Natasha Corballis, Ioannis Merinopoulos, U. Bhalraam, Tharusha Gunawardena, Vasiliki Tsampasian, Rajkumar Natarajan, Upul Wickramarachchi, Mohamed Mohamed, Allan Clark, Mamas A. Mamas, Vassilios S. Vassiliou, Simon Eccleshall, SPARTAN-Norfolk Consortium
Background
The treatment of coronary bifurcation lesions (CBL) remains complex and associated with a higher rate of long-term adverse cardiovascular events due to anatomical and procedural complexity.
Aims
We compared procedural outcomes between a drug coated balloon (DCB) only approach and a 2nd generation drug eluting stent (DES) for treating de novo CBLs.
Methods
We retrospectively identified all patients with CBL treated with either a DCB only or DES only strategy, including all coronary bifurcations and compared a bifurcation-oriented composite endpoint (BOCE) of cardiovascular death, target bifurcation-related myocardial infarction (TB-MI), and clinically driven target bifurcation revascularization (TBR) using nationally obtained clinical outcome measures from 2015 to 2019. A propensity score matched analysis was undertaken.
Results
Of 2113 patients, 1030 patients were treated with a DCB and 1083 with a DES. There was higher lesion complexity in the DCB group, and propensity score-matched analysis was utilized. This included a total of 2052 patients (1026 in each arm). The median age was 68 (59−75), and all clinical presentations were included. The median follow-up time was 3.6 (2.5−4.8) years with 501 (48.8%) patients having follow-up available at 5 years. Propensity matched analysis showed a significant increase in events (14.0% vs. 9.9% respectively) (HR: 1.39 [1.08−1.79], p = 0.01) when using DES compared to DCB, driven predominantly by an increase in TBR (8.9% vs. 5.0%) (HR: 1.79 [1.27−2.50], p ≤ 0.001) and TB-MI (3.0% vs. 1.6%) (HR: 1.92 [1.05−3.57], p 0.03).
Conclusions
The use of DCB-only in a coronary bifurcation is a safe alternative in treating CBL, within the limitations of a retrospective single center analysis. An appropriately designed RCT is now required.
背景：由于解剖和手术的复杂性，冠状动脉分叉病变（CBL）的治疗仍然复杂，并且与较高的长期不良心血管事件发生率相关。目的：我们比较了药物包被球囊（DCB）方法和第二代药物洗脱支架（DES）治疗新生CBLs的手术结果。方法：我们回顾性地确定了所有接受DCB或DES治疗的CBL患者，包括所有冠状动脉分叉，并使用2015年至2019年全国获得的临床结果指标，比较了以分叉为导向的心血管死亡、靶分叉相关心肌梗死（TB-MI）和临床驱动的靶分叉重建术（TBR）的复合终点（BOCE）。进行倾向评分匹配分析。结果：2113例患者中，DCB组1030例，DES组1083例，DCB组病变复杂性较高，采用倾向评分匹配分析。总共包括2052例患者（每组1026例）。中位年龄为68岁（59-75岁），包括所有临床表现。中位随访时间为3.6（2.5-4.8）年，其中501（48.8%）例患者在5年随访。倾向匹配分析显示，与DCB相比，使用DES的事件显著增加（14.0%比9.9%）（HR: 1.39 [1.08-1.79], p = 0.01），主要是由于TBR(8.9%比5.0%)（HR: 1.79 [1.27-2.50], p≤0.001）和TB-MI(3.0%比1.6%)（HR: 1.92 [1.05-3.57], p 0.03）的增加。结论：在回顾性单中心分析的限制下，仅在冠状动脉分叉中使用dcb是治疗CBL的安全选择。现在需要一个适当设计的随机对照试验。
{"title":"A Comparison of a Drug Coated Balloon With Drug Eluting Stent Strategy for Treating Coronary Bifurcation Lesions","authors":"Natasha Corballis, Ioannis Merinopoulos, U. Bhalraam, Tharusha Gunawardena, Vasiliki Tsampasian, Rajkumar Natarajan, Upul Wickramarachchi, Mohamed Mohamed, Allan Clark, Mamas A. Mamas, Vassilios S. Vassiliou, Simon Eccleshall, SPARTAN-Norfolk Consortium","doi":"10.1002/ccd.70273","DOIUrl":"10.1002/ccd.70273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The treatment of coronary bifurcation lesions (CBL) remains complex and associated with a higher rate of long-term adverse cardiovascular events due to anatomical and procedural complexity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We compared procedural outcomes between a drug coated balloon (DCB) only approach and a 2nd generation drug eluting stent (DES) for treating de novo CBLs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively identified all patients with CBL treated with