Journal of interventional cardiology最新文献

{"title":"Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis","authors":"Hossam Alzu’bi,&nbsp;Anan Abu Rmilah,&nbsp;Ikram-UI Haq,&nbsp;Babikir Kheiri,&nbsp;Ahmad Al-abdouh,&nbsp;Bashar Hasan,&nbsp;Omar Elsekaily,&nbsp;Suhaib Jaber,&nbsp;Ibraheem Qaisi,&nbsp;Asil Yagmour,&nbsp;Hamada Dajani,&nbsp;Azza Ahmed,&nbsp; Ahmed elhag,&nbsp;Kianoush Kashani,&nbsp;Abhishek Deshmukh","doi":"10.1155/2022/3380605","DOIUrl":"10.1155/2022/3380605","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. <i>Objective</i>. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. <i>Methods</i>. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. <i>Results</i>. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p &lt; 0.00001). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27–0.98; <i>p</i> = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29–2.75; <i>p</i> = 0.84). <i>Conclusion</i>. The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40474810","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}

{"title":"Antithrombotic Therapy Duration after Patent Foramen Ovale Closure for Stroke Prevention: Impact on Long-Term Outcome","authors":"Joelle Kefer,&nbsp;Karlien Carbonez,&nbsp;Sophie Pierard,&nbsp;François-Pierre Mouthuy,&nbsp;Andre Peeters,&nbsp;Cedric Hermans,&nbsp;Catherine Lambert,&nbsp;Christophe DeMeester,&nbsp;Thierry Sluysmans,&nbsp;Agnes Pasquet","doi":"10.1155/2022/6559447","DOIUrl":"10.1155/2022/6559447","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The optimal duration of antithrombotic therapy (ATT) after patent foramen ovale (PFO) closure remains under debate. This study sought to compare the clinical outcome of patients receiving antithrombotic agents for a short (6 months) versus extended (&gt;6 months) period after the procedure. <i>Methods</i>. This was a retrospective cohort study using a propensity score matching analysis on 259 consecutive patients (131 males, 43 ± 10 years) undergoing PFO closure due to cryptogenic stroke, with complete follow-up (median duration of 10 [4–13] years). The outcome was compared between patients receiving short-term (Group short, <i>N</i> = 88) versus extended ATT (Group long, <i>N</i> = 171). <i>Results</i>. The PFO closure device was successfully implanted in all cases, with 3% of minor complications. After propensity score matching, there were no differences between Groups short and long in the rate of stroke (0.3 vs. 0.4% patient-year, <i>p</i> = 1.00), bleeding (2 vs. 2% patient-year, <i>p</i> = 0.17), and device thrombosis (0.3 vs. 0.1% patient-year; <i>p</i> = 0.60). Univariate analysis showed that short-term ATT was not associated with an increased risk of recurrent stroke (HR: 1.271 [95% CI: 0.247–6.551], <i>p</i> = 0.775) or prosthesis thrombus (HR: 0.50 [95% CI: 0.070–3.548], <i>p</i> = 0.72). Kaplan–Meier analysis revealed similar overall survival in Group short and long (100 vs. 99 ± 1%, respectively; <i>p</i> = 0.25). <i>Conclusions</i>. Short-term (6 months) ATT after PFO closure did not impair the clinical outcome, with a preserved low rate of recurrent stroke (0.3% patient-year) and device thrombosis (0.2% patient-year) at 10-year follow-up.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40474809","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}

{"title":"Balloon-Expandable TAVR Bioprostheses: Area or Perimeter Sizing? A Prospective Pilot Study","authors":"Jonathan Halim,&nbsp;Peter den Heijer,&nbsp;Jeroen Vos,&nbsp;Bas E. Schölzel,&nbsp;Martijn Meuwissen,&nbsp;Ben van den Branden,&nbsp;Andreas Baumbach,&nbsp;Alexander J. J. Ijsselmuiden","doi":"10.1155/2022/3139476","DOIUrl":"10.1155/2022/3139476","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. In TAVR, area sizing is used for balloon-expandable (BE) valves, whereas self-expanding valves are sized to annulus perimeter. For BE valves, this seems illogical: these frames force a circular shape even on an ellipsoid annulus. This can potentially lead to relative undersizing when area sizing is being applied. We developed a perimeter-based sizing algorithm to evaluate the safety and feasibility of perimeter sizing for the Myval BE valve. <i>Methods</i>. In this prospective single-center study, 60 patients with severe aortic stenosis treated with the Myval BE valve were included. Perimeter sizing was used with limited oversizing of 3.7% ± 1.3% compared to the annulus perimeter. After TAVR, clinical outcomes were evaluated at 30 days and 1 year. An echocardiographic follow-up took place at 30 days. <i>Results</i>. At 30 days, the need for PPI and stroke occurred in 2% and 3% of the patients, respectively. Moreover, cardiac death and moderate-severe PVL were absent. At 1-year, cardiac death and stroke were observed in 3% and 8% of the patients, respectively. In 33.3% of the patients, a larger valve size was implanted compared to the valve size calculated by area sizing. <i>Conclusions</i>. Perimeter sizing with the Myval BE valve leads to substantial use of larger valve sizes and favorable clinical outcomes, with low PPI and the absence of significant PVL. A randomized controlled trial is being planned to prove the superiority of this alternative sizing method.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9596236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40448764","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}

