AsiaIntervention最新文献

Background: Provisional stenting is the standard treatment for patients with coronary artery bifurcation lesions.

Aims: This pooled individual patient data (IPD) analysis aims to evaluate the long-term (six-year) outcomes of provisional stenting versus upfront two-stent techniques in patients with true coronary bifurcation lesions treated with drug-eluting stents.

Methods: A systematic review and IPD analysis of randomised trials with centrally adjudicated endpoints was conducted to assess the efficacy and safety of provisional stenting versus upfront two-stent approaches in patients with true coronary bifurcation lesions undergoing percutaneous coronary intervention with drug-eluting stents. All patients were prospectively followed, with their intervention having been completed at least six years earlier. The primary endpoint, re-evaluated by an independent clinical event committee, was target lesion failure (TLF) - a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularisation - assessed at the final follow-up on 8 November 2024.

Results: A total of 6,225 citations were screened, and four randomised trials met the inclusion criteria. Among 1,573 patients in the intention-to-treat population, TLF at six years occurred in 144 patients (Kaplan-Meier estimate 18.2%) in the upfront two-stent group and 193 (Kaplan-Meier estimate 24.7%) in the provisional stenting group (hazard ratio [HR] 0.71, 95% confidence interval [CI]: 0.57-0.89; p=0.0022, τ²=0.00, I²=0%). These results were consistent across both unadjusted and per-protocol analyses. In patients with complex coronary bifurcation lesions, TLF occurred in 88 patients (Kaplan-Meier estimate 19.6%) in the two-stent group and 115 (Kaplan-Meier estimate 27.6%) in the provisional stenting group (HR 0.68, 95% CI: 0.52-0.90; p=0.0066).

Conclusions: This IPD analysis provides robust long-term evidence that upfront two-stent techniques, particularly double-kissing crush stenting, significantly reduce TLF over a six-year follow-up period compared with provisional stenting, especially in patients with complex bifurcations.

Background: The "obesity paradox" has been seen in patients with cardiovascular disease. However, the role of the obesity paradox in patients undergoing percutaneous coronary intervention (PCI) is controversial.

Aims: Our study aims to investigate the effect of weight categories on mortality in patients undergoing PCI.

Methods: The National Inpatient Sample database for the years 2016-2020 was analysed using International Classification of Diseases, Tenth Revision codes in adult patients >18 years of age. Patients undergoing PCI were identified and stratified using weight categories. Univariate and multivariate analyses were performed to assess mortality.

Results: We identified 10,069,454 patients who had undergone PCI. Compared to patients in the normal-weight category, cachectic patients had the highest mortality at 9.78% (odds ratio [OR] 3.88, 95% confidence interval [CI]: 3.65-4.12; p<0.001). Mortality was lowest in overweight patients at 1.28% (OR 0.46, 95% CI: 0.39-0.55; p<0.001), followed by obese patients at 1.61% (OR 0.58, 95% CI: 0.56-0.61; p<0.001). In the morbidly obese category, this protective effect was much less, with mortality being measured at 2.05% (OR 0.75, 95% CI: 0.42-0.78; p<0.001; vs 2.72% in the normal-weight category). After multivariate analysis, mortality remained high in cachectic patients (OR 3.65, 95% CI: 3.42-3.90; p<0.001) and remained low in overweight (OR 0.51, 95% CI: 0.43-0.61; p<0.001) and obese (OR 0.68, 95% CI: 0.66-0.71; p<0.001) patients, but the protective value of weight almost disappeared in the morbidly obese category (OR 0.96, 95% CI: 0.96-1.00; p=0.04).

Conclusions: The obesity paradox held only partially, with the lowest mortality in the overweight category, followed by patients with obesity, then an almost complete loss of protection in those with morbid obesity, and the highest mortality in cachectic patients.

Background: The AHEAD score - comprising atrial fibrillation, haemoglobin, elderly age, abnormal renal function, and diabetes mellitus - is a validated prognostic model for patients with heart failure. However, its predictive value in acute myocardial infarction (MI), particularly in large real-world cohorts, remains uncertain.

Aims: We aimed to assess the utility of the AHEAD score in predicting 1-year all-cause mortality in patients with acute MI.

Methods: This secondary analysis of the Japan Acute Myocardial Infarction Registry (JAMIR) included 3,067 patients with acute MI enrolled across 50 Japanese institutions between December 2015 and May 2017. Patients were stratified by AHEAD score at admission. The primary endpoint was all-cause mortality within 1 year after acute MI. Multivariable Cox regression, Kaplan-Meier survival analysis, and restricted cubic spline modelling were used to evaluate the association between the AHEAD score and mortality.

Results: Higher AHEAD scores were associated with older age, more comorbidities, a higher Killip class, and delayed reperfusion. The 1-year all-cause mortality rate increased significantly with rising AHEAD scores. The AHEAD score was an independent predictor of all-cause mortality (adjusted hazard ratio 1.60; 95% confidence interval: 1.39-1.84; p<0.001), and this association was consistent across predefined subgroups. Spline analysis demonstrated a linear relationship between the AHEAD score and the mortality risk.

Conclusions: The AHEAD score is a simple, bedside-accessible tool that effectively predicts 1-year all-cause mortality in patients with acute MI, regardless of the presence of heart failure. Its use may aid early risk stratification and guide clinical decision-making in acute cardiovascular care. This study was registered with the Japanese UMIN Clinical Trials Registry (UMIN000019479).

Background: Analysing temporal strain changes in right ventricular (RV) and left ventricular (LV) walls post-atrial septal defect (ASD) closure is of clinical importance.

Aims: We aimed to evaluate acute/short-term changes in RV/LV wall deformation after ASD closure using two-dimensional speckle tracking echocardiography (2D-STE).

Methods: A total of 43 patients with ASD and 20 controls had echocardiograms before and after ASD closure.

Results: Of the 43 patients with secundum ASD (mean age 27.37 years), 48.8% were closed surgically, while 51.2% underwent device closure. At baseline, LV global longitudinal strain (GLS; 2-chamber view GLS: 16.95% vs 20.73%; p=0.0001, apical long-axis view GLS 16.48% vs 20.90%; p=0.0001, 4-chamber view GLS 16.93% vs 21.56%; p=0.0001, average GLS 16.75% vs 21.31%; p=0.0001) and RV GLS (19.22% vs 24.27%; p=0.0001) were significantly lower in the patients with ASD compared to controls. After closure, the average LV GLS rapidly improved at 24 hours from baseline (16.75% to 17.28%; p=0.004), with sustained increases at 1 and 3 months (18.16% and 19.40%; p=0.001). The mean RV GLS also improved at all serial timepoints (baseline, 24 hrs, 1 month, and 3 months) with values of 19.22%, 19.85%, 20.70%, and 22.23%, respectively (p=0.0001). As compared to surgery, LV GLS and RV GLS were much better in the device group (average LV GLS at 24 hrs, 1 month, and 3 months: 16.54% vs 17.98%, 17.34% vs 18.92%, and 18.80% vs 19.96%, respectively; mean RV GLS at 24 hrs, 1, and 3 months: 17.83% vs 21.78%, 18.73% vs 22.58%, and 20.70% vs 23.70%, respectively).

Conclusions: This GLS study demonstrates significant reverse remodelling of both the RV and LV after ASD closure. Device closure was associated with superior strain rate recovery compared to surgery at the 3-month midterm follow-up.