Catheterization and Cardiovascular Interventions最新文献_第8页

Comment on “Real-World Outcome of Coronary Orbital Atherectomy in Diabetic Versus Nondiabetic Patients: A Single-Center Experience” 对“糖尿病患者与非糖尿病患者冠状动脉眶动脉粥样硬化切除术的真实结果：单中心经验”的评论。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-29 DOI: 10.1002/ccd.70292

Mashal Naveed, Mawra Naveed, Ahmad Furqan Anjum

引用次数: 0

Obstacles in Screening Below-the-Knee Arterial Lesions in CLTI Patients Using Doppler Ultrasound 多普勒超声筛查CLTI患者膝下动脉病变的障碍。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-29 DOI: 10.1002/ccd.70288

Tomofumi Tsukizawa, Mitsuyoshi Takahara, Yuko Yazu, Masahiko Fujihara

Background

Duplex ultrasound (DUS) is a noninvasive imaging modality increasingly used for the evaluation of lower extremity arterial disease. However, its diagnostic accuracy in below-the-knee (BTK) arteries among patients with chronic limb-threatening ischemia (CLTI) remains uncertain. This study aimed to evaluate the diagnoticic accuracy of DUS for detecting BTK artery lesions in patients with CLTI by comparing its findings with angiography.

Aims

This study aimed to evaluate the diagnostic accuracy of duplex DUS for detecting BTK arterial lesions in patients with CLTI by comparing its findings with angiography.

Methods

We retrospectively analyzed 233 newly diagnosed CLTI patients (Rutherford grades 4–6) treated between 2018 and 2022. DUS findings were compared with angiographic findings in femoropopliteal arteries (FPA) and BTK arteries. The primary outcome was concordance between DUS and angiography. Secondary analyses identified clinical factors influencing concordance.

Results

The concordance rate for FPA was 82.0%, while BTK arteries showed significantly lower concordance: anterior tibial artery 52.9%, posterior tibial artery 58.6%, and peroneal artery 59.9% (all p < 0.001 vs. FPA). Factors associated with reduced concordance included older age, lean BMI, renal failure on dialysis, and FPA stenosis.

Conclusions

DUS demonstrates limited reliability in screening BTK lesions among CLTI patients, particularly in elderly or dialysis-dependent populations. Given these limitations, angiography should be performed to confirm DUS findings in high-risk groups to avoid underestimation of disease severity and inappropriate revascularization strategies. Recognizing key predictors of reduced DUS accuracy may help clinicians identify cases requiring confirmatory imaging and improve individualized diagnostic pathways in CLTI management.

背景：双工超声（DUS）是一种无创成像方式，越来越多地用于评估下肢动脉疾病。然而，其在慢性肢体缺血（CLTI）患者的膝下动脉（BTK）诊断准确性仍不确定。本研究旨在通过与血管造影结果的比较，评价DUS对CLTI患者BTK动脉病变的诊断准确性。目的：本研究旨在通过与血管造影结果的比较，评价双工DUS对CLTI患者BTK动脉病变的诊断准确性。方法：回顾性分析2018年至2022年期间治疗的233例新诊断的CLTI患者（Rutherford分级4-6）。将DUS结果与股腘动脉（FPA）和BTK动脉血管造影结果进行比较。主要结局是DUS和血管造影的一致性。二次分析确定了影响一致性的临床因素。结果：FPA的一致性率为82.0%，而BTK动脉的一致性率明显较低：胫骨前动脉为52.9%，胫骨后动脉为58.6%，腓骨动脉为59.9%（均为p）结论：DUS在CLTI患者中筛查BTK病变的可靠性有限，特别是在老年人或依赖透析的人群中。考虑到这些局限性，应在高危人群中进行血管造影以确认DUS的发现，以避免低估疾病严重程度和不适当的血运重建策略。认识到DUS准确性降低的关键预测因素可能有助于临床医生识别需要确认性影像学检查的病例，并改善CLTI管理中的个性化诊断途径。

