Journal of Invasive Cardiology最新文献

Objectives: While the transradial approach (TRA) is associated with fewer bleeding complications than the transfemoral approach (TFA), its effect on mortality outcomes in real-world clinical practice remains unclear. This study examines the relationship between vascular access site and mortality in patients undergoing percutaneous coronary intervention (PCI).

Methods: This retrospective cohort study used prospectively collected data from the Netherlands Heart Registration, including 130,813 PCI procedures between 2017 and 2021. The primary outcome was 30-day mortality and the secondary outcome was 1-year mortality. Outcomes were adjusted for baseline variables using multivariable logistic regression and propensity score matching.

Results: TFA was associated with significantly higher mortality at 30 days (odds ratio, 2.00; 95% CI, 1.78-2.25) and 1 year (odds ratio, 1.50; 95% CI, 1.39-1.61). Mortality benefits with TRA were pronounced in acute coronary syndrome and in patients 80 years or older, and were consistent across procedural volumes and center-level TRA adoption rates.

Conclusions: TRA is associated with lower short- and long-term mortality in PCI, supporting its broader adoption in routine clinical practice.

Percutaneous left atrial appendage closure (LAAC) is a rapidly emerging therapy for atrial fibrillation patients not suitable for anticoagulation. The study compared procedural time and adverse events between mechanical Brockenbrough needle and the VersaCross radiofrequency system for WATCHMAN implantation. All patients undergoing LAAC at Vancouver General Hospital were prospectively enrolled. Procedural workflow, times, and complications were compared in 20 patients: 10 using VersaCross radiofrequency system and 10 using Brockenbrough needle. Transseptal puncture success was 100%. The radiofrequency wire reduced total procedural time by 27% (21.5 vs 29.5 minutes; P=.008) and fluoroscopy and contrast use without increasing complications. One ischemic stroke occurred during 360-day follow-up unrelated to the device. The multipurpose radiofrequency system streamlines LAAC workflow and is a safe, efficient alternative to mechanical puncture. Larger randomized trials are warranted to confirm these benefits.

Objectives: In patients with myocardial infarction (MI), quantifying platelet FcɣRIIa (pFCG) stratifies the risk of subsequent MI, stroke, and death. The authors conducted a secondary analysis to assess the prognostic implications of the pFCG test over the course of 1 year after MI.

Methods: Patients (n = 764) hospitalized for type 1 MI (ST elevation and non-ST elevation) were enrolled in a prospective non-interventional trial. Inclusion criteria included at least 2 of the following: age 65 years or older, multi-vessel coronary artery disease, prior MI, chronic kidney disease, and diabetes mellitus. Flow cytometry was used to quantify pFCG at a core laboratory. High and low pFCG were defined by a prespecified threshold. The primary endpoint (n = 98) was the composite of MI, stroke, and death.

Results: The time-to-first-event analysis demonstrated that the pFCG test had the greatest prognostic power early after MI. The hazard ratio (HR) for the primary composite endpoint in all subjects was greatest during the first month (3.84, P = .0009), and the HR for the first 6 months was 2.90 (P = .00005). Similar trends were apparent for patients treated with percutaneous coronary intervention and those treated with medical therapy alone. Analysis of components of the primary endpoint, the composite of MI and death, as well as MI alone, showed similar trends.

Conclusions: The pFCG test is a powerful prognostic marker of ischemic risk during the first 6 months after MI. The prognostic information provided by the pFCG test should be useful to clinicians as they balance risk of ischemic events with that of bleeding to define a treatment strategy.