Pub Date : 2024-12-21DOI: 10.1016/j.amjcard.2024.12.021
Piera Capranzano MD, PhD , Paolo Calabrò MD, PhD , Giuseppe Musumeci MD, PhD , Carlo Di Mario MD, PhD , Fabio Chirillo MD , Cristina Rolfo MD, PhD , Alberto Menozzi MD, PhD , Maurizio Menichelli MD , Diego Maffeo MD , Giuseppe Talanas MD , Marco Ferlini MD , Marco Contarini MD , Valerio Lanzilotti MD , Leonardo De Luca MD, PhD
Outcome data on using cangrelor in older patients are limited. This post hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes with the transition from cangrelor to any oral P2Y12 inhibitors in age-stratified subgroups (≥75 years—older, <75 years—younger) of patients with acute coronary syndrome who underwent percutaneous coronary intervention (PCI). Of 995 patients, 215 (21.6%) were older, 115 of whom (11.6%) were aged ≥80 years. Presentation with ST-elevation myocardial infarction was less frequent in older than in younger patients (52.6% vs 62.1%, p = 0.0119). At 30 days after PCI, rates of the study's primary end point of overall bleeding defined according to the Bleeding Academic Research Consortium were not significantly different between the 2 age subgroups (4.6% in the younger vs 7.4% in the older, p = 0.1179). Rates of major adverse cardiac events, defined as the composite of death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis, were significantly lower in younger than in older patients (0.9% vs 3.3%, p = 0.0170). Intraprocedural thrombotic events occurring in the 48 hours after PCI arose in similar proportions in the subgroups (1.4% vs 1.4%, p = 1.000). In conclusion, these data suggest that using cangrelor with transition to any oral P2Y12 inhibitor is a safe and effective antithrombotic treatment in older patients who undergo PCI for acute coronary syndrome in the setting of routine clinical practice.
{"title":"Use of Cangrelor in Older Patients: Findings from the itAlian pRospective Study on CANGrELOr Study","authors":"Piera Capranzano MD, PhD , Paolo Calabrò MD, PhD , Giuseppe Musumeci MD, PhD , Carlo Di Mario MD, PhD , Fabio Chirillo MD , Cristina Rolfo MD, PhD , Alberto Menozzi MD, PhD , Maurizio Menichelli MD , Diego Maffeo MD , Giuseppe Talanas MD , Marco Ferlini MD , Marco Contarini MD , Valerio Lanzilotti MD , Leonardo De Luca MD, PhD","doi":"10.1016/j.amjcard.2024.12.021","DOIUrl":"10.1016/j.amjcard.2024.12.021","url":null,"abstract":"<div><div>Outcome data on using cangrelor in older patients are limited. This post hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes with the transition from cangrelor to any oral P2Y<sub>12</sub> inhibitors in age-stratified subgroups (≥75 years—older, <75 years—younger) of patients with acute coronary syndrome who underwent percutaneous coronary intervention (PCI). Of 995 patients, 215 (21.6%) were older, 115 of whom (11.6%) were aged ≥80 years. Presentation with ST-elevation myocardial infarction was less frequent in older than in younger patients (52.6% vs 62.1%, p = 0.0119). At 30 days after PCI, rates of the study's primary end point of overall bleeding defined according to the Bleeding Academic Research Consortium were not significantly different between the 2 age subgroups (4.6% in the younger vs 7.4% in the older, p = 0.1179). Rates of major adverse cardiac events, defined as the composite of death, myocardial infarction, ischemia-driven revascularization, and stent thrombosis, were significantly lower in younger than in older patients (0.9% vs 3.3%, p = 0.0170). Intraprocedural thrombotic events occurring in the 48 hours after PCI arose in similar proportions in the subgroups (1.4% vs 1.4%, p = 1.000). In conclusion, these data suggest that using cangrelor with transition to any oral P2Y12 inhibitor is a safe and effective antithrombotic treatment in older patients who undergo PCI for acute coronary syndrome in the setting of routine clinical practice.</div><div>Clinical Trial Registration Number: NCT04471870.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 31-37"},"PeriodicalIF":2.3,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-20DOI: 10.1016/j.amjcard.2024.12.017
