Cardiovascular Revascularization Medicine最新文献

{"title":"Two-step recanalization of chronic total occlusion with IVUS-guided antegrade fenestration re-entry.","authors":"Marouane Boukhris, Amine Mamoun Boutaleb, Pierre Chenard, Giuseppe Colletti, Claudiu Ungureanu, Lorenzo Azzalini","doi":"10.1016/j.carrev.2025.03.005","DOIUrl":"10.1016/j.carrev.2025.03.005","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":"102-104"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665007","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":"Editorial: Optimal lesion preparation: to cut or not to cut.","authors":"Manel Sabaté","doi":"10.1016/j.carrev.2025.04.024","DOIUrl":"10.1016/j.carrev.2025.04.024","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":"54-55"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034950","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":"Risk of acute kidney injury after percutaneous coronary intervention with plaque modification.","authors":"Sant Kumar, Kathleen E Kearney, Christine J Chung, David Elison, Zachary L Steinberg, William L Lombardi, James M McCabe, Lorenzo Azzalini","doi":"10.1016/j.carrev.2025.03.004","DOIUrl":"10.1016/j.carrev.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>The use of plaque modification techniques during percutaneous coronary interventions (PCI) has increased. However, these procedures are linked to higher contrast volume and hypotensive episodes, which are risk factors for acute kidney injury (AKI). This study examined the effects of various plaque modification techniques on AKI after PCI.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who underwent PCI at our institution between December 2020 to March 2024, categorizing them into 3 groups based on the plaque modification technique used: atherectomy, intravascular lithotripsy (IVL), or no plaque modification (NPM). The primary endpoint was AKI, and multivariable logistic regression was used to identify independent predictors of AKI. Multivariable analysis and propensity score matching (1:1) were performed to control for confounders.</p><p><strong>Results: </strong>In total, 1758 patients were included. Atherectomy was performed in 268 (15.2 %) patients, IVL in 120 (6.8 %) patients, and 1370 (77.9 %) patients had NPM. Atherectomy patients were older and had worse baseline renal function than the IVL and NPM groups (p < 0.001 for both). Compared with NPM, atherectomy was an independent predictor of AKI (odds ratio [OR] 1.27, 95 % confidence interval [CI] 1.07-1.98, p = 0.037), while IVL was not (OR 1.30, 95 % CI 0.84-2.08, p = 0.209). In a propensity-matched analysis of 101 atherectomy and IVL patient pairs, atherectomy-based PCI remained associated with a higher rate of AKI (11.9 % vs. 2.0 %; p = 0.013).</p><p><strong>Conclusion: </strong>Atherectomy, but not IVL, is associated with a higher risk of AKI after PCI, compared to NPM. This underscores the importance of thoughtfully selecting plaque modification strategies in high-risk patients to reduce renal adverse events following PCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":"12-19"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630945","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":"Machine learning enhanced prediction of deep sternal wound infection after surgical myocardial revascularization.","authors":"Jurij M Kalisnik, Janez Zibert, Tina Kamensek, Maja Hanuna, Giuseppe Santarpino, Theodor Fischlein","doi":"10.1016/j.carrev.2025.07.016","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.016","url":null,"abstract":"<p><strong>Background: </strong>Deep sternal wound infection following surgical myocardial revascularization is a potentially devastating complication. This study aims to improve risk prediction of deep sternal wound infection with machine learning algorithms.</p><p><strong>Methods: </strong>This single-center retrospective study contains data from 5221 consecutive patients who underwent surgical myocardial revascularization between 2007 and 2022. Two machine learning algorithms (Extreme Gradient Boosting and Deep Neural Network) were trained with perioperative parameters and validated to detect deep sternal wound infection. Their predictive accuracy was then compared to conventional statistical modelling in terms of multivariable logistic regression. Shapley Additive Explanations was applied to the Extreme Gradient Boosting model to determine the importance of each contributing feature to the occurrence of deep sternal wound infection.</p><p><strong>Results: </strong>The overall incidence of deep sternal wound infection was 3.4 % and 54.7 % occurred within 15 days after surgery. The predictive accuracy of the applied machine learning models was identical (AUC: 0.851, p = 0.982) whereas both, Extreme Gradient Boosting (AUC: 0.851, p = 0.031) and Deep Neural Network (AUC: 0.851, p = 0.017), outperformed the multivariable logistic regression model (AUC: 0.796). According to the Shapley Additive Explanations, the five most important predictive features were body mass index, red blood cell transfusions, pleural effusion requiring pleurocentesis, lower preoperative hemoglobin levels and concomitant peripheral artery disease.