Circulation: Cardiovascular Interventions最新文献

{"title":"Adjunctive Imaging and Physiology During PCI Among Black and White Medicare Beneficiaries: Disparities in Utilization Patterns and Outcomes.","authors":"Frank A Medina, Ramya C Mosarla, Joseph M Kim, Siling Li, Yang Song, Robert W Yeh, Eric A Secemsky","doi":"10.1161/CIRCINTERVENTIONS.125.015499","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015499","url":null,"abstract":"<p><strong>Background: </strong>Racial differences in the use and outcomes of intravascular imaging (IVI) and invasive physiology (IP) during percutaneous coronary intervention (PCI) are underreported in the United States.</p><p><strong>Methods: </strong>Medicare fee-for-service claims data were used to examine the use and outcomes of IVI- and IP-guided PCI by Black versus White race (2016-2023). Multivariable logistic regression was used to assess the association between race and IVI/IP use. The primary outcome was major adverse cardiovascular events, which included myocardial infarction, repeat revascularization, and death. Outcomes were compared by race according to the device used (IVI versus none; IP versus none; and among all IVI/IP recipients). Cox regression was used to estimate the association between race and 2-year outcomes, adjusting for all baseline characteristics.</p><p><strong>Results: </strong>The study included 1 481 343 PCI patients (5.9% Black, 63.6% male, mean age 75.3±7.0 years). IVI was used in 17.6% of PCIs in White patients and 15.0% in Black patients; IP use was 7.1% and 5.7%, respectively. After adjustment, Black adults were less likely to receive IVI (odds ratio, 0.94 [95% CI, 0.93-0.96]) or IP (odds ratio, 0.83 [95% CI, 0.81-0.85]). IVI- and IP-guided PCI had lower major adverse cardiovascular event risk at 2-years in both racial groups compared with angiography alone: IVI (White: hazard ratio [HR], 0.93 [95% CI, 0.92-0.94]; Black: HR, 0.85 [95% CI, 0.84-0.87]) and IP (White: HR, 0.95 [95% CI, 0.92-0.98]); Black: HR, 0.87 [95% CI, 0.83-0.91]). However, despite global benefits with IVI/IP, Black adults had a higher adjusted risk of major adverse cardiovascular events compared with White adults (HR, 1.02 [95% CI, 1.01-1.03]).</p><p><strong>Conclusions: </strong>IVI- and IP-guided PCI were associated with improved outcomes in both Black and White beneficiaries, yet these technologies were less frequently used in Black adults, and overall PCI outcomes remained worse for this group.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015499"},"PeriodicalIF":7.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Look Into Spontaneous Coronary Artery Dissection: The SwissSCAD Registry.","authors":"Sophie Degrauwe, Gregor Fahrni, Christoph Kaiser, Marion Dupré, Stéphane Cook, Thomas Gillhofer, Marco Roffi, Franz Eberli, Daniel Weilenmann, Matthias Bossard, Dik Heg, Hans Rickli","doi":"10.1161/CIRCINTERVENTIONS.125.015540","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015540","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015540"},"PeriodicalIF":7.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Demir et al to Letter Regarding Article, \"Pressure Derived Indices in the Left Main Coronary Artery: Insights From Comprehensive In Vivo Hemodynamic Studies of Diseased and Unobstructed Vessels\".","authors":"Ozan M Demir, Haseeb Rahman, Divaka Perera","doi":"10.1161/CIRCINTERVENTIONS.125.015752","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015752","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015752"},"PeriodicalIF":7.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transjugular Approach for Evoque Transcatheter Tricuspid Valve Replacement in Patients With Challenging Anatomy.","authors":"Jonathan X Fang, Pedro A Villablanca, Tiberio M Frisoli, Gennaro Giustino, Leo Kar Lok Lai, James C Lee, Pedro Engel Gonzalez, Bryan Zweig, Hussayn Alrayes, Georgi K Fram, Felix Nguyen, Ahmad Jabri, Tyler Andrews, Omar Abdelhai, Gautam Rangavajla, William W O'Neill, Brian P O'Neill","doi":"10.1161/CIRCINTERVENTIONS.125.015276","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015276","url":null,"abstract":"<p><strong>Background: </strong>The Evoque system is the first commercially available transcatheter tricuspid valve replacement (TTVR) system in the United States. However, challenging anatomy in real-world patients could preclude successful transfemoral Evoque TTVR. We aim to investigate the feasibility of the transjugular Evoque TTVR in anatomy unsuitable for a transfemoral approach.</p><p><strong>Methods: </strong>Eleven patients with challenging anatomy underwent transjugular Evoque TTVR at a high-volume center in the United States from February 2024 to January 2025, following an unsuccessful transfemoral attempt (n=9) or anatomic unsuitability (n=2). Procedural characteristics, intraprocedural success, periprocedural outcomes, echocardiographic findings, and 30-day clinical outcomes were assessed using the Tricuspid Valve Academic Research Consortium definitions. The procedural technique is provided in the accompanying supplement.