{"title":"Uric Acid to High-Density Lipoprotein Cholesterol Ratio is a Novel Marker to Predict Functionally Significant Coronary Artery Stenosis","authors":"Fanqi Li,&nbsp;Donghui Zhao,&nbsp;Qiuyu Li,&nbsp;Xiaolong Lin,&nbsp;Haoxuan Sun,&nbsp;Qian Fan","doi":"10.1155/2022/9057832","DOIUrl":"10.1155/2022/9057832","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Intermediate coronary stenosis (ICS) is defined as a visually estimated percentage of diameter stenosis ranging between 40% and 70% by conventional coronary angiography (CAG). Whether to perform percutaneous coronary intervention (PCI) for these lesions is a challenge in clinical practice. The fractional flow reserve (FFR) can guide treatment by determining the functional significance of ICS. Studies have shown that some clinical indicators can be used to predict FFR. However, there is little research on this in the Chinese population. <i>Methods</i>. We retrospectively analyzed 690 patients who underwent FFR measurements to determine the functional significance of a single ICS. Patients were divided into 2 groups: FFR ≤0.8 (<i>n</i> = 280) and FFR &gt;0.8 (<i>n</i> = 410). We compared the clinical factors between the two groups and performed multivariate logistic regression analyses to explore the risk factors. In addition, receiver-operating characteristic (ROC) curves were constructed for FFR ≤0.8 diagnoses. <i>Results</i>. The mean UHR (uric acid to high-density lipoprotein cholesterol ratio) level was significantly higher in the FFR ≤0.8 group (<i>p</i> &lt; 0.001). UHR corrects negatively with FFR (<i>r</i> = −0.44, <i>p</i> &lt; 0.001). High-level UHR was an independent risk factor for the FFR ≤0.8 (OR = 7.17, 95% CI 4.17–12.34). The area under the curve (AUC) of the UHR diagnostic capacity for the FFR ≤0.8 is 0.77, with 77.3% sensitivity and 68.2% specificity. <i>Conclusion</i>. UHR levels were significantly increased in patients with hemodynamically significant coronary lesions. UHR is a novel predictor of functionally significant lesions in patients with a single-vessel disease of ICS.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40656309","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}

{"title":"Relationship among Insulin Therapy, Insulin Resistance, and Severe Coronary Artery Disease in Type 2 Diabetes Mellitus","authors":"Jing Song,&nbsp;Xinyi Xia,&nbsp;Ye Lu,&nbsp;Jing Wan,&nbsp;Haibing Chen,&nbsp;Jun Yin","doi":"10.1155/2022/2450024","DOIUrl":"10.1155/2022/2450024","url":null,"abstract":"<div>\u0000 <p><i>Objectives.</i>The effect of insulin therapy on coronary artery disease (CAD) remains controversial. This study aimed to analyze the association between insulin resistance and the morbidity of severe CAD in type 2 diabetes mellitus (T2DM). <i>Methods.</i> A total of 2044 T2DM patients aged ≥40 years were included in this cross-sectional observational study. Clinical information and laboratory results were collected from the medical records. Those who underwent percutaneous coronary intervention (PCI) were classified as severe CAD, while those who did not have a history of and were not suffering from CAD were classified as patients without CAD. <i>Results.</i> T2DM patients with severe CAD and without CAD had no significant differences in glycosylated hemoglobin A1c (8.55% ± 2.10% vs<i>.</i> 8.39% ± 1.77%, <i>P</i> = 0.234). The proportion of insulin treatment was also similar between the two groups (56.85% <i>vs</i>. 53.65%, odds ratio = 1.138, <i>P</i> = 0.310). In the patients without insulin treatment, the levels of fasting C peptide (FCP) correlated with severe CAD prevalence. FCP was categorized into 3 tertiles (&lt;1.5 ng/mL, 1.5 ng/mL- 3 ng/mL, and ≥3 ng/mL), and the prevalence rates of severe CAD were 7.88%, 14.31%, and 18.28%, respectively (<i>P</i> &lt; 0.05). In the patients with insulin treatment, the body mass index (BMI) was the significant risk factor of severe CAD. The prevalence of severe CAD according to BMI tertiles (&lt;24 kg/m², 24 kg/m²–28 kg/m², and ≥28 kg/m²) was 11.22%, 14.61%, and 24.62%, respectively (<i>P</i> &lt; 0.01). <i>Conclusions.</i> Our results showed that insulin resistance, rather than insulin therapy, increases the risk of severe CAD in T2DM patients with inadequate glycemic control. Non-insulin treated patients with high FCP and insulin-treated patients with high BMI are at higher risk of severe CAD.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33537712","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}