</p><p><strong>Conclusion: </strong>Machine learning algorithms significantly improved risk prediction of deep sternal wound infection after surgical myocardial revascularization with the best predictive accuracy presented so far.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769191","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":"Editorial: Novel risk score for patients undergoing impella-assisted high-risk percutaneous coronary intervention.","authors":"Niku Thapa, Aliza Ahmed, Sarah Aftab Ahmad, Nauman Khalid","doi":"10.1016/j.carrev.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776594","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":"Worldwide procedural variations of primary percutaneous coronary intervention for ST-elevation myocardial infarction: Insights from the \"Stent - Save a Life!\" initiative.","authors":"Hélder Pereira, Ana Rita Pereira, Rita Calé, Dejan Orlić, Rhena Delport, Sayfollah Abdi, Bagrat Alekyan, Khalid F Al Habib, Carolina Artucio, Ignacio Batista, Jorge Belardi, Alfonsina Candiello, Christos Christou, Leonardo De Luca, Andrejs Erglis, António Fiarresga, Habib Gamra, Martine Gilard, Wei-Chung Huang, John Kanakakis, Lukasz Koltowski, Michael Lee, Awad Mohamed, Ștefan Mot, Mzee Ngunga, Paul Ong, Patricio Ortiz, Oleg Polonetsky, Sameh Shaheen, Khaled Shokry, João Silveira, Mohamed Sobhy, Maxim Sokolov, Ibrahim Terzic, Ahmed Vachiat, Deniss Vasiljevs, William Wijns, Kyaw Win, Thomas Alexander, Jan Piek","doi":"10.1016/j.carrev.2025.07.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.017","url":null,"abstract":"<p><strong>Background: </strong>ST-elevation myocardial infarction (STEMI) outcomes have improved through initiatives that promote timely access to primary percutaneous coronary intervention (PCI). However, little is known about how primary PCI is performed across different settings. This study proposes to characterize and compare practical aspects of primary PCI globally.</p><p><strong>Methods: </strong>An electronic survey, assessing thirteen aspects potentially affecting primary PCI timing and efficacy, was distributed to interventional cardiologists in the \"Stent-Save a Life!\" initiative. Comparisons were made based on geographical locations and annual PCI volume.</p><p><strong>Results: </strong>Seven hundred-and-twenty-four responses were received (59 % from Europe, 18 % from Latin America, 15 % from Asia, 9 % from Africa); 88 % of participants worked in high-volume primary PCI centers. African operators generally performed ≤75 primary PCIs annually, in contrast to their counterparts in Europe, Asia, and Latin America. Access route varied significantly across regions: radial access was used in 98 % of primary PCIs in Europe but only 53 % in Africa. Left ventriculography was more frequently performed in Latin America (25 %) and Africa (20 %) than in Europe (9 %) and Asia (6 %). Aspiration thrombectomy was performed under different conditions. Non-culprit lesion revascularization was typically completed during the index procedure or before discharge, except in Asia. Most participants from Europe (82 %) and Asia (85 %) reported pretreating their patients with P2Y₁₂ inhibitors. High-volume operators were more likely to work in 24/7 PCI hospitals, prefer radial access, and routinely perform thrombus aspirations and PCI on non-infarct-related arteries after discharge.</p><p><strong>Conclusions: </strong>This global survey identified procedural variations in performing primary PCI, indicating room for improvement, particularly in the African region.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790346","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":"Artificial intelligence-powered software outperforms interventional cardiologists in assessment of IVUS-based stent optimization.","authors":"Pablo M Rubio, Hector M Garcia-Garcia, Jason Galo, Abhishek Chaturvedi, Brian C Case, Gary S Mintz, Itsik Ben-Dor, Hayder Hashim, Ron Waksman","doi":"10.1016/j.carrev.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.011","url":null,"abstract":"<p><strong>Background: </strong>Optimal stent deployment assessed by intravascular ultrasound (IVUS) is associated with improved outcomes after percutaneous coronary intervention (PCI). However, IVUS remains underutilized due to its time-consuming analysis and reliance on operator expertise. AVVIGO™+, an FDA-approved artificial intelligence (AI) software, offers automated lesion assessment, but its performance for stent evaluation has not been thoroughly investigated.</p><p><strong>Aim: </strong>To assess whether an artificial intelligence-powered software (AVVIGO™+) provides a superior evaluation of IVUS-based stent expansion index (%Stent expansion = Minimum Stent Area (MSA) / Distal reference lumen area) and geographic miss (i.e. >50 % plaque burden - PB - at stent edges) compared to the current gold standard method performed by interventional cardiologists (IC), defined as frame-by-frame visual assessment by interventional cardiologists, selecting the MSA and the reference frame with the largest lumen area within 5 mm of the stent edge, following expert consensus.