Adriaan Wilgenhof MD, Ruurt A. Jukema MD, Roel S. Driessen MD, PhD, Ibrahim Danad MD, PhD, Pieter G. Raijmakers MD, PhD, Niels van Royen MD, PhD, Lokien X. van Nunen MD, PhD, Carlos Collet MD, PhD, Guus A. de Waard MD, PhD, Paul Knaapen MD, PhD
Background
Fractional flow reserve (FFR) has emerged as the invasive gold standard for assessing vessel-specific ischemia. However, FFR measurements are influenced by the hydrostatic effect, which might adversely impact the assessment of ischemia.
Aims
This study aimed to investigate the impact of hydrostatic pressure on FFR measurements by correcting for the height and comparing FFR with [15O]H2O positron emission tomography (PET)-derived relative flow reserve (RFR).
Methods
The 206 patients were included in this analysis. Patients underwent coronary computed tomography angiography (CCTA), [15O]H2O PET, and invasive coronary angiography with routine FFR in every epicardial artery. Height differences between the aortic guiding catheter and distal pressure sensor were quantified on CCTA images. An FFR ≤ 0.80 was considered significant.
Results
The study found a reclassification in 7% of the coronary arteries. Notably, 11% of left anterior descending (LAD) arteries were reclassified from hemodynamically significant to nonsignificant. Conversely, 6% of left circumflex (Cx) arteries were reclassified from nonsignificant to significant. After correcting for the hydrostatic pressure effect, the correlation between FFR and PET-derived RFR increased significantly from r = 0.720 to r = 0.786 (p = 0.009). The average magnitude of correction was +0.05 FFR units in the LAD, −0.03 in the Cx, and −0.02 in the right coronary artery.
Conclusion
Hydrostatic pressure has a small but clinically relevant influence on FFR measurements obtained with a pressure wire. Correcting for this hydrostatic error significantly enhances the correlation between FFR and PET-derived RFR.
背景部分血流储备（FFR）已成为评估血管特异性缺血的有创金标准。本研究旨在通过校正高度来调查静水压对 FFR 测量的影响，并将 FFR 与[15O]H2O 正电子发射断层扫描（PET）得出的相对血流储备（RFR）进行比较。患者接受了冠状动脉计算机断层扫描（CCTA）、[15O]H2O PET 和有创冠状动脉造影术，并对每条心外膜动脉进行了常规 FFR 检查。在 CCTA 图像上量化了主动脉导引导管和远端压力传感器之间的高度差。研究发现，7% 的冠状动脉被重新分类。值得注意的是，11%的左前降支（LAD）动脉从血流动力学显著性重新分类为非显著性。相反，6% 的左侧环曲（Cx）动脉从非显著性重新分类为显著性。校正静水压效应后，FFR 和 PET 导出 RFR 之间的相关性从 r = 0.720 显著增加到 r = 0.786（p = 0.009）。结论静水压力对使用压力导线获得的 FFR 测量值的影响很小，但与临床相关。对这一静水压误差进行校正可显著增强 FFR 与 PET 导出的 RFR 之间的相关性。
{"title":"The effect of hydrostatic pressure on invasive coronary pressure measurements: Comparison with [15O]H2O-positron emission tomography flow data","authors":"Adriaan Wilgenhof MD, Ruurt A. Jukema MD, Roel S. Driessen MD, PhD, Ibrahim Danad MD, PhD, Pieter G. Raijmakers MD, PhD, Niels van Royen MD, PhD, Lokien X. van Nunen MD, PhD, Carlos Collet MD, PhD, Guus A. de Waard MD, PhD, Paul Knaapen MD, PhD","doi":"10.1002/ccd.31215","DOIUrl":"10.1002/ccd.31215","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fractional flow reserve (FFR) has emerged as the invasive gold standard for assessing vessel-specific ischemia. However, FFR measurements are influenced by the hydrostatic effect, which might adversely impact the assessment of ischemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to investigate the impact of hydrostatic pressure on FFR measurements by correcting for the height and comparing FFR with [<sup>15</sup>O]H<sub>2</sub>O positron emission tomography (PET)-derived relative flow reserve (RFR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 206 patients were included in this analysis. Patients underwent coronary computed tomography angiography (CCTA), [<sup>15</sup>O]H<sub>2</sub>O PET, and invasive coronary angiography with routine FFR in every epicardial artery. Height differences between the aortic guiding catheter and distal pressure sensor were quantified on CCTA images. An FFR ≤ 0.80 was considered significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study found a reclassification in 7% of the coronary arteries. Notably, 11% of left anterior descending (LAD) arteries were reclassified from hemodynamically significant to nonsignificant. Conversely, 6% of left circumflex (Cx) arteries were reclassified from nonsignificant to significant. After correcting for the hydrostatic pressure effect, the correlation between FFR and PET-derived RFR increased significantly from <i>r</i> = 0.720 to <i>r</i> = 0.786 (<i>p</i> = 0.009). The average magnitude of correction was +0.05 FFR units in the LAD, −0.03 in the Cx, and −0.02 in the right coronary artery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hydrostatic pressure has a small but clinically relevant influence on FFR measurements obtained with a pressure wire. Correcting for this hydrostatic error significantly enhances the correlation between FFR and PET-derived RFR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 5","pages":"980-989"},"PeriodicalIF":2.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183592","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}
Puck J. A. van Nuland, Dirk Jan van Ginkel MD, Daniel C. Overduin MD, Willem L. Bor MD, Jorn Brouwer MD, PhD, Vincent J. Nijenhuis MD, PhD, Joyce Peper PhD, Arnoud W. J. van't Hof MD, PhD, Pieter A. Vriesendorp MD, PhD, Jurriën M. ten Berg MD, PhD
Background
Bleeding and stroke are frequent complications after transcatheter aortic valve implantation (TAVI). The mortality risk associated with these events has been reported before, but data regarding their impact on health-related quality of life (QoL) is limited.
