination therapies (with IVL, with RA/OA, with both IVL and RA/OA) were presented and compared using statistical methods appropriate to the data type.

Results: This analysis included 98 interventions using ELCA (67 as a sole device, 22 with IVL, 6 with RA/OA, 3 with IVL and RA/OA). ELCA alone or in conjunction with IVL were most utilized for in stent restenosis/underexpansion compared with ELCA in conjunction with RA/OA +/-IVL, which were used more frequently for uncrossable/calcified lesions. The frequency of coronary artery perforation across the entire cohort was 4.1%. Target vessel revascularization frequency was 9.2%, and target vessel myocardial infarction was 3.1% at a median of 1051 days, with no statistically significant differences between the device groups.

Conclusions: ELCA combination therapies have a potential role in certain complex cases and though these are associated with higher risk, they can be safely performed in selected centers using radial access with good medium-term outcomes.