Cardiovascular Intervention and Therapeutics最新文献

Coronary angioscopy (CAS) enables direct qualitative assessment of the coronary artery lumen, while integrated backscatter intravascular ultrasound (IB-IVUS) provides a quantitative evaluation of coronary plaque tissue characteristics. Despite the utility of both techniques in assessing coronary plaque status, data on the correlation between their findings remain limited. To investigate the association between CAS-derived findings and results obtained through IB-IVUS. This retrospective analysis included 36 patients who underwent both CAS and IB-IVUS during percutaneous coronary intervention (PCI) at our institution. CAS and IB-IVUS were performed on the same coronary artery treated during PCI. Plaques were categorized into four groups based on their yellow color grade using CAS. For the IB-IVUS analysis, measurements were performed at the minimum lumen diameter site of the culprit lesion. A significant correlation was observed between plaque yellowishness and plaque characteristics on IB-IVUS. Higher plaque yellowishness was associated with an increased percentage of all lipid pool (P < 0.01), a greater proportion of attenuated plaque (P < 0.01), and a larger estimated lipid plaque volume (P < 0.01). Additionally, plaques with higher yellowishness grades had significantly thinner fibrous caps (P < 0.01). The findings suggest that higher plaque yellowishness observed via CAS correlates with a larger lipid plaque volume and thinner fibrous caps, as assessed through IB-IVUS.

This study evaluates the efficacy and safety of transcatheter patent foramen ovale (PFO) closure for the treatment of drug-resistant migraine in Japan. Previous studies have suggested a potential benefit for migraine with aura, although large-scale trials in the United States and Europe have failed to confirm efficacy as a primary endpoint. The study included 27 patients (mean age 36.4 years, 15 female, 21 with aura) who had more than two migraine attacks per month despite medication. All had PFO confirmed by transesophageal echocardiography and underwent transcatheter closure with the Amplatzer PFO Occluder. Patients were followed up to 12 months with migraine severity monitored by headache specialist. The procedure was successful and without complications in all cases. One patient required a larger occluder (35 mm) due to the size of PFO. At 12 months, 22 of 27 (81%) patients reported either complete resolution or improvement of migraine. Specifically, 10 of 21 (48%) patients with aura experienced complete resolution of migraine at one year. Patients without aura had a lower response rate, with only one case of complete resolution. Despite limitations such as the lack of a control group and potential patient selection bias, the study demonstrated that PFO closure may provide significant relief for patients with drug-resistant migraine, particularly those with aura. These findings support further investigation to better define its clinical indications and potential benefits.

The prevalence of malignancies in patients undergoing percutaneous coronary intervention (PCI) is increasing with aging. Active malignancy is a significant contributor to high bleeding risk. For cancer patients requiring oral anticoagulant (OAC) therapy, the choice between direct oral anticoagulants (DOAC) and warfarin is critical. The aim of this study was to investigate long-term bleeding events in patients with malignancy undergoing PCI. The CLIDAS (Clinical Deep Data Accumulation System) multicenter database includes data from seven tertiary medical hospitals in Japan. This retrospective analysis included 6451 patients who underwent PCI between April 2013 and March 2019 and completed 3-year follow-up. The patients were divided into two groups; No malignancy (n = 5787) and Malignancy group (n = 664). Malignancy was defined by a history of cancer treatment. These groups were further subcategorized based on OAC therapy; (1) No malignancy without OAC (n = 5134), (2) No malignancy with DOAC (n = 261), (3) No malignancy with warfarin (n = 392), (4) Malignancy without OAC (n = 589), (5) Malignancy with DOAC (n = 38), and (6) Malignancy with warfarin (n = 37). The primary outcome was the incidence of bleeding events, defined according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries classification of moderate and severe bleeding. The secondary outcomes were major adverse cardiac events (MACE) and net adverse clinical events (NACE). Multivariable Cox regression analysis showed that the malignancy with warfarin group had a significantly higher risk of bleeding events compared to the malignancy without OAC group (hazard ratio [HR], 3.64; 95% confidence interval [CI], 1.38-9.61, p value = 0.009). No significant differences were observed for MACE (HR, 1.39; 95% CI 0.59-3.25, p value = 0.454) or NACE (HR, 1.62; 95% CI, 0.80-3.29; p value = 0.184). Malignancy patients receiving warfarin were associated with a higher risk of bleeding events. DOACs may represent a preferable alternative to warfarin with regard to bleeding risk in patients with malignancy undergoing PCI.

