Circulation: Cardiovascular Interventions最新文献

{"title":"Effect of TAVI on Epicardial Functional Indices and Their Relationship to Coronary Microvascular Function.","authors":"Emanuele Gallinoro, Roberto Scarsini, Marco B Ancona, Pasquale Paolisso, Leonardo Portolan, Paolo Springhetti, Francesco Della Mora, Andrea Mainardi, Marta Belmonte, Francesco Moroni, Luca A Ferri, Barbara Bellini, Filippo Russo, Ciro Vella, Michele Mattia Viscusi, Thabo Mahendiran, Gabriele Pesarini, Giovanni Benfari, Matteo Montorfano, Flavio Ribichini, Marc Vanderheyden, Emanuele Barbato","doi":"10.1161/CIRCINTERVENTIONS.124.014940","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014940","url":null,"abstract":"<p><strong>Background: </strong>The anatomic and physiological changes associated with severe aortic stenosis may influence the functional evaluation of coronary stenoses. In this study, we aimed to assess changes in functional resting and hyperemic indices before and immediately after transcatheter aortic valve implantation (TAVI) and their relationship with microvascular resistance.</p><p><strong>Methods: </strong>In this pooled analysis of 3 prospective observational studies, fractional flow reserve (FFR), resting full-cycle ratio (RFR), and resting distal coronary pressure to aortic pressure ratio (Pd/Pa) were measured in patients with severe aortic stenosis before and after TAVI in the left anterior descending artery. Coronary microcirculation was also assessed using thermodilution-based methods, with microvascular resistance reserve (cutoff ≤3) used to identify coronary microvascular dysfunction.</p><p><strong>Results: </strong>A total of 126 patients were included. Baseline Pd/Pa, RFR, and FFR measurements were 0.93±0.04, 0.90±0.07, and 0.89±0.07, respectively. Immediately post-TAVI, a small but significant decrease was observed for both RFR and FFR (RFR, 0.88±0.08; FFR, 0.88±0.08; <i>P</i><0.05 for all). Coronary flow reserve and microvascular resistance reserve also remained unchanged. Applying the established cutoff values, 16 (12.7%) vessels had a positive FFR, while a higher proportion of vessels were positive for Pd/Pa and RFR (35.7% and 43.7%, respectively; <i>P</i><0.001). The concordance between pre- and post-TAVI FFR was higher (92.8%) compared with Pd/Pa (75.4%) and RFR (73.8%) (<i>P</i><0.001 for both). The rate of disagreement between resting and hyperemic indices remained unchanged, regardless of the presence of coronary microvascular dysfunction.</p><p><strong>Conclusions: </strong>TAVI is associated with a small but significant reduction in FFR and RFR immediately post-procedure. Overall, the agreement between pre- and post-TAVI values of FFR was higher compared with resting indices.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014940"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968766","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":"Age-Related Outcomes After Revascularization for Chronic Limb-Threatening Ischemia: An Analysis of BEST-CLI.","authors":"Khanjan B Shah, Hanaa Aridi, Michael D Dake, Gheorghe Doros, Alik Farber, Matthew T Menard, Raghu Motaganahalli, Cassius Ochoa Chaar, Kenneth Rosenfield, Salvatore T Scali, Samir K Shah, Michael B Strong, Gilbert R Upchurch, William P Robinson","doi":"10.1161/CIRCINTERVENTIONS.124.014833","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014833","url":null,"abstract":"<p><strong>Background: </strong>The impact of age on outcomes after revascularization for chronic limb-threatening ischemia has not been studied in a prospective trial.</p><p><strong>Methods: </strong>A total of 1780 patients were grouped into age quartiles (≤55 years, 55< age ≤65 years, 65< age ≤75 years, and >75 years) and by type of revascularization (open bypass or endovascular). The primary outcome was major adverse limb events (MALE) or death, and the secondary outcomes were above-ankle amputation, reintervention, and major adverse cardiovascular events.</p><p><strong>Results: </strong>Death and major adverse cardiovascular events were significantly higher in the oldest quartile (>75 years), whereas MALE and above-ankle amputation were highest in the youngest cohort (≤55 years). Younger patients (≤55 years) had the lowest adjusted risk of MALE or all-cause death with open bypass compared with endovascular revascularization. There was no difference in MALE or all-cause death by treatment strategy in patients >75 years of age.</p><p><strong>Conclusions: </strong>Older age was associated with the highest risks of death and major adverse cardiovascular events and the lowest risks of MALE and above-ankle amputation among patients enrolled in BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Chronic Limb-Threatening Ischemia). Age also had a differential impact by revascularization strategy: youngest patients had the lowest risk of MALE and all-cause death with bypass surgery compared with endovascular revascularization, while there was no difference among those >75 years. These data should be used to facilitate shared decision-making in patients with chronic limb-threatening ischemia.</p><p><strong>Registration: </strong>URL: https://biolincc.nhlbi.nih.gov/studies/best_cli/; Unique identifier: HLB02932424a.