Interventional Cardiology Review最新文献

{"title":"Severe Acute Thrombocytopenia After Treatment with Tirofiban: A Case Series Approach.","authors":"Gian-Manuel Jiménez-Rodríguez, Patricia Carmona-Levario, José-Alberto Ayón-Martínez, Aleksandra Gasecka, Luis Eduardo Juárez-Orozco, Antonio Reyes-Ortega, Patricia Espinosa-González, Gyna Alejandra Altamirano-Solorzano, Guering Eid-Lidt","doi":"10.15420/icr.2022.23","DOIUrl":"10.15420/icr.2022.23","url":null,"abstract":"<p><p>Glycoprotein IIb/IIIa inhibitors are an adjuvant therapy for the treatment of patients with acute coronary syndromes. The main adverse reactions are bleeding and thrombocytopenia in 1-2% of cases. A 66-year-old woman arrived at the emergency department with ST-elevation MI. The catheterisation lab was busy, so she received thrombolytic therapy. Coronary angiography revealed a 90% stenosis in the middle segment of the left anterior descending artery and Thrombolysis in MI 2 flow. Subsequent percutaneous coronary intervention showed abundant thrombus and a coronary dissection and it was necessary to insert five drug-eluting stents. Non-fractionated heparin and a tirofiban infusion were used. After the percutaneous coronary intervention, she developed severe thrombocytopenia, haematuria and gingivorrhagia, for which infusion of tirofiban was suspended. In follow-up, no major bleeding or subsequent haemorrhagic complications were identified. It is crucial to distinguish between heparin-induced thrombocytopenia and thrombocytopenia caused by other drugs. A high level of suspicion should be employed in these cases.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e15"},"PeriodicalIF":0.2,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/8c/icr-18-e15.PMC10311402.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9737626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes for Drug-eluting Balloons versus Drug-eluting Stents in the Treatment of Small Vessel Coronary Artery Disease: A Systematic Review and Meta-analysis.","authors":"Greg Murphy, Ailish Naughton, Rory Durand, Elizabeth Heron, Conor McCaughey, Ross T Murphy, Ian Pearson","doi":"10.15420/icr.2022.26","DOIUrl":"10.15420/icr.2022.26","url":null,"abstract":"<p><p><b>Background:</b> This systematic review and meta-analysis compares long-term outcomes follow-up data comparing drug-eluting balloons (DEBs) and drug-eluting stents (DESs) in interventional treatment of small coronary artery disease (<3 mm). <b>Methods:</b> A systematic review was undertaken along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was 1-3-year performance of DEB versus DES in major adverse cardiac events. Secondary outcomes include all-cause mortality, MI, cardiac death, vessel thrombosis, major bleeding, target vessel revascularisation and target lesion revascularisation. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and random effects models. ORs are presented with a 95% CI. <b>Results:</b> Of 4,661 articles, four randomised control trials were included (1,414 patients). DEBs demonstrated reduced rates of non-fatal MI at 1 year (OR 0.44; 95% CI [0.2-0.94]), and BASKET-SMALL 2 reported a significant reduction in 2-year bleeding rates (OR 0.3; 95% CI [0.1-0.91]). There was no significant difference in all other outcomes. <b>Conclusion:</b> Long-term follow-up of DEB and DES use in small coronary arteries demonstrates DEBs be comparable with DESs in all outcomes at 1, 2 and 3 years of follow-up. A significant reduction was found in rates of non-fatal MI at 1 year in the DEB arm, and a reduction in major bleeding episodes at 2 years in the BASKET-SMALL 2 trial. These data highlight the potential long-term utility of novel DEBs in small coronary artery disease revascularisation.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e14"},"PeriodicalIF":0.2,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/8c/icr-18-e14.PMC10311399.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9737631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural and Technological Innovations Facilitating Ultra-low Contrast Percutaneous Coronary Interventions.","authors":"Breda Hennessey, Asad Shabbir, Alejandro Travieso, Nieves Gonzalo, Javier Escaned","doi":"10.15420/icr.2022.32","DOIUrl":"10.15420/icr.2022.32","url":null,"abstract":"<p><p>Ultra-low-dose contrast percutaneous coronary intervention (PCI) is a valuable approach in selected complex high-risk patients with renal failure. One of the objectives of ultra-low contrast PCI is to decrease the probability of developing postprocedural contrast-induced nephropathy (CIN), which predominately affects patients with baseline renal dysfunction. CIN is associated with poor clinical outcomes and increased healthcare-related costs. Another two clinical scenarios in which reduced dependence on contrast administration by the operator may contribute to improved safety are PCI in complex, high-risk indicated patients and in shock. In this review, we discuss the procedural techniques and recent technological innovations that enable ultra-low-dose contrast PCI to be performed in the cardiac cath lab.