Journal of Invasive Cardiology最新文献

Objectives. The use of a microaxial flow pump (mAFP) to support high-risk percutaneous coronary intervention (HRPCI) in patients with cardiogenic shock (CS) is well established. A high-flow, surgically implanted mAFP (Impella 5.5, Abiomed/Johnson & Johnson MedTech) is increasingly used in patients with CS, yet little is known about the outcomes in HRPCI. The authors aimed to describe the outcomes, patient and procedural characteristics of Impella 5.5-supported HRPCI in a high-volume center.Methods. The authors identified all adult patients who underwent Impella 5.5-supported percutaneous coronary intervention (PCI) at Providence St. Vincent Medical Center from January 1, 2021, to December 31, 2024. Patient demographics and clinical data were abstracted from the medical record. Categorical data were reported as frequency and percentage. Continuous variables represented by intervals were summarized using mean and SD or median and IQR.Results. Of the 34 patients identified, 31 were male, and the mean age was 62.9 (± 9.7) years. All patients had a maximal CS stage of C-E. The mean left ventricular ejection fraction was 24.3%. Unprotected left main was treated in 50% of the study cohort, and 94% of the patients required multivessel PCI. The mean SYNTAX score was 35.9 (± 10.8) and the residual SYNTAX score was 7.4 (± 5.9). Major adverse cardiac and cerebrovascular events occurred in 41% of the patients. The 90-day all-cause mortality was 38%.Conclusions. Impella 5.5 is feasible to support HRPCI in patients with severe multivessel coronary artery disease, severe heart failure, and CS with acceptable short- and intermediate-term patient outcomes.

Objectives: Systematic reviews and meta-analyses have highlighted the benefits of distal over proximal transradial access, including lower rates of radial artery occlusion and faster hemostasis. Despite the increasing adoption of distal transradial access by interventionalists, there is a lack of data addressing gender-specific differences. This study aimed to assess those differences in routine coronary procedures via distal transradial access.

Methods: The authors conducted a retrospective analysis of a large, real-world sample of 6871 consecutive all-comers who underwent coronary procedures via distal transradial access using data from the DISTRACTION registry.

Results: The mean patient ages were 63.8 ± 15.7 years, 63.5 ± 17.7, and 64.4 ± 11.1 years for total, male, and female groups, respectively; 65% of the patients were male. In the female group, there was statistically significant predominance of hypertension (82.2% vs 74%), diabetes (46.8% vs 37%), obesity (29.3% vs 22.2%), severe mitral valve disease (3.1% vs 1.1%), coronary angiography-only (48.7% vs 36%), and access-site crossovers (3.1% vs 1.5%). In the male group, there were more rates of former or current smoking (54.2% vs 40.8%), previous percutaneous coronary intervention (PCI) (29.8% vs 19.7%), previous coronary artery bypass grafting (4.5% vs 1.9%), ST-segment elevation myocardial infarction (24.2% vs 18.5%), PCI (66.1% vs 52.5%), left main PCI (2.6% vs 1.7%), redo right distal transradial access (15.3% vs 9.9%), and 7F sheath size (2.6% vs 0.9%). No major adverse cerebrovascular and cardiac events directly related to distal transradial access, no hand/thumb dysfunction or ischemia after any procedure, and no relevant access-site-related bleeding were recorded.

Conclusions: The adoption of distal transradial access by proficient operators as the default approach for routine coronary procedures appears to be safe and feasible in both male and female patients, with very low rates of access site crossovers and complications.

Objectives: Increasing atrial fibrillation (AF) disease-related healthcare burden, coupled with positive evidence on catheter ablation for AF, has led to pressure on hospital procedure efficiency. Medtronic's Sphere-9 system (a novel lattice-tip dual-energy pulsed field and radiofrequency [RF] ablation catheter) demonstrated non-inferiority in effectiveness and superiority in procedural times compared with a contact-force sensing RF catheter (ThermoCool SmartTouch SF [STSF]). This analysis evaluated the impact of procedural efficiencies on electrophysiology (EP) lab utilization.

Methods: A discrete event simulation model evaluated EP lab efficiency using procedure times from the SPHERE Per-AF trial for pulmonary vein isolation-only cases and those with additional ablation lesion sets. Lab day ran from 7 am to 7 pm with 1 hour needed to perform an additional non-ablation EP case, and same-day discharge was allowed for cases ending by 5 pm.

Results: Analysis included 211 patients in the Sphere-9 arm and 207 in the STSF arm. Procedure times were 100.8 ± 31 minutes for Sphere-9 and 125.9 ± 49 for STSF. Sphere-9 resulted in more than a 10-fold reduction in cumulative overtime hours (41 hours for Sphere-9 vs 424 for STSF). Overtime occurred on 7% of lab days with Sphere-9 and 36% with STSF. Additionally, 73% of Sphere-9 lab days allowed for 1 additional non-ablation EP case compared with 40% of STSF lab days. Finally, 38% of Sphere-9 lab days allowed for same-day discharge for the third case compared with 17% of STSF lab days.

Conclusions: In patients with persistent AF, the Sphere-9 system was more efficient and predictable compared with STSF, leading to significant improvements in EP lab efficiency.