Ozgur Selim Ser MD , Deniz Mutlu MD , Michaella Alexandrou MD , Dimitrios Strepkos MD , Pedro E.P. Carvalho MD , Oleg Krestyaninov MD , Dmitrii Khelimskii MD , Barkin Kultursay MD , Ali Karagoz MD , Ufuk Yildirim MD , Korhan Soylu MD , Mahmut Uluganyan MD , Olga Mastrodemos BA , Bavana V. Rangan BDS, MPH , Sandeep Jalli DO , Konstantinos Voudris MD, PhD , M. Nicholas Burke MD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD
The outcomes of bifurcation percutaneous coronary intervention (PCI) in patients aged ≥80 and ≥90 years have received limited study. We compared the procedural characteristics and outcomes of bifurcation PCIs in patients aged ≥80 years and those aged <80 years in a multicenter registry. Of 1,253 patients who underwent 1,262 bifurcation PCIs between 2014 and 2024 at 6 centers, 194 (15%) were aged ≥80 and ≥90 years. These patients were more likely to have atrial fibrillation (30 vs 12%, p <0.001) and heart failure (39 vs 19%, p <0.001) than were younger patients. They were more likely to have bifurcation lesions with greater angiographic complexity, including severe calcification (38% vs 14%, p <0.001) and left main coronary artery (30% vs 0%, p <0.001) and left anterior descending artery (80% vs 70%, p <0.001) stenoses. Patients aged ≥80 years had lower procedural success (87% vs 92%, p = 0.026) and greater incidence of in-hospital major adverse cardiovascular events (MACE, 8.3% vs 3.4%, p = 0.002) and death (3.1% vs 1%, p = 0.035). During a median follow-up of 903 days, patients aged ≥80 years had greater follow-up MACE (47.3% vs 28.1%, p <0.001), mortality (38.4% vs 10.9%, p <0.001), and stroke (6.8% vs 2.9%, p = 0.018) than did younger patients. In multivariable analysis, follow-up MACE was independently associated with age ≥80 years (hazard ratio 1.46, 95% confidence intervals 1.05 to 2.04, p = 0.026). In conclusion, success rates were lower than those in younger patients and the risk of complications greater in patients aged ≥80 years who underwent bifurcation PCI.
{"title":"Bifurcation Percutaneous Coronary Intervention in Patients Aged ≥80 Years: Insights from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions Registry","authors":"Ozgur Selim Ser MD , Deniz Mutlu MD , Michaella Alexandrou MD , Dimitrios Strepkos MD , Pedro E.P. Carvalho MD , Oleg Krestyaninov MD , Dmitrii Khelimskii MD , Barkin Kultursay MD , Ali Karagoz MD , Ufuk Yildirim MD , Korhan Soylu MD , Mahmut Uluganyan MD , Olga Mastrodemos BA , Bavana V. Rangan BDS, MPH , Sandeep Jalli DO , Konstantinos Voudris MD, PhD , M. Nicholas Burke MD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2024.12.017","DOIUrl":"10.1016/j.amjcard.2024.12.017","url":null,"abstract":"<div><div>The outcomes of bifurcation percutaneous coronary intervention (PCI) in patients aged ≥80 and ≥90 years have received limited study. We compared the procedural characteristics and outcomes of bifurcation PCIs in patients aged ≥80 years and those aged <80 years in a multicenter registry. Of 1,253 patients who underwent 1,262 