Aim
To evaluate the impact of bleeding and stroke occurring within 30 days after TAVI, on mortality and QoL during the first year after TAVI.
Methods
POPular TAVI was a randomized clinical trial that evaluated the addition of clopidogrel to aspirin or oral anticoagulation in patients undergoing TAVI. Besides clinical outcomes, QoL was assessed using the Short Form-12 and EuroQoL Five Dimensions questionnaires before, and at 3, 6, and 12 months after TAVI.
Results
Major or life-threatening bleeding occurred in 81 patients (8.3%) and was associated with an increased risk of death (hazard ratio [HR] 1.95 [95% confidence interval (CI) 1.00–3.79]); minor bleeding occurred in 104 patients (10.6%) and was not associated with mortality (HR 0.75 [95% CI 0.30–1.89]). Stroke occurred in 35 patients (3.6%) and was associated with an increased risk of death (HR 2.90 [95% CI 1.23–6.83]). Mean mental component summary (MCS-12) scores over time were lower in patients with major or life-threatening bleeding (p = 0.01), and similar in patients with minor bleeding, compared to patients without bleeding; mean physical component summary (PCS-12) scores, EQ-5D index, and visual analog scale (VAS) were similar between those patients. Mean MCS-12 scores were lower in patients with stroke (p = 0.01), mean PCS-12, EQ-5D index, and VAS were similar compared to patients without stroke.
Conclusion
Major or life-threatening bleeding and stroke were associated with an increased risk of death and decreased mental QoL in the first year after TAVI.
背景出血和中风是经导管主动脉瓣植入术（TAVI）后的常见并发症。方法POPular TAVI是一项随机临床试验，评估了在阿司匹林或口服抗凝药的基础上加用氯吡格雷对接受TAVI的患者的影响。除临床结果外，还在 TAVI 术前、术后 3、6 和 12 个月使用 Short Form-12 和 EuroQoL Five Dimensions 问卷对患者的 QoL 进行了评估。结果81例患者（8.3%）发生大出血或危及生命的出血，与死亡风险增加有关（危险比 [HR] 1.95 [95% 置信区间 (CI) 1.00-3.79]）；104例患者（10.6%）发生轻微出血，与死亡率无关（HR 0.75 [95% CI 0.30-1.89]）。35名患者（3.6%）发生了中风，与死亡风险增加有关（HR 2.90 [95% CI 1.23-6.83]）。与没有出血的患者相比，大出血或危及生命的患者在一段时间内的平均精神成分汇总（MCS-12）得分较低（P = 0.01），而轻微出血患者的平均精神成分汇总（PCS-12）得分类似；这些患者的平均身体成分汇总（PCS-12）得分、EQ-5D指数和视觉模拟量表（VAS）相似。结论：大出血或危及生命的出血和中风与TAVI术后第一年死亡风险增加和心理QoL下降有关。
{"title":"The impact of stroke and bleeding on mortality and quality of life during the first year after TAVI: A POPular TAVI subanalysis","authors":"Puck J. A. van Nuland, Dirk Jan van Ginkel MD, Daniel C. Overduin MD, Willem L. Bor MD, Jorn Brouwer MD, PhD, Vincent J. Nijenhuis MD, PhD, Joyce Peper PhD, Arnoud W. J. van't Hof MD, PhD, Pieter A. Vriesendorp MD, PhD, Jurriën M. ten Berg MD, PhD","doi":"10.1002/ccd.31218","DOIUrl":"10.1002/ccd.31218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bleeding and stroke are frequent complications after transcatheter aortic valve implantation (TAVI). The mortality risk associated with these events has been reported before, but data regarding their impact on health-related quality of life (QoL) is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the impact of bleeding and stroke occurring within 30 days after TAVI, on mortality and QoL during the first year after TAVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>POPular TAVI was a randomized clinical trial that evaluated the addition of clopidogrel to aspirin or oral anticoagulation in patients undergoing TAVI. Besides clinical outcomes, QoL was assessed using the Short Form-12 and EuroQoL Five Dimensions questionnaires before, and at 3, 6, and 12 months after TAVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Major or life-threatening bleeding occurred in 81 patients (8.3%) and was associated with an increased risk of death (hazard ratio [HR] 1.95 [95% confidence interval (CI) 1.00–3.79]); minor bleeding occurred in 104 patients (10.6%) and was not associated with mortality (HR 0.75 [95% CI 0.30–1.89]). Stroke occurred in 35 patients (3.6%) and was associated with an increased risk of death (HR 2.90 [95% CI 1.23–6.83]). Mean mental component summary (MCS-12) scores over time were lower in patients with major or life-threatening bleeding (<i>p</i> = 0.01), and similar in patients with minor bleeding, compared to patients without bleeding; mean physical component summary (PCS-12) scores, EQ-5D index, and visual analog scale (VAS) were similar between those patients. Mean MCS-12 scores were lower in patients with stroke (<i>p</i> = 0.01), mean PCS-12, EQ-5D index, and VAS were similar compared to patients without stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Major or life-threatening bleeding and stroke were associated with an increased risk of death and decreased mental QoL in the first year after TAVI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 5","pages":"1107-1118"},"PeriodicalIF":2.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183593","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}
Ignacio J. Amat-Santos MD, PhD, FESC, Javier Gómez-Herrero MD, Pablo Pinon MD, Luis Nombela-Franco MD, PhD, Raúl Moreno MD, PhD, Antonio J. Munoz-García MD, Alfredo Redondo MD, Antonio Gómez-Menchero MD, PhD, Itziar Gómez-Salvador MD, J. Alberto San Román MD, PhD
Background
Hemodynamic impact of commissural alignment (CA) with self-expandable transcatheter aortic valves (TAVR) has not been investigated yet.
