Circulation: Cardiovascular Interventions最新文献

{"title":"Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs.","authors":"Joo Myung Lee, Sang Yoon Lee, Woochan Kwon, Seung-Jae Lee, Jong-Young Lee, Seung Hun Lee, Doosup Shin, Sang Yeub Lee, Sang Min Kim, Kyeong Ho Yun, Jae Young Cho, Chan Joon Kim, Hyo-Suk Ahn, Chang-Wook Nam, Hyuck-Jun Yoon, Yong Hwan Park, Wang Soo Lee, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Young Bin Song, Joo-Yong Hahn","doi":"10.1161/CIRCINTERVENTIONS.124.014920","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014920","url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging-guided percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with complex coronary artery lesions compared with angiography-guided PCI. However, the prognostic impact of suboptimal findings on intravascular imaging such as stent underexpansion, malapposition, or dissection is unclear in the era of contemporary drug-eluting stents.</p><p><strong>Methods: </strong>From RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) which compared imaging-guided PCI with angiography-guided PCI in patients with complex lesions, post-PCI intravascular imaging findings, including minimum stent area (MSA), relative stent underexpansion (MSA≤80% of the average reference lumen area), malapposition, or dissection, were assessed in nonleft main target lesions. The primary end point was target lesion failure (TLF), a composite of cardiac death, target lesion-related myocardial infarction, target lesion revascularization, or definite stent thrombosis.</p><p><strong>Results: </strong>A total of 897 nonleft main lesions from 714 patients undergoing imaging-guided PCI were included. During a median follow-up duration of 2.1 years, the optimal cutoff value of MSA to predict the occurrence of TLF was 5.5 mm², and MSA<5.5 mm² was associated with a significantly higher risk of TLF than MSA≥5.5 mm² (2.2% versus 4.8%; adjusted hazard ratio, 3.09 [95% CI, 1.01-9.50]; <i>P</i>=0.048). Compared with the reference group (MSA≥5.5 mm² and no suboptimal findings), the subgroup of patients with MSA≥5.5 mm² and post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, or major dissection was associated with a numerically increased risk of TLF (0.0% versus 3.2%; <i>P</i>=0.057). Compared with the same reference group, the subgroup of patients with MSA<5.5 mm² and suboptimal post-PCI intravascular imaging findings was associated with a significantly increased risk of TLF (0.0% versus 4.7%; <i>P</i>=0.017).</p><p><strong>Conclusions: </strong>After intravascular imaging-guided PCI with contemporary drug-eluting stents for nonleft main complex lesions, inadequate absolute stent expansion was independently associated with a higher risk of TLF. Suboptimal post-PCI intravascular imaging findings of relative stent underexpansion, major malapposition, and major dissection seem to contribute to the risk of TLF.</p><p><strong>Registration: </strong>https://www.clinicaltrials.gov; Unique identifier: NCT03381872.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 2","pages":"e014920"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448249","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":"Ultra-Low Contrast IVUS-Guided PCI in Patients With Severe Chronic Kidney Disease: An Observational Prospective Study.","authors":"Tony Truong, Marouane Boukhris, Anne Sophie Tuffreau-Martin, Antoine Molho, Paul-Matthieu Chiaroni, Patrick Zamora, Aurélien De Pommereau, Laura Rostain, Andrea Mangiameli, Andrea Cianci, Victor Aboyans, Emmanuel Teiger, Madjid Boukantar, Romain Gallet","doi":"10.1161/CIRCINTERVENTIONS.124.014854","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014854","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014854"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064240","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":"Intravascular Imaging as a Performance Measure for Percutaneous Coronary Intervention.","authors":"Elliot J Stein, Elise Mesenbring, Tracy Smith, Annika Hebbe, Taufiq Salahuddin, Stephen W Waldo, Michael D Dyal, Jacob A Doll","doi":"10.1161/CIRCINTERVENTIONS.124.014528","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014528","url":null,"abstract":"<p><strong>Background: </strong>Intravascular imaging (IVI) is widely recognized to improve outcomes after percutaneous coronary intervention (PCI). However, IVI is underutilized and is not yet established as a performance measure for quality PCI.</p><p><strong>Methods: </strong>We examined temporal trends of IVI use for all PCIs performed at Veterans Affairs hospitals in the United States from 2010 to 2022 using retrospective observational cohorts. IVI was defined as intravascular ultrasound or optical coherence tomography. A contemporary subset of PCIs from 2020 to 2022 was used to examine clinical characteristics associated with IVI use and test the reliability of IVI as a pass/fail performance measure. We then used a generalized linear mixed model to estimate the proportion of IVI use variability attributable to the hospital, physician, and patient level. Cox proportional hazard models were used to assess the association of IVI with clinical outcomes at 1 year.