Cardiovascular Revascularization Medicine最新文献

{"title":"Percutaneous coronary intervention strategies in non-ST segment elevation acute coronary syndrome patients with multivessel coronary artery disease: Systematic review pairwise and network meta-analysis","authors":"Wilbert Huang ,&nbsp;Samuel Flindy ,&nbsp;Apridya Nurhafizah ,&nbsp;Khairiya Alya Nafisa ,&nbsp;Alvin Frederich ,&nbsp;Januar Wibawa Martha","doi":"10.1016/j.carrev.2024.10.009","DOIUrl":"10.1016/j.carrev.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>More than half of NSTEACS patients are presented with multivessel CAD. Culprit vessel only or complete revascularization (CR) guided either by angiography or fractional flow reserve (FFR) is available percutaneous coronary intervention (PCI) options. This study aims to compare different PCI strategies in NSTEACS patients with multivessel CAD.</div></div><div><h3>Methods</h3><div>Observational and RCTs studies are selected and compared for short- and long-term outcomes of all-cause mortality, MACE, and repeat revascularization. Odds ratio (OR) and SUCRA ranking of 4 interventions; (A) culprit vessel only revascularization, (B) single stage CR guided by angiography, (C) single stage CR guided by FFR, and (D) multistage CR guided by angiography are reported as pairwise and pooled network frequentist analysis conducted using RevMan and R software.</div></div><div><h3>Results</h3><div>Thirty- six studies with 213,254 patients were included. Pairwise analysis of A vs B shows no significant difference in short term outcomes. Pooled network analysis demonstrates that B, C, and D resulted in a significantly lower odds of long-term all-cause mortality compared to A (OR 0.42–0.77, 95 % CrI: 0.19–0.91). SUCRA ranking shows that C is more favorable compared to other interventions to reduce long term all-cause mortality and MACE (SUCRA 0.932 and 0.953). Sensitivity analysis with only RCTs and propensity matched scoring observational studies retains the significance and ranking of the interventions.</div></div><div><h3>Conclusion</h3><div>CR is just as safe as culprit vessel revascularization and single stage CR guided by FFR is the most preferable strategy to reduce risk of all- cause mortality and MACE.</div></div><div><h3>PROSPERO ID</h3><div>CRD42023491792.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 66-80"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630416","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: Stroke in V-A ECMO: A challenge to a life-saving technology","authors":"Tim A. Fischell","doi":"10.1016/j.carrev.2025.02.012","DOIUrl":"10.1016/j.carrev.2025.02.012","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 8-9"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517030","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":"Rota-Sesame technique for chronic total occlusion percutaneous coronary intervention","authors":"Reza Masoomi,&nbsp;Lorenzo Azzalini,&nbsp;Kathleen E. Kearney,&nbsp;William L. Lombardi","doi":"10.1016/j.carrev.2024.09.009","DOIUrl":"10.1016/j.carrev.2024.09.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 58-60"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336997","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":"Hyperemic vs non-hyperemic indexes discordance: Role of epicardial and microvascular resistance (HyperDisco Study)","authors":"A. Di Molfetta ,&nbsp;V. Cusimano ,&nbsp;M. Cesario ,&nbsp;P. Mollo ,&nbsp;G. Di Ruzza ,&nbsp;M. Menichelli","doi":"10.1016/j.carrev.2024.09.004","DOIUrl":"10.1016/j.carrev.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Literature reports a 20 % discordance between hyperemic (FFR) and non-hyperemic indexes (NHi) of coronary stenosis lesions. This work aims to develop and test clinically, a formula relating FFR and NHi (including iFR, RFR and Pd/Pa) to study their discordance.</div></div><div><h3>Methods</h3><div>We conducted a prospective, single-center, clinical study enrolling all patients undergoing full coronary physiology assessment with Coroventis CoroFlow Cardiovascular System (Abbott Vascular, St. Paul, Minnesota) to validate the developed formula:<span><span><span><math><mi>FFR</mi><mo>/</mo><mi>NHi</mi><mo>=</mo><mfenced><mrow><mi>IMR</mi><mo>/</mo><mi>BMR</mi></mrow></mfenced><mfenced><mrow><mi>BSR</mi><mo>+</mo><mi>BMR</mi></mrow></mfenced><mo>/</mo><mfenced><mrow><mi>HSR</mi><mo>+</mo><mi>IMR</mi></mrow></mfenced></math></span></span></span></div><div>where IMR(BMR) is the hyperemic (basal) microvascular resistance and HSR(BSR) is the hyperemic (basal) stenosis resistance.