Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version.
{"title":"CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024.","authors":"Yukio Ozaki, Akihiro Tobe, Yoshinobu Onuma, Yoshio Kobayashi, Tetsuya Amano, Takashi Muramatsu, Hideki Ishii, Kyohei Yamaji, Shun Kohsaka, Tevfik F Ismail, Shiro Uemura, Yutaka Hikichi, Kenichi Tsujita, Junya Ako, Yoshihiro Morino, Yuichiro Maekawa, Toshiro Shinke, Junya Shite, Yasumi Igarashi, Yoshihisa Nakagawa, Nobuo Shiode, Atsunori Okamura, Takayuki Ogawa, Yoshisato Shibata, Takafumi Tsuji, Kentaro Hayashida, Junji Yajima, Teruyasu Sugano, Hiroyuki Okura, Hideki Okayama, Katsuhiro Kawaguchi, Kan Zen, Saeko Takahashi, Toshihiro Tamura, Kazuhiko Nakazato, Junichi Yamaguchi, Osamu Iida, Reina Ozaki, Fuminobu Yoshimachi, Masaharu Ishihara, Toyoaki Murohara, Takafumi Ueno, Hiroyoshi Yokoi, Masato Nakamura, Yuji Ikari, Patrick W Serruys, Ken Kozuma","doi":"10.1007/s12928-024-01036-y","DOIUrl":"https://doi.org/10.1007/s12928-024-01036-y","url":null,"abstract":"<p><p>Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1007/s12928-024-01046-w
Hidenari Matsumura, Kenichiro Shimoji
{"title":"Utilization of proximal cap disruption using intravascular lithotripsy for severely calcified bifurcated-CTO entry.","authors":"Hidenari Matsumura, Kenichiro Shimoji","doi":"10.1007/s12928-024-01046-w","DOIUrl":"https://doi.org/10.1007/s12928-024-01046-w","url":null,"abstract":"","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The hemodynamic impact of the implantation depth for balloon-expandable valves is under-investigated, especially with higher implantation techniques. We assessed the hemodynamic performance of supra-annular SAPIEN 3 valve implantation. This retrospective study involved consecutive patients who underwent transcatheter aortic valve replacement (TAVR) using the SAPIEN 3. The device implantation depth and transcatheter heart valve (THV) leaflet-nadir position were angiographically analyzed, and supra-annular implantation was defined as a higher leaflet-nadir position than the original annular line. The Doppler hemodynamic status was evaluated at patient discharge. Among 184 patients, 120 (65%) underwent supra-annular implantation, and their mean implantation depth was significantly lower than that of intra-annular implantation (1.1 vs. 5.2 mm, p < 0.001). No patients developed valve embolization or coronary occlusion, and none required the TAV-in-TAV procedure. Two (1.6%) patients in the supra-annular implantation group had a mild or greater paravalvular leak. Echocardiography demonstrated that supra-annular implantation had better hemodynamic performance, showing a larger indexed effective orifice area (iEOA) compared with intra-annular implantation (1.09 vs. 0.97 cm2/m2, p < 0.01). There was a weak but negative correlation between the implantation depth and iEOA (r = - 0.27, p < 0.01). Moderate or severe prosthesis-patient mismatch (PPM) was found in 35.9% of the intra-annular group and 9.2% of supra-annular of the supra-annular group (p < 0.01). In the multivariable analysis, supra-annular implantation was an independent predictor of better THV function (iEOA > 0.85). Supra-annular SAPIEN 3 implantation provides beneficial hemodynamic effects and reduces the PPM risk.