bifurcation PCIs between 2014 and 2024 at 6 centers, 194 (15%) were aged ≥80 and ≥90 years. These patients were more likely to have atrial fibrillation (30 vs 12%, p <0.001) and heart failure (39 vs 19%, p <0.001) than were younger patients. They were more likely to have bifurcation lesions with greater angiographic complexity, including severe calcification (38% vs 14%, p <0.001) and left main coronary artery (30% vs 0%, p <0.001) and left anterior descending artery (80% vs 70%, p <0.001) stenoses. Patients aged ≥80 years had lower procedural success (87% vs 92%, p = 0.026) and greater incidence of in-hospital major adverse cardiovascular events (MACE, 8.3% vs 3.4%, p = 0.002) and death (3.1% vs 1%, p = 0.035). During a median follow-up of 903 days, patients aged ≥80 years had greater follow-up MACE (47.3% vs 28.1%, p <0.001), mortality (38.4% vs 10.9%, p <0.001), and stroke (6.8% vs 2.9%, p = 0.018) than did younger patients. In multivariable analysis, follow-up MACE was independently associated with age ≥80 years (hazard ratio 1.46, 95% confidence intervals 1.05 to 2.04, p = 0.026). In conclusion, success rates were lower than those in younger patients and the risk of complications greater in patients aged ≥80 years who underwent bifurcation PCI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 24-30"},"PeriodicalIF":2.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-20DOI: 10.1016/j.amjcard.2024.10.034
Peiren Zhang, Bin Luo, Peilan Zhang, Xiaoqing Yu, Xiaoyue Long, Yuxuan Du, Haozhi Tian, Liwen Wang
Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis after stroke. However, the impact of a single SVD, especially cumulative SVD burden, on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This study evaluated the occurrence of SVD in patients with AIS who were treated with intravenous thrombolytic therapy using multimodal magnetic resonance imaging. The study involved patients with AIS who received multimodal magnetic resonance imaging scans before receiving intravenous thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA). Validated scales were used to document each SVD characteristic and measure the overall impact of SVD using an extensive scoring method. Functional outcomes were evaluated using the modified Rankin scale score within a 3-month time frame, with poor outcomes categorized as a modified Rankin scale score of ≥2. Using a logistic regression model while accounting for potential confounding variables, we examined the relation among individual SVD characteristics, the overall SVD impact, and patient outcomes. In total, 282 patients were included. Severe white matter hyperintensities and lacunas were linked to negative clinical results in patients with SVD, even after accounting for age, National Institutes of Health Stroke Scale score at admission, onset to treatment time, and hypertension (odds ratio 2.394, 95% confidence interval 1.246 to 4.6; odds ratio 2.3, 95% confidence interval 1.214 to 4.36, respectively). When evaluating the SVD global burden, a strong association between the SVD score and negative clinical results was observed, except for cases with an SVD score of 2 points. The findings suggest that the presence of pre-existing SVD, particularly characterized by the severity of white matter changes and lacunes, has a detrimental impact on the clinical outcomes of patients with ischemic stroke receiving intravenous rt-PA treatment. In conclusion, this information could be useful for predicting the prognosis of patients with stroke who underwent intravenous rt-PA therapy.
