Catheterization and Cardiovascular Interventions最新文献

Background: Chronic kidney disease (CKD) is associated with worse outcomes in peripheral artery disease (PAD). The impact of the severity of CKD on mortality and major adverse limb events (MALE) after endovascular revascularization of the superficial femoral artery (SFA) is unknown.

Aims: To assess the relationship of increasing severity of CKD on the risk of mortality and MALE in patients after endovascular revascularization of the SFA.

Methods: We followed a cohort of 202 patients (253 limbs) with SFA endovascular revascularization for claudication or chronic limb-threatening ischemia in two academic centers between 2003 and 2011. Patients were categorized into four Kidney Disease Improving Global Outcomes (KDIGO) categories of increasingly worse CKD based on estimated glomerular filtration rate (eGFR). The primary outcome was all-cause death. Secondary outcomes included cardiovascular death, noncardiovascular death, and MALE. The relationship between CKD severity and outcomes was assessed by hazard ratios (HR) and 95% confidence intervals (95%CI) from cause-specific multivariable Cox proportional hazards models and Fine-Gray competing risks analyses.

Results: During a median follow-up of 9.3 years, there was a graded and increasing risk of all-cause, cardiovascular, and noncardiovascular mortality with worse eGFR (all tests of trend p < 0.001). The lowest eGFR category (< 45 mL/min/1.73 m²) was associated with the highest risk of all-cause mortality (HR = 5.0, 95% CI = 2.4, 10), cardiovascular mortality (HR = 5.8, 95% CI = 1.8, 18), and noncardiovascular mortality (HR = 4.5, 95% CI = 1.9, 11). There was no significant association between CKD severity and MALE or minor revascularization events.

Conclusion: The risk of mortality risk after SFA endovascular revascularization incrementally increases with decreasing renal function. However, impaired renal function is not related to the risk of adverse limb events and supports femoral revascularization in these patients.

Background: The Jetstream device is an effective treatment option for debulking calcified lesions; however, it carries a risk of damaging the healthy vessel wall. This study aimed to evaluate the safety and efficacy of the Jetstream device combined with wire bias adjustments for treating eccentric calcified lesions.

Aims: The aim of this study was to evaluate the safety and efficacy of JET EDGE technique for treating eccentric calcified lesions.

Methods: This single-center, retrospective, nonrandomized observational study was conducted at a cardiovascular department in Japan. It included patients aged ≥ 20 years with eccentric calcified lesions (Rutherford classification 3-6) who underwent endovascular therapy using the Jetstream catheter for femoropopliteal disease between October 2022 and September 2024.

Results: Twenty-eight lesions in 28 patients (28.6% female; mean age: 76.9 ± 7.3 years) with a mean follow-up period of 409 ± 174 days were analyzed. All lesions were graded 3 or 4 on the peripheral arterial calcium scoring system. The procedural success rate was 96.4%. No vascular perforations or medial layer damage were observed on imaging following the use of the Jetstream catheter. The 1-year Kaplan-Meier estimates for primary patency, freedom from major adverse limb events, and freedom from target lesion revascularization were 88.6%, 88.1%, and 91.3%, respectively.

Conclusions: This retrospective study demonstrates that eccentric calcified lesions, which pose a risk of damaging the healthy vessel wall during treatment with the Jetstream catheter, can be safely treated by adjusting the wire bias during the procedure.

In 2023-2024, there was a surge in research on structural heart disease. This review aims to provide a comprehensive overview of the field for both general and interventional cardiologists, especially those with a keen interest in structural heart interventions. It summarizes the most important randomized controlled trials, meta-analyses, retrospective analyses, data registries, and noteworthy late-breaking studies unveiled at prominent cardiology conferences.

Background: Cangrelor is an intravenous P2Y12 receptor antagonist that exerts rapid and potent antiplatelet effects. It is associated with a reduction in the indcidence of ischemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Aims: The aim of our study was to investigate the racial disparities and their impact on outcomes among patients with ACS who were treated with cangrelor during PCI.

Methods: We reviewed the data of patients with ACS who were treated with cangrelor during PCI at our center from 2018 to 2023 and divided between African American (AA) and Caucasian patients. The primary safety outcome was in-hospital thrombolysis in myocardial infarction (TIMI) major bleeding. The primary efficacy outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, MI, or stroke. Multivariate regression analysis was performed to assess the primary outcomes after controlling for differences in baseline characteristics.

Results: The study included 1181 patients who received cangrelor during PCI for ACS, including 616 AA and 565 Caucasian patients. AA patients were significantly younger (61 ± 13 vs. 64 ± 12 years; p < 0.001) and had higher rates of hypertension, diabetes mellitus, and end-stage renal disease requiring dialysis. There were no significant differences between AA and Caucasian patients regarding in-hospital TIMI major bleeding (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.16-1.88; p = 0.343) and in-hospital MACE (OR: 1.82; 95% CI: 0.71-4.69; p = 0.212) after controlling for relevant baseline differences.

Conclusion: No racial disparities were observed with regard to the administration of cangrelor during PCI in patients presenting with ACS, and cangrelor was not associated with increased bleeding for AA patients as compared to Caucasian patients.

Background: Sex differences in ST-segment elevation myocardial infarction (STEMI) due to obstructive coronary artery disease (CAD) are well-established, but limited research exists on sex differences in STEMI patients with nonobstructive coronary arteries (MINOCA) and MINOCA mimickers.

Methods: We analyzed 8560 consecutive STEMI patients, enrolled in the Midwest STEMI Consortium from 2003 to 2020. Patients with non-obstructive CAD were classified into MINOCA (defined as < 50% coronary artery stenosis and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) and MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or non-ischemic cardiomyopathy). The primary outcome was 5-year all-cause mortality.