either a DCB only or DES only strategy, including all coronary bifurcations and compared a bifurcation-oriented composite endpoint (BOCE) of cardiovascular death, target bifurcation-related myocardial infarction (TB-MI), and clinically driven target bifurcation revascularization (TBR) using nationally obtained clinical outcome measures from 2015 to 2019. A propensity score matched analysis was undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2113 patients, 1030 patients were treated with a DCB and 1083 with a DES. There was higher lesion complexity in the DCB group, and propensity score-matched analysis was utilized. This included a total of 2052 patients (1026 in each arm). The median age was 68 (59−75), and all clinical presentations were included. The median follow-up time was 3.6 (2.5−4.8) years with 501 (48.8%) patients having follow-up available at 5 years. Propensity matched analysis showed a significant increase in events (14.0% vs. 9.9% respectively) (HR: 1.39 [1.08−1.79], <i>p</i> = 0.01) when using DES compared to DCB, driven predominantly by an increase in TBR (8.9% vs. 5.0%) (HR: 1.79 [1.27−2.50], <i>p</i> ≤ 0.001) and TB-MI (3.0% vs. 1.6%) (HR: 1.92 [1.05−3.57], <i>p</i> 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of DCB-only in a coronary bifurcation is a safe alternative in treating CBL, within the limitations of a retrospective single center analysis. An appropriately designed RCT is now required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"3-14"},"PeriodicalIF":1.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.70273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Percutaneous coronary intervention (PCI) for left main bifurcation lesions remains technically challenging, particularly when using two-stent techniques such as double-kissing (DK) culotte stenting. Achieving optimal rewiring and complete stent apposition is essential for procedural success but can be difficult under angiographic guidance alone. Moreover, differences in stent design, including the maximum expansion diameter, may affect stent deformation and apposition in the large-caliber left main bifurcation segment.
Aims
This study aimed to evaluate whether three-dimensional optical frequency domain imaging (3D-OFDI) guidance and the use of stents with a larger maximum expansion diameter could improve rewiring precision and stent apposition, thereby optimizing DK-culotte stenting for left main bifurcation lesions.
Methods
Two bench model experiments were conducted using a 3D-printed left main bifurcation model. In Experiment 1, DK-culotte stenting using the same stent (Ultimaster Tansei) was compared between angiography-guided (n = 6) and 3D-OFDI-guided (n = 6) groups. In Experiment 2, two stents (Tansei vs. Nagomi) were compared under 3D-OFDI guidance (n = 6 each). Endpoints included the rate of optimal rewiring and the incidence of incomplete stent apposition (ISA) at both the side branch and the opposite side of the bifurcation.
Results
Compared to angiography guidance, 3D-OFDI guidance significantly improved the rate of optimal rewiring and reduced ISA at the side branch side. Among 3D-OFDI-guided cases, the Nagomi stent, which has a larger maximum expansion capacity than Tansei, showed a lower incidence of ISA at the opposite side, with no cases of sparse distribution of struts at the left anterior descending coronary artery ostium.
Conclusions
3D-OFDI guidance and the use of stents with sufficient maximum expansion capacity each contribute to improved procedural outcomes by enhancing rewiring accuracy and stent apposition, supporting the optimization of culotte stenting in left main bifurcation lesions.
