Cardiovascular Intervention and Therapeutics最新文献

Approximately 60% of patients with angina symptoms do not have obstructive coronary lesions, a condition known as ischemia with non-obstructive coronary arteries (INOCA). Among these patients, coronary microvascular dysfunction (CMD) is found in nearly half. The epicardial coronary arteries represent only a small portion of the heart's vascular bed, with CMD increasingly recognized as a significant mechanism of myocardial ischemia in INOCA. Recent revisions in the Japanese and European guidelines emphasize the importance of a comprehensive functional evaluation through interventional diagnostic procedure (IDP) for diagnosing CMD and coronary vasospastic angina, two primary causes of ischemia in INOCA patients. IDP allows clinicians to identify the underlying endotype and implement tailored therapeutic strategies, moving beyond empirical therapy. Despite its clinical relevance, INOCA remains under-recognized due to a lack of awareness among healthcare providers as well as the general public, leading to diagnostic delays and undertreatment. Public education campaigns and clinician training are crucial for improving disease recognition and reducing diagnostic delay. Future directions for INOCA management include standardizing and simplifying IDP protocols, incorporating artificial intelligence for diagnostic support, and developing non-invasive alternatives for coronary functional testing. These efforts will enhance the accuracy and accessibility of IDP, facilitating its integration into routine clinical practice. Ultimately, the continued evolution of IDP will play a key role in advancing precision cardiovascular medicine, bridging the gap between symptoms, diagnosis, and meaningful care, and improving outcomes for INOCA patients.

In-stent protrusion is sometimes observed after the stent implantation to the culprit lesion of ST-segment elevation myocardial infarction (STEMI). However, it remains unclear whether additional interventions are necessary for non-obstructive in-stent protrusions. The purpose of this retrospective study was to compare clinical outcomes of patients with STEMI between with and without angiographically visible in-stent protrusions, and to evaluate the association between angiographically visible in-stent protrusions and long-term clinical outcomes in patients with STEMI. We included 639 patients with STEMI who underwent stent implantation and divided them into the protrusion group (n = 59) and the clear stent group (n = 580). In-stent protrusion was defined as an angiographically visible in-stent contrast filling defect at final angiography. The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, non-fatal myocardial infarction, and ischemia-driven target vessel revascularization. During the median follow-up duration of 620 (213-1379) days, MACE were more frequently observed in the protrusion group than in the clear stent group (p = 0.002). The multivariate Cox hazard analysis revealed that in-stent protrusion was significantly associated with MACE after controlling for multiple confounding factors (HR 2.373, 95% CI 1.311-4.294, p = 0.004). In conclusion, angiographically visible in-stent contrast filling defect at final angiography is a marker for worse clinical outcomes in primary PCI. When interventional cardiologists recognize visible irregular protrusion after stent implantation for STEMI, additional intervention or careful clinical follow up may be needed.

This systematic review and meta-analysis evaluate Acute Kidney Injury (AKI) differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and how surgical risk stratification and diagnostic criteria influence outcomes. Following the PRISMA guidelines, we included both non-randomized studies and randomized clinical trials that reported AKI criteria and patients' surgical risk in patients with aortic stenosis by searching PubMed, Scopus, and Web of Science until late September. We executed a random-effects model in Review Manager to pool effect estimates of AKI incidence or the need for dialysis as an odds ratio (OR) and I² heterogeneity, and we utilized R for meta-regression to address any heterogeneity with subgroup analysis for surgical risk, AKI criteria, and study design. We used the Newcastle Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of bias assessment and GRADE for certainty assessment. Involving 17 studies and a total of 13,777 patients, we found that the AKI incidence was significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30, 0.44], I² = 55%, P = 0.003), along with the need for dialysis (OR = 0.35; 95% CI: [0.19, 0.63], I² = 0%, P = 0.92). The study also found that intermediate and low-risk patients had more favorable outcomes. However, the retrospective study design and VARC-2 criteria were associated with unfavorable outcomes. TAVR effectively reduced the risk of AKI in all surgical risk categories and the need for dialysis compared to SAVR in patients with AS.