对球囊扩张瓣膜植入深度对血流动力学的影响研究不足,尤其是对较高植入技术的影响。我们评估了环上 SAPIEN 3 瓣膜植入术的血液动力学表现。这项回顾性研究涉及使用 SAPIEN 3 进行经导管主动脉瓣置换术(TAVR)的连续患者。通过血管造影分析了装置植入深度和经导管心脏瓣膜(THV)的瓣叶脐位置,瓣上植入的定义是瓣叶脐位置高于原始瓣环线。患者出院时对多普勒血流动力学状态进行了评估。在184名患者中,120人(65%)进行了瓣上植入,其平均植入深度明显低于瓣内植入(1.1 mm vs. 5.2 mm, p 2/m2, p 0.85)。环上 SAPIEN 3 植入术可提供有益的血流动力学效应并降低 PPM 风险。
{"title":"Hemodynamic effect of supra-annular implantation of SAPIEN 3 balloon expandable valve.","authors":"Masakazu Yasuda, Kazuki Mizutani, Kyohei Onishi, Naoko Onishi, Kosuke Fujita, Masafumi Ueno, Atsushi Okamura, Yoshitaka Iwanaga, Genichi Sakaguchi, Gaku Nakazawa","doi":"10.1007/s12928-024-01040-2","DOIUrl":"https://doi.org/10.1007/s12928-024-01040-2","url":null,"abstract":"<p><p>The hemodynamic impact of the implantation depth for balloon-expandable valves is under-investigated, especially with higher implantation techniques. We assessed the hemodynamic performance of supra-annular SAPIEN 3 valve implantation. This retrospective study involved consecutive patients who underwent transcatheter aortic valve replacement (TAVR) using the SAPIEN 3. The device implantation depth and transcatheter heart valve (THV) leaflet-nadir position were angiographically analyzed, and supra-annular implantation was defined as a higher leaflet-nadir position than the original annular line. The Doppler hemodynamic status was evaluated at patient discharge. Among 184 patients, 120 (65%) underwent supra-annular implantation, and their mean implantation depth was significantly lower than that of intra-annular implantation (1.1 vs. 5.2 mm, p < 0.001). No patients developed valve embolization or coronary occlusion, and none required the TAV-in-TAV procedure. Two (1.6%) patients in the supra-annular implantation group had a mild or greater paravalvular leak. Echocardiography demonstrated that supra-annular implantation had better hemodynamic performance, showing a larger indexed effective orifice area (iEOA) compared with intra-annular implantation (1.09 vs. 0.97 cm<sup>2</sup>/m<sup>2</sup>, p < 0.01). There was a weak but negative correlation between the implantation depth and iEOA (r = - 0.27, p < 0.01). Moderate or severe prosthesis-patient mismatch (PPM) was found in 35.9% of the intra-annular group and 9.2% of supra-annular of the supra-annular group (p < 0.01). In the multivariable analysis, supra-annular implantation was an independent predictor of better THV function (iEOA > 0.85). Supra-annular SAPIEN 3 implantation provides beneficial hemodynamic effects and reduces the PPM risk.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1007/s12928-024-01042-0
Viroj Muangsillapasart, Yuta Morioka, Masashi Nakao, Hiroyuki Arashi, Junichi Yamaguchi
Endovascular treatment (EVT) for peripheral artery disease in patients with chronic limb-threatening ischemia (CLTI) is a common practice in contemporary medicine and its effectiveness is widely acknowledged. However, refractory ulcers can occasionally be encountered, particularly in patients who underwent renal transplantation (RT), even after successful EVT. To date, there have been no data on prognosis reported following EVT for CLTI in RT recipients. We included all RT recipients who underwent EVT in our hospital between 2010 and 2022. We analyzed data from 43 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, which were managed solely with EVT (i.e., no bypass surgery was performed). The primary and secondary outcomes of our study were the incidence of complete wound healing and major adverse limb events (MALE), including clinically driven target vessel revascularization, major amputation, and all-cause death. The median follow-up was 31 months. The mean age of the study population was 64.7 ± 8.7 years, with predominantly male participants (79.1%). The overall wound healing rate was 34.9%. Kaplan-Meier curve revealed that wound healing rates at 1 and 3 years were 33.6% and 40.9%, respectively. The wound healing rates of RT recipients who underwent EVT for CLTI were found to be less than satisfactory.