{"title":"Optimization of a Double-Kissing Culotte Stenting Using Three-Dimensional Optical Frequency Domain Imaging for Left Main Coronary Bifurcation Lesions: A Bench Model Analysis","authors":"Tatsuhiro Fujimura, Takayuki Okamura, Yosuke Miyazaki, Hideaki Akase, Tetsuya Matsuyama, Tanaka Shinji, Yuki Nakata, Takuma Nanno, Yasutake Yano, Keita Kaneyuki, Takeshi Suetomi, Motoaki Sano","doi":"10.1002/ccd.70286","DOIUrl":"10.1002/ccd.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Percutaneous coronary intervention (PCI) for left main bifurcation lesions remains technically challenging, particularly when using two-stent techniques such as double-kissing (DK) culotte stenting. Achieving optimal rewiring and complete stent apposition is essential for procedural success but can be difficult under angiographic guidance alone. Moreover, differences in stent design, including the maximum expansion diameter, may affect stent deformation and apposition in the large-caliber left main bifurcation segment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to evaluate whether three-dimensional optical frequency domain imaging (3D-OFDI) guidance and the use of stents with a larger maximum expansion diameter could improve rewiring precision and stent apposition, thereby optimizing DK-culotte stenting for left main bifurcation lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two bench model experiments were conducted using a 3D-printed left main bifurcation model. In Experiment 1, DK-culotte stenting using the same stent (Ultimaster Tansei) was compared between angiography-guided (<i>n</i> = 6) and 3D-OFDI-guided (<i>n</i> = 6) groups. In Experiment 2, two stents (Tansei vs. Nagomi) were compared under 3D-OFDI guidance (<i>n</i> = 6 each). Endpoints included the rate of optimal rewiring and the incidence of incomplete stent apposition (ISA) at both the side branch and the opposite side of the bifurcation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to angiography guidance, 3D-OFDI guidance significantly improved the rate of optimal rewiring and reduced ISA at the side branch side. Among 3D-OFDI-guided cases, the Nagomi stent, which has a larger maximum expansion capacity than Tansei, showed a lower incidence of ISA at the opposite side, with no cases of sparse distribution of struts at the left anterior descending coronary artery ostium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>3D-OFDI guidance and the use of stents with sufficient maximum expansion capacity each contribute to improved procedural outcomes by enhancing rewiring accuracy and stent apposition, supporting the optimization of culotte stenting in left main bifurcation lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"15-22"},"PeriodicalIF":1.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mikias Legesse Gebremedhin, Milan Sigdel, Zhao Ruixue, BinBin Du, Yanzhou Zhang
Background
Right coronary artery (RCA) percutaneous coronary intervention (PCI) is often complicated by anatomical factors such as the RCA ostium's variable position within the aortic sinus, the orientation of the proximal RCA segment, aortic root diameter, and lesion complexity that can compromise guide catheter engagement and support. Although the Extra Back‑Up (EBU) catheter is typically used for left coronary interventions, it may have a selective role in RCA PCI, particularly in complex anatomies or as a bailout after failure of standard guides.
Methods
We performed a single-center, retrospective analysis of two cohorts of RCA PCI procedures. The EBU group included 60 RCA PCI procedures performed between 2019 and 2023 where the EBU catheter was used selectively for complex anatomy or after standard catheter failure. The control group comprised 200 consecutive RCA PCI procedues performed in 2023 using standard guide catheters. Primary outcome was catheter success. Secondary outcomes encompassed procedural efficiency and safety endpoints.
Results
Catheter success rates did not differ significantly between EBU and standard groups (93.3% vs. 94.5%; p = 0.729), despite a markedly higher prevalence of chronic total occlusions in the EBU cohort (48.3% vs. 15.0%; p < 0.001). Overall complication rates including catheter-induced dissection, no-reflow, and general systemic events were low and comparable between cohorts. Operators reported particular EBU utility in low-sitting and upward-take-off RCA ostia.
Conclusion
The EBU catheter can be an effective bailout option for RCA PCI after failure of standard guides, demonstrating comparable procedural success and safety in selected appropriate scenarios. Nevertheless, its off-label use mandates a cautious approach.
