Acute myocardial infarction (MI) is one of the major scenarios of extracorporeal membrane oxygenation (ECMO) use. The utilization of mechanical circulatory support systems including ECMO varies widely at the hospital level, while whether ECMO volume per hospital is associated with outcomes in acute MI is unclear. Using a Japanese nationwide administrative database, a total of 26,913 patients with acute MI undergoing percutaneous coronary intervention from 154 hospitals were included. The relations among PCI volume for acute MI, observed and predicted in-hospital mortality, and observed and predicted rates of ECMO use were evaluated at the hospital level. Of 26,913 patients, 423 (1.6%) were treated with ECMO, and 1561 (5.8%) died during the hospitalization. Median ECMO use per hospital per year was 0.5. An observed rate of ECMO use was linearly correlated with the predicted probability of ECMO use and was not associated with the observed/predicted in-hospital mortality ratio. The observed/predicted mortality ratio was lowest in hospitals with the observed/predicted ECMO use ratio of around one. In conclusion, ECMO was infrequently used in a setting of acute MI at each hospital annually. An observed rate of ECMO use was not associated with observed/predicted in-hospital mortality ratio, while the observed/predicted in-hospital mortality ratio was lowest when ECMO was used as predicted, suggesting that standardized ECMO use may be an institutional quality indicator in acute MI.
{"title":"Volume-outcome relationships for extracorporeal membrane oxygenation in acute myocardial infarction.","authors":"Yuichi Saito, Kazuya Tateishi, Masato Kanda, Yuki Shiko, Yohei Kawasaki, Yoshio Kobayashi, Takahiro Inoue","doi":"10.1007/s12928-023-00976-1","DOIUrl":"10.1007/s12928-023-00976-1","url":null,"abstract":"<p><p>Acute myocardial infarction (MI) is one of the major scenarios of extracorporeal membrane oxygenation (ECMO) use. The utilization of mechanical circulatory support systems including ECMO varies widely at the hospital level, while whether ECMO volume per hospital is associated with outcomes in acute MI is unclear. Using a Japanese nationwide administrative database, a total of 26,913 patients with acute MI undergoing percutaneous coronary intervention from 154 hospitals were included. The relations among PCI volume for acute MI, observed and predicted in-hospital mortality, and observed and predicted rates of ECMO use were evaluated at the hospital level. Of 26,913 patients, 423 (1.6%) were treated with ECMO, and 1561 (5.8%) died during the hospitalization. Median ECMO use per hospital per year was 0.5. An observed rate of ECMO use was linearly correlated with the predicted probability of ECMO use and was not associated with the observed/predicted in-hospital mortality ratio. The observed/predicted mortality ratio was lowest in hospitals with the observed/predicted ECMO use ratio of around one. In conclusion, ECMO was infrequently used in a setting of acute MI at each hospital annually. An observed rate of ECMO use was not associated with observed/predicted in-hospital mortality ratio, while the observed/predicted in-hospital mortality ratio was lowest when ECMO was used as predicted, suggesting that standardized ECMO use may be an institutional quality indicator in acute MI.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037443","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 : 2024-04-01Epub Date: 2024-01-05DOI: 10.1007/s12928-023-00977-0
Takeshi Yagyu, Teruo Noguchi
Patients with heritable connective tissue disorders (HCTDs), represented by Marfan syndrome, can develop fatal aortic and/or arterial complications before age 50. Therefore, accurate diagnosis, appropriate medical treatment, and early prophylactic surgical treatment of aortic and arterial lesions are essential to improve prognosis. Patients with HCTDs generally present with specific physical features due to connective tissue abnormalities, while some patients with heritable thoracic aortic diseases (HTADs) have few distinctive physical characteristics. The development of genetic testing has made it possible to provide accurate diagnoses for patients with HCTDs/HTADs. This review provides an overview of the diagnosis and treatment of HCTDs/HTADs, including current evidence on cardiovascular interventions for this population.