Aims
To determine hemodynamic impact of CA with self-expandable TAVR.
Methods
Multicentric ambispective study comparing patients who underwent self-expandable TAVR in seven centers with the Evolut Pro/Pro+ (EP) (Medtronic) and Acurate neo2 (AN2) (Boston Scientific) with and without CA strategies. The degree of commissural misalignment (CMA) was assessed by computed tomography/angiography and 1-year transvalvular gradients/regurgitation evaluated by echocardiography. A matched comparison according to annular dimensions/eccentricity, prosthesis size/type, and baseline left ventricular function and gradients was performed.
Results
A total of 557 patients, mean age 80.7 ± 6.6 years, 61.4% men, and STS score of 4.3 ± 3.1% were analyzed. A CA technique was attempted in 215 patients (38.6%), including 113 patients with AN2 and 102 patients with EP. None/mild CMA was found in 158 (73.5% vs. 43.6% if no CA attempted, p < 0.001) with no differences between devices (AN2:75.2%; EP:71.6%, p = 0.545). Patients with moderate/severe CMA had a greater aortic peak gradient (22.3 ± 8.7 vs. 19.7 ± 8.5, p = 0.001), significantly greater progression of both peak (p = 0.002) and mean gradients (p = 0.001) after matching, and higher rate of central aortic regurgitation (1.2% vs. 0.4%, p = 0.005) at 1-year, but not a greater proportion of patients with mean gradient ≥ 10 mmHg.
Conclusions
The use of CA strategies significantly reduced the rate of CMA for the self-expandable TAVR devices ACN2 and EP which was associated to lower transvalvular gradients and intra-prosthetic regurgitation progression at 1-year although no criteria of structural deterioration were met at this follow up. Clinicaltrials.org: NCT05097183.
{"title":"Impact of commissural alignment on the hemodynamic performance of supra-annular self-expandable transcatheter aortic valves","authors":"Ignacio J. Amat-Santos MD, PhD, FESC, Javier Gómez-Herrero MD, Pablo Pinon MD, Luis Nombela-Franco MD, PhD, Raúl Moreno MD, PhD, Antonio J. Munoz-García MD, Alfredo Redondo MD, Antonio Gómez-Menchero MD, PhD, Itziar Gómez-Salvador MD, J. Alberto San Román MD, PhD","doi":"10.1002/ccd.31201","DOIUrl":"10.1002/ccd.31201","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hemodynamic impact of commissural alignment (CA) with self-expandable transcatheter aortic valves (TAVR) has not been investigated yet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To determine hemodynamic impact of CA with self-expandable TAVR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicentric ambispective study comparing patients who underwent self-expandable TAVR in seven centers with the Evolut Pro/Pro+ (EP) (Medtronic) and Acurate neo2 (AN2) (Boston Scientific) with and without CA strategies. The degree of commissural misalignment (CMA) was assessed by computed tomography/angiography and 1-year transvalvular gradients/regurgitation evaluated by echocardiography. A matched comparison according to annular dimensions/eccentricity, prosthesis size/type, and baseline left ventricular function and gradients was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 557 patients, mean age 80.7 ± 6.6 years, 61.4% men, and STS score of 4.3 ± 3.1% were analyzed. A CA technique was attempted in 215 patients (38.6%), including 113 patients with AN2 and 102 patients with EP. None/mild CMA was found in 158 (73.5% vs. 43.6% if no CA attempted, <i>p</i> < 0.001) with no differences between devices (AN2:75.2%; EP:71.6%, <i>p</i> = 0.545). Patients with moderate/severe CMA had a greater aortic peak gradient (22.3 ± 8.7 vs. 19.7 ± 8.5, <i>p</i> = 0.001), significantly greater progression of both peak (<i>p</i> = 0.002) and mean gradients (<i>p</i> = 0.001) after matching, and higher rate of central aortic regurgitation (1.2% vs. 0.4%, <i>p</i> = 0.005) at 1-year, but not a greater proportion of patients with mean gradient ≥ 10 mmHg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of CA strategies significantly reduced the rate of CMA for the self-expandable TAVR devices ACN2 and EP which was associated to lower transvalvular gradients and intra-prosthetic regurgitation progression at 1-year although no criteria of structural deterioration were met at this follow up. Clinicaltrials.org: NCT05097183.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 5","pages":"1060-1070"},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183594","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}
Saurabh Deshpande DM, Hiroyuki Sawatari PhD, Kapil Rangan DM, Anusha Buchade DM, Raheel Ahmed MRCP, Kamleshun Ramphul MD, Mushood Ahmed MBBS, Mohammed Y. Khanji PhD, Virend K. Somers PhD, Farhan Shahid PhD, Anwar A. Chahal PhD, Deepak Padmanabhan DM
Background
Cardiac tamponade or pericardial tamponade (PT) can be a complication following invasive cardiac procedures.