背景：右冠状动脉（RCA）经皮冠状动脉介入治疗（PCI）常常因解剖因素而复杂化，如RCA口在主动脉窦内的位置变化、RCA近端段的方向、主动脉根直径和病变复杂性，这些因素都会影响导管的连接和支持。尽管额外后备（EBU）导管通常用于左冠状动脉介入治疗，但它可能在RCA PCI中具有选择性作用，特别是在复杂解剖结构或标准导管失败后作为救助。方法：我们对两组RCA PCI手术进行了单中心回顾性分析。EBU组包括2019年至2023年期间进行的60例RCA PCI手术，其中EBU导管选择性地用于复杂解剖或标准导管失效后。对照组包括在2023年使用标准引导导管进行的200例连续RCA PCI手术。主要结局为导管成功。次要终点包括程序效率和安全性终点。结果：EBU组和标准组之间的导管成功率没有显著差异（93.3% vs. 94.5%; p = 0.729），尽管EBU队列中慢性全闭塞的患病率明显更高(48.3% vs. 15.0%； p 结论：EBU导管可以是标准导尿管失败后RCA PCI的有效辅助选择，在选择适当的情况下显示出相当的手术成功率和安全性。然而，它的标签外使用要求谨慎。
{"title":"Efficacy of the EBU Guide Catheter as a Bailout and Selective Strategy in Challenging Right Coronary Artery Interventions","authors":"Mikias Legesse Gebremedhin, Milan Sigdel, Zhao Ruixue, BinBin Du, Yanzhou Zhang","doi":"10.1002/ccd.70284","DOIUrl":"10.1002/ccd.70284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Right coronary artery (RCA) percutaneous coronary intervention (PCI) is often complicated by anatomical factors such as the RCA ostium's variable position within the aortic sinus, the orientation of the proximal RCA segment, aortic root diameter, and lesion complexity that can compromise guide catheter engagement and support. Although the Extra Back‑Up (EBU) catheter is typically used for left coronary interventions, it may have a selective role in RCA PCI, particularly in complex anatomies or as a bailout after failure of standard guides.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center, retrospective analysis of two cohorts of RCA PCI procedures. The EBU group included 60 RCA PCI procedures performed between 2019 and 2023 where the EBU catheter was used selectively for complex anatomy or after standard catheter failure. The control group comprised 200 consecutive RCA PCI procedues performed in 2023 using standard guide catheters. Primary outcome was catheter success. Secondary outcomes encompassed procedural efficiency and safety endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Catheter success rates did not differ significantly between EBU and standard groups (93.3% vs. 94.5%; <i>p</i> = 0.729), despite a markedly higher prevalence of chronic total occlusions in the EBU cohort (48.3% vs. 15.0%; <i>p</i> < 0.001). Overall complication rates including catheter-induced dissection, no-reflow, and general systemic events were low and comparable between cohorts. Operators reported particular EBU utility in low-sitting and upward-take-off RCA ostia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The EBU catheter can be an effective bailout option for RCA PCI after failure of standard guides, demonstrating comparable procedural success and safety in selected appropriate scenarios. Nevertheless, its off-label use mandates a cautious approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3982-3991"},"PeriodicalIF":1.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The role of intra-aortic balloon pump (IABP) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) without cardiogenic shock remains controversial.
Aims
To assess the association between IABP use and in-hospital mortality in this population and to identify high-risk subgroups.
Methods
This multicenter retrospective study analyzed data from the CCC-ACS Project. Propensity score matching (PSM) and multivariable logistic regression were performed to adjust for confounders. Subgroup analyses identified patients groups at greater risk. A supplementary meta-analysis was conducted to reflect existing uncertainty in the broader literature.
Results
Among 32,863 ACS patients, 1,127 (3.4%) received IABP. In the propensity-matched cohort, IABP use was associated with higher in-hospital mortality (adjusted OR: 2.56, 95% CI: 1.30–5.04, p = 0.006). The risk was more pronounced in patients with ST-segment elevation myocardial infarction, heart failure, reduced left ventricular ejection fraction, and renal impairment. The meta-analysis of 10 studies showed no significant association between IABP use and mortality (RR = 1.06, 95% CI: 0.79–1.42, p = 0.70).
Conclusions
IABP use in ACS patients without cardiogenic shock was associated with increased in-hospital mortality, particularly among high-risk subgroups. Careful patient selection is warranted, and further research is needed to refine its clinical indications.