</div></div><div><h3>Results</h3><div>A total of 51 patients were enrolled, 72 % male, average age 67.4 ± 8.9. Mean hemodynamic data were: FFR 0.87 ± 0.07, iFR 0.93 ± 0.05, RFR 0.91 ± 0.05, Pd/Pa 0.92 ± 0.05, BMR 76.6 ± 51.6 mmHg*s, IMR 28.4 ± 22.8 mmHg*s, BSR 5.5 ± 4.7 mmHg, HSR 3.8 ± 2.9 mmHg*s, coronary flow reserve (CFR) 2.9 ± 1.6, resistive reserve ratio (RRR) 3.3 ± 2.0. Lin's Concordance and Bland Altman analysis showed an optimal correlation between measured and estimated data. Sensitivity analysis showed that: (1) FFR can underestimate epicardial stenosis severity leading to FFR- vs NHi + discordance in case of elevated IMR, (2) NHi can overestimate epicardial stenosis severity leading to FFR- vs NHi + in the case of low BMR, (3) if BSR &gt; HSR, FFR- vs NHi + discordance can occur, while if BSR &lt; HSR, FFR+ vs NHi- discordance can occur.</div></div><div><h3>Conclusion</h3><div>(1) NHi can be more reliable in case of elevated IMR; (2) FFR-CFR combination can be more reliable for low BMR occurring to compensate an epicardial stenosis; (3) NHi-CFR combination can be more reliable when BSR &gt; HSR, while FFR-CFR combination can be more reliable when BSR &lt; HSR. The combination between pressure and flow indexes (FFR-CFR or NHi-CFR) is more reliable when compensatory mechanisms occur.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 44-51"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336994","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: Navigating the complexity of bleeding and hypercoagulable disorders in patients with acute myocardial infarction","authors":"Felice Gragnano ,&nbsp;Dominick J. Angiolillo","doi":"10.1016/j.carrev.2024.11.015","DOIUrl":"10.1016/j.carrev.2024.11.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 16-18"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814652","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":"Percutaneous endovascular intervention for left ventricular assist device outflow graft obstruction: A single-center experience","authors":"Ryan Wallace ,&nbsp;Toby Rogers ,&nbsp;Michael Slack ,&nbsp;Farooq H. Sheikh ,&nbsp;Keki Balsara ,&nbsp;Gaby Weissman ,&nbsp;Lowell F. Satler ,&nbsp;Ron Waksman ,&nbsp;Itsik Ben-Dor","doi":"10.1016/j.carrev.2024.05.017","DOIUrl":"10.1016/j.carrev.2024.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Outflow graft obstruction (OGO) is an uncommon yet life-threatening complication in patients with left ventricular assist devices (LVADs). In this retrospective, single-center case series, we identify the baseline demographics and presenting features of patients who develop LVAD OGO and the procedural details and outcomes surrounding percutaneous endovascular intervention (PEI).</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients with LVADs at our institution between January 2010 and February 2023 who developed OGO and were treated with PEI. Details of the PEI including procedure time, fluoroscopy time, contrast use, stent size, number of stents, change in gradient, and change in flow after intervention were collected.</div></div><div><h3>Results</h3><div>A total of 12 patients who had 14 cases of OGO were identified from January 2010 to February 2023. The average age at presentation was 64.78 years. Nine of the 14 cases occurred in male patients. Eleven of the 14 cases occurred with Heartware devices (2 recurrences), 2 in Heartmate 2 and 1 in Heartmate 3. Notable procedural details include a mean procedure time of 90.86 min and mean contrast use of 162.5 mL. The initial gradient across the OGO was reduced by an average of 72 %, to a mean post-PEI of 11.57 mmHg. The average number of stents to achieve this gradient was around 2.08, with the most common stent diameter being 10 mm. Thirty-day mortality after PEI was 7 % (1/14) in this high-risk patient population.</div></div><div><h3>Conclusion</h3><div>In our single-center experience, PEI can be a safe and effective treatment for LVAD OGO.