Cardiovascular Revascularization Medicine最新文献

{"title":"Clinical judgment and formal frailty assessment are complementary, not interchangeable, in TAVR.","authors":"Artur Dziewierz, Natalia Kulicka, Paweł Kleczyński","doi":"10.1016/j.carrev.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.003","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of increased coronary physiology and intracoronary imaging use with downstream healthcare costs.","authors":"Christopher Low, Ramzi Ibrahim, Christopher Kanaan, Reza Arsanjani, Kwan Lee, Tiffany Nelson, Mayurkumar Bhakta","doi":"10.1016/j.carrev.2026.07.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.002","url":null,"abstract":"<p><strong>Background: </strong>Invasive coronary physiology and intracoronary imaging improve coronary lesion assessment and percutaneous coronary intervention optimization, but their financial implications in routine community-based practice remain incompletely defined. We evaluated the association between increased use of coronary physiology/imaging-guided assessment and downstream healthcare costs.</p><p><strong>Methods: </strong>We conducted a retrospective observational analysis of patients undergoing invasive coronary angiography within the HonorHealth health system between January 1, 2021 and December 31, 2022. The year 2021 represented baseline practice, whereas 2022 followed implementation of an institutional initiative encouraging physiologic assessment or intracoronary imaging during coronary angiography and PCI. Procedures were categorized as diagnostic left heart catheterization alone, physiologic testing without PCI, physiologic testing with PCI, or PCI without physiologic testing. Mean healthcare costs were compared at 30 days, 90 days, and 6 months after the index procedure.</p><p><strong>Results: </strong>A total of 1807 diagnostic coronary angiograms were performed in 2021 and 1821 in 2022, with similar PCI volumes. Use of physiologic assessment increased from 44.4% to 51.0% after implementation (p < 0.001). Although 30-day costs were higher for procedures involving physiologic testing in 2022, mean 6-month costs were lower across all procedural categories. Estimated cumulative 6-month cost reductions totaled $1,661,504.</p><p><strong>Conclusions: </strong>In this retrospective health-system analysis, increased use of invasive coronary physiology and intracoronary imaging was associated with lower cumulative 6-month healthcare costs despite higher short-term procedural expenses. Further multicenter studies with longer follow-up are warranted.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CRT 2026 late breaking trials in coronary interventions: A narrative review of the trial designs, hypotheses, and findings.","authors":"Beni Rai Verma, Abhinav Sood, Bailey G Salimes, Asa Phichaphop, Jason Galo, Ori Waksman, Edward Ha, Brian C Case, Hayder D Hashim, Itsik Ben-Dor, Ron Waksman","doi":"10.1016/j.carrev.2026.06.020","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.020","url":null,"abstract":"<p><p>Clinicians from around the world presented prominent interventional cardiology trials at Cardiovascular Research Technologies (CRT) 2026. The trials raise important discussions for the past, present, and future for coronary interventions. Medical professionals from the field of interventional cardiology, electrophysiology, heart failure, cardiac imaging, non-invasive cardiology, cardiac and vascular surgery, endovascular specialists, allied health professionals, and more attend this meeting. We designed this article to discuss the hypotheses, trial findings, and future directions of all late-breaking coronary intervention clinical trials from CRT 2026.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of high peak radiation skin dose in primary percutaneous coronary interventions","authors":"Midori Sato,&nbsp;Kenichi Sakakura,&nbsp;Hiroyuki Jinnouchi,&nbsp;Yousuke Taniguchi,&nbsp;Kei Yamamoto,&nbsp;Takunori Tsukui,&nbsp;Masashi Hatori,&nbsp;Taku Kasahara,&nbsp;Yusuke Watanabe,&nbsp;Shun Ishibashi,&nbsp;Masaru Seguchi,&nbsp;Hideo Fujita","doi":"10.1016/j.carrev.2025.10.016","DOIUrl":"10.1016/j.carrev.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Primary percutaneous coronary intervention (PCI) has improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, radiation skin damage is one of serious complications in primary PCI. The purpose of this study was to identify the determinants of the excess radiation dose in primary PCI.