{"title":"Diagnosis and treatment of cardiovascular disease in patients with heritable connective tissue disorders or heritable thoracic aortic diseases.","authors":"Takeshi Yagyu, Teruo Noguchi","doi":"10.1007/s12928-023-00977-0","DOIUrl":"10.1007/s12928-023-00977-0","url":null,"abstract":"<p><p>Patients with heritable connective tissue disorders (HCTDs), represented by Marfan syndrome, can develop fatal aortic and/or arterial complications before age 50. Therefore, accurate diagnosis, appropriate medical treatment, and early prophylactic surgical treatment of aortic and arterial lesions are essential to improve prognosis. Patients with HCTDs generally present with specific physical features due to connective tissue abnormalities, while some patients with heritable thoracic aortic diseases (HTADs) have few distinctive physical characteristics. The development of genetic testing has made it possible to provide accurate diagnoses for patients with HCTDs/HTADs. This review provides an overview of the diagnosis and treatment of HCTDs/HTADs, including current evidence on cardiovascular interventions for this population.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105877","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":"Pacing for better visualization of the left atrial appendage prior to transcatheter left atrial appendage closure.","authors":"Keisuke Hosono, Mike Saji, Ryo Wada, Hiroshi Ohara, Tadashi Fujino, Takanori Ikeda","doi":"10.1007/s12928-023-00969-0","DOIUrl":"10.1007/s12928-023-00969-0","url":null,"abstract":"","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138294715","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}
Real-world data on coronary events (CE) in elderly patients with atrial fibrillation (AF) are lacking in the direct oral anticoagulant era. This prespecified sub-analysis of the ANAFIE Registry, a prospective observational study in > 30,000 Japanese patients aged ≥ 75 years with non-valvular AF (NVAF), investigated CE incidence and risk factors. The incidence and risk factors for new-onset CE (a composite of myocardial infarction [MI] and cardiac intervention for coronary heart diseases other than MI), MI, and cardiac intervention for coronary heart diseases other than MI during the 2-year follow-up were assessed. Bleeding events in CE patients were also examined. Among 32,275 patients, the incidence rate per 100 patient-years was 0.48 (95% confidence interval (CI): 0.42-0.53) for CE during the 2-year follow-up, 0.20 (0.16-0.23) for MI, and 0.29 (0.25-0.33) for cardiac intervention for coronary heart diseases other than MI; that of stroke/systemic embolism was 1.62 (1.52-1.73). Patients with CE (n = 287) likely had lower creatinine clearance (CrCL) and higher CHADS2 and HAS-BLED scores than patients without CE (n = 31,988). Significant risk factors associated with new-onset CE were male sex, systolic blood pressure of ≥ 130 mmHg, diabetes mellitus (glycated hemoglobin ≥ 6.0%), CE history, antiplatelet agent use, and CrCL < 50 mL/min. Major bleeding incidence was significantly higher in patients with new-onset CE vs without CE (odds ratio [95% CI], 3.35 [2.06-5.43]). In elderly patients with NVAF, CE incidence was lower than stroke/systemic embolism incidence. New-onset CE (vs no CE) was associated with a higher incidence of major bleeding.Trial registration: UMIN000024006.
在直接口服抗凝剂的时代,缺乏有关老年房颤患者冠心病事件(CE)的真实数据。ANAFIE 登记是一项前瞻性观察研究,研究对象是年龄大于 75 岁的 30,000 名日本非瓣膜性房颤(NVAF)患者,本预设子分析调查了 CE 的发生率和风险因素。该研究评估了随访 2 年期间新发 CE(心肌梗死 [MI] 和心肌梗死以外的冠心病心脏介入治疗的综合)、心肌梗死和心肌梗死以外的冠心病心脏介入治疗的发病率和风险因素。此外,还对 CE 患者的出血事件进行了研究。在 32,275 名患者中,随访 2 年期间每 100 患者年的 CE 发生率为 0.48(95% 置信区间 (CI):0.42-0.53),MI 为 0.20(0.16-0.23),MI 以外的冠心病心脏介入治疗为 0.29(0.25-0.33);中风/系统性栓塞的发生率为 1.62(1.52-1.73)。与无 CE 的患者(n = 31,988)相比,有 CE 的患者(n = 287)肌酐清除率 (CrCL) 可能较低,CHADS2 和 HAS-BLED 评分可能较高。与新发 CE 相关的重要风险因素包括:男性、收缩压≥ 130 mmHg、糖尿病(糖化血红蛋白≥ 6.0%)、CE 病史、使用抗血小板药物和 CrCL
{"title":"Coronary events in elderly patients with non-valvular atrial fibrillation: a prespecified sub-analysis of the ANAFIE registry.","authors":"Masato Nakamura, Hiroshi Inoue, Takeshi Yamashita, Masaharu Akao, Hirotsugu Atarashi, Takanori Ikeda, Yukihiro Koretsune, Ken Okumura, Wataru Shimizu, Shinya Suzuki, Hiroyuki Tsutsui, Kazunori Toyoda, Masahiro Yasaka, Takenori Yamaguchi, Satoshi Teramukai, Yoshiyuki Morishima, Masayuki Fukuzawa, Atsushi Takita, Atsushi Hirayama","doi":"10.1007/s12928-024-00984-9","DOIUrl":"10.1007/s12928-024-00984-9","url":null,"abstract":"<p><p>Real-world data on coronary events (CE) in elderly patients with atrial fibrillation (AF) are lacking in the direct oral anticoagulant era. This prespecified sub-analysis of the ANAFIE Registry, a prospective observational study in > 30,000 Japanese patients aged ≥ 75 years with non-valvular AF (NVAF), investigated CE incidence and risk factors. The incidence and risk factors for new-onset CE (a composite of myocardial infarction [MI] and cardiac intervention for coronary heart diseases other than MI), MI, and cardiac intervention for coronary heart diseases other than MI during the 2-year follow-up were assessed. Bleeding events in CE patients were also examined. Among 32,275 patients, the incidence rate per 100 patient-years was 0.48 (95% confidence interval (CI): 0.42-0.53) for CE during the 2-year follow-up, 0.20 (0.16-0.23) for MI, and 0.29 (0.25-0.33) for cardiac intervention for coronary heart diseases other than MI; that of stroke/systemic embolism was 1.62 (1.52-1.73). Patients with CE (n = 287) likely had lower creatinine clearance (CrCL) and higher CHADS<sub>2</sub> and HAS-BLED scores than patients without CE (n = 31,988). Significant risk factors associated with new-onset CE were male sex, systolic blood pressure of ≥ 130 mmHg, diabetes mellitus (glycated hemoglobin ≥ 6.0%), CE history, antiplatelet agent use, and CrCL < 50 mL/min. Major bleeding incidence was significantly higher in patients with new-onset CE vs without CE (odds ratio [95% CI], 3.35 [2.06-5.43]). In elderly patients with NVAF, CE incidence was lower than stroke/systemic embolism incidence. New-onset CE (vs no CE) was associated with a higher incidence of major bleeding.Trial registration: UMIN000024006.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atrial septal defect closure via left subclavian vein: a novel technique using a steerable sheath.","authors":"Yusuke Akazawa, Takashi Higaki, Hidemi Takata, Hiroshi Sakamoto, Shunji Uchita, Osamu Yamaguchi","doi":"10.1007/s12928-023-00970-7","DOIUrl":"10.1007/s12928-023-00970-7","url":null,"abstract":"","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138476792","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}
Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software.