</p><p><strong>Methods: </strong>This retrospective study included 60 patients (47,997 IVUS frames) who underwent IVUS guided PCI, independently analyzed by IC and AVVIGO™+. Assessments included minimum stent area (MSA), stent expansion index, and PB at proximal and distal reference segments. For expansion, a threshold of 80 % was used to define suboptimal results. The time required for expansion analysis was recorded for both methods. Concordance, absolute and relative differences were evaluated.</p><p><strong>Results: </strong>AVVIGO™ + consistently identified lower mean expansion (70.3 %) vs. IC (91.2 %), (p < 0.0001), primarily due to detecting frames with smaller MSA values (5.94 vs. 7.19 mm², p = 0.0053). This led to 25 discordant cases in which AVVIGO™ + reported suboptimal expansion while IC classified the result as adequate. The analysis time was significantly shorter with AVVIGO™ + (0.76 ± 0.39 min) vs IC (1.89 ± 0.62 min) (p < 0.0001), representing a 59.7 % reduction. For geographic miss, AVVIGO™ + reported higher PB than IC at both distal (51.8 % vs. 43.0 %, p < 0.0001) and proximal (50.0 % vs. 43.0 %, p = 0.0083) segments. When applying the 50 % PB threshold, AVVIGO™ + identified PB ≥50 % not seen by IC in 12 cases (6 distal, 6 proximal).</p><p><strong>Conclusion: </strong>AVVIGO™ + demonstrated improved detection of suboptimal stent expansion and geographic miss compared to interventional cardiologists, while also significantly reducing analysis time. These findings suggest that AI-based platforms may offer a more reliable and efficient approach to IVUS-guided stent optimization, with potential to enhance consistency in clinical practice.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761786","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":"Outcomes for single antiplatelet, dual antiplatelet, or oral anticoagulation after Amulet: Insights from EMERGE LAA post-approval study.","authors":"Atman P Shah, James V Freeman, Mohamad Alkhouli, Himanshu Agarwal, Megan Coylewright, Akash Makkar, Jordan Anderson, Ryan Gage, Xavier Freixa, Jens Erik Nielsen-Kudsk, Dhanunjaya Lakkireddy","doi":"10.1016/j.carrev.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.012","url":null,"abstract":"<p><strong>Background: </strong>Outcomes associated with different antithrombotic strategies after Amulet left atrial appendage occlusion (LAAO) are not well described.</p><p><strong>Objective: </strong>This analysis compared outcomes from patients discharged on dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) following Amulet implant in the EMERGE LAA post-approval study.</p><p><strong>Methods: </strong>Patients with a successful Amulet implant and discharged from the hospital between August 14, 2021 and December 15, 2023 and entered into the National Cardiovascular Data Registry (NCDR) LAAO Registry were included. A safety endpoint of all-cause death, stroke, major bleeding, or systemic embolism and effectiveness endpoint of ischemic stroke, systemic embolism, or cardiovascular death were assessed through 6 months as well as major adverse events.</p><p><strong>Results: </strong>A total of 11,445 patients were included in this analysis with 9355 discharged on DAPT (81.7 %), 606 on SAPT (5.3 %), and 1484 on OAC (13.0 %). Patients in the SAPT group had more comorbid conditions and were at the greatest bleeding risk pre-Amulet implant. At 45-days, clinically relevant closure (≤3 mm peri-device leak) was achieved in >95 % of all patients. At 6 months, the safety endpoint rates were 8.8 %, 7.0 %, and 7.0 % in the DAPT, SAPT, and OAC groups, respectively (p = 0.045) and effectiveness endpoint rates were 2.1 %, 1.6 %, and 1.7 % in the DAPT, SAPT, and OAC groups, respectively (p = 0.511). Despite higher baseline bleeding risk, the SAPT group had numerically lower bleeding rates than the DAPT group through 6 months (DAPT 4.8 % vs. SAPT 3.9 %; HR 1.23 [0.78, 1.95]) with no difference in device-related thrombus rates (DAPT 0.8 % vs. 0.8 % SAPT; HR 0.91 [0.33, 2.50]). However, after adjusting for differences in baseline characteristics, no significant differences (p > 0.05) were noted for any clinical events between the three medication groups at 45 days or 6 months.</p><p><strong>Conclusion: </strong>In the present cohort of patients treated with Amulet LAAO there were high rates of LAA complete closure, and SAPT emerged as a viable alternative to the current DAPT regimen potentially reducing the risk of bleeding complications in patients at high risk without compromising effectiveness.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765637","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":"Clinical utilization of high-frequency optical coherence tomography in large coronary arteries.","authors":"Emma Caron, Yasemin Ciftcikal, Matthew Cannata, Doosup Shin, Zainab Sami, Misha Gujja, Rafid Hoque, Koshiro Sakai, Fernando Sosa, Giovanni Ughi, Jeffrey W Moses, Richard A Shlofmitz, Allen Jeremias, Ziad A Ali, Evan Shlofmitz","doi":"10.1016/j.carrev.2025.07.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.013","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859738","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":"Comment on \"A stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction\".","authors":"Çağrı Zorlu","doi":"10.1016/j.carrev.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.07.010","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718906","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}