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 34-37"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027423","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 revascularization with risk of ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: Systematic review and meta-analysis","authors":"Mohammed Al-Sadawi ,&nbsp;Michael Tao ,&nbsp;David Zhang ,&nbsp;Brett L. Wanamaker ,&nbsp;Amrish Deshmukh ,&nbsp;Michael Ghannam ,&nbsp;Frank Bogun ,&nbsp;Jackson J. Liang","doi":"10.1016/j.carrev.2024.11.006","DOIUrl":"10.1016/j.carrev.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Coronary chronic total occlusion (CTO) can result in ischemic cardiomyopathy which may create substrate supportive of ventricular arrhythmias (VA). The purpose of this meta-analysis is to evaluate the association of CTOs with risk of ventricular arrhythmias (VAs) and to assess the utility of CTO percutaneous coronary intervention (PCI) in this setting.</div></div><div><h3>Methods</h3><div>A literature search was conducted for studies reporting an association between CTOs and VAs and PCI VAs among patients with CTO. VAs were defined as ventricular tachycardia, ventricular fibrillation, sudden cardiac death, and appropriate implantable cardiac defibrillator therapy. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.</div></div><div><h3>Results</h3><div>Nine studies with 3068 participants (1405 with CTOs and 1663 with coronary artery disease [CAD]) met inclusion criteria. CTOs were associated with significantly higher risk of VAs compared with patients with CAD without CTOs (OR 2.25, 95 % CI 1.92–2.64; <em>p</em> &lt; 0.01). Three studies with 1830 patients with CTOs (970 revascularized, 860 on optimal medical therapy) met inclusion criteria for evaluating the association of CTO revascularization and VAs. CTO PCI was associated with a significantly lower risk of VAs compared with patients treated with optimal medical therapy.</div></div><div><h3>Conclusions</h3><div>Patients with CTOs appear to have a higher burden of VAs compared with patients with CAD without CTOs. Revascularization of CTOs was found to be associated with significant reduction in risk of VAs, however additional high-quality studies are required to further evaluate this association.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 81-85"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752013","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":"Stroke volume index (SVI) predicts all-cause mortality following transcatheter aortic valve replacement (TAVR)","authors":"Vinesh R. Jonnala ,&nbsp;Haroon S. Quadri ,&nbsp;Leili Pourafkari ,&nbsp;Stanley F. Fernandez ,&nbsp;Vijay S. Iyer ,&nbsp;Nader D. Nader","doi":"10.1016/j.carrev.2024.06.014","DOIUrl":"10.1016/j.carrev.2024.06.014","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Left ventricular systolic dysfunction<span> in patients with severe aortic stenosis (AS) may result in low transvalvular gradients and underestimation of AS severity. A low-flow state may occur with reduced </span></span>LVEF. Little is known about the implications of low compared to normal flow in patients with reduced LVEF undergoing </span>transcatheter aortic valve replacement (TAVR).</div></div><div><h3>Objectives</h3><div><span>We compared survival rates with degree of flow across stenosed </span>aortic valves<span> and left ventricular dysfunction. We hypothesized that the stroke volume index (SVI) offers essential information regarding survival following TAVR.</span></div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with LVEF &lt;50 % undergoing TAVR at the Gates Vascular Institute in Buffalo, New York, from 2012 to 2017. We performed Receiver Operator Characteristics to examine the value of SVI in predicting the postoperative outcome of patients. Kaplan-Meier and Cox regression<span> analyses were used to investigate the effect of a low-flow state on five-year survival in patients with systolic dysfunction undergoing TAVR.</span></div></div><div><h3>Results</h3><div>Five-year survival following TAVR was decreased in patients with low-flow AS (SVI &lt;35 mL/m²) compared to patients with normal flow. Seventy-four percent (<em>n</em> = 50) of patients with low-flow compared to 43 % (<em>n</em> = 22) of patients with normal flow were deceased five years post-TAVR (<em>p</em> ≤0.001). ROC curve indicated SVI to be a clinical predictor of five year survival (AUC 0.732, 95 % CI: 0.641–0.823, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Patients with systolic dysfunction and low transvalvular flow AS had increased mortality five years following TAVR. These findings highlight a better prognosis in patients with normal flow and LV systolic dysfunction.