{"title":"Insight on Efficacy of Renal Artery Denervation for Refractory Hypertension with Chronic Kidney Diseases: A Long-Term Follow-Up of 24-Hour Ambulatory Blood Pressure","authors":"Han Cai,&nbsp;Zhoufei Fang,&nbsp;Ruofan Lin,&nbsp;Wenqin Cai,&nbsp;Ying Han,&nbsp;Jinzi Su","doi":"10.1155/2022/6895993","DOIUrl":"10.1155/2022/6895993","url":null,"abstract":"<div>\u0000 <p><i>Aims</i>. To explore the long-term efficacy and safety of renal denervation in patients with RHT and CKD, a post hoc analysis of eGFR subgroups was completed. <i>Methods</i>. Fifty-four patients with refractory hypertension with chronic kidney disease were treated with RDN and enrolled in the study. Patients were divided into three groups according to eGFR: eGFR 46–90 ml/min group, eGFR 15–45 ml/min group, and eGFR &lt;15 ml/min group. The planned follow-up period was 48 months to assess 24 h ambulatory blood pressure, renal function, type of antihypertensive medication, and RDN complications. <i>Results</i>. The ablation sites of the GFR 46–90 ml/min group and GFR 15–45 ml/min group were 32.57 ± 2.99 and 29.53 ± 5.47, respectively. No complications occurred in the GFR 46–90 ml/min group. The GFR&lt;15 ml/min group was treated with 27.07 ± 5.59  ablation. Renal artery dissection occurred in each group of GFR 15–45 ml/min and GFR &lt;15 ml/min. And renal stent implantation artery was performed on these two patients. No severe renal artery stenosis occurred. There were no significant differences in Scr and eGFR between the three groups at each follow-up point. Compared with baseline, SBP was significantly of each group decreased to varying degrees at each follow-up time point. SBP decreased most in the GFR 46–90 ml/min group. Compared with baseline, the type of antihypertensive drugs used in the GFR46-90 ml/min group decreased significantly except for 36 and 48 months. At 48 months’ postadmission, there was a significant decrease in the type of antihypertensive medication used in the GFR15-45 ml/min group, and there was no significant decrease in the type of antihypertensive medication used in the GFR&lt;15 ml/min group. <i>Conclusions</i>. RDN can safely reduce SBP in CKD patients combined with RHT for 48 months, with the most pronounced reduction in the GFR15-45 ml/min group. The variety of antihypertensive drugs was significantly reduced after RDN. This was particularly evident in patients with GFR 15–45 ml/min.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9519348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497193","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}