Results: Of the 8560 patients, 409 (4.8%) had non-obstructive CAD, including 120 (1.4%) MINOCA and 289 (3.4%) MINOCA mimickers. Females were more likely to have MINOCA and MINOCA mimickers (49.2% and 56.4%, respectively). There were no significant sex differences in in-hospital or 5-year mortality in MINOCA, but females with MINOCA mimickers had higher unadjusted 5-year mortality (HR 2.90, 95% CI 1.53-5.53). After adjusting for age and comorbidities, the long-term mortality risk was similar between sexes (adjusted HR 1.16, 95% CI: 0.61-2.24). Females with obstructive CAD had higher 5-year mortality in unadjusted models (HR 1.66, 95% CI 1.48, 1.86), but the difference was not significant after adjustment (adjusted HR 1.1, 95% CI: 0.98-1.24).

Conclusions: Our findings highlight important sex-based differences in the prevalence, treatment, and long-term outcomes of STEMI patients with MINOCA, MINOCA mimickers, and obstructive CAD. Despite clinical disparities, mortality risks were similar across sexes after adjusting for comorbidities.

Managing coronary artery disease (CAD) in patients with chronic kidney disease (CKD) poses significant challenges, particularly in reducing contrast volume to prevent worsening renal function. We present the case of a 67-year-old male with an initial presentation of inferior STEMI and 2:1 Mobitz Type II AV block, who underwent successful primary percutaneous coronary intervention (PPCI) for a thrombotic occlusion in the right coronary artery (RCA) then staged procedure for calcium modification and stenting. This report highlights two key aspects of the procedure: using saline instead of contrast for optical coherence tomography (OCT) to minimize contrast exposure, and and employing combination of orbital atherectomy followed by intravascular lithotripsy (IVL) for calcium modification in a heavily calcified lesion. The case underscores the importance of individualized procedural strategies to optimize outcomes in patients with complex coronary anatomy and comorbid CKD. In conclusion, using saline-enhanced OCT provides adequate imaging and helps to minimize contrast use to prevent kidney injury while the combined use of orbital atherectomy and IVL allowed for optimal calcium modification, enabling excellent stent deployment in a severely calcified coronary disease.

Background: The outcomes and characteristics of patients with side branch occlusion (SBO) after bifurcation percutaneous coronary intervention (PCI) have received limited study.

Methods: We compared the procedural characteristics and outcomes of patients with and without SBO among 933 provisional bifurcation PCIs performed in 803 patients at six centers between 2014 and 2024.

Results: The prevalence of SBO was 13% (n = 121). SBO patients had lower rates of hypertension, prior coronary artery bypass graft surgery (CABG), and prior PCI but higher angiographic complexity, with higher prevalence of left anterior descending artery stenoses, smaller side branch diameter and more severe side branch diameter stenoses. SBO patients were more likely to convert from provisional to two-stent strategies (24.8% vs 6.0%, p < 0.001), and to require plaque modification (39.7% vs 17.5%, p < 0.001) and side branch percutaneous transluminal coronary angioplasty (PTCA) (25.6% vs 12.9%, p < 0.001). SBO patients had lower technical (78.5% vs 96.2%, p < 0.001) and procedural (73.5% vs 92.2%, p < 0.001) success and similar in-hospital major adverse cardiovascular events (MACE), but higher dissection rates (7.1% vs 2.0%, p = 0.007). Patients with untreated SBO had similar in-hospital MACE with untreated SBO patients. During a median follow-up of 1,095 days patients with treated SBO (83.9%, n = 94) had lower follow-up MACE (hazard ratio [HR]: 0.29, 95% confidence intervals [CI]: 0.10, 0.84, p = 0.023) and mortality (HR: 0.22, CI: 0.065, 0.755, p = 0.016) compared with patients with untreated SBO.

Conclusions: SBO occurs in 13% of provisional PCIs. SBO patients had more complex coronary lesions and worse follow-up clinical outcomes if the SBO was left untreated.

Background: The changes over time and effects on long-term clinical outcomes beyond 1 year of irregular protrusion (IP) in chronic coronary syndrome (CCS) remains unclear.

Aims: This study aimed to assess the time-dependent change and long-term clinical impact of IP in CCS lesions.

Methods: This study was a post hoc analysis of COLLABORATION study, which was a multicenter, prospective, observational study conducted from July 2018 to February 2020, assessing 1- and 12-month serial vessel responses after stent implantation using OCT and coronary angioscopy. Time-dependent change in the presence of IP was evaluated using the serial OCT examinations. The cumulative 3-year incidence of TLR was compared between the lesions with and without IP, as well as between those with and without residual IP at 1 month.

Results: Among 107 lesions, IP was detected in post-OCT pullbacks in 38 (35.5%) lesions. Out of the 38 lesions, IP remained in 9 (23.7%) lesions at 1 month and existed in 2 (5.3%) lesions at 12 months. The cumulative 3-year incidence of TLR was significantly higher in IP group than in non-IP group (13.6% vs. 3.0%, p = 0.04). Similarly, it was significantly higher in lesions with residual IP at 1 month than those without (33.3% vs. 4.3%, p < 0.01). All residual IP at 1 month were composed of angioscopic yellow plaques and red thrombi.

Conclusions: The presence of IP decreased over time, but approximately one-fourth of IP remained at 1 month. IP and residual IP at 1 month were important post-stent OCT findings leading to long-term TLR in patients with CCS.

Background: Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.

Methods: Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.

Results: HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm² vs. 1.72 ± 0.43 cm²; p = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm² vs. 1.45 ± 0.34 cm²; p = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83-1.70; p = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08-13.7; p = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89-5.99; p = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45-1.73; p = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203-2468) days.

Conclusions: HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.