Cardiovascular Intervention and Therapeutics最新文献

The administration of crushed or chewed P2Y12 inhibitors (P2Y12i) allows faster platelet inhibition in patients presenting acute coronary syndrome (ACS). Whether this administration approach is safe needs further analysis. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing chewed/crushed to integral P2Y12i administration in patients with ACS. Major bleeding, minor bleeding, and major adverse cardiovascular events (MACE) were analyzed as binary outcomes. Platelet reactivity unit (PRU) was assessed as a continuous outcome to estimate the impact on platelet physiology. A subgroup analysis of P2Y12i administered was performed. Nine studies comprising 1091 patients with ACS were included, 77% were males. Overall, 87% presented with ST-segment elevation acute myocardial infarction. Six studies administered Ticagrelor, while 3 studies used Prasugrel. The absolute risk of bleeding, assessed by TIMI, was low in both intervention and control arms (0.36% vs. 0.95% for major bleedings and 3.3% vs. 4.4% for minor bleedings), and crushed/chewed administration did not increase the relative risk of bleeding events for TIMI major or minor bleedings (RR 0.51, 95% CI 0.09-2.77, p = 0.293; RR 0.76, 95% CI 0.24-2.43, p = 0.542) or MACE (RR 0.94, 95% CI 0.28-3.19, p = 0.902). PRU was significantly reduced within 1 h after administration in the crushed/chewed P2Y12i group (MD: -70.0%, 95% CI, -89.0 to -51.1%, p<0.01) while we did not observe a significant difference after 4 h (MD: -15.1%, 95% CI -34.2 to 4.0%, p = 0.12). The type of drug did not influence the relative risk of crushed/chewed P2Y12i on major or minor bleeding (p_interaction = 0.62 and p_interaction = 0.23_, respectively). The crushed/chewed administration of P2Y12i in the setting of ACS was not associated with an increased risk of bleeding, suggesting the safety of this strategy.

Patients with atrial fibrillation (AF) often present with concomitant significant mitral regurgitation (MR). Percutaneous left atrial appendage closure (LAAC) is indicated for patients with AF to prevent thromboembolism and reduce the need for long-term anticoagulation. Transcatheter edge-to-edge repair (TEER) is recommended for patients with significant MR. However, the feasibility and efficacy of combining these therapeutic interventions remain uncertain. This study included consecutive patients who underwent LAAC. Feasibility was assessed by comparing outcomes between those undergoing combined LAAC + TEER and those receiving LAAC alone. Among 192 patients, 11 underwent the combined LAAC + TEER procedure, while 181 underwent LAAC alone. Procedural success was high in both groups (100% vs. 99%). At the 1-year follow-up, the incidence of significant device leak and device-related thrombus did not differ significantly between the groups (0% vs. 1.1% and 0% vs. 6.7%, respectively; p > 0.05 for both). Additionally, the cumulative incidence of thromboembolic and bleeding events was comparable between the two groups (thromboembolic p = 0.57 and bleeding p = 0.42). The combination of LAAC + TEER may be a feasible and effective therapeutic strategy when performed in carefully selected patients at high-volume, experienced centers.

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.