</div></div><div><h3>Methods</h3><div>We included 1126 patients with STEMI and divided them into an excess radiation group (<em>n</em> = 61; peak skin dose ≥2 Gy) and a standard radiation group (<em>n</em> = 1065; peak skin dose &lt;2 Gy). Univariate and multivariate logistic regression analyses were performed to find patient or procedural factors associated with excess radiation.</div></div><div><h3>Results</h3><div>In patient factors, body mass index (BMI) was significantly associated with excess radiation [odds ratio (OR) 1.09, 95 % confidence interval (CI) 1.01–1.18, <em>P</em> = 0.022] after controlling for confounding factors. In procedural factors, use of intra-aortic balloon pumping (OR 2.12, 95 % CI 1.05–4.27, <em>P</em> = 0.035), number of used guidewire (OR 1.70, 95 % CI 1.26–2.31, <em>P</em> &lt; 0.001), number of used balloon (OR 1.50, 95 % CI 1.18–1.92, <em>P</em> = 0.001), total length of stents (OR 1.25, 95 % CI 1.09–1.44, <em>P</em> = 0.002), use of microcatheters (OR 2.18, 95 % CI 1.13–4.21, <em>P</em> = 0.02) and thrombus aspiration (OR 3.86, 95 % CI 2.07–7.20, <em>P</em> &lt; 0.001) were significantly associated with excess radiation after controlling for confounding factors.</div></div><div><h3>Conclusions</h3><div>In primary PCI for STEMI, high BMI and using many devices were significantly associated with excess radiation. We should pay special attention to patients with high BMI and complex lesions which require many devices to prevent excess skin radiation.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 72-77"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of diabetes in long-term outcomes following intravascular brachytherapy for in-stent restenosis","authors":"Mangesh Kritya,&nbsp;Gal Sella,&nbsp;Chloe Kharsa,&nbsp;Devin Olek,&nbsp;Bin S. Teh,&nbsp;Muhammad Faraz Anwaar,&nbsp;Joseph Elias,&nbsp;Elia El Hajj,&nbsp;Albert E. Raizner,&nbsp;Andrew Farach,&nbsp;Neal S. Kleiman,&nbsp;Alpesh R. Shah","doi":"10.1016/j.carrev.2025.11.007","DOIUrl":"10.1016/j.carrev.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>In-stent restenosis (ISR) remains a significant clinical challenge after percutaneous coronary intervention (PCI), especially in patients with diabetes mellitus. Intravascular brachytherapy (IVBT) has re-emerged as a treatment for ISR, but data on its effectiveness in patient with diabetes remain limited.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study with patients undergoing IVBT for ISR. Patients were stratified according to diabetes status. The primary outcome was target lesion revascularization (TLR), with secondary endpoints including MACE, all-cause mortality, myocardial infarction (MI), and heart failure hospitalization (HFH). Statistical analysis was performed using Program R version 4.4.2.</div></div><div><h3>Results</h3><div>Out of 227 patients, 145 (64 %) had diabetes. Baseline and procedural characteristics were generally comparable between diabetic and non-patient with diabetes. Diabetes was independently associated with higher long-term mortality (HR 3.67, 95 % CI: 1.43–9.40; <em>p</em> = 0.007) but not with TLR, MACE, MI, or HFH. Additional stenting (HR 3.27, <em>p</em> = 0.0038) and female sex (HR 3.33, <em>p</em> = 0.016) were also associated with increased mortality. RMST analysis demonstrated shorter 5-year survival in diabetics (−0.80 years, <em>p</em> &lt; 0.001). Spline modeling revealed a non-linear increase in mortality risk with age, particularly beyond 70 years.</div></div><div><h3>Conclusions</h3><div>Among patients undergoing IVBT for ISR, diabetes was independently associated with increased mortality but not with ischemic and heart failure outcomes. Mortality-focused risk stratification and further studies incorporating glycemic and inflammatory markers are needed to optimize outcomes in this high-risk group.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 49-56"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative coronary angiography and outcomes in acute type A aortic dissection with coronary malperfusion: A retrospective cohort study","authors":"Kentaro Fukano,&nbsp;Yusuke Sasabuchi,&nbsp;Hiroki Matsui,&nbsp;Yusuke Iizuka,&nbsp;Atsushi Yamaguchi,&nbsp;Masamitsu Sanui,&nbsp;Hideo Yasunaga","doi":"10.1016/j.carrev.2025.10.008","DOIUrl":"10.1016/j.carrev.