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e09"},"PeriodicalIF":0.2,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/ea/icr-18-e09.PMC10301683.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now.","authors":"Samer Fawaz,&nbsp;Sarosh Khan,&nbsp;Rupert Simpson,&nbsp;Gerald Clesham,&nbsp;Christopher M Cook,&nbsp;John R Davies,&nbsp;Grigoris V Karamasis,&nbsp;Thomas R Keeble","doi":"10.15420/icr.2022.30","DOIUrl":"10.15420/icr.2022.30","url":null,"abstract":"<p><p>The landscape of interventional cardiology is ever evolving. Contemporary practice has shifted from a stenosis-centred approach to the total characterisation of both the epicardial and microcirculatory vessels. Microcirculatory dysfunction plays an important role in the pathophysiology of acute and chronic coronary syndromes, and characterisation of the microcirculation has important clinical consequences. Accordingly, the invasive diagnosis of microcirculatory dysfunction is becoming a key feature of the interventional cardiologist's toolkit. This review focuses on the methodology underpinning the invasive diagnosis of microvascular dysfunction and highlights the indices that have arisen from these methodologies.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e07"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/56/icr-18-e07.PMC10433108.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10047176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiographic and Procedural Characteristics in Frail Older Patients with Non-ST Elevation Acute Coronary Syndrome.","authors":"Benjamin Beska, Hanna Ratcovich, Alan Bagnall, Amy Burrell, Richard Edwards, Mohaned Egred, Rebecca Jordan, Amina Khan, Greg B Mills, Emma Morrison, Daniell Edward Raharjo, Fateh Singh, Chris Wilkinson, Azfar Zaman, Vijay Kunadian","doi":"10.15420/icr.2022.20","DOIUrl":"10.15420/icr.2022.20","url":null,"abstract":"<p><strong>Background: </strong>Angiographic and procedural characteristics stratified by frailty status are not known in older patients with non-ST elevation acute coronary syndrome (NSTEACS). We evaluated angiographic and procedural characteristics in older adults with NSTEACS by frailty category, as well as associations of baseline and residual SYNTAX scores with long-term outcomes.</p><p><strong>Methods: </strong>In this study, 271 NSTEACS patients aged ≥75 years underwent coronary angiography. Frailty was assessed using the Fried criteria. Angiographic analysis was performed using QAngio® XA Medis in a core laboratory. Major adverse cardiovascular events (MACE) consisted of all-cause mortality, MI, stroke or transient ischaemic attack, repeat unplanned revascularisation and significant bleeding.</p><p><strong>Results: </strong>Mean (±SD) patient age was 80.5 ± 4.9 years. Compared with robust patients, patients with frailty had more severe culprit lesion calcification (OR 5.40; 95% CI [1.75-16.8]; p=0.03). In addition, patients with frailty had a smaller mean improvement in culprit lesion stenosis after percutaneous coronary intervention (50.6%; 95% CI [45.7-55.6]) than robust patients (58.6%; 95% CI [53.5-63.7]; p=0.042). There was no association between frailty phenotype and completeness of revascularisation (OR 0.83; 95% CI [0.36-1.93]; p=0.67). A high baseline SYNTAX score (≥33) was associated with adjusted (age and sex) 5-year MACE (HR 1.40; 95% CI [1.08-1.81]; p=0.01), as was a high residual SYNTAX score (≥8; adjusted HR 1.22; 95% CI [1.00-1.49]; p=0.047).</p><p><strong>Conclusion: </strong>Frail adults presenting with NSTEACS have more severe culprit lesion calcification. Frail adults were just as likely as robust patients to receive complete revascularisation. Baseline and residual SYNTAX score were associated with MACE at 5 years.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e04"},"PeriodicalIF":0.2,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/d2/icr-18-e04.PMC10442670.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial.","authors":"Sean Fitzgerald,&nbsp;Maria Rubini Gimenez,&nbsp;Abdelhakim Allali,&nbsp;Ralph Toelg,&nbsp;Dmitriy S Sulimov,&nbsp;Volker Geist,&nbsp;Adnan Kastrati,&nbsp;Holger Thiele,&nbsp;Gert Richardt,&nbsp;Mohamed Abdel-Wahab","doi":"10.15420/icr.2022.07","DOIUrl":"https://doi.org/10.15420/icr.2022.07","url":null,"abstract":"<p><p><b>Background</b>: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. <b>Methods</b>: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). <b>Results</b>: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. <b>Conclusion</b>: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e02"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/9f/icr-18-e02.PMC9987508.