Methods
Patients who underwent various procedures in the cardiac catheterization lab (viz. coronary interventions) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (International classification of diseases [ICD]-9-Clinical modification [CM] and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, PT-related events, and in-hospital death were also abstracted from the NIS database.
Results
The frequency of PT-related events in the patients undergoing CI from 2010 to 2017 ranged from 3.3% to 8.4%. Combined in-hospital mortality/morbidity of PT-related events were higher with increasing age (odds ratio [OR] [95% CI]: chronic total occlusion (CTO) = 1.19 [1.10-1.29]; acute coronary syndrome (ACS) = 1.21 [1.11-1.33], both p < 0.0001) and female sex (OR [95%CI]: CTO = 1.70 [1.45-2.00]; ACS = 1.72 [1.44-2.06], both p < 0.0001). In-hospital mortality related to PT-related events was found to be 8.5% for coronary procedures. In-hospital mortality was highest amongst the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for ACS (ACS vs. non-CTO PTCA vs. CTO PTCA: 15.7% vs. 10.4% and 14.4%, p < 0.0001 and ACS vs. non-CTO PTCA vs. CTO PTCA: 12.1% vs. 8.1% and 5.6%, p = 0.0001, respectively).
Conclusions
In the real-world setting, PT-related events in CI were found to be 3.3%−8.4%, with in-hospital mortality of 8.5%. The patients undergoing PTCA for ACS were found to have highest mortality. Older patients undergoing CTO PTCA independently predicted higher mortality.
{"title":"Pericardial tamponade in coronary interventions: Morbidity and mortality","authors":"Saurabh Deshpande DM, Hiroyuki Sawatari PhD, Kapil Rangan DM, Anusha Buchade DM, Raheel Ahmed MRCP, Kamleshun Ramphul MD, Mushood Ahmed MBBS, Mohammed Y. Khanji PhD, Virend K. Somers PhD, Farhan Shahid PhD, Anwar A. Chahal PhD, Deepak Padmanabhan DM","doi":"10.1002/ccd.31213","DOIUrl":"10.1002/ccd.31213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac tamponade or pericardial tamponade (PT) can be a complication following invasive cardiac procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent various procedures in the cardiac catheterization lab (viz. coronary interventions) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (International classification of diseases [ICD]-9-Clinical modification [CM] and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, PT-related events, and in-hospital death were also abstracted from the NIS database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The frequency of PT-related events in the patients undergoing CI from 2010 to 2017 ranged from 3.3% to 8.4%. Combined in-hospital mortality/morbidity of PT-related events were higher with increasing age (odds ratio [OR] [95% CI]: chronic total occlusion (CTO) = 1.19 [1.10-1.29]; acute coronary syndrome (ACS) = 1.21 [1.11-1.33], both <i>p</i> < 0.0001) and female sex (OR [95%CI]: CTO = 1.70 [1.45-2.00]; ACS = 1.72 [1.44-2.06], both <i>p</i> < 0.0001). In-hospital mortality related to PT-related events was found to be 8.5% for coronary procedures. In-hospital mortality was highest amongst the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for ACS (ACS vs. non-CTO PTCA vs. CTO PTCA: 15.7% vs. 10.4% and 14.4%, <i>p</i> < 0.0001 and ACS vs. non-CTO PTCA vs. CTO PTCA: 12.1% vs. 8.1% and 5.6%, <i>p</i> = 0.0001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the real-world setting, PT-related events in CI were found to be 3.3%−8.4%, with in-hospital mortality of 8.5%. The patients undergoing PTCA for ACS were found to have highest mortality. Older patients undergoing CTO PTCA independently predicted higher mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 4","pages":"707-713"},"PeriodicalIF":2.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153197","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}
Nick S. R. Lan MBBS (Hons), MClinUS, MClinRes (Dist), MSc, HuiJun Chih BSc (Hons), PhD, Angela L. Brennan CCRN, Girish Dwivedi MD, PhD, Gemma A. Figtree MBBS, DPhil, Diem Dinh PhD, Dion Stub MBBS, PhD, Christopher M. Reid MSc, PhD, Abdul Rahman Ihdayhid MBBS (Hons), PhD, The ASPECT Investigators
Background
Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear.