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>The optimal strategy for acute type A aortic dissection (ATAAD) with coronary malperfusion remains unclear. This study aimed to compare in-hospital mortality between coronary angiography followed by aortic repair and direct aortic repair without coronary angiography in patients with ATAAD and coronary malperfusion.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database, from July 2010 to March 2022. We included patients who were admitted emergently and underwent surgery for ATAAD on the day of admission. Patients were defined as having preoperative coronary malperfusion if they had a diagnosis of acute myocardial infarction present on admission or underwent coronary angiography or percutaneous coronary intervention on the day of surgery. The primary outcome was in-hospital mortality. Patients were categorized as coronary angiography followed by aortic repair (CAG group) or direct aortic repair (DAR group). A multivariable Cox regression model was used to compare the time to in-hospital death between groups.</div></div><div><h3>Results</h3><div>We identified 1167 patients with ATAAD with coronary malperfusion. Of these, 508 (43.5 %) were in the CAG group and 659 (56.5 %) were in the DAR group. Cox regression analysis revealed no significant differences in the in-hospital mortality between the groups (hazard ratio, 1.05; 95 % confidence interval, 0.83 to 1.34, <em>p</em> = 0.661).</div></div><div><h3>Conclusions</h3><div>Among patients with ATAAD with coronary malperfusion, in-hospital mortality did not differ significantly between those who underwent coronary angiography followed by aortic repair and those who underwent direct aortic repair.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 42-48"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and prognostic value of electrocardiographic changes in patients with myocardial injury after elective PCI.","authors":"Alexander LaRaja, Ashish Chakraborty, Nina Talmor, Claire Graves, Sam Kozloff, Vincent J Major, Binita Shah, Anvar Babaev, Louai Razzouk, Sunil V Rao, Michael Attubato, Frederick Feit, James Slater, Nathaniel R Smilowitz","doi":"10.1016/j.carrev.2026.06.021","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.06.021","url":null,"abstract":"<p><strong>Background: </strong>Myocardial injury after percutaneous coronary intervention (PCI) is common and associated with adverse outcomes. Contemporary definitions of periprocedural myocardial infarction require biomarker elevation with or without ischemic electrocardiographic (ECG) findings. However, the incremental prognostic value of ECG beyond biomarker-defined injury alone remains uncertain.</p><p><strong>Objectives: </strong>To determine the incidence and independent prognostic value of ischemic ECG changes after elective PCI.</p><p><strong>Methods: </strong>Consecutive adults age ≥ 18 years undergoing elective PCI at NYU Langone Health between 2011 and 2020 were included. Creatine kinase-myocardial band (CKMB) concentrations were measured at 1 and 3 h post-PCI. Among patients with myocardial injury, baseline and post-PCI ECGs (within 24 h) were reviewed to identify development of ischemic ECG changes (ST segment abnormalities, T wave abnormalities, and Q waves). Relationships between ischemic ECG findings and mortality were evaluated in Cox proportional hazards models adjusted for age, sex, and assay-normalized CKMB.</p><p><strong>Results: </strong>Among 10,735 patients, 1741 (16.2%) developed post-PCI myocardial injury. New ischemic ECG changes occurred in 18.4% of patients with myocardial injury and increased stepwise with higher concentrations of CKMB. New T wave abnormalities were most common (11%), followed by ST depressions (4.9%), Q waves (3.0%), and ST elevations (1.5%). Over a median follow-up of 5.3 years, new ischemic ECG changes were not independently associated with increased mortality among patients with myocardial injury (aHR 1.27, 95% CI 0.82-1.96).</p><p><strong>Conclusions: </strong>Among patients with myocardial injury after elective PCI, new ischemic ECG changes were uncommon and did not confer independent prognostic value for long-term mortality.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital outcomes of elective percutaneous coronary intervention in patients with metastatic cancer","authors":"Renxi Li,&nbsp;William M. Rienas,&nbsp;Brian G. Choi","doi":"10.1016/j.carrev.2025.10.018","DOIUrl":"10.1016/j.carrev.