Low-dose prasugrel could provide a better balance between adverse ischemic and bleeding events compared to other P2Y12 receptor inhibitors as part of dual antiplatelet therapy (DAPT) for patients with ischemic heart disease. This study evaluated these risks of adverse events associated with low-dose prasugrel and other P2Y12 receptor inhibitors. A network meta-analysis was conducted, searching for randomized controlled trials (RCTs) comparing clopidogrel (75 mg), low-dose (3.75 mg) and standard-dose (10 mg or 5 mg) prasugrel, or ticagrelor (180 mg). The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. The secondary endpoint was major bleeding, cardiovascular death, myocardial infarction, and stroke. Across 13 RCTs, neither low-dose prasugrel, standard-dose prasugrel, nor ticagrelor showed a statistically significant difference in MACE compared to clopidogrel [risk ratio (RR): 0.73, 95% confidence interval (CI) 0.49-1.09; RR: 0.86, 95% CI 0.68-1.09; RR: 1.02, 95% CI 0.62-1.67, respectively]. However, the standard dose of prasugrel was associated with a significantly higher risk of bleeding events compared to clopidogrel (RR, 0.72; 95% CI 0.35-1.49; RR, 1.26; 95% CI 1.01-1.58; RR, 1.26; 95% CI 0.82-1.96). The surface under the cumulative ranking curves was highest for low-dose prasugrel for both MACE and bleeding events (17.3 and 64.6 for clopidogrel, 84.5 and 84.9 for low-dose prasugrel, 62.0 and 11.8 for standard-dose prasugrel, and 36.2 and 38.7 for ticagrelor, respectively). Low-dose prasugrel may be a viable option in addition to standard P2Y12 receptor inhibitors.

Transcatheter aortic valve replacement is a key intervention for high-risk patients with severe aortic stenosis. Myval, a newer transcatheter heart valve (THV), shows promise, but a comprehensive comparison with other THVs is lacking. This study evaluates the safety and efficacy of Myval compared with contemporary THVs. A systematic review and meta-analysis of six studies involving 2335 patients was performed. Primary outcomes included all-cause mortality, cardiovascular mortality, new permanent pacemaker implantation (PPI), device success, early safety, acute kidney injury, stroke, vascular complications, and valve regurgitation. Myval was associated with significantly lower rates of new PPI (RR, 0.62; 95% CI 0.45-0.86; P = .004), higher rates of device success (RR, 1.08; 95% CI 1.01-1.16; P = .02), and early safety (RR, 1.15; 95% CI 1.05-1.27; P = .003) compared with contemporary THVs. No significant differences were observed in all-cause mortality, cardiovascular mortality, acute kidney injury, stroke, vascular complications, and valve regurgitation. Myval may offer better short-term outcomes in terms of new PPI, device success, and early safety compared with contemporary THVs. Larger, prospective studies with longer follow-ups are needed to confirm these findings.

Data on the impact of the initial Navitor transcatheter heart valve (THV) deployment orientation on the final valve orientation in transcatheter aortic valve implantation (TAVI) assessed using post-implantation computed tomography (CT) is scarce. This study aimed to assess the impact of the initial deployment orientation of Navitor THV on the final orientation and neocommissural overlap with the coronary arteries. Additionally, the incidence of commissural misalignment (CMA) of Navitor THV and its impact on coronary access and short-term valve performance were evaluated. Post-TAVI CT was analysed in 77 patients. Severe coronary artery overlap with THV neocommissure was defined as 0°-20° apart. CMA was categorized by angle deviation from the native commissures: aligned (0°-15°), mild (15°-30°), moderate (30°-45°), and severe (45°-60°). The Navitor delivery system was introduced via the femoral artery with the lock button facing the 3, 6, 9, and 12 o'clock positions. Initial Navitor THV deployment orientation had no impact on the incidence of severe coronary artery overlap. Severe CMA was observed in 80.0% at 3 o'clock, 66.7% at 6 o'clock, 53.8% at 9 o'clock, and 42.2% at 12 o'clock position (p = 0.12). Severe CMA was not associated with the success rate of coronary cannulation after TAVI, short-term valve haemodynamics, or the incidence of hypoattenuated leaflet thickening. Initial Navitor THV orientation did not affect coronary artery overlap or CMA. Moreover, CMA of the Navitor THV did not affect coronary access or short-term valve performance.

Two year overall survival (OS) is crucial for treating symptomatic lower extremity arterial disease (LEAD). This study aimed to develop a nomogram to predict 2 year OS in dialysis patients with LEAD following endovascular therapy (EVT), addressing the gap in data for this high-risk population. This study, conducted at three centers in Taiwan between July 2005 and December 2019, included 593 dialysis patients (349 in the development group and 244 in the validation group). Multivariate logistic regression was used to identify 2 year OS predictors. The nomogram's predictive accuracy, discriminative ability, and clinical utility were evaluated using receiver-operating characteristic curves, calibration curves, the Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA). The mean patient age was 68.4 ± 11.1 years (56% men); 251 died within 2 years (median follow-up 2.42 years), and the 2 year OS rates were similar between groups (59.3% vs. 55.0%, P = 0.220). Multivariate analysis revealed elevated neutrophil-to-lymphocyte ratio, congestive heart failure, chronic atrial fibrillation, use of renin-angiotensin-aldosterone system inhibitors, and prognostic nutritional index as predictors of 2 year OS. The areas under the curve were 0.822 (95% confidence interval [CI] 0.773-0.870) and 0.838 (95% CI 0.789-0.887) in the development and validation groups, respectively. The HL tests χ2 values were 11.61 (P = 0.170) and 6.706 (P = 0.569). DCA showed that this model was practical for 10-90% survival probabilities. This nomogram accurately predicts 2 year OS in dialysis patients with symptomatic LEAD post-EVT. This model can aid clinicians in personalized risk stratification and treatment planning in real-world clinical practice.