Cardiovascular Intervention and Therapeutics最新文献

Advances in chronic thromboembolic pulmonary hypertension (CTEPH) treatment have improved prognosis, shifting focus towards symptom management. This study aimed to identify factors influencing the World Health Organization functional class (WHO-FC) in CTEPH patients. The CTEPH AC registry is a prospective, multicenter database from 35 Japanese institutions, analyzing data from August 2018 to July 2023. We examined factors associated with achieving WHO-FC I and WHO-FC changes over time in 1,270 patients. Significant factors for WHO-FC I achievement included male sex (odds ratio: 1.86, p = 0.019), age (0.98, p = 0.007), pulmonary vasodilator use (0.51, p = 0.001), post-balloon pulmonary angioplasty (BPA) (1.93, p = 0.010), lower mean pulmonary arterial pressure (0.94, p = 0.004), and lower pulmonary vascular resistance (PVR) (0.78, p = 0.006). Multivariate analysis showed that WHO-FC improvement correlated with male sex, baseline PVR, and BPA during follow-up. WHO-FC deterioration was associated with cancer, history of pulmonary endarterectomy and/or BPA at registration, bleeding risks, and thyroid disease or hormone therapy. BPA implementation is closely linked to symptomatic improvement and achieving WHO-FC I, while symptom worsening is often associated with patient-specific, difficult-to-control conditions.

Background: Treatment of residual mitral regurgitation (MR) with different percutaneous devices after transcatheter edge-to-edge repair (TEER) has been reported as an alternative option to reclipping or surgery. This review aims at describing the different transcatheter strategies available and their results when managing residual MR after TEER.

Methods: A literature search was undertaken across Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases, to identify article reporting patients with post-TEER residual MR managed by a transcatheter approach that did not involve only the implantation of new clips.

Results: From 439 deduplicated studies, 24 articles ultimately met the inclusion criteria. Fifteen described an occluder device implantation, 12 with an Amplatzer and 3 with a Cardioform. The most feared complications were hemolysis and device embolization. Three cases of transcatheter annuloplasty were reported in patients with residual functional MR. An electrosurgical detachment of the TEER device from the anterior mitral leaflet (ELASTA-Clip) before mitral valve replacement was reported in 6 articles.

Conclusions: Transcatheter procedures addressing residual MR after TEER in carefully selected patients are feasible in experienced centers. Outcomes are promising despite some technical issues. Percutaneous strategies and related complications should be anticipated using multimodality imaging.

In clinical practice, the impact of procedural or patient-related risk factors on 1-year clinical outcomes in patients receiving 1-month of dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy after contemporary percutaneous coronary intervention (PCI) remains unclear. Using data from the multi-center REIWA registry which included patients treated with thin-strut biodegradable polymer drug-eluting stent (BP-DES) and 1-month DAPT followed by P2Y12 inhibitor monotherapy, we assessed the primary endpoint (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, ischemic or hemorrhagic stroke, and major or minor bleeding) in patients with and without procedural (treatment of three vessels, three or more lesions, three or more stents, bifurcation with two stents, long stenting, and target of chronic total occlusion) and patient-related risk factor (renal insufficiency, anemia, peripheral vascular disease, prior or current history of heart failure and advanced age of ≥ 75 years). Among the 1,202 patients who underwent complete revascularization by PCI, 276 (23.0%) had at least one procedural factor and 510 (42.4%) had one or more patient-related risks. At the 1-year follow-up, there were no statistical differences in the primary endpoint between patients with and without procedural risk factors. However, patients with patient-related risk factors, particularly those with renal insufficiency, anemia, heart failure, or advanced age, had a significantly higher incidence of the primary endpoint. In conclusion, patient-related risk factors significantly affected the 1-year clinical outcomes after BP-DES implantation and 1-month DAPT followed by P2Y12 inhibitor monotherapy, whereas procedural risk factors had little impact.

This study aimed to investigate the relationship between the restoration of coronary flow just before stent deployment and the final thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients with ST-segment elevation myocardial infarction (STEMI) whose initial TIMI flow grade ≤ 1. In primary percutaneous coronary intervention (PCI), initial TMI flow grade ≤ 1 is closely associated with suboptimal final TIMI flow grade. We included 466 STEMI patients with initial TIMI flow grade ≤ 1 and divided into a restored flow group or an unrestored flow group according to the TIMI flow grade just before stent deployment. The primary endpoint was the achievement of final TIMI flow grade 3. We compared clinical characteristics between the two groups and performed a multivariate logistic analysis to investigate the association between the coronary flow restoration and the final TIMI flow grade. The prevalence of final TIMI flow grade 3 was significantly higher in the restored flow group than the unrestored flow group. The multivariate logistic regression analysis revealed that the restoration of coronary flow just before stent deployment was significantly associated with final TIMI flow grade 3 (OR 7.771, 95% CI 3.412-17.699, p < 0.001). The restoration of coronary flow just before stent deployment was significantly associated with the achievement of final TIMI flow grade 3 in STEMI patients with initial TIMI flow grade ≤ 1. Interventional cardiologist may pay more attention to the coronary flow restoration just before stent deployment when the initial TIMI flow grade is ≤ 1.