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Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/S2772-9303(24)02088-X

引用次数: 0

Balancing Affordability and Need: Should We Use Renal Denervation in Hypertension Management? 平衡经济承受能力与需求：我们是否应该在高血压治疗中使用肾脏去神经支配？

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102248

Lucas Lauder MD , Thilo Burkard MD , Felix Mahfoud MD, MA

引用次数: 0

A Single-Center Review of Clinical Outcomes After Transcatheter Relief of Superior Vena Cava Stenosis in a Pediatric and Young Adult Population 经导管缓解小儿和青少年上腔静脉狭窄后临床疗效的单中心综述

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102245

Sarah Pradhan MD, MSc , Sarosh P. Batlivala MD, MSCI , Luisa Raga Pombo MD , Nicholas Ollberding PhD , Zhiqian Gao PhD, MSPH , Nicholas Szugye MD, MSc , Shabana Shahanavaz MBBS , Russel Hirsch MD

Background

The suspected etiology of superior vena cava (SVC) obstruction is predominantly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, although there is a paucity of published data in pediatrics. We aim to describe patient characteristics and clinical outcomes after transcatheter SVC intervention at a single-center pediatric quaternary care center.

Methods

Single-center, retrospective study of all pediatric and young adult patients who underwent transcatheter SVC intervention from December 2006 to January 2020. SVC gradients and changes in vessel diameter were compared using paired-sample t-tests. Balloon and stent cohorts were compared using the Wilcoxon rank sum test or Fisher exact χ² test. Reintervention was compared between balloon and stent cohorts using the McNemar test to determine if initial procedural type was associated with reintervention. Time to reintervention was compared between balloon vs stent cohorts using Kaplan-Meier survival analysis with a log-rank test.

Results

A total of 42 patients (median age, 1.5 years; IQR, 0.31-15; 64.2% male) underwent 81 procedures with 1 minor complication and no mortality attributed to the procedure. Most (71.4%) patients were asymptomatic. Affected patient subgroups include those with a history of central venous line (92.9%), congenital heart disease (76.2%), postorthotopic heart transplant (42.9%), post-ECMO (31.0%), and history of surgical baffling or SVC surgery (9.5%). Those who underwent initial balloon angioplasty were significantly younger and smaller than those with an initial stent. Significantly lower pressure gradients and larger SVC dimensions were achieved after stenting. The majority of patients (54.8%) resolved after initial balloon angioplasty and reintervention rates were similar between initial balloon angioplasty and stent, although reintervention trended toward being earlier after the balloon.

Conclusions

Transcatheter SVC intervention in pediatrics is acutely effective and safe in relieving SVC obstruction in all subgroups. Reintervention rates are similar between balloon and stenting, with balloon tending to be earlier, with the majority resolving after initial intervention. Further research is necessary to investigate the most effective transcatheter intervention for each patient subgroup.

背景上腔静脉（SVC）阻塞的疑似病因主要是先天性的。经导管介入治疗可缓解狭窄，并具有良好的长期效果，但在儿科领域发表的数据很少。方法对 2006 年 12 月至 2020 年 1 月期间接受经导管 SVC 介入治疗的所有儿童和年轻成人患者进行单中心回顾性研究。采用配对样本t检验比较SVC梯度和血管直径的变化。使用 Wilcoxon 秩和检验或 Fisher exact χ2 检验比较球囊和支架队列。使用 McNemar 检验比较球囊和支架队列之间的再介入情况，以确定初始手术类型是否与再介入有关。结果共有 42 名患者（中位年龄为 1.5 岁；IQR 为 0.31-15；64.2% 为男性）接受了 81 例手术，其中 1 例为轻微并发症，无死亡病例。大多数患者（71.4%）无症状。受影响的患者亚群包括有中心静脉置管病史者（92.9%）、先天性心脏病患者（76.2%）、异位心脏移植术后患者（42.9%）、ECMO术后患者（31.0%）以及有外科挡板或SVC手术史者（9.5%）。初次接受球囊血管成形术的患者明显比初次接受支架植入术的患者更年轻、更瘦小。支架植入术后，压力梯度明显降低，SVC尺寸明显增大。大多数患者（54.8%）在最初的球囊血管成形术后病情得到缓解，最初的球囊血管成形术和支架术的再介入率相似，但球囊术后再介入的时间有提前的趋势。球囊和支架置入术的再介入率相似，球囊置入术的再介入率更早，大多数患者在初次介入后就能解决问题。有必要开展进一步的研究，探讨针对不同患者亚群最有效的经导管介入治疗方法。

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引用次数: 0

Corrigenda to Abstracts in issue 3/5S of the Journal of the Society for Cardiovascular Angiography & Interventions 心血管血管造影和介入学会杂志》第 3/5S 期摘要勘误表

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102246

引用次数: 0

Contemporary Saphenous Vein Graft Intervention: New Insights but Still More Questions 当代无隐静脉移植介入治疗：新见解但仍有更多问题

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102282

Giorgio A. Medranda MD , Sandeep Nathan MD, MSc

引用次数: 0

Catheter-Based Radiofrequency Renal Denervation in the United States: A Cost-Effectiveness Analysis Based on Contemporary Evidence 美国基于导管的射频肾脏去神经支配：基于当代证据的成本效益分析

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102234

David E. Kandzari MD , Khoa N. Cao MBBS, MPH, MS , Anne M. Ryschon MA , Andrew S.P. Sharp MBChB, MD , Jan B. Pietzsch PhD

Background

Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved as an adjunctive treatment for hypertensive patients without adequate blood pressure control. This study assessed the cost-effectiveness of RF RDN in the United States based on contemporary clinical evidence.