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引用次数: 0

A Comparison of a Drug Coated Balloon With Drug Eluting Stent Strategy for Treating Coronary Bifurcation Lesions 药物包被球囊与药物洗脱支架治疗冠状动脉分叉病变的比较。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-28 DOI: 10.1002/ccd.70273

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。

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引用次数: 0

Optimization of a Double-Kissing Culotte Stenting Using Three-Dimensional Optical Frequency Domain Imaging for Left Main Coronary Bifurcation Lesions: A Bench Model Analysis 利用三维光学频域成像优化左主干冠状动脉分叉病变的双吻冠状动脉支架置入：实验模型分析。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-28 DOI: 10.1002/ccd.70286

Tatsuhiro Fujimura, Takayuki Okamura, Yosuke Miyazaki, Hideaki Akase, Tetsuya Matsuyama, Tanaka Shinji, Yuki Nakata, Takuma Nanno, Yasutake Yano, Keita Kaneyuki, Takeshi Suetomi, Motoaki Sano

Background

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.

背景：经皮冠状动脉介入治疗（PCI）左主干分叉病变在技术上仍然具有挑战性，特别是当使用双支架技术时，如双吻（DK）冠脉支架植入术。实现最佳的重新布线和完全支架放置对于手术成功至关重要，但仅在血管造影指导下可能很困难。此外，支架设计的差异，包括最大膨胀直径，可能会影响支架在大口径左主分叉段的变形和放置。目的：本研究旨在评估三维光学频域成像（3D-OFDI）引导和使用更大最大扩张直径的支架是否可以提高重新连接精度和支架放置，从而优化左主干分叉病变的dk - crod支架置入。方法：采用3d打印左主分叉模型进行两次台架模型实验。实验1比较了血管造影引导组（n = 6）和3d - ofdi引导组（n = 6）使用同一种支架（Ultimaster Tansei）进行dk - cuot支架置入。实验2在3D-OFDI引导下比较两种支架（Tansei和Nagomi）（各n = 6）。终点包括最佳重新布线率和支架不完全贴置（ISA）在侧分支和对侧分支的发生率。结果：与血管造影引导相比，3D-OFDI引导可显著提高最佳重线率，降低侧支侧ISA。3d - ofdi引导病例中，Nagomi支架最大扩张容量大于Tansei支架，对侧ISA发生率较低，左侧冠状动脉前降口无支撑物稀疏分布病例。结论：3D-OFDI引导和使用具有足够最大扩张容量的支架均有助于改善手术效果，提高重新布线精度和支架放置，支持左主干分叉病变主动脉瓣支架置入的优化。

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引用次数: 0

Managing Persistent Radial Artery Spasm During Coronary Catheterization: A Complex Case Study 处理冠状动脉导管置入期间持续桡动脉痉挛：一个复杂的案例研究。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-28 DOI: 10.1002/ccd.70289

Mohsin Tariq, Muhammad Ahmad, Mian Zain Hayat, Suleman Arshad

引用次数: 0

Efficacy of the EBU Guide Catheter as a Bailout and Selective Strategy in Challenging Right Coronary Artery Interventions EBU引导导管在具有挑战性的右冠状动脉介入治疗中作为救助和选择策略的有效性。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-28 DOI: 10.1002/ccd.70284

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}

引用次数: 0

Intra-Aortic Balloon Pump Use in Acute Coronary Syndrome Without Cardiogenic Shock: Association With Mortality in the CCC-ACS Cohort 在无心源性休克的急性冠状动脉综合征中使用主动脉内球囊泵：与CCC-ACS队列的死亡率相关

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-28 DOI: 10.1002/ccd.70257

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

Background

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。

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引用次数: 0

The C-Reactive Protein to Albumin Ratio Is a Novel Marker for Predicting Functionally Significant Coronary Artery Stenosis in Chronic Coronary Syndrome Patients c反应蛋白/白蛋白比值是预测慢性冠脉综合征患者功能性显著冠状动脉狭窄的新指标。

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-26 DOI: 10.1002/ccd.70283

Seda Tükenmez Karakurt, Hüseyin Karakurt

Background

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.