个体脑血管疾病（SVD）标志物独立预测脑卒中后不良预后。然而，单一SVD，特别是累积SVD负担对急性缺血性卒中（AIS）静脉溶栓后预后的影响尚不清楚。本研究通过多模态MRI成像评估接受静脉溶栓治疗的AIS患者小血管病变（SVD）的发生。该研究涉及在接受rt-PA静脉溶栓治疗前接受多模态MRI扫描的AIS患者。使用经过验证的量表记录每个小血管疾病的特征，并使用广泛的评分方法测量SVD的总体影响。在3个月的时间框架内，使用改进的Rankin量表（mRS）评分评估功能结局，不良结局分类为mRS评分≥2。在考虑潜在混杂变量的同时，我们利用逻辑回归模型检验了个体SVD特征、总体SVD影响和患者结局之间的关系。共纳入282例患者。严重的白质高信号（WMH）和腔隙与SVD患者的阴性临床结果相关，即使考虑到年龄、入院时NIHSS评分、发病至治疗时间（OTT）和高血压（OR分别为2.394,95% CI 1.246-4.6和OR 2.3, 95% CI 1.214-4.36）。在评估SVD总体负担时，除了SVD评分为2分的病例外，观察到SVD评分与阴性临床结果之间存在很强的相关性。研究结果提示，缺血性脑卒中患者接受静脉注射rt-PA治疗后，原有SVD的存在，特别是以白质改变和腔隙的严重程度为特征，对其临床结果有不利影响。总之，这一信息可用于预测接受静脉rt-PA治疗的脑卒中患者的预后。
{"title":"Impact of Small Vessel Disease on Patient Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke.","authors":"Peiren Zhang, Bin Luo, Peilan Zhang, Xiaoqing Yu, Xiaoyue Long, Yuxuan Du, Haozhi Tian, Liwen Wang","doi":"10.1016/j.amjcard.2024.10.034","DOIUrl":"10.1016/j.amjcard.2024.10.034","url":null,"abstract":"<p><p>Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis after stroke. However, the impact of a single SVD, especially cumulative SVD burden, on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This study evaluated the occurrence of SVD in patients with AIS who were treated with intravenous thrombolytic therapy using multimodal magnetic resonance imaging. The study involved patients with AIS who received multimodal magnetic resonance imaging scans before receiving intravenous thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA). Validated scales were used to document each SVD characteristic and measure the overall impact of SVD using an extensive scoring method. Functional outcomes were evaluated using the modified Rankin scale score within a 3-month time frame, with poor outcomes categorized as a modified Rankin scale score of ≥2. Using a logistic regression model while accounting for potential confounding variables, we examined the relation among individual SVD characteristics, the overall SVD impact, and patient outcomes. In total, 282 patients were included. Severe white matter hyperintensities and lacunas were linked to negative clinical results in patients with SVD, even after accounting for age, National Institutes of Health Stroke Scale score at admission, onset to treatment time, and hypertension (odds ratio 2.394, 95% confidence interval 1.246 to 4.6; odds ratio 2.3, 95% confidence interval 1.214 to 4.36, respectively). When evaluating the SVD global burden, a strong association between the SVD score and negative clinical results was observed, except for cases with an SVD score of 2 points. The findings suggest that the presence of pre-existing SVD, particularly characterized by the severity of white matter changes and lacunes, has a detrimental impact on the clinical outcomes of patients with ischemic stroke receiving intravenous rt-PA treatment. In conclusion, this information could be useful for predicting the prognosis of patients with stroke who underwent intravenous rt-PA therapy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The Optimal Intravascular Ultrasound (OPTIVUS)-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 528 patients (52.0%) without CKD (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2), 391 patients (38.5%) with moderate CKD (60 >eGFR ≥30 ml/min/1.73 m2), and 96 patients (9.5%) with severe CKD (eGFR <30 ml/min/1.73 m2 or hemodialysis). The rate of meeting OPTIVUS criteria was not different across the 3 groups. The cumulative 1-year incidence of the primary end point was 9.1%, 9.0%, and 22.1% in patients without CKD, with moderate CKD, and with severe CKD, respectively (log-rank p <0.001). After adjusting confounders, the higher risk of severe CKD relative to no CKD remained significant for the primary end point (hazard ratio 2.42, 95% confidence interval 1.30 to 4.25, p = 0.01), whereas the risk of moderate CKD relative to no CKD was not significant for the primary end point (hazard ratio 0.97, 95% confidence interval 0.61 to 1.53, p = 0.88). In conclusion, in patients who underwent multivessel IVUS-guided PCI, and were managed with contemporary clinical practice, 1-year clinical outcomes were worse in patients with severe CKD, whereas 1-year clinical outcomes were not different between patients without CKD and with moderate CKD.