Methods
Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used.
Results
Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24–4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06–6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001).
Conclusions
Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.
{"title":"Clinical outcomes and coronary artery lesion characteristics of young patients with ST elevation myocardial infarction and no standard modifiable risk factors","authors":"Nick S. R. Lan MBBS (Hons), MClinUS, MClinRes (Dist), MSc, HuiJun Chih BSc (Hons), PhD, Angela L. Brennan CCRN, Girish Dwivedi MD, PhD, Gemma A. Figtree MBBS, DPhil, Diem Dinh PhD, Dion Stub MBBS, PhD, Christopher M. Reid MSc, PhD, Abdul Rahman Ihdayhid MBBS (Hons), PhD, The ASPECT Investigators","doi":"10.1002/ccd.31205","DOIUrl":"10.1002/ccd.31205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; <i>p</i> < 0.001), female (22.6% <i>vs.</i> 15.5%; <i>p</i> < 0.001), thrombolysed (20.1% vs. 12.5%; <i>p</i> < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; <i>p</i> = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24–4.08; <i>p</i> = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06–6.12; <i>p</i> = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; <i>p</i> = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; <i>p</i> = 0.002) but more procedural complications (5.1% vs. 2.7%; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 4","pages":"714-722"},"PeriodicalIF":2.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153196","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}
Min Jin MD, Haitao Zhang MD, Qing Zhou MD, PhD, Shuchun Li MD, PhD, Dongjin Wang MD, PhD
Background
Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic valve stenosis. However, its application for severe aortic regurgitation (AR) is still under evaluation. This study aims to present the 3-year follow-up outcomes of the J-Valve system in managing severe AR.
Aims
The aim of this study was to evaluate the mid-term efficacy and durability of the J-Valve system in the treatment of severe AR and to provide new information on this intervention.
Methods
In this retrospective, single-center study, we evaluated the prognostic outcomes of patients with AR, who underwent treatment with the J-Valve system at Nanjing Drum Tower Hospital. Consecutive patients who were treated with the J-Valve were included in the analysis. The study focused on the echocardiographic follow-up to assess the effectiveness and durability of the J-Valve system in managing AR.
Results
From January 2018 to December 2022, 36 high-risk AR patients treated with the J-Valve system had a procedural success rate of 97.2%, with one case requiring open-heart surgery due to valve displacement. Significant improvements were observed in left ventricular diameter (from 63.50 [58.75–69.50] mm to 56.50 [53.00–60.50] mm, p < 0.001) and left atrial diameter (from 44.00 [40.00–45.25] mm to 39.00 [36.75–41.00] mm, p = 0.003) postsurgery. All patients completed the 1-year follow-up, with an overall mortality rate of 2 out of 36 (5.6%). Among the surviving patients, there was one case of III° atrioventricular block and one case of stroke, both occurring within 90 days postsurgery. After a 3-year follow-up, 15.0% of patients had mild or moderate valvular regurgitation, with no cases of moderate or severe paravalvular leak. Additionally, 89.5% of patients were classified as New York Heart Association class I or II, showing significantly enhanced cardiac function.
Conclusion
The J-Valve system has shown positive therapeutic outcomes in treating AR, with notable effectiveness in managing the condition and significant improvements in heart failure symptoms and cardiac remodeling. However, due to the limited sample size and partial follow-up data, it is important to emphasize the need for further research with comprehensive long-term follow-up, to fully validate these results.