背景：主动脉内球囊泵（IABP）在急性冠状动脉综合征（ACS）经皮冠状动脉介入治疗（PCI）无心源性休克患者中的作用仍有争议。目的：评估该人群使用IABP与住院死亡率之间的关系，并确定高危亚群。方法：本多中心回顾性研究分析CCC-ACS项目的资料。采用倾向评分匹配（PSM）和多变量逻辑回归来调整混杂因素。亚组分析确定了风险较大的患者组。我们进行了一项补充荟萃分析，以反映更广泛文献中存在的不确定性。结果：32,863例ACS患者中，1127例（3.4%）接受了IABP治疗。在倾向匹配的队列中，IABP的使用与较高的住院死亡率相关（调整比值比：2.56,95% CI: 1.30-5.04, p = 0.006）。st段抬高型心肌梗死、心力衰竭、左室射血分数降低和肾功能损害患者的风险更明显。10项研究的荟萃分析显示，IABP使用与死亡率之间无显著关联（RR = 1.06, 95% CI: 0.79-1.42, p = 0.70）。结论：无心源性休克的ACS患者使用IABP与住院死亡率增加相关，特别是在高危亚组中。谨慎的患者选择是必要的，需要进一步的研究来完善其临床适应症。
{"title":"Intra-Aortic Balloon Pump Use in Acute Coronary Syndrome Without Cardiogenic Shock: Association With Mortality in the CCC-ACS Cohort","authors":"Chu Fan, Yi Zou, Liangguo Chen, Yue Wang, Shuo Pang, Shen Wang, Boqun Shi, Zhenbai Qin, Fadong Li, Wenxin Zhao, Pengrong Guo, Leli Zhang, Xiaofan Wu","doi":"10.1002/ccd.70257","DOIUrl":"10.1002/ccd.70257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of intra-aortic balloon pump (IABP) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) without cardiogenic shock remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the association between IABP use and in-hospital mortality in this population and to identify high-risk subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study analyzed data from the CCC-ACS Project. Propensity score matching (PSM) and multivariable logistic regression were performed to adjust for confounders. Subgroup analyses identified patients groups at greater risk. A supplementary meta-analysis was conducted to reflect existing uncertainty in the broader literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 32,863 ACS patients, 1,127 (3.4%) received IABP. In the propensity-matched cohort, IABP use was associated with higher in-hospital mortality (adjusted OR: 2.56, 95% CI: 1.30–5.04, <i>p</i> = 0.006). The risk was more pronounced in patients with ST-segment elevation myocardial infarction, heart failure, reduced left ventricular ejection fraction, and renal impairment. The meta-analysis of 10 studies showed no significant association between IABP use and mortality (RR = 1.06, 95% CI: 0.79–1.42, <i>p</i> = 0.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IABP use in ACS patients without cardiogenic shock was associated with increased in-hospital mortality, particularly among high-risk subgroups. Careful patient selection is warranted, and further research is needed to refine its clinical indications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"107 1","pages":"23-33"},"PeriodicalIF":1.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145396152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Numerous studies conducted at heart disease centers globally have demonstrated that fractional flow reserve (FFR) serves as a dependable physiological metric for appraising the functional significance of coronary stenosis. The CRP/Albumin ratio (CAR) is a new inflammation-based risk index that offers an accurate assessment of inflammatory status and prognosis for patients with chronic coronary syndrome (CCS).
Aims
This study evaluates the relationship between the functional significance of FFR measurements and CAR in cases of intermediate coronary stenosis (40%–70% as assessed visually) among CCS patients.
Methods
During this period, 253 patients with CCS and single-vessel stenosis featuring moderate coronary lesions were admitted to the hospital. Following the exclusion of patients based on the stated criteria, 172 patients with borderline stenosis in a single vessel were included. After measuring CRP and albumin levels, and patients with intermediate coronary stenosis were divided into two groups: those with FFR > 0.8 and FFR ≤ 0.8.
Results
The study's primary outcome indicates that coronary stenosis is functionally significant based on FFR measurements, which demonstrated an independent link to CAR levels. Univariate and multivariate analyses revealed that the CAR is independent predictor for the development of FFR positivity. The CAR optimal cut-off value of >3.15 predicted FFR ≤ 0.80 with a sensitivity of 53.2% and a specificity of 84.8%.
Conclusion
This study finds that CAR was higher in patients with FFR ≤ 0.80 and remained an independent predictor after adjustment.