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9089990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dovetailing Intra-coronary Imaging and Physiology … the True Gold Standard.","authors":"Kalpa De Silva","doi":"10.15420/icr.2022.29","DOIUrl":"https://doi.org/10.15420/icr.2022.29","url":null,"abstract":"","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e01"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/8a/icr-18-e01.PMC9987505.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9089993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?","authors":"Yasar Sattar,&nbsp;Prasanna M Sengodan,&nbsp;Mustafa Sajjad Cheema,&nbsp;Nismat Javed,&nbsp;Shoaib Ashraf,&nbsp;Sadaf Fakhra,&nbsp;Anas Alharbi,&nbsp;Moinuddin Syed,&nbsp;Mahboob Alam,&nbsp;Islam Y Elgendy,&nbsp;Affan Haleem,&nbsp;Akram Kawsara,&nbsp;M Chadi Alraies,&nbsp;Ramesh Daggubati","doi":"10.15420/icr.2023.10","DOIUrl":"https://doi.org/10.15420/icr.2023.10","url":null,"abstract":"<p><p><b>Background</b>: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. <b>Methods</b>: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. <b>Results</b>: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. <b>Conclusion</b>: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e18"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/99/icr-18-e18.PMC10331561.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden Cardiac Death in Ischaemic Cardiomyopathy and the Primary Prevention ICD: Time for a More a Personalised Approach?","authors":"Saad M Ezad,&nbsp;Girish Babu,&nbsp;Peter O'Kane","doi":"10.15420/icr.2022.14","DOIUrl":"https://doi.org/10.15420/icr.2022.14","url":null,"abstract":"<p><p>Guidelines recommend primary prevention implantable cardioverter defibrillator (PPICD) for left ventricular ejection fraction (LVEF) <35% only after 3 months of optimal medical therapy (OMT) or 6 weeks after acute MI with persistent LVEF dysfunction. A 73-year-old woman presented with decompensated heart failure secondary to ischaemic cardiomyopathy. Severe coronary disease with sufficient dysfunctional myocardial segments on cardiac MRI suggested potential benefit from revascularisation. Following discussion with the heart team, she underwent percutaneous coronary intervention (PCI). PPICD implantation was deferred as per guideline recommendations. However, 20 days post-PCI, the patient died from malignant ventricular arrhythmia captured on a Holter monitor. This case demonstrates that some high-risk patients may not receive a potentially life-saving PPICD if guidelines are stringently adhered to. We highlight evidence that LVEF alone is of limited value in a risk assessment of arrhythmogenic death, and postulate that a more personalised ICD prescription should be considered using scar characteristics on cardiac MRI to prompt upstream ICD implantation in high-risk patients.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/c6/icr-18-e11.PMC10311393.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9737630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on Anti-thrombotic Therapy Following Transcatheter Aortic Valve Implantation: Expert Cardiologist Opinion from a UK and Ireland Delphi Group.","authors":"Azfar Zaman,&nbsp;Bernard Prendergast,&nbsp;David Hildick-Smith,&nbsp;Daniel Blackman,&nbsp;Richard Anderson,&nbsp;Mark S Spence,&nbsp;Darren Mylotte,&nbsp;David Smith,&nbsp;Ben Wilding,&nbsp;Chris Chapman,&nbsp;Kirsty Atkins,&nbsp;Kevin G Pollock,&nbsp;Ayesha C Qureshi,&nbsp;Adrian Banning","doi":"10.15420/icr.2022.11","DOIUrl":"https://doi.org/10.15420/icr.2022.11","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) is an effective and established treatment for symptomatic aortic stenosis. However, there is a lack of consensus concerning the need for peri- and post-procedural anti-thrombotic medication. Contemporary guidelines recommend that anti-thrombotic therapy is balanced against a patient's bleeding risk following TAVI, but do not fully consider the evolving evidence base. The purpose of the Delphi panel recommendations presented here is to provide a consensus elicited from a panel of experts who regularly prescribe anti-thrombotic therapy post-TAVI. The goal was to address evidence gaps across four key topics: anti-thrombotic therapy (anti-platelet and/or anti-coagulant) in TAVI patients in sinus rhythm; anti-thrombotic therapy in TAVI patients with AF; direct oral anti-coagulants versus vitamin K antagonists; and the need for UK/Ireland specific guidance. This consensus statement aims to inform clinical decision-making by providing a concise, evidence-based summary of best practice for prescribing anti-thrombotic therapies following TAVI and highlights areas where further research is needed.</p>","PeriodicalId":38586,"journal":{"name":"Interventional Cardiology Review","volume":"18 ","pages":"e13"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/39/icr-18-e13.PMC10311398.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}