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014833"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Total Occlusion Percutaneous Coronary Intervention: Present and Future.","authors":"Emmanouil S Brilakis, Yader Sandoval, Lorenzo Azzalini, Gregor Leibundgut, Roberto Garbo, Allison B Hall, Rhian E Davies, Kambis Mashayekhi, Masahisa Yamane, Alexandre Avran, Jaikirshan J Khatri, Khaldoon Alaswad, Farouc A Jaffer, Stephane Rinfret","doi":"10.1161/CIRCINTERVENTIONS.124.014801","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014801","url":null,"abstract":"<p><p>Chronic total occlusion percutaneous coronary intervention has evolved into a subspecialty of interventional cardiology. Using a variety of antegrade and retrograde techniques, experienced operators currently achieve success rates of 85% to 90%, with an incidence of major periprocedural complications of ≈2% to 3%. Several developments in equipment (new microcatheters and guidewires, novel reentry devices), imaging (computed tomography angiography guidance, intravascular imaging for reentry), techniques (intraocclusion contrast injection, advanced subintimal tracking and reentry), and artificial intelligence (automated computed tomography image analysis and prediction of the likelihood of crossing success with various techniques) could further improve outcomes. Global collaboration and rapid dissemination of new developments accelerate the pace of progress. While innovation is exciting and necessary, adhering to the basic principles of chronic total occlusion percutaneous coronary intervention (such as continual assessment of risks and benefits, meticulous angiographic review, and use of dual injection) remains critical for achieving optimal patient outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014801"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955391","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":"Why Age Matters: Revascularization Strategy and Outcomes in Young and Elderly With CLTI.","authors":"Yulanka Castro-Dominguez, Devanshi Damani, Jun Li","doi":"10.1161/CIRCINTERVENTIONS.125.015423","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015423","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015423"},"PeriodicalIF":6.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126910","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":"Aspirin in Dual Antiplatelet Therapy After PCI: One Duration Does Not Fit All.","authors":"Uwe Zeymer, Christoph B Olivier, Daniel Dürschmied","doi":"10.1161/CIRCINTERVENTIONS.125.015518","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015518","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015518"},"PeriodicalIF":6.1,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180964","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":"Letter by Movahed Regarding Article, \"Chronic Total Occlusion Percutaneous Coronary Intervention: Present and Future\".","authors":"Mohammad Reza Movahed","doi":"10.1161/CIRCINTERVENTIONS.125.015552","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015552","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015552"},"PeriodicalIF":6.1,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181189","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 Skalidis et al to Letter Regarding Article, \"Comparing the Efficacy of Sirolimus and Paclitaxel-Eluting Balloon Catheters in the Treatment of Coronary In-Stent Restenosis: A Prospective Randomized Study (TIS 2 Study)\".","authors":"Leos Pleva, Pavel Kukla, Tomas Kovarnik, Jana Zapletalova","doi":"10.1161/CIRCINTERVENTIONS.125.015470","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015470","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015470"},"PeriodicalIF":6.1,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181508","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 According to Ultrasound-Guided Access in TAVI: A Propensity-Matched Comparative Subanalysis From the PULSE Registry.","authors":"David Grundmann, Tanja Rudolph, Matti Adam, Caroline Kellner, Sabine Bleiziffer, Daniel Braun, Alexander R Tamm, Max Meertens, Matthias Renker, Jonas Gmeiner, Alexander Sedaghat, David Leistner, Christian W Hamm, Hendrik Wienemann, Norvydas Zapustas, Benjamin Juri, Mostafa Salem, Roman Benetti-Lehmann, Henryk Dreger, Alina Gossling, Awesta Nahif, Stefan Blankenberg, Hermann Reichenspurner, Niklas Schofer, Andreas Schaefer, Jasmin Popara, Misumasa Sudo, Martin Geyer, Marc Vorpahl, Derk Frank, Max Potratz, Won Kim, Moritz Seiffert","doi":"10.1161/CIRCINTERVENTIONS.124.014771","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014771","url":null,"abstract":"<p><strong>Background: </strong>Access-related vascular and bleeding complications during transcatheter aortic valve implantation (TAVI) are associated with significant morbidity and mortality. Ultrasound-guided (USG) puncture may reduce the incidence of these adverse events, particularly in large-bore arterial access. However, large-scale data on this approach are limited, and it has not yet been fully implemented into standard clinical practice. We compared access-related vascular and bleeding complications in USG versus fluoroscopy-guided access from a large multicenter TAVI registry.</p><p><strong>Methods: </strong>The PULSE registry (Plug- or Suture-Based Vascular Closure After TAVI) retrospectively evaluated data of 9295 patients who underwent transfemoral TAVI at 10 high-volume German heart centers (2016-2021). USG and fluoroscopy-guided access were performed in 1992 (21.4%) and 7303 (78.6%) patients, respectively. Propensity score matching (1:1) yielded 895 matched pairs. The primary end point, a composite of minor and major vascular complications or bleeding type II-IV, was assessed according to Valve Academic Research Consortium definitions.