{"title":"The C-Reactive Protein to Albumin Ratio Is a Novel Marker for Predicting Functionally Significant Coronary Artery Stenosis in Chronic Coronary Syndrome Patients","authors":"Seda Tükenmez Karakurt, Hüseyin Karakurt","doi":"10.1002/ccd.70283","DOIUrl":"10.1002/ccd.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Numerous studies conducted at heart disease centers globally have demonstrated that fractional flow reserve (FFR) serves as a dependable physiological metric for appraising the functional significance of coronary stenosis. The CRP/Albumin ratio (CAR) is a new inflammation-based risk index that offers an accurate assessment of inflammatory status and prognosis for patients with chronic coronary syndrome (CCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study evaluates the relationship between the functional significance of FFR measurements and CAR in cases of intermediate coronary stenosis (40%–70% as assessed visually) among CCS patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>During this period, 253 patients with CCS and single-vessel stenosis featuring moderate coronary lesions were admitted to the hospital. Following the exclusion of patients based on the stated criteria, 172 patients with borderline stenosis in a single vessel were included. After measuring CRP and albumin levels, and patients with intermediate coronary stenosis were divided into two groups: those with FFR > 0.8 and FFR ≤ 0.8.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study's primary outcome indicates that coronary stenosis is functionally significant based on FFR measurements, which demonstrated an independent link to CAR levels. Univariate and multivariate analyses revealed that the CAR is independent predictor for the development of FFR positivity. The CAR optimal cut-off value of >3.15 predicted FFR ≤ 0.80 with a sensitivity of 53.2% and a specificity of 84.8%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study finds that CAR was higher in patients with FFR ≤ 0.80 and remained an independent predictor after adjustment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3963-3968"},"PeriodicalIF":1.9,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wayne C. Zheng, Sara Vogrin, Jiwon Kim, Brendan Backhouse, Diem Dinh, Angela L. Brennan, Kawa Haji, Nalin Dayawansa, James A. Shaw, Derek P. Chew, Jeffrey Lefkovits, Christopher M. Reid, Dion Stub, David M. Kaye, Nicholas Cox, William Chan
Background
Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly performed with variable reported outcomes and consensus on definition.
Aims
We evaluated the relationship between cardiac surgery availability and CHIP-PCI volume (stratified into tertiles < 16, 16‒36, > 36 annual cases) at treating hospitals with 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.
Methods
All procedures (2014‒2021) captured by a multicenter PCI registry (Victoria, Australia) were analyzed. CHIP-PCI was defined by composite risk score of ≥ 5 points, with prognostic factors assigned three points (e.g., mechanical circulatory support), two points (e.g., age ≥ 80, peripheral vascular disease, severe left ventricular dysfunction, renal impairment) and one point (female, previous stroke, left main/three-vessel PCI, total stent length > 60 mm, rotational atherectomy).
Results
Of 91,961 procedures, 6476 (7.0%) were CHIP-PCI (mean age 82 years; 66% females). CHIP-PCI group had high burden of comorbidities including diabetes (26%), renal impairment (93%), and prior coronary bypass surgery (11%). CHIP-PCI was performed for STEMI (21%), non-STEMI (26%) and nonacute coronary syndrome (47%) indications. Overall, 30-day MACCE and 5-year mortality were 13% and 36% respectively. There was no difference in 30-day MACCE and long-term mortality among CHIP-PCI patients treated at cardiac surgical centers versus Nonsurgical centers (all p > 0.05). Likewise, there was no association between tertiles of annual CHIP-PCI volume with 30-day MACCE and long-term mortality (all p > 0.05).
Conclusions
In contemporary practice, CHIP-PCI outcomes appear similar across institutional CHIP-PCI volume tertiles and availability of cardiac surgery. High rates of adverse outcomes underscore the need for further research regarding revascularization appropriateness.