背景：在全球心脏病中心进行的大量研究表明，血流储备分数（FFR）是评估冠状动脉狭窄功能意义的可靠生理指标。CRP/白蛋白比值（CAR）是一种新的炎症风险指标，可准确评估慢性冠状动脉综合征（CCS）患者的炎症状态和预后。目的：本研究评估CCS患者中度冠状动脉狭窄（目测40%-70%）中FFR测量与CAR的功能意义之间的关系。方法：在此期间，我院收治了253例伴有中度冠状动脉病变的CCS合并单支狭窄患者。根据所述标准排除患者后，纳入172例单血管边缘性狭窄患者。测量CRP和白蛋白水平后，将中度冠状动脉狭窄患者分为两组：FFR为>.8和FFR≤0.8。结果：该研究的主要结果表明，基于FFR测量的冠状动脉狭窄在功能上是显著的，这表明与CAR水平有独立的联系。单因素和多因素分析显示，CAR是FFR阳性发展的独立预测因子。CAR最佳临界值bbb3.15预测FFR≤0.80，敏感性为53.2%，特异性为84.8%。结论：本研究发现，CAR在FFR≤0.80的患者中较高，经调整后仍是一个独立的预测因子。

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引用次数: 0

Effect of Cardiac Surgery Availability and Institutional Procedural Volume on Clinical Outcomes Following Complex, High-Risk, and Indicated Percutaneous Coronary Intervention 心脏手术可及性和机构手术量对复杂、高风险和指征性经皮冠状动脉介入治疗后临床结果的影响

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-26 DOI: 10.1002/ccd.70277

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.

背景：复杂、高风险和有指征（CHIP）的经皮冠状动脉介入治疗（PCI）越来越多地被用于不同的报道结果和对定义的共识。目的：我们评估心脏手术可及性与CHIP-PCI容量（按每年36例分层）在30天主要心脑血管不良事件（MACCE）和长期死亡率之间的关系。方法：对多中心PCI登记处（澳大利亚维多利亚）记录的所有手术（2014-2021年）进行分析。CHIP-PCI的定义为综合风险评分≥5分，预后因素分为3分（如机械循环支持）、2分（如年龄≥80岁、外周血管疾病、严重左心室功能障碍、肾功能损害）和1分（女性、既往卒中、左主干/三支PCI、支架总长度bbb60 mm、旋转动脉粥样硬化切除术）。结果：91961例手术中，6476例（7.0%）采用CHIP-PCI（平均年龄82岁，66%为女性）。CHIP-PCI组有较高的合并症负担，包括糖尿病（26%）、肾脏损害（93%）和既往冠状动脉搭桥手术（11%）。CHIP-PCI适用于STEMI（21%）、非STEMI（26%）和非急性冠状动脉综合征（47%）适应症。总体而言，30天MACCE和5年死亡率分别为13%和36%。在心脏外科中心与非手术中心治疗的CHIP-PCI患者的30天MACCE和长期死亡率无差异（均p < 0.05）。同样，CHIP-PCI年度容积与30天MACCE和长期死亡率之间也没有相关性（均p < 0.05）。结论：在当前的实践中，CHIP-PCI的结果在机构CHIP-PCI容积和心脏手术的可用性方面似乎相似。高比例的不良结果强调了进一步研究血运重建适宜性的必要性。

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引用次数: 0

Potential of a Novel Large Left Atrial Appendage Closure Device: Short-Term Outcomes of the WATCHMAN FLX Pro 40-mm Versus 35-mm 一种新型大左心附件关闭装置的潜力：WATCHMAN FLX Pro 40-mm与35-mm的短期结果

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions

Pub Date : 2025-10-26 DOI: 10.1002/ccd.70282

Ryuki Chatani, Haruka Harata, Mikitaka Fujita, Naoki Nishiura, Kazunori Mushiake, Sachiyo Ono, Hiroshi Tasaka, Takeshi Maruo, Kazushige Kadota, Shunsuke Kubo

引用次数: 0