Journal of Invasive Cardiology最新文献

Objectives: Severe coronary calcification is a predictor for procedural failure during percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) delivers acoustic pressure waves to modify coronary calcification to optimize stent results. The efficacy of IVL compared to conventional balloon angioplasty (BA) prior to drug-eluting stent (DES) implantation is largely unknown. This study aimed to compare pretreatment with IVL vs BA for severely calcified coronary lesions prior to DES implantation.

Methods: A total of 60 patients with severely calcified coronary disease undergoing PCI were randomly assigned (1:1 ratio) to conventional BA or IVL pretreatment groups. The primary efficacy endpoint was procedural success (successful stent implantation without bailout calcium modification devices, no major angiographic complications, and residual stenosis less than 20%). The primary safety endpoint was freedom from in-hospital major adverse cardiovascular events (MACE) including death, periprocedural myocardial infarction, stroke, and target vessel revascularization/target lesion failure.

Results: Procedural success was achieved in 15 (55.6%) patients in the BA group and 24 (72.7%) patients in the IVL group (P = .165). Requirement for bailout calcium modification was higher in the BA group (22.2% vs 0.0%; P = .004). The primary safety endpoint was achieved in 26 (96.3%) patients in the BA group and 30 (90.9%) patients in the IVL group (P = .405).

Conclusions: In PCI of severely calcified coronary disease, no significant differences in procedural success or in-hospital MACE were identified when comparing IVL to conventional BA pretreatment. There was a higher need for additional dedicated calcium modification observed with conventional BA.

Objectives: This retrospective study aims to evaluate the safety and efficacy of percutaneous removal of pulmonary intravascular foreign bodies in children.

Methods: This single-center, retrospective study analyzed cases of pulmonary intravascular foreign body removal in children over a 13-year peiod.

Results: There were a total of 9 children, with a mean age of 8.6 years. The most common foreign bodies were catheter fragments (n = 7). The success rate of foreign body retrieval was 100%, with only one case of transient arrhythmia as a complication.

Conclusions: Preliminary findings suggest that percutaneous retrieval is a safe and effective method for removing pulmonary intravascular foreign bodies in children.

Objectives: There is a paucity of data on the use of protamine after PCI. The purpose of this study was to assess the incidence of thrombotic complications of protamine after high-risk PCI.

Methods: The authors conducted a retrospective analysis of 168 patients. All patients received protamine intra- or immediately post-index PCI. Baseline characteristics and procedural characteristics including heparin dosing, protamine dosing, and bleeding and thrombotic complications were evaluated. The primary outcome was the incidence of acute stent thrombosis (ST), subacute ST, and 'other' thrombotic complications. Secondary outcomes included mortality within 24 hours and within 30 days of the index procedure.

Results: A total of 168 patients were included. The majority of patients received dual anti-platelet therapy prior to the index procedure (85%). The average procedure time was 202 ± 103 minutes, and an average of 2.59 (± 1.38) stents were deployed. An average protamine dose of 32mg was administered, and the median dose was 20mg (IQR 20). Seventy-three (43%) had a coronary perforation and five (3%) had access site related bleeding requiring transfusion. Four (2%) patients had acute ST, no patients experienced subacute ST, and 2 (1%) patients developed non-coronary arterial thrombosis. Eight (5%) died within 24 hours of their PCI and 14 (8%) patients died within 30 days after PCI.

Conclusions: In our cohort, administration of protamine was well tolerated in the majority of patients, however, 3.6% of patients did experience coronary or peripheral arterial thrombosis warranting caution when using protamine in these challenging scenarios.

Objectives: Transradial access (TRA) catheterization has demonstrated significant reductions in procedural complications compared with other access routes. However, radial artery occlusion (RAO) remains a concern, and the optimal dose of heparin to mitigate RAO has yet to be determined. This study aims to address this gap by investigating the impact of weight-adjusted heparin doses on the incidence of RAO in patients undergoing diagnostic transradial catheterization.

Methods: This study is a subanalysis of a multicenter, prospective, randomized trial evaluating heparin dosing strategies in 1494 patients undergoing diagnostic transradial catheterization. All participants received a standard fixed dose of 5000 IU of heparin at the start of the procedure, with additional analyses stratifying patients by weight-adjusted heparin doses. RAO was assessed using Doppler ultrasound within 12 hours post-procedure.