Methods

A decision-analytic Markov model projected costs, quality-adjusted life years (QALY), and clinical events for an active cohort treated with RF RDN and a control cohort treated with standard-of-care (defined as 1, 2, or 3 antihypertensive medications). Cohort demographics and therapy effect were derived from the SPYRAL HTN-ON MED study demonstrating an absolute 9.9 mm Hg reduction in office systolic blood pressure and 4.9 mm Hg reduction compared with sham control. Clinical event risk reduction from blood pressure lowering was based on a meta-regression of 47 hypertension trials. The incremental cost-effectiveness ratio was evaluated against willingness-to-pay thresholds of $50,000 per QALY (high value) and $150,000 per QALY (intermediate value). Extensive scenario and sensitivity analyses were conducted to assess robustness of the findings.

Results

RF RDN yielded a significant risk reduction in clinical events (0.80 for stroke, 0.88 for myocardial infarction, and 0.85 for cardiovascular death over 10 years). Over lifetime, RF RDN added 0.34 QALY at an additional cost of $11,275, leading to an incremental cost-effectiveness ratio of $32,732 per QALY. The cost-effectiveness of RF RDN was robust across a broad range of scenarios and sensitivity analyses.

Conclusions

Based on a lifetime projection, catheter-based RF RDN is a cost-effective, high-value intervention for hypertensive patients with uncontrolled hypertension.

背景导管射频肾脏去神经支配（RF RDN）最近被批准作为血压控制不佳的高血压患者的辅助治疗手段。该研究根据当代临床证据评估了 RF RDN 在美国的成本效益。方法一个决策分析马尔可夫模型预测了接受 RF RDN 治疗的活跃队列和接受标准护理（定义为 1、2 或 3 种降压药）治疗的对照队列的成本、质量调整生命年 (QALY) 和临床事件。队列人口统计学和治疗效果来自 SPYRAL HTN-ON MED 研究，该研究显示，与假对照组相比，诊室收缩压绝对值降低了 9.9 mm Hg，降低了 4.9 mm Hg。降压带来的临床事件风险降低是基于 47 项高血压试验的元回归结果。根据每 QALY 5 万美元（高值）和每 QALY 15 万美元（中值）的支付意愿阈值对增量成本效益比进行了评估。结果RF RDN显著降低了临床事件风险（10年内中风风险为0.80，心肌梗死风险为0.88，心血管死亡风险为0.85）。在整个生命周期中，RF RDN 增加了 0.34 QALY，额外成本为 11,275 美元，因此每 QALY 的增量成本效益比为 32,732 美元。RF RDN 的成本效益在各种情况和敏感性分析中都是稳健的。结论根据终生预测，对于未得到控制的高血压患者而言，基于导管的 RF RDN 是一项具有成本效益的高价值干预措施。

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引用次数: 0

Is Robotic-Assisted Bypass Grafting Really Better Than PCI When It Comes to LAD CTO? 就 LAD CTO 而言，机器人辅助旁路移植术真的比 PCI 更好吗？

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102385

Michael Arustamyan MD, Rimmy Farrakhan MD, Robert T. Pyo MD

引用次数: 0

Complete Obstruction of Superior Mustard Baffle: Electrosurgical Transcatheter Recanalization—First-in-Human Case Report 上芥蒂挡板完全阻塞：电外科经导管再通术--首例人体病例报告

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-10-01 DOI: 10.1016/j.jscai.2024.102280

Jessica Heibel MD , Asad Qadir MD , Odai Alhasanat MD , Paige Castaneda MSN, RN , Rolando Zamora-Salinas MD

Systemic venous baffle obstruction is a long-term complication that can arise from the Mustard operation. We outline a novel percutaneous approach to a long segment, complete occlusion of a Mustard baffle using electrosurgical recanalization and stenting.