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Metastasis is a key hallmark of cancer progression and significantly affects the management of other comorbidities, including coronary artery disease (CAD). Perioperative outcomes of elective percutaneous coronary intervention (PCI) for patients with metastatic cancer have not been thoroughly investigated. This study aimed to provide a comprehensive, population-based analysis of in-hospital outcomes of elective PCI among patients with metastatic cancer using a national database.</div></div><div><h3>Methods</h3><div>Adult patients who underwent elective PCI were identified by ICD-10-PCS codes in National Inpatient Sample from Q4 2015–2021. Patients who had concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer status between patients with and without metastatic cancer. In-hospital outcomes were examined.</div></div><div><h3>Results</h3><div>Among 44,654 patients who underwent elective PCI, 233 (0.50 %) had metastatic cancer. After propensity-score matching, all patients with metastatic cancer were matched to 671 controls. Metastatic cancer patients had higher mortality (7.17 % vs 2.09 %, p &lt; 0.01), cardiogenic shock (11.21 % vs 5.66 %, p = 0.01), mechanical ventilation (14.35 % vs 4.02 %, p &lt; 0.01), acute kidney injury (AKI; 24.66 % vs 17.59 %, p = 0.02), hemorrhage/hematoma (25.11 % vs 9.84 %, p &lt; 0.01), infection (8.07 % vs 1.79 %, p &lt; 0.01), and transfer out (17.49 % vs 9.24 %, p &lt; 0.01). In addition, metastatic cancer patients had longer length of stay (p &lt; 0.01) and higher total hospital charges (p &lt; 0.01). Significant morbidities associated with in-hospital mortality metastatic cancer patients included pericardial complications (aOR 75.91, p &lt; 0.01), mechanical ventilation (aOR 28.09, p &lt; 0.01), and AKI (aOR 12.53, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Considering their elevated risks of in-hospital mortality and morbidities, elective PCI should be carefully considered in metastatic cancer patients. These findings could help guide preprocedural counseling, clinical decision-making, and goals of care discussion for these patients. Early identification and management of morbidities, particularly pericardial complications, may help reduce early mortality in these patients.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 66-71"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert perspectives on tricuspid repair | replacement | medical therapy — Beyond the Guidelines: Insights from the cardiovascular research technologies 2026 meeting","authors":"Asa Phichaphop,&nbsp;Gregg W. Stone,&nbsp;Maurice Enriquez-Sarano,&nbsp;Sanjay Kaul,&nbsp;Dee Dee Wang,&nbsp;Chirag Bavishi,&nbsp;Kashish Goel,&nbsp;Sumbal Janjua,&nbsp;Brinder S. Kanda,&nbsp;Firas Zahr,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2026.04.017","DOIUrl":"10.1016/j.carrev.2026.04.017","url":null,"abstract":"<div><div>Advancements in transcatheter tricuspid valve intervention (TTVI) technology have yielded meaningful improvements in quality-of-life (QOL) for patients with tricuspid regurgitation (TR). The recent Food and Drug Administration (FDA) approval of two TTVI devices, TriClip and EVOQUE, has prompted extensive discussion regarding patient selection, device preference, and optimal timing of intervention. A dedicated session titled “Beyond the Guidelines: Tricuspid repair, replacement, medical therapy” was convened to examine clinical scenarios not adequately addressed by existing guidelines. This review summarizes the key observations and expert panel discussion to identify evidence gaps and inform the framework for future guideline development.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 1-4"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractional flow reserve versus intravascular ultrasound to guide percutaneous coronary intervention: A systematic review and meta-analysis","authors":"Akshat Banga,&nbsp;Sawai Singh Rathore,&nbsp;Ashish Yadav,&nbsp;Sidharth Misra,&nbsp;Nitesh Gautam,&nbsp;Ankit Agrawal,&nbsp;Sarju Ganatra,&nbsp;Kapil Yadav,&nbsp;Sourbha S. Dani,&nbsp;Andrew M. Goldsweig","doi":"10.1016/j.carrev.2025.10.015","DOIUrl":"10.1016/j.carrev.2025.10.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"88 ","pages":"Pages 78-80"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}