{"title":"Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and Chronic Kidney Disease","authors":"Ko Yamamoto MD , Hiroki Shiomi MD , Ryusuke Nishikawa MD , Takeshi Morimoto MD, MPH , Akiyoshi Miyazawa MD , Toru Naganuma MD , Satoru Suwa MD , Takanari Fujita MD , Takenori Domei MD , Shojiro Tatsushima MD , Yukihiro Hamaguchi MD , Yuji Nishimoto MD , Kensho Matsuda MD , Yohei Takayama MD , Jun Kuribara MD , Hidekuni Kirigaya MD , Kohei Yoneda MD , Masataka Shigetoshi MD , Takafumi Yokomatsu MD , Kazushige Kadota MD , Takeshi Kimura MD","doi":"10.1016/j.amjcard.2024.12.020","DOIUrl":"10.1016/j.amjcard.2024.12.020","url":null,"abstract":"<div><div>There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The Optimal Intravascular Ultrasound (OPTIVUS)-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 528 patients (52.0%) without CKD (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m<sup>2</sup>), 391 patients (38.5%) with moderate CKD (60 >eGFR ≥30 ml/min/1.73 m<sup>2</sup>), and 96 patients (9.5%) with severe CKD (eGFR <30 ml/min/1.73 m<sup>2</sup> or hemodialysis). The rate of meeting OPTIVUS criteria was not different across the 3 groups. The cumulative 1-year incidence of the primary end point was 9.1%, 9.0%, and 22.1% in patients without CKD, with moderate CKD, and with severe CKD, respectively (log-rank p <0.001). After adjusting confounders, the higher risk of severe CKD relative to no CKD remained significant for the primary end point (hazard ratio 2.42, 95% confidence interval 1.30 to 4.25, p = 0.01), whereas the risk of moderate CKD relative to no CKD was not significant for the primary end point (hazard ratio 0.97, 95% confidence interval 0.61 to 1.53, p = 0.88). In conclusion, in patients who underwent multivessel IVUS-guided PCI, and were managed with contemporary clinical practice, 1-year clinical outcomes were worse in patients with severe CKD, whereas 1-year clinical outcomes were not different between patients without CKD and with moderate CKD.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 20-27"},"PeriodicalIF":2.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-17DOI: 10.1016/j.amjcard.2024.12.019
Ariane Lemieux MD , Helen Hashemi MD , Charles S. Roberts MD , Jeffrey M. Schussler MD
{"title":"Acute Ascending Aortic Dissection Masquerading as an ST Elevation Myocardial Infarction","authors":"Ariane Lemieux MD , Helen Hashemi MD , Charles S. Roberts MD , Jeffrey M. Schussler MD","doi":"10.1016/j.amjcard.2024.12.019","DOIUrl":"10.1016/j.amjcard.2024.12.019","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"237 ","pages":"Pages 83-85"},"PeriodicalIF":2.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.amjcard.2024.12.018
William W. O'Neill MD
{"title":"Routine Usage of Impella for High-Risk Percutaneous Coronary Intervention","authors":"William W. O'Neill MD","doi":"10.1016/j.amjcard.2024.12.018","DOIUrl":"10.1016/j.amjcard.2024.12.018","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 18-19"},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.amjcard.2024.12.015
Filippo Luca Gurgoglione MD , Dario Gattuso Eng , Antonio Greco MD , Giorgio Benatti MD , Giampaolo Niccoli MD, PhD , Bernardo Cortese MD
Percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) has been expanding progressively in recent years. Convincing evidence demonstrated the ability of some DCB to promote positive vessel remodeling, with potential clinical benefits at follow-up. When PCI with DCB results in suboptimal angiographic results (residual stenosis >30% or type C to F dissection), bailout stenting (BS) implantation is recommended to mitigate the risk of abrupt vessel occlusion or restenosis. However, clinical studies focusing on BS during PCI with DCB are scarce. This study aimed to compare the 2-year clinical outcomes of patients requiring BS with those who underwent sirolimus-coated balloon (SCB)–only PCI and investigate clinical and angiographic predictors of BS.
