Journal of Invasive Cardiology最新文献

Objectives: Additional studies are needed on the follow-up outcomes of 1- vs 2-stent techniques in bifurcation percutaneous coronary interventions (PCI).

Methods: The authors examined the angiographic and procedural characteristics, and outcomes of 1306 bifurcation PCIs (1139 patients) performed at 6 centers between 2014 and 2024 from the PROGRESS-BIFURCATION registry.

Results: Upfront 1-stent PCI (96.2% provisional stenting, 2% mini crush with 1 stent, 1.7% side branch [SB] stent only) was used in 75.5% of lesions; upfront 2-stent PCI was used in 24.5% (48.1% double kissing crush, 16.9% culotte, 35% other). Patients treated with an upfront 2-stent strategy were older (68 ± 12 vs 66 ± 12 years; P = .011) and more likely to have dyslipidemia (82.7% vs 76.0%; P = .019) and a history of heart failure (27.6% vs 20.3%; P = .011). An upfront 2-stent strategy was more common in left main bifurcations and lesions with moderate/severe calcification or larger SB diameter. Upfront 2-stent strategies required longer procedure and fluoroscopy times and higher patient radiation dose but similar contrast volume. Two-stent strategies were associated with higher technical success (98.4% vs 94.4%; P = .003), but similar procedural success (93.5% vs 90.4%; P = .116) and in-hospital major adverse cardiac events (MACE) (5.2% vs 3.9%; P = .355) compared with 1-stent strategies. Follow-up data was available for 783 patients. During a median follow-up of 1095 days, patients treated with an upfront 2-stent strategy had similar incidence of MACE, target vessel revascularization, myocardial infarction, and all-cause mortality (hazard ratio, 0.99; 95% CI, 0.61-1.62; P = .98).

Conclusions: Upfront 1- vs 2-stent bifurcation PCI was associated with similar procedural success and follow-up outcomes during a median follow-up of 3 years.

Objectives. Anesthetic agents (general anesthesia [GA]) used during transcatheter aortic valve replacement (TAVR) have been observed to affect intracardiac pressures when measured by catheter and echocardiography. The authors hypothesized that, during GA-employed TAVR, there is significant reduction in the invasively measured aortic valve gradients (AVG) as a result of the GA.Methods. The authors performed a retrospective analysis of 298 patients undergoing TAVR. All patients had preoperative TTE and procedural AVG. Preprocedural AVG measured by TTE were compared to the AVG measured invasively after GA induction. The authors investigated the relationship between AVG discrepancy and the types of GA agents used and compared various hemodynamic parameters before and after GA induction.Results. There were statistically significant reductions in both the maximum (mean reduction: 16.99 mm Hg; P<.001; 95% CI, 14.70-19.27 mm Hg) and mean AVG (mean reduction: 7.084 mm Hg; P <.001; 95% CI, 5.672-8.496 mm Hg) when measured invasively under anesthesia compared with awake pre-anesthesia AVG by TTE. There were statistically significant reductions in blood pressure (mean reduction: 16.41 mm Hg; P <.001; 95% CI, 12.26-20.56 mm Hg) and heart rate (mean reduction: 6.299 bpm; P < .001; 95% CI, 3.735-8.863 bpm), and a statistically significant increase in stroke volume (mean increase: 8.212 mL; P < .001; 95% CI, 3.559-12.86 mL). Further linear regression analysis proved that the aforementioned AVG discrepancy is directly related to AS severity.Conclusions. In patients undergoing TAVR with GA, there is a significant reduction in AVG when compared with the preprocedural TTE measurements. This phenomenon is directly related to AS severity.