</p><p><strong>Results: </strong>Intraprocedural success was achieved in all 11 patients, with reasonable procedural time and no major procedural complications, except for 1 pacemaker implantation. At 30 days, the clinical success rate was 100%. Tricuspid regurgitation was reduced to none-to-trivial in 8 patients, mild in 2 patients, and moderate in 1 patient. There was no stroke, mortality, or rehospitalization. Nine out of 11 patients experienced an improvement in New York Heart Association functional class.</p><p><strong>Conclusions: </strong>In the largest single-center cohort of patients reported to date, transjugular Evoque TTVR demonstrated favorable intraprocedural, periprocedural, and short-term clinical outcomes, and was found to be a feasible alternative for patients with anatomy unsuitable for transfemoral Evoque TTVR.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015276"},"PeriodicalIF":7.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of Intracoronary Imaging-Guided PCI in Contemporary Practice: Insights From BMC2.","authors":"Thomas Basala, Milan Seth, Ryan D Madder, Brett Wanamaker, Brittany Fuller, Evan Shlofmitz, Edouard Daher, Michael Tucciarone, Chadi Alraies, Amir Kaki, Sunil V Rao, Hitinder S Gurm, Devraj Sukul","doi":"10.1161/CIRCINTERVENTIONS.124.014886","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014886","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest percutaneous coronary intervention (PCI) guided by intracoronary imaging (ICI) results in larger balloon/stent diameters and longer stents. Whether this occurs in real-world PCI is poorly understood.</p><p><strong>Methods: </strong>De novo PCIs performed at 48 nonfederal Michigan hospitals between July 2019 and June 2022 were evaluated with regression modeling to evaluate associations between ICI-guided PCI and balloon/stent dimensions. The association between ICI-guided PCI and coronary dissection/perforation was assessed using adjusted odds ratios.</p><p><strong>Results: </strong>ICI was used in 16 777 (22.5%) PCI-treated lesions and increased from 11.2% of cases in July 2019 to 32.1% in June 2022. Compared with angiography alone, the average patient/procedural-adjusted treatment effect of ICI use included: +0.19 mm stent diameter (95% CI +0.16 to +0.22), +0.45 mm maximum balloon diameter (95% CI +0.40 to +0.51), and +3.51 mm stent length (95% CI +2.54 to +4.48). These findings persisted when controlling for the operator. ICI use was associated with a higher risk of dissections (adjusted odds ratio, 2.55 [95% CI, 2.05-3.16]) and perforations (adjusted odds ratio, 2.25 [95% CI, 1.74-2.91]); however, increased use of ICI and larger stent/balloon sizes over the study period (<i>P</i><0.001 for trend for both) was not associated with a concomitant increase in rates of dissection or perforation (<i>P</i>=0.78 and <i>P</i>=0.33 for trend, respectively).</p><p><strong>Conclusions: </strong>In real-world practice, ICI-guided PCI was associated with larger stent/balloon diameters and longer stents. While ICI use was associated with dissections and perforations, there was no significant increase in the rate of these complications despite significant increases in ICI use and stent/balloon sizes during the study period. Further research is needed to evaluate the association between ICI use and procedural complications.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014886"},"PeriodicalIF":7.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural and Clinical Outcomes After Orbital Atherectomy Versus Intravascular Lithotripsy in Patients With Calcified Nodules.","authors":"Ali H Dakroub, Doosup Shin, Mandeep Singh, Sarah Malik, Rick H J A Volleberg, Jonathan Weber, Yasemin Ciftcikal, Alysse Fazal, Koshiro Sakai, Takao Sato, Akiko Maehara, Mitsuaki Matsumura, Jeffrey W Moses, Gary S Mintz, Omar Khalique, Fernando Sosa, Evan Shlofmitz, Allen Jeremias, Richard A Shlofmitz, Ziad A Ali","doi":"10.1161/CIRCINTERVENTIONS.125.015254","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015254","url":null,"abstract":"<p><strong>Background: </strong>Calcified nodules (CNs) remain a major challenge in percutaneous coronary intervention (PCI). We sought to compare procedural and clinical outcomes after orbital atherectomy (OA) versus intravascular lithotripsy (IVL)-facilitated PCI in patients with CNs.</p><p><strong>Methods: </strong>We identified patients with optical coherence tomography (OCT)-defined CNs who underwent PCI with either OA or IVL between 2012 and 2022 and had both pre- and post-PCI OCT images available. The imaging end point was the minimal stent area on final post-PCI OCT. The clinical end point was 2-year target-lesion failure, a composite of cardiac death, target-vessel myocardial infarction, or clinically driven target-lesion revascularization. A multivariable Cox proportional hazards regression model was used to estimate hazard ratio and 95% CI. Sensitivity analyses were performed using propensity score matching, incorporating covariates such as age, sex, diabetes, and pre-PCI calcium burden assessed by OCT (length, arc, and thickness).