Results: Patients were grouped by weight-adjusted heparin quartiles: less than 58.14 IU/kg (Quartile 1), 58.14 to 65.79 IU/kg (Quartile 2), 65.79 to 74.63 IU/kg (Quartile 3), and greater than 74.63 IU/kg (Quartile 4). The incidence of RAO was similar across groups (2.1%, 2.6%, 2.8%, and 3.0%, respectively; P = .86). Comparisons of extreme dosages (less than 50 IU/kg vs greater than 80 IU/kg) also revealed no significant differences (1.9% vs 2.5%; P = .71). No major bleeding events were reported, and hematoma rates were consistent across groups.

Conclusions: Heparin doses adjusted by weight did not significantly influence the incidence of RAO when a baseline dose of 5000 IU was maintained. These findings reinforce the safety and efficacy of using 5000 IU heparin during diagnostic TRA procedures.

Objectives: Contrast volume minimization can mitigate acute kidney injury (AKI) risk following percutaneous coronary intervention (PCI), but national data regarding contemporary contrast volume dosing patterns are lacking. The authors analyzed data from the National Cardiovascular Data Registry (NCDR) CathPCI registry to assess the prevalence and outcomes of renal function-based contrast dosing during PCI in patients with pre-existing renal impairment.

Methods: The authors analyzed data from 463 753 patients with an eGFR ≤ 60 mL/min/1.73 m2, and categorized patients based on contrast volume/eGFR: high (> 3), low (1-3), and ultra-low (less than 1). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. The primary outcome was occurrence of AKI. Outcomes were adjusted based on covariates derived from a validated AKI prediction model.

Results: The majority (51.4%) of patients received high contrast volume. Compared with patients who received low contrast volume, patients with high contrast volume use had a significantly higher incidence of AKI (adjusted OR 1.36 [1.28 to 1.45]) and a higher stage of AKI (adjusted OR 1.90 [1.80 to 2.00]). The incidence of AKI was similar between low and ultra-low contrast volume use. The development of new need for dialysis was higher in patients who received high contrast volume (2.8%) compared with those who received low contrast volume (0.8%) and ultra-low contrast volume (0.8%) (P less than .001).

Conclusions: High contrast volume during PCI is associated with worse outcomes including AKI and new need for dialysis. Our study provides further support for the use of contrast volume less than 3 times the eGFR as a target to guide contrast dosing during PCI.

Objectives: The ValveClamp system (Hanyu Medical Technology) is a novel transcatheter edge-to-edge repair (TEER) system designed for ease of operation; however, there is a lack of data on its application in secondary mitral regurgitation (SMR). The authors report the mid-term outcomes of TEER using the ValveClamp system in SMR.

Methods: The study prospectively analyzed consecutive severe SMR patients who underwent transapical ValveClamp implantation at 10 Chinese centers. The enrolled patients were categorized into atrial SMR (aSMR) and ventricular SMR (vSMR) groups. Clinical and echocardiographic outcomes were evaluated at baseline and at follow-up.

Results: A total of 19 aSMR and 24 vSMR patients were enrolled. Technical success was achieved in 100% of the patients and the overall 30-day device success rate was 88.37%. At 1 year, sustained MR reduction to less than or equal to 1+ was achieved in 76.47% of aSMR cases and 77.27% of vSMR cases, and positive reverse left cardiac remodeling was observed. The estimated overall 1-year survival and HF rehospitalization rates for aSMR and vSMR were 83.33% and 83.59%, respectively (log rank P = .98), and improvement of New York Heart Association functional class and Kansas City Cardiomyopathy Questionnaire score were observed in both groups. In multivariable logistic analysis, a lower leaflet-to-annulus index (LAI) (odds ratio [OR], 0.021; 95% CI, 0.001-0.042; P = .02) and a narrow MR jet type (OR, 12.029; 95% CI, 1.530-94.592-0.990; P = .02) were independently associated with a higher incidence of a residual MR of at least 2+ at 3 months after TEER.

Conclusions: TEER using the ValveClamp system is a safe and feasible therapeutic option for patients with SMR regardless of MR etiology. A lower LAI and a narrow MR jet type were independent predictors of residual MR at follow-up.

The authors propose a modified transcatheter aortic valve replacement technique wherein the removal of the guidewire and delivery catheter immediately after the valve implantation helps to not only shorten the procedure but also decrease complications induced by the guidewire and delivery catheter.