全身静脉挡板阻塞是芥子气手术可能引起的一种长期并发症。我们概述了一种新颖的经皮方法，该方法利用电外科再通路和支架来治疗长段、完全闭塞的 Mustard 挡板。

引用次数: 0

Efficacy of Zwolle Score in Predicting Outcomes of Patients With ST-Segment Elevation Myocardial Infarction. Zwolle评分预测st段抬高型心肌梗死预后的疗效。

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-09-26 eCollection Date: 2024-12-01 DOI: 10.1016/j.jscai.2024.102389

Akshay Machanahalli Balakrishna, Khansa Ahmad, Melvin G Joice, Alexander G Truesdell, Syed Tanveer Rab, Jinnette Dawn Abbott, Saraschandra Vallabhajosyula

引用次数: 0

Peak Procedural ACT Is Associated With All-Cause Mortality After Femoral Access PCI. 手术性ACT峰值与股骨PCI术后全因死亡率相关。

Journal of the Society for Cardiovascular Angiography & Interventions

Pub Date : 2024-09-23 eCollection Date: 2024-12-01 DOI: 10.1016/j.jscai.2024.102387

Revathy Sampath-Kumar, Ori Ben-Yehuda, Belal Al Khiami, Lawrence Ang, Anna Melendez, Ryan Reeves, Ehtisham Mahmud

Background: A minimum threshold activated clotting time (ACT) to guide heparin dosing during percutaneous coronary intervention (PCI) is associated with lower ischemic complications. However, data are variable regarding the risk of high ACT levels. The aim of this study was to assess the impact of peak procedural ACT on complications and mortality for transfemoral and transradial access PCI.

Methods: The UC San Diego Health National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent native vessel PCI from January 2007 to September 2022. Coronary artery bypass graft patients and those who received bivalirudin were excluded. Complications and all-cause mortality at 30 days and 1-year post-PCI were assessed by ACT tertile.

Results: A total of 2473 patients (age 65 ± 12 years; 74% male) undergoing PCI with 53% femoral and 47% radial access were included. The majority (82%) had 1-vessel coronary artery disease with heterogeneous clinical presentations (21.8% ST-elevation myocardial infarction, 25.4% non-ST-elevation myocardial infarction, 4.9% unstable angina, 33.8% stable angina, 3.4% atypical chest pain, 10.7% other indication for PCI). With femoral access, patients in the third tertile (ACT ≥ 275) had significantly higher all-cause mortality at 30 days (5.3% vs 2.7% vs 0.9%; P < .001), 6 months (6.3% vs 4.0% vs 2.0%; P = .007), and 1 year (9.0% vs 6.0% vs 2.7%; P < .001) compared to the second (ACT 228-275) and first tertile (ACT ≤ 228), respectively. A 30-day landmark analysis revealed that there was no difference in all-cause mortality beyond 30 days (3.9% vs 3.4% vs 1.8%; P = .176). There were increased bleeding complications in the highest tertile (12.8% vs 9.8% vs 7.5%; P = .034) and a higher need for blood products (10.4% vs 6.7% vs 5.4%; P = .014). There was no difference in ischemic major adverse cardiovascular events specifically periprocedural myocardial infarction or stroke between tertiles. There was no difference in clinical outcomes by peak ACT for patients who had radial access.

Conclusions: Higher ACT with transfemoral access PCI was associated with increased 30-day mortality, bleeding complications, and need for blood products post-PCI.

背景：在经皮冠状动脉介入治疗（PCI）中，指导肝素剂量的最小阈值激活凝血时间（ACT）与较低的缺血性并发症相关。然而，关于高ACT水平风险的数据是可变的。本研究的目的是评估程序性ACT峰值对经股动脉和经桡动脉PCI手术并发症和死亡率的影响。方法：使用加州大学圣地亚哥分校健康国家心血管数据登记处（CathPCI登记处）获取2007年1月至2022年9月接受原生血管PCI治疗的患者的数据。排除冠状动脉旁路移植术患者和接受比伐鲁定治疗的患者。采用ACT方法评估pci术后30天和1年的并发症和全因死亡率。结果：共2473例患者(年龄65±12岁；74%男性)接受PCI，其中53%为股骨通路，47%为桡骨通路。大多数患者（82%）患有单支冠状动脉疾病，临床表现不均匀（21.8% st段抬高型心肌梗死，25.4%非st段抬高型心肌梗死，4.9%不稳定型心绞痛，33.8%稳定型心绞痛，3.4%不典型胸痛，10.7%其他PCI指征）。对于股骨通路，第三阶段（ACT≥275）的患者在30天的全因死亡率明显更高(5.3% vs 2.7% vs 0.9%；P < 0.001)， 6个月(6.3% vs 4.0% vs 2.0%；P = .007)和1年(9.0% vs 6.0% vs 2.7%；P < 0.001)，分别高于第二分位（ACT 228 ~ 275）和第一分位（ACT≤228）。一项30天的里程碑式分析显示，30天以上的全因死亡率没有差异(3.9% vs 3.4% vs 1.8%；P = .176)。最高不育组出血并发症增加(12.8% vs 9.8% vs 7.5%；P = 0.034)和更高的血液制品需求(10.4% vs 6.7% vs 5.4%；P = .014)。各组间缺血性主要不良心血管事件，特别是围手术期心肌梗死或卒中发生率无差异。桡骨通路患者的临床结果与ACT峰值没有差异。结论：经股通道PCI术中ACT升高与PCI术后30天死亡率、出血并发症和血液制品需求增加相关。

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