We conducted a post hoc analysis of the prospective, multicenter, thE All-comers Sirolimus-coaTed BallOon eURopeaN rEgistry (EASTBOURNE) study. The overall cohort was stratified into 2 study groups: patients requiring BS versus those who underwent SCB-only PCI.
The primary end point was target lesion revascularization (TLR) at the 24-month follow-up. Propensity score matching was used to balance clinical and procedural characteristics between the 2 study groups.
The study population included 2,084 patients for a total of 2,318 treated lesions. Of them, 181 (7.8%) required BS for suboptimal results during PCI with SCB. Coronary lesions requiring BS were more frequently de novo stenoses (p = 0.016), longer (p = 0.012), and had a smaller median reference vessel diameter (p <0.001). At 24 months, TLR occurred in 133 (6.4%) patients. The 2 study groups experienced a similar rate of TLR in the unmatched cohort (6.3% in the SCB-only group vs 7.3% in the BS group, p = 0.683) and after propensity score matching analysis (4.2% in the SCB-only group vs 8.5% in the BS group, p = 0.223). These results were consistent when considering subpopulations with de novo lesions, in-stent restenosis, and large and small vessel disease. Revascularization of de novo lesions and smoking habit were independent positive predictors of BS, whereas the SCB inflation time was an independent negative predictor of BS by multivariable logistic analysis in the overall population. In contrast, we did not record any case of vessel thrombosis during follow-up.
In conclusion, BS was associated with similar 2-year outcomes compared with SCB-only PCI and, thus, appear to be a safe bailout strategy for suboptimal angiographic results after DCB angioplasty.
{"title":"Predictors and Long-Term Prognostic Significance of Bailout Stenting During Percutaneous Coronary Interventions With Sirolimus-Coated Balloon: A Subanalysis of the Eastbourne Study","authors":"Filippo Luca Gurgoglione MD , Dario Gattuso Eng , Antonio Greco MD , Giorgio Benatti MD , Giampaolo Niccoli MD, PhD , Bernardo Cortese MD","doi":"10.1016/j.amjcard.2024.12.015","DOIUrl":"10.1016/j.amjcard.2024.12.015","url":null,"abstract":"<div><div>Percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) has been expanding progressively in recent years. Convincing evidence demonstrated the ability of some DCB to promote positive vessel remodeling, with potential clinical benefits at follow-up. When PCI with DCB results in suboptimal angiographic results (residual stenosis >30% or type C to F dissection), bailout stenting (BS) implantation is recommended to mitigate the risk of abrupt vessel occlusion or restenosis. However, clinical studies focusing on BS during PCI with DCB are scarce. This study aimed to compare the 2-year clinical outcomes of patients requiring BS with those who underwent sirolimus-coated balloon (SCB)–only PCI and investigate clinical and angiographic predictors of BS.</div><div>We conducted a post hoc analysis of the prospective, multicenter, thE All-comers Sirolimus-coaTed BallOon eURopeaN rEgistry (EASTBOURNE) study. The overall cohort was stratified into 2 study groups: patients requiring BS versus those who underwent SCB-only PCI.</div><div>The primary end point was target lesion revascularization (TLR) at the 24-month follow-up. Propensity score matching was used to balance clinical and procedural characteristics between the 2 study groups.</div><div>The study population included 2,084 patients for a total of 2,318 treated lesions. Of them, 181 (7.8%) required BS for suboptimal results during PCI with SCB. Coronary lesions requiring BS were more frequently de novo stenoses (p = 0.016), longer (p = 0.012), and had a smaller median reference vessel diameter (p <0.001). At 24 months, TLR occurred in 133 (6.4%) patients. The 2 study groups experienced a similar rate of TLR in the unmatched cohort (6.3% in the SCB-only group vs 7.3% in the BS group, p = 0.683) and after propensity score matching analysis (4.2% in the SCB-only group vs 8.5% in the BS group, p = 0.223). These results were consistent when considering subpopulations with de novo lesions, in-stent restenosis, and large and small vessel disease. Revascularization of de novo lesions and smoking habit were independent positive predictors of BS, whereas the SCB inflation time was an independent negative predictor of BS by multivariable logistic analysis in the overall population. In contrast, we did not record any case of vessel thrombosis during follow-up.</div><div>In conclusion, BS was associated with similar 2-year outcomes compared with SCB-only PCI and, thus, appear to be a safe bailout strategy for suboptimal angiographic results after DCB angioplasty.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 68-74"},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.amjcard.2024.12.014