</p><p><strong>Results: </strong>Patients in the USG and fluoroscopy-guided groups (median age, 81.9 [78.3-85.0] years; 47.8% female patients) showed well-balanced baseline characteristics. The overall risk profile was comparable (median EuroSCORE II: 3.2 versus 3.5; SD, 0.007 [-0.086 to 0.099]). The composite primary end point occurred less frequently in the USG group (11.7% versus 16.0%; odds ratio, 0.7; <i>P</i>=0.01), driven by lower rates of procedural bleeding (5.4% versus 9.2%; odds ratio, 0.56; <i>P</i>=0.002) and with lower rates of endovascular treatment (0.7% versus 2.5%; <i>P</i>=0.005).</p><p><strong>Conclusions: </strong>In patients with transfemoral TAVI, USG access demonstrated lower rates of access-related vascular complications and type II-IV bleeding compared with fluoroscopy-guided access. Implementing USG puncture as the standard of care may improve access-related outcomes after TAVI.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014771"},"PeriodicalIF":6.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172296","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":"Ethical Considerations for Informed Consent in Acute Myocardial Infarction Clinical Trials.","authors":"Manasi Tannu, W Schuyler Jones, John H Alexander, Roxana Mehran, Adrian F Hernandez, Jennifer A Rymer","doi":"10.1161/CIRCINTERVENTIONS.124.015016","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.015016","url":null,"abstract":"<p><p>Obtaining informed consent for clinical trial participation in acute myocardial infarction presents unique ethical and logistical challenges because of the patient distress, sedation, and the urgency of treatment. Traditional consent procedures often conflict with the narrow enrollment windows, prompting the use of legally authorized representatives and short- and long-form consent models. Although these approaches enable faster trial enrollment, they may compromise patient autonomy, introduce selection bias, or create postenrollment ethical dilemmas. This review explores the complexities of informed consent in acute myocardial infarction research, evaluating the advantages and limitations of existing strategies, including legally authorized representative consent, 2-step consent processes, and alternatives such as deferred and verbal consent. It also examines international variations in regulatory oversight and presents emerging solutions, such as preemptive consent, opt-out models, electronic platforms, and registry-based trials, to streamline the enrollment without delaying care. Ultimately, consent regulations should be re-evaluated and potentially relaxed to better support timely research. A thoughtful reassessment of consent frameworks is essential to ethically and effectively advance acute myocardial infarction research in time-sensitive settings.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015016"},"PeriodicalIF":6.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149507","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":"Impact of Coronary Artery Disease on Cardiovascular Outcomes Differs Between Men and Women With Severe Aortic Stenosis.","authors":"Kayla Brown, Ke Xu, Rebecca T Hahn, Philippe Pibarot, Jonathon Leipsic, Ying Ma, Marie-Annick Clavel, Sammy Elmariah, Neil J Weissman, Federico M Asch, Omar Khalique, Martin B Leon, Paul Cremer, Brian R Lindman, Maria C Alu, Pamela S Douglas, Melissa A Daubert","doi":"10.1161/CIRCINTERVENTIONS.124.014999","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014999","url":null,"abstract":"<p><strong>Background: </strong>There is heterogeneity in coronary artery disease (CAD) severity among individuals with severe aortic stenosis (AS), but whether this differentially influences prognosis is unknown.</p><p><strong>Methods: </strong>Patients with severe AS in the PARTNER 1, 2, and 3 trials and registries (Placement of Aortic Transcatheter Valves) were stratified by obstructive CAD (coronary stenosis ≥50%, prior myocardial infarction, or revascularization) or no obstructive CAD (all stenoses <50%). Multivariable Cox proportional-hazards models examined the association between CAD severity groups and clinical outcomes. The primary composite end point was death, heart failure hospitalization, or stroke at 5 years. Interaction between sex and CAD severity was evaluated.</p><p><strong>Results: </strong>Among 7505 patients with severe AS, 2062 (27.5%) had no obstructive CAD and were more likely to be women (60.5%) with fewer CAD risk factors. After multivariable adjustment, the primary end point was significantly lower among patients with no obstructive CAD compared with those with obstructive CAD (adjusted hazard ratio, 0.92 [CI, 0.84-1.00]; <i>P</i>=0.04), irrespective of AS treatment. However, there were significant differences by sex (<i>P</i>_interaction=0.0002). Men with no obstructive CAD had a 16% lower event rate compared with men with obstructive CAD (adjusted hazard ratio, 0.84 [CI, 0.73-0.96]; <i>P</i>=0.01). In contrast, women with no obstructive CAD did not have a significantly lower rate of death, stroke, or heart failure hospitalization compared with women with obstructive CAD (adjusted hazard ratio, 0.95 [CI, 0.85-1.07]; <i>P</i>=0.41). Women with no obstructive CAD had a more advanced heart failure phenotype and higher event rates compared with men with no obstructive CAD.</p><p><strong>Conclusions: </strong>Obstructive CAD was associated with a higher risk of long-term adverse events after treatment for severe AS, but there was a significant sex disparity in clinical outcomes among men and women with no obstructive CAD. Further study is needed to optimize the evaluation and management of women with severe AS.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014999"},"PeriodicalIF":6.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149510","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}