背景：经导管主动脉瓣植入术（TAVI）是一种治疗严重主动脉瓣狭窄的成熟干预方法。然而，其对严重主动脉瓣反流（AR）的应用仍在评估中。目的：本研究旨在评估J-瓣膜系统治疗重度主动脉瓣反流的中期疗效和耐久性，并提供有关该介入治疗的新信息：在这项回顾性单中心研究中，我们评估了在南京鼓楼医院接受J-活瓣系统治疗的AR患者的预后结果。接受过 J-Valve 治疗的患者均被纳入分析范围。研究重点是超声心动图随访，以评估J-活瓣系统管理AR的有效性和耐久性：从2018年1月到2022年12月，36名高风险AR患者接受了J-Valve系统治疗，手术成功率为97.2%，其中一例患者因瓣膜移位需要进行开胸手术。左心室直径明显改善（从 63.50 [58.75-69.50] mm 降至 56.50 [53.00-60.50] mm，p 结论：J-瓣膜系统显示出良好的治疗效果：J-Valve 系统在治疗 AR 方面取得了积极的疗效，在控制病情方面效果显著，并显著改善了心衰症状和心脏重塑。然而，由于样本量有限且随访数据不全面，必须强调需要进一步开展全面的长期随访研究，以充分验证这些结果。
{"title":"Transcatheter aortic valve implantation for severe aortic regurgitation using the J-Valve system: A midterm follow-up study","authors":"Min Jin MD, Haitao Zhang MD, Qing Zhou MD, PhD, Shuchun Li MD, PhD, Dongjin Wang MD, PhD","doi":"10.1002/ccd.31196","DOIUrl":"10.1002/ccd.31196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic valve stenosis. However, its application for severe aortic regurgitation (AR) is still under evaluation. This study aims to present the 3-year follow-up outcomes of the J-Valve system in managing severe AR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the mid-term efficacy and durability of the J-Valve system in the treatment of severe AR and to provide new information on this intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective, single-center study, we evaluated the prognostic outcomes of patients with AR, who underwent treatment with the J-Valve system at Nanjing Drum Tower Hospital. Consecutive patients who were treated with the J-Valve were included in the analysis. The study focused on the echocardiographic follow-up to assess the effectiveness and durability of the J-Valve system in managing AR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From January 2018 to December 2022, 36 high-risk AR patients treated with the J-Valve system had a procedural success rate of 97.2%, with one case requiring open-heart surgery due to valve displacement. Significant improvements were observed in left ventricular diameter (from 63.50 [58.75–69.50] mm to 56.50 [53.00–60.50] mm, <i>p</i> < 0.001) and left atrial diameter (from 44.00 [40.00–45.25] mm to 39.00 [36.75–41.00] mm, <i>p</i> = 0.003) postsurgery. All patients completed the 1-year follow-up, with an overall mortality rate of 2 out of 36 (5.6%). Among the surviving patients, there was one case of III° atrioventricular block and one case of stroke, both occurring within 90 days postsurgery. After a 3-year follow-up, 15.0% of patients had mild or moderate valvular regurgitation, with no cases of moderate or severe paravalvular leak. Additionally, 89.5% of patients were classified as New York Heart Association class I or II, showing significantly enhanced cardiac function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The J-Valve system has shown positive therapeutic outcomes in treating AR, with notable effectiveness in managing the condition and significant improvements in heart failure symptoms and cardiac remodeling. However, due to the limited sample size and partial follow-up data, it is important to emphasize the need for further research with comprehensive long-term follow-up, to fully validate these results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 5","pages":"1052-1059"},"PeriodicalIF":2.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153198","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}
Hugo Pilichowski MD, Radu Spînu MD, Sébastien Gerelli MD, PhD, Lionel Mangin MD, Marc Bonnet MD
Mitral valve repair or replacement poses a potential risk of injury to the left circumflex coronary artery (LCx). Such injuries can arise from either direct LCx injury caused by encircling or transfixing stitches, or indirect occlusion resulting from the distortion of adjacent tissues. We provide and illustrate a representative image depicting LCx distortion. Additionally, we offer guidance to aid angiographers in comprehending the angiographic appearance and the underlying mechanism of occlusion.
{"title":"Circumflex distortion following mitral valve repair","authors":"Hugo Pilichowski MD, Radu Spînu MD, Sébastien Gerelli MD, PhD, Lionel Mangin MD, Marc Bonnet MD","doi":"10.1002/ccd.31220","DOIUrl":"10.1002/ccd.31220","url":null,"abstract":"<p>Mitral valve repair or replacement poses a potential risk of injury to the left circumflex coronary artery (LCx). Such injuries can arise from either direct LCx injury caused by encircling or transfixing stitches, or indirect occlusion resulting from the distortion of adjacent tissues. We provide and illustrate a representative image depicting LCx distortion. Additionally, we offer guidance to aid angiographers in comprehending the angiographic appearance and the underlying mechanism of occlusion.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 6","pages":"1225-1227"},"PeriodicalIF":2.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131905","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}
Tim Kinnaird MD, Sean Gallagher MD, Vasim Farooq PhD, Majd B. Protty PhD, Hannah Cranch MD, Peader Devlin MD, Andrew Sharp MD, Nick Curzen PhD, Peter Ludman MD, David Hildick-Smith MD, Tom Johnson PhD, Mamas A. Mamas DPhil
Background
Although data suggests ad hoc percutaneous coronary intervention (PCI) results in similar patient outcomes compared to planned PCI in nonselected patients, data for ad hoc unprotected left main stem PCI (uLMS-PCI) are lacking.
Aim
To determine if in-hospital outcomes of uLMS-PCI vary by ad hoc versus planned basis.
Methods
Data were analyzed from all patients undergoing uLMS-PCI in the United Kingdom 2006–2018, and patients grouped into uLMS-PCI undertaken on an ad hoc or a planned basis. Patients who presented with ST-segment elevation, cardiogenic shock, or with an emergency PCI indication were excluded.