</p><p><strong>Results: </strong>IVI use increased from 12.3% in 2010 to 43.1% in 2022 in 136 071 PCIs included in the study. Among 22 918 PCIs in the contemporary cohort, IVI was more frequent with nonemergent presentations, chronic total occlusions, and left main lesions but usage variability was primarily attributable to hospital (54%) and physician (33%) levels. As a pass/fail performance measure, reliability was high (>0.96) at hospital and physician levels. However, IVI use was not associated with statistically significant differences in mortality or major adverse cardiovascular events in this cohort.</p><p><strong>Conclusions: </strong>IVI use for PCI is increasing rapidly at Veterans Affairs hospitals in the United States but with marked variation at the hospital and physician levels. IVI meets established criteria for an effective performance measure and should be measured and reported by local and national organizations to encourage further uptake. Ongoing training and quality improvement may be required to maximize the benefit of IVI as it is more widely utilized.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014528"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027609","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":"How Can We Optimize the Results of Coronary Bioresorbable Scaffolds?","authors":"Fernando Alfonso, Teresa Bastante, Fernando Rivero","doi":"10.1161/CIRCINTERVENTIONS.124.014889","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014889","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014889"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001188","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":"Door to Pulmonary Artery Perfusion: Are We Ready for a New Time-Based Metric?","authors":"Sanjum S Sethi, Mehdi H Shishehbor","doi":"10.1161/CIRCINTERVENTIONS.124.014990","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014990","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014990"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001244","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":"Outcomes of Intracoronary Imaging-Guided PCI With Optimal Versus Suboptimal Results: A Meta-Analysis.","authors":"Mohamed Hamed, Sheref A Mohamed, Asmaa Ahmed, Muhammad Adnan Haider, El-Moatasem Gabr, Dharam J Kumbhani, Anthony Bavry, Emmanouil S Brilakis, Mamas A Mamas, Ayman Elbadawi","doi":"10.1161/CIRCINTERVENTIONS.124.014681","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014681","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014681"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001267","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":"Comparison of Transcatheter Versus Surgical Tricuspid Repair Among Patients With Tricuspid Regurgitation: Two-Year Results.","authors":"Tomonari M Shimoda, Hiroki A Ueyama, Yoshihisa Miyamoto, Atsuyuki Watanabe, Hiroshi Gotanda, Dhaval Kolte, Azeem Latib, Tsuyoshi Kaneko, Alan Zajarias, Sammy Elmariah, Hiroo Takayama, Yusuke Tsugawa, Toshiki Kuno","doi":"10.1161/CIRCINTERVENTIONS.124.014825","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014825","url":null,"abstract":"<p><strong>Background: </strong>Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches.</p><p><strong>Methods: </strong>We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders.</p><p><strong>Results: </strong>A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, <i>P</i><0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, <i>P</i><0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48]).</p><p><strong>Conclusions: </strong>Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014825"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647057","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":"Comparative Outcomes of Transcatheter Edge-to-Edge Repair and Tricuspid Valve Surgery for Isolated Tricuspid Valve Regurgitation.","authors":"Conor M Lane, Mackram F Eleid","doi":"10.1161/CIRCINTERVENTIONS.124.014991","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014991","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"18 1","pages":"e014991"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001234","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 Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG.","authors":"Daimy M M Dillen, Hisao Otsuki, Kuniaki Takahashi, Yuhei Kobayashi, Zsolt Piroth, Nicolas Noiseux, Badih El Nakadi, Gintaras Kalinauskas, Laszlo Szekely, Giedrius Davidavičius, Koen Teeuwen, Pim A L Tonino, Nico H J Pijls, Bernard De Bruyne, William F Fearon, Frederik M