{"title":"Effect of Cardiac Surgery Availability and Institutional Procedural Volume on Clinical Outcomes Following Complex, High-Risk, and Indicated Percutaneous Coronary Intervention","authors":"Wayne C. Zheng, Sara Vogrin, Jiwon Kim, Brendan Backhouse, Diem Dinh, Angela L. Brennan, Kawa Haji, Nalin Dayawansa, James A. Shaw, Derek P. Chew, Jeffrey Lefkovits, Christopher M. Reid, Dion Stub, David M. Kaye, Nicholas Cox, William Chan","doi":"10.1002/ccd.70277","DOIUrl":"10.1002/ccd.70277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly performed with variable reported outcomes and consensus on definition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We evaluated the relationship between cardiac surgery availability and CHIP-PCI volume (stratified into tertiles < 16, 16‒36, > 36 annual cases) at treating hospitals with 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All procedures (2014‒2021) captured by a multicenter PCI registry (Victoria, Australia) were analyzed. CHIP-PCI was defined by composite risk score of ≥ 5 points, with prognostic factors assigned three points (e.g., mechanical circulatory support), two points (e.g., age ≥ 80, peripheral vascular disease, severe left ventricular dysfunction, renal impairment) and one point (female, previous stroke, left main/three-vessel PCI, total stent length > 60 mm, rotational atherectomy).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 91,961 procedures, 6476 (7.0%) were CHIP-PCI (mean age 82 years; 66% females). CHIP-PCI group had high burden of comorbidities including diabetes (26%), renal impairment (93%), and prior coronary bypass surgery (11%). CHIP-PCI was performed for STEMI (21%), non-STEMI (26%) and nonacute coronary syndrome (47%) indications. Overall, 30-day MACCE and 5-year mortality were 13% and 36% respectively. There was no difference in 30-day MACCE and long-term mortality among CHIP-PCI patients treated at cardiac surgical centers versus Nonsurgical centers (all <i>p</i> > 0.05). Likewise, there was no association between tertiles of annual CHIP-PCI volume with 30-day MACCE and long-term mortality (all <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In contemporary practice, CHIP-PCI outcomes appear similar across institutional CHIP-PCI volume tertiles and availability of cardiac surgery. High rates of adverse outcomes underscore the need for further research regarding revascularization appropriateness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3969-3981"},"PeriodicalIF":1.9,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Potential of a Novel Large Left Atrial Appendage Closure Device: Short-Term Outcomes of the WATCHMAN FLX Pro 40-mm Versus 35-mm","authors":"Ryuki Chatani, Haruka Harata, Mikitaka Fujita, Naoki Nishiura, Kazunori Mushiake, Sachiyo Ono, Hiroshi Tasaka, Takeshi Maruo, Kazushige Kadota, Shunsuke Kubo","doi":"10.1002/ccd.70282","DOIUrl":"10.1002/ccd.70282","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3959-3962"},"PeriodicalIF":1.9,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew P. Hill, Ryan L. Wallace, Abhishek Chaturvedi, Flavia Tejada Frisancho, Matteo Cellamare, Vaishnavi Sawant, Sevket Ozturk, Vijoli Cermak, Cheng Zhang, Ron Waksman, Hayder D. Hashim, Brian C. Case
Background
Angiographic coronary slow flow (CSF) has been correlated with coronary microvascular dysfunction (CMD) and abnormal myocardial blush grade (MBG) has been associated with worse outcomes in acute myocardial infarction. Their validity has not been compared with newer invasive forms of coronary functional CMD testing. Therefore, we aimed to investigate whether angiographic assessment of CSF and MBG correlate with gold-standard invasive assessments of CMD.
Methods
Using the Coronary Microvascular Disease Registry (NCT05960474), we identified patients with angina and non-obstructive coronary arteries (ANOCA) who underwent invasive coronary functional testing (CFT) between August 2021 and August 2024. CMD was defined as coronary flow reserve (CFR) < 2.5 with an index of microcirculatory resistance (IMR) > 25 using invasive bolus thermodilution technique. CSF was defined as > 3 cardiac cycles for distal opacification of vessels with contrast. Slow Thrombolysis in Myocardial Infarction frame count (TFC) was defined as a corrected frame count of > 25. MBG was categorized as abnormal (Grade 0 or 1). Rates of abnormal CSF and MBG were compared between the CMD-positive and negative groups.
Results
A total of 304 patients were included, of whom 81 (26.6%) were CMD positive. Patients were predominantly female (67.9 vs. 63.7%, p = 0.50) and slightly older (64.0 ± 11.3 vs. 60.6 ± 10.8 years, p = 0.02) with a lower BMI (28.5 ± 5.7 vs. 31.6 ± 6.9; p < 0.001) in the CMD positive group. Common comorbidities included hypertension, hyperlipidemia, and diabetes with a similar prevalence in both groups. There was no difference between CMD-positive and negative groups for CSF, (8.6% vs. 4.9%, p = 0.23) or slow cTFC (14.8% vs. 15.7%, p = 0.85). Additionally, the rate of abnormal MBG was similar in both groups (1.3% vs. 3.1%; p = 0.37).
Conclusion
Our findings suggest that, while readily available and previously used for diagnosis, the angiographic findings of CSF and MBG do not reliably indicate the presence of CMD in ANOCA patients. Therefore, dedicated CFT should be pursued if there is clinical suspicion of CMD.
