Cardiovascular Intervention and Therapeutics最新文献

The clinical outcomes of percutaneous coronary intervention (PCI) in patients with dialysis are still worse compared with those without dialysis. Among patients with dialysis, those who started dialysis due to diabetic nephropathy (DMN) may have a worse prognosis than those who started dialysis due to non-DMN. This retrospective study aimed to compare the clinical outcomes in dialysis patients who underwent PCI between with and without long-term dialysis due to DMN. We included 303 dialysis patients with PCI. The length of dialysis at the time of PCI was used to stratify the study patients. Patients with DMN and the length of dialysis ≥ 3 years were defined as the long-DMN group (n = 117), and the others were defined as the other group (n = 186). The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, and ischemia-driven target vessel revascularization. A total of 165 MACE were observed with the median follow-up of 568 days. The Kaplan-Meier curves showed that MACE was more frequently observed in the long-DMN group than in the other group (p = 0.005). In the multivariate Cox hazard model, long-DMN was significantly associated with MACE (hazard ratio 1.483, 95% confidence interval 1.075-2.046, p = 0.016) after controlling for multiple confounding factors. Among patients with dialysis, the combination of DMN and a long history of dialysis is closely associated with poor clinical outcomes. These patients should be carefully followed up by both cardiologists and nephrologists.

The hemodynamic and clinical differences between balloon- (BEV) and self-expandable valves (SEV) are critical for patients with a small aortic annulus (SAA). This meta-analysis aims to evaluate the clinical and hemodynamic performance of these two systems in patients with severe aortic stenosis and SAA. A systematic review was conducted from inception to June 2024 for randomized and propensity-score studies comparing BEV and SEV outcomes in patients with a SAA. Reconstructed individual patient data (IPD) from Kaplan Meier curves was pooled for overall survival and rehospitalization for heart failure. Nine studies with 2856 patients met our inclusion criteria: 1427 in the BEV group and 1429 in the SEV group. SEV demonstrated superior hemodynamic performance, including improved iEOA (Standardized Mead Difference [SMD]: 0.52, p = 0.0012), lower mean gradients (SMD: - 0.89, p < 0.0001), and reduced PPM (Odds Ratio [OR]: 0.38, p < 0.0001) compared to BEV. BEV presented lower new pacemaker rates compared to SEV (OR: 1.52, p = 0.0447). There were no significant differences between SEV and BEV in terms of rates of > mild paravalvular leaks, early stroke, and Valve Academic Research Consortium-defined outcomes. Reconstructed IPD showed no significant differences in overall survival (Hazard Ratio [HR]: 0.95, p = 0.584) and rehospitalization for heart failure (HR: 1.05, p = 0.828) during follow-up. In patients with SAA undergoing TAVI the use of BEV was associated with higher frequency of PPM and/or pressure gradients. Similar early stroke, survival and rehospitalization rates were reported. Pacemaker rates were higher with SEV. Long-term follow-up studies are required, especially with newer-generation devices.

For severe aortic stenosis (AS) patients awaiting valve replacement, managing acute decompensated heart failure (ADHF) is crucial due to poor prognosis. The LOHAS registry evaluated the effect of tolvaptan in patients (mean age: 85 years) with severe AS and ADHF, demonstrating stable hemodynamics and sufficient diuresis. We investigated predictors of rapid successful decongestion. In the LOHAS study, eligible patients received tolvaptan (7.5 mg) on day 1 plus standard ADHF treatments. Patients were divided based on decongestion achievement on day 4. Of 59 enrolled, 35 (59%) achieved decongestion (decongestion group), and 24 (41%) remained congested (congestion group). Changes in body weight, renal function, and hemodynamics were comparable between groups over the first 4 days. However, the maximum inferior vena cava (IVC) diameter at admission was significantly larger in the decongestion group than the congestion group (12.6 ± 6.3 vs. 7.6 ± 4.8 mm, p = 0.007). ROC analysis revealed a cut-off of 11 mm for maximum IVC diameter to predict decongestion on day 4 (AUC: 0.73, 95% CI 0.58-0.88). In-hospital mortality was lower in the decongestion group (0% vs. 13%, p = 0.06). In conclusion, in this high-risk severe AS and ADHF population, adding tolvaptan to standard therapy may rapidly improve decompensation if patients have a sufficiently expanded IVC at admission. Maximum IVC diameter could predict successful decongestion with tolvaptan.

New-generation single-layer polytetrafluorethylene (PTFE-) or polyurethane (PU-) covered stent (CS) for the treatment of coronary artery perforation (CAP) during PCI offer high procedural efficacy. To evaluate the comparative long-term safety and efficacy of both devices. This is a multicenter pooled analysis of individual data of patients with CAP undergoing implantation of single-layer PTFE-CS or PU-CS. Procedural endpoint was strategy success defined as successful placement of CS and sealing of perforation without surgical conversion. Clinical endpoints were mortality, myocardial infarction (MI), target vessel revascularization (TVR) and definite or probable stent thrombosis (def/prob ST) at 12 months. Seventy patients with CAP underwent implantation of two hundred eight CS, ninety-two PTFE-CS, and one hundred sixteen PU-CS. More than 1 stent was implanted in 13 patients (17.1%) in PTFE-CS group and 19 patients (20.2%) in PU-CS group, P = 0.80. Strategy success was high (96.1% versus 92.5%., P = 0.62). At 12 months, 71 patients (93.2%) in PTFE-CS group versus 79 patients (81%) in the PU-CS were alive, P = 0.05; TVR occurred in 14 patients (28.4%) in PTFE-CS group and 12 patients (17.9%) in PU-CS group, P= 0.54; MI in 1 patient (1.3%) in PTFE-CS group and 1 patients (1.1%) in PU-CS group, P = 0.86. Rates of def/prob ST were comparable 1.3% in PTFE-CS versus 3.1% in PU-CS P = 0.95. A strategy of implantation of a new-generation single-layer PTFE- or PU-CS for the treatment of coronary artery perforation showed high success rates. Both new-generation CS showed favorable and similar clinical safety, in particular with regard to thrombotic events.