Omar Abdel-Razek MD MSc , Nhi Vo MD , Jeffrey Weinstein MD , Cyrus A. Kholdani MD , David Liu MD , Roger J. Laham MD
Our study presents cases demonstrating the technique and safety of percutaneous occlusion of adult patients with partial anomalous pulmonary venous return (PAPVR). PAPVR is a rare condition that is traditionally treated surgically. Percutaneous interventions are rarely reported. Most patients with PAPVR present in youth and are surgical candidates. In nonsurgical candidates or those who prefer a percutaneous approach, there are little available data to guide therapy. Patients with PAPVR and indications for intervention were treated with percutaneous techniques to occlude anomalous venous return and relieve the hemodynamic effects of these anomalies. Several different percutaneous techniques were used, sometimes in tandem to achieve occlusion. Percutaneous closure was achieved successfully in 3 cases, with improvement in symptoms and in hemodynamic status. A total of 2 patients achieved positive remodeling in right chamber sizes. In conclusion, percutaneous occlusion of PAPVR is feasible, with a multitude of transcatheter options available. This represents a novel approach to the adult patient with PAPVR, specifically, those without a surgical option.
Condensed Abstract: Partial anomalous pulmonary venous return is a rare congenital condition, which is traditionally treated surgically. Adult patients with congenital heart disease are potentially nonsurgical candidates and, as such, benefit from percutaneous approaches. Our study describes the safety and feasibility of percutaneous closure of partial anomalous pulmonary venous return and the positive impact on hemodynamic and chamber measures.
{"title":"Percutaneous Transcatheter Approach to Partial Anomalous Pulmonary Venous Return: A Case Series","authors":"Omar Abdel-Razek MD MSc , Nhi Vo MD , Jeffrey Weinstein MD , Cyrus A. Kholdani MD , David Liu MD , Roger J. Laham MD","doi":"10.1016/j.amjcard.2024.12.014","DOIUrl":"10.1016/j.amjcard.2024.12.014","url":null,"abstract":"<div><div>Our study presents cases demonstrating the technique and safety of percutaneous occlusion of adult patients with partial anomalous pulmonary venous return (PAPVR). PAPVR is a rare condition that is traditionally treated surgically. Percutaneous interventions are rarely reported. Most patients with PAPVR present in youth and are surgical candidates. In nonsurgical candidates or those who prefer a percutaneous approach, there are little available data to guide therapy. Patients with PAPVR and indications for intervention were treated with percutaneous techniques to occlude anomalous venous return and relieve the hemodynamic effects of these anomalies. Several different percutaneous techniques were used, sometimes in tandem to achieve occlusion. Percutaneous closure was achieved successfully in 3 cases, with improvement in symptoms and in hemodynamic status. A total of 2 patients achieved positive remodeling in right chamber sizes. In conclusion, percutaneous occlusion of PAPVR is feasible, with a multitude of transcatheter options available. This represents a novel approach to the adult patient with PAPVR, specifically, those without a surgical option.</div><div><strong>Condensed Abstract:</strong> Partial anomalous pulmonary venous return is a rare congenital condition, which is traditionally treated surgically. Adult patients with congenital heart disease are potentially nonsurgical candidates and, as such, benefit from percutaneous approaches. Our study describes the safety and feasibility of percutaneous closure of partial anomalous pulmonary venous return and the positive impact on hemodynamic and chamber measures.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 64-67"},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-12DOI: 10.1016/j.amjcard.2024.12.010