背景：冠状动脉慢血流（CSF）与冠状动脉微血管功能障碍（CMD）相关，心肌红晕等级（MBG）异常与急性心肌梗死的不良结局相关。其有效性尚未与较新的有创冠状动脉功能CMD测试形式进行比较。因此，我们的目的是研究脑脊液和MBG的血管造影评估是否与CMD的金标准侵入性评估相关。方法：使用冠状动脉微血管疾病登记处（NCT05960474），我们确定了2021年8月至2024年8月期间接受有创冠状动脉功能测试（CFT）的心绞痛和非阻塞性冠状动脉（ANOCA）患者。CMD定义为冠脉血流储备（CFR） 25。对于远端血管造影剂混浊，脑脊液被定义为>.3心跳周期。心肌梗死慢溶栓帧数（TFC）定义为校正后的帧数bbb25。MBG为异常（0级或1级）。比较cd阳性组和阴性组脑脊液和MBG异常率。结果：共纳入304例患者，其中CMD阳性81例（26.6%）。患者以女性为主（67.9 vs. 63.7%, p = 0.50），年龄稍大（64.0±11.3 vs. 60.6±10.8,p = 0.02）， BMI较低（28.5±5.7 vs. 31.6±6.9）。结论：我们的研究结果表明，虽然脑脊液和MBG的血管造影结果很容易获得，并且以前用于诊断，但不能可靠地指示ANOCA患者是否存在CMD。因此，如果临床怀疑CMD，应进行专门的CFT。
{"title":"Comparative Visual Analysis of Coronary Slow Flow and Myocardial Blush Grade in Relation to Invasive Testing for Coronary Microvascular Dysfunction","authors":"Andrew P. Hill, Ryan L. Wallace, Abhishek Chaturvedi, Flavia Tejada Frisancho, Matteo Cellamare, Vaishnavi Sawant, Sevket Ozturk, Vijoli Cermak, Cheng Zhang, Ron Waksman, Hayder D. Hashim, Brian C. Case","doi":"10.1002/ccd.70246","DOIUrl":"10.1002/ccd.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Angiographic coronary slow flow (CSF) has been correlated with coronary microvascular dysfunction (CMD) and abnormal myocardial blush grade (MBG) has been associated with worse outcomes in acute myocardial infarction. Their validity has not been compared with newer invasive forms of coronary functional CMD testing. Therefore, we aimed to investigate whether angiographic assessment of CSF and MBG correlate with gold-standard invasive assessments of CMD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Coronary Microvascular Disease Registry (NCT05960474), we identified patients with angina and non-obstructive coronary arteries (ANOCA) who underwent invasive coronary functional testing (CFT) between August 2021 and August 2024. CMD was defined as coronary flow reserve (CFR) < 2.5 with an index of microcirculatory resistance (IMR) > 25 using invasive bolus thermodilution technique. CSF was defined as > 3 cardiac cycles for distal opacification of vessels with contrast. Slow Thrombolysis in Myocardial Infarction frame count (TFC) was defined as a corrected frame count of > 25. MBG was categorized as abnormal (Grade 0 or 1). Rates of abnormal CSF and MBG were compared between the CMD-positive and negative groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 304 patients were included, of whom 81 (26.6%) were CMD positive. Patients were predominantly female (67.9 vs. 63.7%, <i>p</i> = 0.50) and slightly older (64.0 ± 11.3 vs. 60.6 ± 10.8 years, <i>p</i> = 0.02) with a lower BMI (28.5 ± 5.7 vs. 31.6 ± 6.9; <i>p</i> < 0.001) in the CMD positive group. Common comorbidities included hypertension, hyperlipidemia, and diabetes with a similar prevalence in both groups. There was no difference between CMD-positive and negative groups for CSF, (8.6% vs. 4.9%, <i>p</i> = 0.23) or slow cTFC (14.8% vs. 15.7%, <i>p</i> = 0.85). Additionally, the rate of abnormal MBG was similar in both groups (1.3% vs. 3.1%; <i>p</i> = 0.37).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that, while readily available and previously used for diagnosis, the angiographic findings of CSF and MBG do not reliably indicate the presence of CMD in ANOCA patients. Therefore, dedicated CFT should be pursued if there is clinical suspicion of CMD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3953-3958"},"PeriodicalIF":1.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aslan Erdoğan, Muhammet Mert Göksu, Gamze Acar, Yeliz Güler
{"title":"Reply to Letter to the Editor for Case Series Entitled “Optimizing Stent Expansion in Calcified Coronary Lesions: A Case Series on the Efficacy of Scoring Balloons for Acute Underexpansion”","authors":"Aslan Erdoğan, Muhammet Mert Göksu, Gamze Acar, Yeliz Güler","doi":"10.1002/ccd.70235","DOIUrl":"10.1002/ccd.70235","url":null,"abstract":"","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 7","pages":"3951-3952"},"PeriodicalIF":1.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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