Catheterization and Cardiovascular Interventions最新文献

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.

Background

Carotid artery stenosis is a major contributor to stroke, a leading cause of mortality and disability worldwide. Carotid artery stenting (CAS) is commonly performed to reduce the risk of stroke in affected individuals. The Precise DAPT score, originally designed to predict bleeding risk in percutaneous coronary intervention (PCI) patients, has shown potential in predicting adverse outcomes in other vascular interventions.

Aim

This study investigates the role of the Precise DAPT score associated with short- and long-term clinical outcomes in patients undergoing CAS.

Methods

A retrospective cohort study was conducted using data from 376 patients who underwent CAS at Health Sciences University Siyami Ersek Thoracic and Cardiovascular Surgery Center between December 2012 and January 2018. The study analyzed the relationship between the Precise DAPT score and short- and long-term outcomes, including peri-procedural complications, recurrent stroke, and mortality. Statistical analyses included Cox regression, survival analysis, and receiver operating characteristic (ROC) curves.

Results

Patients were stratified into two groups based on their Precise DAPT score: high score (≥ 25) and low score (< 25). After a mean follow-up of 54.3 months, those in the high-score group exhibited significantly higher long-term all-cause mortality (36.3% vs. 6.1%, p < 0.001) and major stroke events (18.6% vs. 9.1%, p = 0.01). The high-score group also had worse renal function and were older. A multivariable Cox regression model demonstrated that the Precise DAPT score ≥ 25 was associated with long-term mortality (adjusted HR 4.82, 95% CI 2.75–8.45, p < 0.001) and major stroke (adjusted HR 2.11, 95% CI 1.14–3.92, p = 0.018).

Conclusions

The Precise DAPT score, despite being designed for PCI patients, is a valuable prognostic tool in patients undergoing CAS. It is independently associated with both long-term mortality and major stroke, highlighting its potential to guide personalized therapeutic strategies. These findings suggest that integrating the Precise DAPT score into clinical practice may enhance the management of patients undergoing carotid interventions, particularly in risk stratification for bleeding and ischemic events.

Background

Use of coils during percutaneous coronary interventions (PCI) is often life-saving and useful, although their off-label use according to the instructions for use.

Aims

Evaluation of in-hospital and long-term outcomes of patients undergoing PCI with coil implantation for treating coronary perforation or closing coronary artery aneurysms/fistulas.

Methods

Among 245,652 PCIs performed in 17 high-volume European centers, 143 patients (0.06%) undergoing coil implantation during PCI were finally included in the analysis. PCI strategy (coiling performed during coronary perforation vs. closing aneurysm/fistulas) and procedural devices used were collected. The primary outcome was technical success, defined as the successful sealing of coronary perforation or aneurysm/fistulas, and procedural success defined as technical success without in-hospital major cardiovascular events (MACE). Long-term MACE and mortality were also reported.

Results

The primary outcome occurred in 95.7% of cases, with no significant differences observed between the perforation and aneurysm/fistulas groups (94.5% vs. 100%, p = 0.19). Patients in the perforation group had a significantly lower rate of procedural success (83.5% vs. 96.6%, p = 0.01). Target lesion failure occurred in 11.4% of cases without differences between groups at a median follow-up of 2 years.

Conclusions

Coils implantation during PCI is safe and feasible among patients treated for coronary perforations or closing aneurysms/fistulas.

Objectives

Valvular heart disease (VHD) is a growing global health concern with increasing prevalence, particularly in aging populations. While surgical valve replacement (VRS) remains a definitive treatment, limited data exists from developing countries regarding postoperative outcomes. This study aimed to evaluate mid-term clinical outcomes, specifically survival and major adverse cardiovascular events (MACE), in patients undergoing isolated mitral and aortic valve replacement surgery, and to identify factors associated with mortality.

Methods

In this retrospective cohort study, 1044 patients who underwent isolated mitral or aortic VRS at Tehran Heart Center between 2003 and 2023 were analyzed. Demographic, clinical, and echocardiographic data were collected. The primary outcome was all-cause mortality; the secondary outcome was MACE. Statistical analyses included univariate and multivariate Cox regression, ROC curve analysis, and log-rank tests.

Results

The mean age of patients was 55 years, and 52% were male. Over a mean follow-up of 23.9 months, the overall mortality rate was 4.3%, and 8.4% experienced MACE. Multivariate analysis identified older age (p = 0.002) and female gender (p = 0.006) as independent predictors of mortality. Age > 50 years had a sensitivity of 85.5% and specificity of 34% for predicting mortality (AUC = 0.639, p = 0.001). No significant predictors of MACE were identified.

Conclusion

Advanced age and female gender were associated with increased mortality following isolated VRS. These findings underscore the importance of tailored preoperative risk assessment to optimize surgical outcomes, particularly in developing healthcare settings.

Background

Coronary artery disease (CAD) is a leading cause of death worldwide. Among acute coronary syndromes, non-ST-elevation myocardial infarction (NSTEMI) poses a higher long-term risk than ST-elevation myocardial infarction (STEMI). Eptifibatide, a glycoprotein IIb/IIIa inhibitor, is used during percutaneous coronary intervention (PCI) to prevent clots, but its long-term effects in NSTEMI patients remain unclear.

Aims

This study assesses the impact of Eptifibatide on major adverse cardiac events (MACE) and survival in NSTEMI patients undergoing PCI.

Methods

A retrospective cohort study of NSTEMI patients treated between 2015 and 2022 at Tehran Heart Center. Patients were grouped based on whether they received Eptifibatide. MACE outcomes were tracked during hospitalization and 1 year later. Statistical adjustments were made for baseline differences.

Results

Among 5309 patients, 12% received Eptifibatide. There were no significant differences between groups in MACE (17.2% vs. 15.6%) or survival (HR 0.97, p = 0.901).

Conclusion

Eptifibatide showed no significant effect on MACE or survival in NSTEMI patients undergoing PCI. Further research is needed to explore its role in high-risk subgroups.

Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Troponin elevation is increasingly used for risk stratification, but its prognostic utility remains variably reported across studies. To evaluate the prognostic value of troponin elevation in patients with acute PE, concerning short-term mortality and adverse clinical outcomes. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed was searched from January 2000 to the present, using terms such as “pulmonary embolism,” “troponin,” and “prognosis.” Eligible studies reported associations between troponin elevation and mortality or adverse events in adult patients with PE. Data were synthesised quantitatively and narratively. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Sixty studies (n = 25,282) were included. Meta-analysis showed that elevated troponin was significantly associated with increased in-hospital mortality (OR: 5.42; 95% CI: 4.35–6.83), 30-day mortality (OR: 4.35; 95% CI: 3.30–5.74), right ventricular dysfunction (OR: 3.42; 95% CI: 2.69–4.31), haemodynamic instability (OR: 3.29 95% CI: 2.48–4.39), and intensive care unit admission (OR: 5.81 95% CI: 3.52–9.68). Non-meta-analysed mortality data were similar to the meta-analysed data, showing an association between elevated troponin levels and worse outcomes in PE. These associations were observed across both conventional and high-sensitivity assays, as well as normotensive or low-risk patients. Elevated troponin is a strong and consistent predictor of short-term mortality and clinical deterioration in acute PE. With further research, it has the potential to be more widely integrated into risk stratification frameworks.