Zimmermann","doi":"10.1161/CIRCINTERVENTIONS.124.014610","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014610","url":null,"abstract":"<p><strong>Background: </strong>In the era of first-generation drug-eluting stents and angiography-guided percutaneous coronary intervention (PCI), the presence of a bifurcation lesion was associated with adverse outcomes after PCI. In contrast, the presence of a bifurcation lesion had no impact on outcomes following coronary artery bypass grafting (CABG). Therefore, the presence of a coronary bifurcation lesion requires special attention when choosing between CABG and PCI. The aim of this study is to assess whether the presence of a bifurcation lesion still influences clinical outcomes after contemporary PCI using second-generation drug-eluting stent and fractional flow reserve (FFR) guidance versus CABG.</p><p><strong>Methods: </strong>The randomized FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared FFR-guided PCI using current drug-eluting stents with CABG in patients with 3-vessel coronary artery disease. The prespecified key end point at 3-year follow-up was the composite of death, myocardial infarction, or stroke. In this substudy, the impact of bifurcation lesions on outcomes after FFR-guided PCI and CABG was investigated.</p><p><strong>Results: </strong>The FAME 3 trial enrolled 1500 patients and 653 (45.2%) patients had at least 1 true bifurcation lesion. There was no difference in the composite of death, myocardial infarction, or stroke at the 3-year follow-up between patients with or without at least 1 true bifurcation lesion (11.6% versus 10.0%; hazard ratio, 1.17 [95% CI, 0.86-1.61]; <i>P</i>=0.32), regardless of revascularization strategy. The composite end point was not statistically different between FFR-guided PCI and CABG in patients with at least 1 true bifurcation lesion (hazard ratio, 1.27 [95% CI, 0.80-2.00]) or without a true bifurcation lesion (hazard ratio, 1.36 [95% CI, 0.87-2.12]), with no significant interaction (<i>P</i>_interaction=0.81).</p><p><strong>Conclusions: </strong>In patients with 3-vessel coronary artery disease, the presence of a true bifurcation lesion was not associated with a different treatment effect after FFR-guided PCI with contemporary drug-eluting stent versus CABG.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014610"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892643","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":"Extended Rhythm Monitoring to Assess for Ventricular Arrhythmias After Transcatheter Pulmonary Valve Replacement With the Harmony Valve.","authors":"Jeffrey K Yang, Laura Wattenbarger, Anne C Taylor, Henry Chubb, Anitra W Romfh, Lynn F Peng, Scott R Ceresnak, Anne M Dubin, Doff B McElhinney","doi":"10.1161/CIRCINTERVENTIONS.124.014381","DOIUrl":"10.1161/CIRCINTERVENTIONS.124.014381","url":null,"abstract":"<p><strong>Background: </strong>Varying rates of nonsustained ventricular tachycardia (NSVT) have been reported early after transcatheter pulmonary valve replacement (TPVR) with the Harmony valve, but data regarding rhythm outcomes beyond hospital discharge are limited. This study aims to characterize ventricular arrhythmias after Harmony TPVR from implant through mid-term follow-up.</p><p><strong>Methods: </strong>Ventricular arrhythmia data from postimplant telemetry and follow-up extended rhythm monitoring (ERM) were analyzed after Harmony TPVR.</p><p><strong>Results: </strong>Fifty-four patients with tetralogy of Fallot (n=39), valvar pulmonary stenosis (n=10), or pulmonary atresia with intact ventricular septum (n=5) were studied; 22% had prior NSVT and 24% were on prior rhythm medication. On postimplant telemetry, 27 patients (50%) had NSVT, including 1 who had torsade de pointes, but most had <5 episodes. Pre-TPVR NSVT or rhythm medications, diagnosis other than tetralogy, and substantial device contact with the myocardium were associated with more frequent NSVT on telemetry. Ten patients (19%) were started on a new antiarrhythmic medication. On discharge ERM, 37% of patients had NSVT, most with <5 episodes and only 13% with NSVT beyond 5 days post-discharge. On follow-up ERM, 14% of patients had a single episode of NSVT and 1 had 5 episodes. During follow-up, antiarrhythmic medications were discontinued in 8 of 10 patients and no patients died or had sustained ventricular tachycardia.</p><p><strong>Conclusions: </strong>NSVT and ventricular ectopy were common early after TPVR but were infrequent in most cases and diminished rapidly after discharge. The incidence of NSVT on follow-up ERM was similar to preimplant incidence. Few patients had antiarrhythmic medications initiated, and most were discontinued on follow-up. There were no major arrhythmic events after discharge.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014381"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892640","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}