Results
In total, 8574 uLMS-PCI procedures were undertaken with 2837 (33.1%) of procedures performed on an ad hoc basis. There was a lower likelihood of intervention for stable angina (28.8% vs. 53.8%, p < 0.001) and a higher rate of potent P2Y12 inhibitor use (16.4% vs. 12.1%, p < 0.001) in the ad hoc PCI group compared to the planned PCI group. Patients undergoing uLMS-PCI on an ad hoc basis tended to undergo less complex procedures. Acute procedural complications including slow flow (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.01–2.86), coronary dissection (OR: 1.41, 95% CI: 1.12–1.77) and shock induction (OR: 2.80, 95% CI: 1.64–4.78) were more likely in the ad hoc PCI group. In-hospital death (OR: 1.65, 95% CI: 1.19–2.27) and in-hospital major adverse cardiac or cerebrovascular events (OR: 1.50, 95% CI: 1.13–1.98) occurred more frequently in the ad hoc group. In sensitivity analyses, these observations did not differ when several subgroups were separately examined.
Conclusions
Ad hoc PCI for uLMS disease is associated with adverse outcomes compared to planned PCI. These data should inform uLMS-PCI procedural planning.
{"title":"In-hospital outcomes of ad hoc versus planned PCI for unprotected left-main disease: An analysis of 8574 cases from British Cardiovascular Intervention Society database 2006–2018","authors":"Tim Kinnaird MD, Sean Gallagher MD, Vasim Farooq PhD, Majd B. Protty PhD, Hannah Cranch MD, Peader Devlin MD, Andrew Sharp MD, Nick Curzen PhD, Peter Ludman MD, David Hildick-Smith MD, Tom Johnson PhD, Mamas A. Mamas DPhil","doi":"10.1002/ccd.31210","DOIUrl":"10.1002/ccd.31210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although data suggests ad hoc percutaneous coronary intervention (PCI) results in similar patient outcomes compared to planned PCI in nonselected patients, data for ad hoc unprotected left main stem PCI (uLMS-PCI) are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine if in-hospital outcomes of uLMS-PCI vary by ad hoc versus planned basis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were analyzed from all patients undergoing uLMS-PCI in the United Kingdom 2006–2018, and patients grouped into uLMS-PCI undertaken on an ad hoc or a planned basis. Patients who presented with ST-segment elevation, cardiogenic shock, or with an emergency PCI indication were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 8574 uLMS-PCI procedures were undertaken with 2837 (33.1%) of procedures performed on an ad hoc basis. There was a lower likelihood of intervention for stable angina (28.8% vs. 53.8%, <i>p</i> < 0.001) and a higher rate of potent P2Y12 inhibitor use (16.4% vs. 12.1%, <i>p</i> < 0.001) in the ad hoc PCI group compared to the planned PCI group. Patients undergoing uLMS-PCI on an ad hoc basis tended to undergo less complex procedures. Acute procedural complications including slow flow (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.01–2.86), coronary dissection (OR: 1.41, 95% CI: 1.12–1.77) and shock induction (OR: 2.80, 95% CI: 1.64–4.78) were more likely in the ad hoc PCI group. In-hospital death (OR: 1.65, 95% CI: 1.19–2.27) and in-hospital major adverse cardiac or cerebrovascular events (OR: 1.50, 95% CI: 1.13–1.98) occurred more frequently in the ad hoc group. In sensitivity analyses, these observations did not differ when several subgroups were separately examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ad hoc PCI for uLMS disease is associated with adverse outcomes compared to planned PCI. These data should inform uLMS-PCI procedural planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 4","pages":"697-706"},"PeriodicalIF":2.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131906","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}
Michael L. Savage BAppSc, Karen Hay BVSc, PhD, William Vollbon BAppSc, Dale J. Murdoch MBBS, FRACP, Christopher Hammett MBChB, MD, FRACP, James Crowhurst BSc (Hons), PhD, Karl Poon MBBS, FRACP, Rohan Poulter MBBS, FRACP, Darren L. Walters MBBS, FRACP, MPhil, Russell Denman MBBS, FRACP, Isuru Ranasinghe MBChB, MMed, PhD, FRACP, Owen Christopher Raffel MB, CHB, FRACP
Background
Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies.
Methods
Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017–December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30-day and 1-year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models.
Results
Overall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; p < 0.001), had longer total ischemic time (69 min vs. 52 min; p < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; p < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8–2.2; p = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7–2.1; p = 0.58) effect of female sex on 30-day mortality. One-year mortality was higher in females (6.9% vs. 4.4%; p = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0–2.3; p = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9–4.7; p = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6–1.6; p = 0.94) indicated sex differences were explained by confounders and mediators.
Conclusion
Small sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.