{"title":"Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics.","authors":"Taku Asano, Toru Tanigaki, Kazumasa Ikeda, Masafumi Ono, Hiroyoshi Yokoi, Yoshio Kobayashi, Ken Kozuma, Nobuhiro Tanaka, Yoshiaki Kawase, Hitoshi Matsuo","doi":"10.1007/s12928-024-00988-5","DOIUrl":"10.1007/s12928-024-00988-5","url":null,"abstract":"<p><p>Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139897852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with severe aortic stenosis often experience pulmonary congestion due to incremental afterload. The trajectory of pulmonary fluid volume during transcatheter aortic valve replacement (TAVR) remains uncertain. Remote dielectric sensing (ReDS) is a recently introduced device for non-invasive quantification of lung fluid volume without expert techniques. We evaluated the trajectory of ReDS values during TAVR and its prognostic implications. Patients with severe aortic stenosis who underwent ReDS measurements upon admission and at the index discharge after TAVR between 2021 and 2022 were eligible. They were followed up until August 2023. The primary focus was on the trajectory of ReDS values during TAVR, with secondary consideration given to its impact on the composite of death or all-cause readmission after TAVR. A total of 57 patients were included. Median age was 84 years and 24 were male. ReDS value remained unchanged after TAVR, changing from 27% (IQR 24%, 29%) to 26% (IQR 24%, 30%) (p = 0.65). ReDS value did not decrease in 23 (40%) patients. The presence of coronary artery disease and atrial fibrillation were associated with no decrease in ReDS value. This lack of decrease in ReDS value was linked to death or all-cause readmission after TAVR, with an age-adjusted hazard ratio of 3.40 (95% confidence interval 1.01-11.4, p = 0.048). The degree of lung fluid amount did not decrease in 40% of TAVR candidates during the procedure. The lack of decrease in lung fluid amount was associated with mortality and morbidity after TAVR. The next concern is to establish therapeutic strategy for patients with residual pulmonary congestion after TAVR.
{"title":"Trajectory of pulmonary congestion during TAVR.","authors":"Teruhiko Imamura, Toshihide Izumida, Hiroshi Onoda, Shuhei Tanaka, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno, Koichiro Kinugawa","doi":"10.1007/s12928-023-00971-6","DOIUrl":"10.1007/s12928-023-00971-6","url":null,"abstract":"<p><p>Patients with severe aortic stenosis often experience pulmonary congestion due to incremental afterload. The trajectory of pulmonary fluid volume during transcatheter aortic valve replacement (TAVR) remains uncertain. Remote dielectric sensing (ReDS) is a recently introduced device for non-invasive quantification of lung fluid volume without expert techniques. We evaluated the trajectory of ReDS values during TAVR and its prognostic implications. Patients with severe aortic stenosis who underwent ReDS measurements upon admission and at the index discharge after TAVR between 2021 and 2022 were eligible. They were followed up until August 2023. The primary focus was on the trajectory of ReDS values during TAVR, with secondary consideration given to its impact on the composite of death or all-cause readmission after TAVR. A total of 57 patients were included. Median age was 84 years and 24 were male. ReDS value remained unchanged after TAVR, changing from 27% (IQR 24%, 29%) to 26% (IQR 24%, 30%) (p = 0.65). ReDS value did not decrease in 23 (40%) patients. The presence of coronary artery disease and atrial fibrillation were associated with no decrease in ReDS value. This lack of decrease in ReDS value was linked to death or all-cause readmission after TAVR, with an age-adjusted hazard ratio of 3.40 (95% confidence interval 1.01-11.4, p = 0.048). The degree of lung fluid amount did not decrease in 40% of TAVR candidates during the procedure. The lack of decrease in lung fluid amount was associated with mortality and morbidity after TAVR. The next concern is to establish therapeutic strategy for patients with residual pulmonary congestion after TAVR.</p>","PeriodicalId":9439,"journal":{"name":"Cardiovascular Intervention and Therapeutics","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457980","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}