{"title":"Trans-myocardial Extraction of Endothelin-1 Correlates with Increased Microcirculatory Resistance following Percutaneous Coronary Intervention","authors":"George R. Abraham,&nbsp;Duuamene Nyimanu,&nbsp;Rhoda E. Kuc,&nbsp;Janet J. Maguire,&nbsp;Anthony P. Davenport,&nbsp;Stephen P. Hoole","doi":"10.1155/2022/9154048","DOIUrl":"10.1155/2022/9154048","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. Coronary microvascular dysfunction (CMD) can complicate successful percutaneous coronary intervention (PCI). The potent endogenous vasoconstrictor peptide Endothelin-1 (ET-1) may be an important mediator. To investigate the mechanism, we sought to define the peri-procedural trans-myocardial gradient (TMG-coronary sinus minus aortic root levels) of ET-1 and its precursor peptide – Big ET-1. We then assessed correlation with pressure-wire indices of CMD: coronary flow reserve (CFR) and index of microvascular resistance (IMR). <i>Methods</i>. Paired blood samples from the guide catheter and coronary sinus were collected before and after pressure-wire-guided PCI from patients with stable angina. Plasma was analysed using a specific enzyme-linked immunosorbent assay for quantification of ET-1 peptides and correlated with pressure-wire data. Non normally distributed continuous variables are presented as median [IQR]. <i>Results</i>. ET-1 and Big ET-1 increased post-PCI in the aorta (ET-1: 0.98 [0.76–1.26] pg/ml to 1.20 [1.03–1.67] pg/ml, <i>P</i> &lt; 0.001 and Big ET-1: 2.74 [1.78–2.50] pg/ml to 3.36 [2.33–3.97] pg/ml, <i>P</i> &lt; 0.001) and coronary sinus (ET-1: 1.00 [0.81–1.28] pg/ml to 1.09 [0.91–1.30] pg/ml, <i>P</i> = 0.03 and Big ET-1: 2.89 [1.95–3.83] pg/ml to 3.56 [2.66–4.83] pg/ml, <i>P</i> = 0.01). TMG of ET-1 shifted negatively compared with baseline following PCI reflecting significantly increased extraction (0.03 [−0.12–0.17] pg/ml pre-PCI versus −0.16 [−0.36–0.07] pg/ml post-PCI, <i>P</i> = 0.01). Increased ET-1 trans-myocardial extraction correlated with higher IMR (Pearson’s <i>r</i> = 0.293, <i>P</i> = 0.02) and increased hyperemic transit time (Pearson’s <i>r</i> = 0.333, <i>P</i> &lt; 0.01). In subgroup analysis, mean ET-1 trans-myocardial extraction was higher amongst patients with high IMR compared with low IMR (0.73 pg/ml, SD:0.78 versus 0.17 pg/ml, SD:0.42, <i>P</i> = 0.02). There was additionally a numerical trend towards increased ET-1 trans-myocardial extraction in subgroups of patients with low CFR and in patients with Type 4a Myocardial Infarction, albeit not reaching statistical significance. <i>Conclusions</i>. Circulating ET-1 increases post-PCI and upregulated ET-1 trans-myocardial extraction contributes to increased microcirculatory resistance.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558166","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}

{"title":"Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis","authors":"Sumit Sohal,&nbsp;Harsh Mehta,&nbsp;Krishna Kurpad,&nbsp;Sheetal Vasundara Mathai,&nbsp;Rajiv Tayal,&nbsp;Gautam K. Visveswaran,&nbsp;Najam Wasty,&nbsp;Sergio Waxman,&nbsp;Marc Cohen","doi":"10.1155/2022/5688026","DOIUrl":"10.1155/2022/5688026","url":null,"abstract":"<div>\u0000 <p><i>Introduction</i>. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become significantly less common. This study analyzes in detail the trend of TA access for TAVR over the course of 7 years. <i>Methods</i>. The national inpatient sample database was reviewed from 2011–2017 and patients with AS were identified by using validated ICD 9-CM and ICD 10-CM codes. Patients who underwent TAVR through TA access were classified as TA-TAVR, and any procedure other than TA access was classified as non-TA-TAVR. We compared the yearly trends of TA-TAVR to those of non-TA-TAVR as the primary outcome. <i>Results</i>. A total of 3,693,231 patients were identified with a diagnosis of AS. 129,821 patients underwent TAVR, of which 10,158 (7.8%) underwent TA-TAVR and 119,663 (92.2%) underwent non-TA-TAVR. After peaking in 2013 at 27.7%, the volume of TA-TAVR declined to 1.92% in 2017 (<i>p</i> &lt; 0.0001). Non-TA-TAVR started in 2013 at 72.2% and consistently increased to 98.1% in 2017. In-patient mortality decreased from a peak of 5.53% in 2014 to 3.18 in 2017 (<i>p</i> = 0.6) in the TA-TAVR group and from a peak of 4.51% in 2013 to 1.24% in 2017 (<i>p</i> = 0.0001) in the non-TA-TAVR group. <i>Conclusion</i>. This study highlights a steady decline in TA access for TAVR, higher inpatient mortality, increased length of stay, and higher costs compared to non-TA-TAVR.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558167","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}