{"title":"Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI","authors":"Michael L. Savage BAppSc, Karen Hay BVSc, PhD, William Vollbon BAppSc, Dale J. Murdoch MBBS, FRACP, Christopher Hammett MBChB, MD, FRACP, James Crowhurst BSc (Hons), PhD, Karl Poon MBBS, FRACP, Rohan Poulter MBBS, FRACP, Darren L. Walters MBBS, FRACP, MPhil, Russell Denman MBBS, FRACP, Isuru Ranasinghe MBChB, MMed, PhD, FRACP, Owen Christopher Raffel MB, CHB, FRACP","doi":"10.1002/ccd.31206","DOIUrl":"10.1002/ccd.31206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017–December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30-day and 1-year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; <i>p</i> < 0.001), had longer total ischemic time (69 min vs. 52 min; <i>p</i> < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; <i>p</i> < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8–2.2; <i>p</i> = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7–2.1; <i>p</i> = 0.58) effect of female sex on 30-day mortality. One-year mortality was higher in females (6.9% vs. 4.4%; <i>p</i> = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0–2.3; <i>p</i> = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9–4.7; <i>p</i> = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6–1.6; <i>p</i> = 0.94) indicated sex differences were explained by confounders and mediators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Small sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 5","pages":"934-944"},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124942","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}
Xiao Wang MD, Hong Zhang MD, Xiaojun Bai MD, Li Zhang MD, Chengxiang Li MD, Xiaobo Mao MD, Jue Chen MD, Jianfang Luo MD, Yan Zhao MD, Binquan Zhou MD, Bei'an You MD, Yuelan Zhang MD, Likun Ma MD, Zhimin Du MD, Yan Chen MD, Fucheng Sun MD, Chunguang Qiu MD, Zhujun Shen MD, Shangyu Wen MD, Gary S. Mintz MD, Fei Ye MD, Shaoping Nie MD, PhD, China Rota Elite Group
Background
Rotational atherectomy (RA) remains an integral tool for the treatment of severe coronary calcified lesions despite emergence of newer techniques. We aimed to evaluate the contemporary clinical practices and outcomes of RA in China.
Methods
The Rota China Registry (NCT03806621) was an investigator-initiated, prospective, multicenter registry based on China Rota Elite Group. Consecutive patients treated with RA were recruited. A pre-designed, standardized protocol was recommended for the RA procedure. The primary safety endpoint was major adverse cardiovascular events (MACE: composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 30 days. The primary efficacy endpoint was procedural success.
Results
Between July 2018 and December 2020, 980 patients were enrolled at 19 sites in China. Mean patient age was 68.4 years, and 61.4% were men. Radial access was used in 79.1% patients, and 32.7% procedures were guided by intravascular imaging. A total of 22.6% procedures used more than 1 burr, and the maximal burr size was ≥1.75 mm in 24.4% cases, with burr upsizing in 19.3% cases, achieving a final burr-to-artery ratio of 0.52. Procedural success was achieved in 91.1% of patients, and the rate of 30-day and 1-year MACE was 4.9% and 8.2%, respectively. Multivariable analysis identified the total lesion length (HR 1.014, 95% CI: 1.002–1.027; p = 0.021) as predictor of 30-day MACE, and renal insufficiency (HR 1.916, 95% CI: 1.073–3.420; p = 0.028) as predictor of 1-year MACE.
Conclusions
In this contemporary prospective registry in China, the use of RA was effective in achieving high procedural success rate with good short- and long-term outcomes in patients with severely calcified lesions.
{"title":"Practices and outcomes of rotational atherectomy in China: The Rota China registry","authors":"Xiao Wang MD, Hong Zhang MD, Xiaojun Bai MD, Li Zhang MD, Chengxiang Li MD, Xiaobo Mao MD, Jue Chen MD, Jianfang Luo MD, Yan Zhao MD, Binquan Zhou MD, Bei'an You MD, Yuelan Zhang MD, Likun Ma MD, Zhimin Du MD, Yan Chen MD, Fucheng Sun MD, Chunguang Qiu MD, Zhujun Shen MD, Shangyu Wen MD, Gary S. Mintz MD, Fei Ye MD, Shaoping Nie MD, PhD, China Rota Elite Group","doi":"10.1002/ccd.31211","DOIUrl":"10.1002/ccd.31211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rotational atherectomy (RA) remains an integral tool for the treatment of severe coronary calcified lesions despite emergence of newer techniques. We aimed to evaluate the contemporary clinical practices and outcomes of RA in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Rota China Registry (NCT03806621) was an investigator-initiated, prospective, multicenter registry based on China Rota Elite Group. Consecutive patients treated with RA were recruited. A pre-designed, standardized protocol was recommended for the RA procedure. The primary safety endpoint was major adverse cardiovascular events (MACE: composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 30 days. The primary efficacy endpoint was procedural success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between July 2018 and December 2020, 980 patients were enrolled at 19 sites in China. Mean patient age was 68.4 years, and 61.4% were men. Radial access was used in 79.1% patients, and 32.7% procedures were guided by intravascular imaging. A total of 22.6% procedures used more than 1 burr, and the maximal burr size was ≥1.75 mm in 24.4% cases, with burr upsizing in 19.3% cases, achieving a final burr-to-artery ratio of 0.52. Procedural success was achieved in 91.1% of patients, and the rate of 30-day and 1-year MACE was 4.9% and 8.2%, respectively. Multivariable analysis identified the total lesion length (HR 1.014, 95% CI: 1.002–1.027; <i>p</i> = 0.021) as predictor of 30-day MACE, and renal insufficiency (HR 1.916, 95% CI: 1.073–3.420; <i>p</i> = 0.028) as predictor of 1-year MACE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this contemporary prospective registry in China, the use of RA was effective in achieving high procedural success rate with good short- and long-term outcomes in patients with severely calcified lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"104 4","pages":"664-675"},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119083","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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