{"title":"Clinical outcomes of endovascular therapy for chronic limb-threatening ischemia in renal transplant recipients.","authors":"Viroj Muangsillapasart, Yuta Morioka, Masashi Nakao, Hiroyuki Arashi, Junichi Yamaguchi","doi":"10.1007/s12928-024-01042-0","DOIUrl":"https://doi.org/10.1007/s12928-024-01042-0","url":null,"abstract":"<p><p>Endovascular treatment (EVT) for peripheral artery disease in patients with chronic limb-threatening ischemia (CLTI) is a common practice in contemporary medicine and its effectiveness is widely acknowledged. However, refractory ulcers can occasionally be encountered, particularly in patients who underwent renal transplantation (RT), even after successful EVT. To date, there have been no data on prognosis reported following EVT for CLTI in RT recipients. We included all RT recipients who underwent EVT in our hospital between 2010 and 2022. We analyzed data from 43 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, which were managed solely with EVT (i.e., no bypass surgery was performed). The primary and secondary outcomes of our study were the incidence of complete wound healing and major adverse limb events (MALE), including clinically driven target vessel revascularization, major amputation, and all-cause death. The median follow-up was 31 months. The mean age of the study population was 64.7 ± 8.7 years, with predominantly male participants (79.1%). The overall wound healing rate was 34.9%. Kaplan-Meier curve revealed that wound healing rates at 1 and 3 years were 33.6% and 40.9%, respectively. The wound healing rates of RT recipients who underwent EVT for CLTI were found to be less than satisfactory.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.
对于接受经导管主动脉瓣置换术(TAVR)的主动脉瓣狭窄(AS)患者来说,虚弱程度评估对于决定治疗策略至关重要。最近,日本修订版心血管健康研究(J-CHS)标准被用于虚弱评估;然而,该标准是否有助于对这些患者进行风险分层尚不清楚。我们研究了使用修订版 J-CHS 标准进行虚弱评估对接受 TAVR 的 AS 患者临床预后的影响。我们对 2018 年 5 月至 2022 年 12 月期间在两家三甲医院接受 TAVR 的 205 例连续重度 AS 患者进行了研究。TAVR前根据修订后的J-CHS标准(评分≥3分)对虚弱进行定义。主要研究结果为重大心脏或脑血管不良事件(MACCE)。研究患者的平均年龄为 84 岁,65% 为女性。51%的患者体质虚弱。在1000天(四分位数间距为677-1210)的中位随访期间,22名患者发生了MACCE。经调整与营养状况、强直性脊柱炎严重程度、合并症相关的混杂因素后,孱弱与较高的 MACCE 风险明显相关[危险比 (HR) 5.09,95% 置信区间 (CI) 1.70-15.23;HR 3.94,95% CI 1.34-11.55;HR 3.12,95% CI 1.14-8.53;HR 3.31,95% CI 1.21-9.02]。根据修订后的J-CHS标准确定的虚弱程度与临床结果相关,这表明这些标准有助于对接受TAVR的日本AS患者进行风险分层。
{"title":"Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.","authors":"Takahiro Abe, Toshiyuki Nagai, Atsunori Yuasa, Yusuke Tokuda, Suguru Ishizaka, Sakae Takenaka, Yoshifumi Mizuguchi, Motoki Nakao, Takuma Sato, Taro Temma, Kiwamu Kamiya, Toshihisa Anzai","doi":"10.1007/s12928-024-01043-z","DOIUrl":"https://doi.org/10.1007/s12928-024-01043-z","url":null,"abstract":"<p><p>Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Calcified nodules in the stented segment concomitant with stent deformation at the hinge point.","authors":"Yoshinori Sakamoto, Atsuhiko Sugimoto, Toshiyuki Iwaya, Yoshiyasu Minami","doi":"10.1007/s12928-024-01041-1","DOIUrl":"https://doi.org/10.1007/s12928-024-01041-1","url":null,"abstract":"","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evolut PRO successfully deployed above the annulus plane for type 2 bicuspid aortic valve.","authors":"Daigo Hiraya, Hiroaki Watabe, Tomoya Hoshi, Kentaro Minami, Kimi Sato, Tomoko Ishizu","doi":"10.1007/s12928-024-01038-w","DOIUrl":"https://doi.org/10.1007/s12928-024-01038-w","url":null,"abstract":"","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}