{"title":"Short-Term Outcomes of Elective High-Risk PCI with Extracorporeal Membrane Oxygenation Support: A Single-Centre Registry","authors":"Alexander M. Griffioen,&nbsp;Stijn C. H. Van Den Oord,&nbsp;Marleen H. Van Wely,&nbsp;Gerard C. Swart,&nbsp;Herbert B. Van Wetten,&nbsp;Peter W. Danse,&nbsp;Peter Damman,&nbsp;Niels Van Royen,&nbsp;Robert Jan M. Van Geuns","doi":"10.1155/2022/7245384","DOIUrl":"10.1155/2022/7245384","url":null,"abstract":"<div>\u0000 <p><i>Background.</i> If surgical revascularization is not feasible, high-risk PCI is a viable option for patients with complex coronary artery disease. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides hemodynamic support in patients with a high risk for periprocedural cardiogenic shock. <i>Objective.</i> This study aims to provide data about short-term outcomes of elective high-risk PCI with ECMO support. <i>Methods.</i> A retrospective single-center registry was performed on patients with high-risk PCI receiving VA-ECMO support. The short-term outcome was defined as the incidence of major adverse cardiac events (MACE) during the hospital stay and within 60 days after discharge. <i>Results.</i> Between January 2020 and December 2021, 14 patients underwent high-risk PCI with ECMO support. The mean age was 66.5 (±2.5) and the majority was male (71.4%) with a mean left ventricular ejection fraction of 33% (±3.0). Complexity indexes were high (STS-PROM risk score: 2.9 (IQR 1.5–5.8), SYNTAX score I: 35.5 (±2.0), SYNTAX score II (PCI): 49.8 (±3.2)). Femoral artery ECMO cannulation was performed in 13 patients (92.9%) requiring additional antegrade femoral artery cannula in one patient because of periprocedural limb ischemia. The mean duration of the ECMO run was 151 (±32) minutes. One patient required prolonged ECMO support and was weaned after 2 days. Successful revascularization was achieved in 13 patients (92.8%). Procedural success was achieved in 12 patients (85.7%) due to one unsuccessful revascularization and one procedural death. MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%). <i>Conclusion.</i> High-risk PCI with hemodynamic support using VA-ECMO is a feasible treatment option, if surgical revascularization is considered very high risk. Larger and prospective studies are awaited to confirm the benefits of ECMO support in elective high-risk PCI comparing ECMO with other mechanical circulatory support devices, including coaxial left cardiac support devices and IABP. <i>Trial Registration</i>. This trial is registered with NCT05387902.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390452","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}

{"title":"Dual Antiplatelet Therapy in Patients Aged 75 Years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review","authors":"Garly Saint Croix,&nbsp;Spencer C. Lacy,&nbsp;Amre Gazzhal,&nbsp;Michel Ibrahim,&nbsp;Medeona Gjergjindreaj,&nbsp;Jorge Perez,&nbsp;Malik Shehadeh,&nbsp;Karthik Vedantam,&nbsp;Christian Torres,&nbsp;Nirat Beohar,&nbsp;Esteban Escolar","doi":"10.1155/2022/3111840","DOIUrl":"10.1155/2022/3111840","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. This systematic review and meta-analysis evaluates the safety and efficacy of dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS). <i>Background</i>. The safety and efficacy of DAPT in elderly patients with ACS is not well characterized. <i>Methods</i>. We performed a systematic literature review to identify clinical studies that reported safety and efficacy outcomes after DAPT for ACS in elderly patients. The primary outcomes of primary efficacy endpoint rates and bleeding event rates were reported as random effects risk ratio (RR) with 95% confidence interval. No prior ethical approval was required since all data are public. <i>Results</i>. Our search yielded 660 potential studies. We included 8 studies reporting on 29,217 patients. There was a higher risk of bleeding event rates in elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 1.17 (95% CI 1.08 to 1.27, <i>p</i> &lt; 0.05). There was no difference in primary efficacy endpoint rates between elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 0.85 (95% CI 0.68 to 1.07, <i>p</i> = 0.17). <i>Conclusions</i>. This systematic review and meta-analysis suggests that DAPT with prasugrel or ticagrelor compared to clopidogrel is associated with a higher risk of bleeding events in elderly patients with ACS. There was no difference in the primary efficacy endpoints between the two treatment groups.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9499790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40383466","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}