</p><p><strong>Results: </strong>Among 4856 patients with evaluable pre- and post-PCI OCT images, 493 patients (10.2%) had CNs, and 167 patients underwent PCI with either OA (n=83) or IVL (n=84). The 2 groups had similar baseline demographic and lesion characteristics. After PCI, final minimal stent area was comparable between the 2 groups (OA, 5.6 mm² [interquartile range, 4.8-6.7] versus IVL, 5.5 mm² [interquartile range, 4.8-7.0]; <i>P</i>=0.75). At a median follow-up of 2.4 years, there was no difference in target-lesion failure between the OA and IVL groups (12.0% versus 9.8%, respectively; log-rank <i>P</i>=0.64; adjusted hazard ratio, 1.20 [95% CI, 0.43-3.36]; <i>P</i>=0.74). Overall results remained consistent in the propensity score-matched population (n=68 per group), with similar minimal stent area (5.6 mm² [4.8-6.7] versus 5.5 mm² [4.7-6.8]; <i>P</i>=0.73) and comparable 2-year target-lesion failure rate (9.8% versus 8.8%; log-rank <i>P</i>=0.82).</p><p><strong>Conclusions: </strong>In patients with OCT-defined CNs, OA- and IVL-assisted PCI resulted in comparable post-PCI minimal stent area and 2-year clinical outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015254"},"PeriodicalIF":7.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Ulacia Flores and Bertrand to Letter Regarding Article, \"Randomized Study Comparing Angiography Guidance With Physiology Guidance After PCI: The EASY-PREDICT Study\".","authors":"Paola Ulacia Flores, Olivier F Bertrand","doi":"10.1161/CIRCINTERVENTIONS.125.015633","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015633","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015633"},"PeriodicalIF":7.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Is Not Always Better: Reassessing Acetylcholine Provocation in the Diagnosis of Coronary Vasospasm.","authors":"Haseeb Rahman, Aish Sinha, Divaka Perera","doi":"10.1161/CIRCINTERVENTIONS.125.015677","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015677","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015677"},"PeriodicalIF":7.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Valve: Sex-Specific Insights in Aortic Stenosis and Coronary Artery Disease.","authors":"Gianluca Mincione, Giulio Giuseppe Stefanini, Valeria Paradies","doi":"10.1161/CIRCINTERVENTIONS.125.015565","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015565","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015565"},"PeriodicalIF":7.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Coronary Function Testing in Patients With Prior PCI Who Have Persistent ANOCA.","authors":"Vedant S Pargaonkar, Christopher C Y Wong, Yasuhiro Honda, Ingela Schnittger, Jennifer A Tremmel","doi":"10.1161/CIRCINTERVENTIONS.125.015344","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015344","url":null,"abstract":"<p><strong>Background: </strong>Patients with post-percutaneous coronary intervention (PCI) angina are challenging to manage. Comprehensive coronary function testing (CFT) can identify occult coronary abnormalities in patients with angina and nonobstructive coronary arteries. Its utility in patients with post-PCI persistent angina who have no obstructive coronary artery disease is unexplored.</p><p><strong>Methods: </strong>We assessed 46 patients with a prior PCI experiencing persistent angina. CFT evaluated the presence of endothelial dysfunction, epicardial and microvascular spasm, low fractional flow reserve, coronary microvascular dysfunction, and myocardial bridging by intravascular ultrasound. The Seattle Angina Questionnaire measured symptom severity before and 1-year post-CFT.</p><p><strong>Results: </strong>The median age was 60 (53-69) years, with 63% being women. Pre-PCI lesion stenosis was 80 (70-90)% and pre-PCI fractional flow reserve (n=7) was 0.72 (0.67-0.74). Left anterior descending artery PCI was performed in 47.8%. The median duration between PCI and CFT was 19.5 (11.2-57.2) months. Patients reported severe anginal symptoms and poor quality of life on the Seattle Angina Questionnaire. CFT revealed a median fractional flow reserve of 0.84 (0.82-0.87), and 19.6% had a fractional flow reserve ≤0.8. Endothelial dysfunction was diagnosed in 36.9%, of whom 64.7% had moderate to severe endothelial dysfunction. Epicardial and microvascular spasm were present in 56.5% and 17.4%, respectively. Coronary microvascular dysfunction was present in 43.5%, and 63% had myocardial bridging. Patients reported significant improvement in Seattle Angina Questionnaire scores 1-year post-CFT.</p><p><strong>Conclusions: </strong>Patients with post-PCI persistent angina have severe symptoms and poor quality of life, with the majority exhibiting endothelial dysfunction, epicardial spasm, coronary microvascular dysfunction, and myocardial bridging. Comprehensive CFT should be considered in these patients to help diagnose an underlying cause of their persistent angina and guide therapy for a better outcome.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015344"},"PeriodicalIF":7.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}