Ashwin Balu, Gregory Y H Lip
{"title":"The Impact of Atrial Fibrillation and Smoking History on Brain Deficits.","authors":"Ashwin Balu, Gregory Y H Lip","doi":"10.1016/j.amjcard.2024.12.010","DOIUrl":"10.1016/j.amjcard.2024.12.010","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is unclear whether the impact of prereperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment elevation myocardial infarction. This study is a post hoc analysis of the Japanese registry for Pectaneous Ventricular Assist Device (J-PVAD) registry. In all patients registered in J-PVAD between February 2020 and December 2021, patients with ST-segment elevation myocardial infarction complicated with cardiogenic shock and treated with Impella support alone were selected. A total of 2 cohorts were provided based on whether the onset-to-unloading time was <6 hours. The patients were divided into 2 groups according to prereperfusion or postreperfusion unloading in each cohort. The primary outcome was the 30-day survival rate. The independent factors of survival were identified with a multivariable Cox proportional hazard regression analysis after adjusting for the variables that were statistically significant in the univariable analysis. Patients with prereperfusion unloading had a significantly higher 30-day survival rate than patients with postreperfusion unloading (91% vs 67%, p <0.01) in the cohort with an onset-to-unloading time ≥6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time <6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249, 95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time ≥6 hours cohort. In conclusion, prereperfusion left ventricular unloading could be a crucial treatment to improve the short-term survival rate when the onset-to-left ventricular unloading time was ≥6 hours.
{"title":"Impact of Prereperfusion Left Ventricle Unloading on ST-Segment Elevation Myocardial Infarction According to the Onset-to-Unloading Time","authors":"Naotaka Okamoto MD, Yasuyuki Egami MD, Ayako Sugino MD, Noriyuki Kobayashi MD, Masaru Abe MD, Mizuki Osuga MD, Hiroaki Nohara MD, Shodai Kawanami MD, Akito Kawamura MD, Kohei Ukita MD, Koji Yasumoto MD, Yasuharu Matsunaga-Lee MD, Masamichi Yano MD, PhD, Masami Nishino MD, PhD, J-PVAD investigators","doi":"10.1016/j.amjcard.2024.12.003","DOIUrl":"10.1016/j.amjcard.2024.12.003","url":null,"abstract":"<div><div>It is unclear whether the impact of prereperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment elevation myocardial infarction. This study is a post hoc analysis of the Japanese registry for Pectaneous Ventricular Assist Device (J-PVAD) registry. In all patients registered in J-PVAD between February 2020 and December 2021, patients with ST-segment elevation myocardial infarction complicated with cardiogenic shock and treated with Impella support alone were selected. A total of 2 cohorts were provided based on whether the onset-to-unloading time was <6 hours. The patients were divided into 2 groups according to prereperfusion or postreperfusion unloading in each cohort. The primary outcome was the 30-day survival rate. The independent factors of survival were identified with a multivariable Cox proportional hazard regression analysis after adjusting for the variables that were statistically significant in the univariable analysis. Patients with prereperfusion unloading had a significantly higher 30-day survival rate than patients with postreperfusion unloading (91% vs 67%, p <0.01) in the cohort with an onset-to-unloading time ≥6 hours, whereas patients with prereperfusion or postreperfusion unloading had similar 30-day survival rates (88% vs 91%, p = 0.64) in the cohort with an onset-to-unloading time <6 hours. A multivariable analysis revealed that prereperfusion use of Impella was an independent factor of survival (hazard ratio 0.249, 95% confidence interval 0.070 to 0.889, p = 0.03) in the onset-to-unloading time ≥6 hours cohort. In conclusion, prereperfusion left ventricular unloading could be a crucial treatment to improve the short-term survival rate when the onset-to-left ventricular unloading time was ≥6 hours.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 43-50"},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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