</div></div><div><h3>Condensed abstract</h3><div><span>Low-flow aortic stenosis<span> can occur with reduced left ventricular function. We compared survival rates of patients with known reduced left ventricular function in low-flow and normal flow aortic stenosis. This retrospective single-center study examined </span></span>mortality rates following transcatheter aortic valve replacement. The mean gradient was not a predictor of mortality. This study shows patients with low-flow aortic stenosis have decreased five-year survival following valve replacement.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 38-43"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433107","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":"2023 ACC/AHA Chronic Coronary Disease Guideline – An opportunity to reestablish coronary artery bypass recommendations","authors":"Adnaldo da Silveira Maia ,&nbsp;Magaly Arrais dos Santos","doi":"10.1016/j.carrev.2024.04.020","DOIUrl":"10.1016/j.carrev.2024.04.020","url":null,"abstract":"<div><div><span>Coronary artery bypass (CABG) has evolved over the decades, supported by scientific evidence from robust studies. The downgrade of the recommendation for CABG in patients with </span>multivessel coronary artery disease<span> proposed by the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization<span> and the 2023 ACC/AHA Chronic Coronary Disease Guidelines has brought this discussion to the fore, with prestigious cardiothoracic surgery societies such as AATS and STS not supporting these recommendations. The purpose of this article is to broaden this discussion in light of published studies.</span></span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 19-22"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852305","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 risk factors associated with stroke when utilizing peripheral VA-ECMO","authors":"Mohamed Ramzi Almajed ,&nbsp;Raef A. Fadel ,&nbsp;Austin Parsons ,&nbsp;Ahmad Jabri ,&nbsp;Asem Ayyad ,&nbsp;Ryan Shelters ,&nbsp;Daizo Tanaka ,&nbsp;Jennifer Cowger ,&nbsp;Gillian Grafton ,&nbsp;Mohammad Alqarqaz ,&nbsp;Pedro Villablanca ,&nbsp;Gerald Koenig ,&nbsp;Mir Babar Basir","doi":"10.1016/j.carrev.2024.10.010","DOIUrl":"10.1016/j.carrev.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has brought forward a paradigm shift in the management of cardiogenic shock. Neurological complications associated with VA-ECMO represent a significant source of morbidity and mortality and serve as a limiting factor in its application and duration of use.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective case-control study of patients who developed stroke while managed with peripheral VA-ECMO from January 2018 to September 2022 at a quaternary center. We included consecutive patients above the age of 18 who were admitted to the cardiac intensive care unit and were managed with peripheral VA-ECMO. All patients who developed a stroke while on VA-ECMO were included in the case cohort, and compared to those who did not suffer stroke. Multivariable logistic regression was performed to identify risk factors associated with stroke on VA-ECMO. In-hospital outcomes were assessed out to 30 days.</div></div><div><h3>Results</h3><div>A total 244 patients were included in the final analysis, 36 (14.7 %) of whom developed stroke on VA-ECMO. Ischemic stroke was seen in 20 patients (55.6 %) whereas hemorrhagic stroke was seen in 16 patients (44.4 %). The use of P2Y₁₂ antagonists (aOR 2.70, p = 0.019), limb ischemia (aOR 4.41, p = 0.002), and blood transfusion requirement (aOR 8.55, p = 0.041) were independently associated with development of stroke on VA-ECMO. Female sex trended towards statistical significance (aOR 2.19, p = 0.053) while age was not independently associated with development of stroke on VA-ECMO. There was no significant association between stroke development and outcomes of VA-ECMO duration, hospital length of stay, and all-cause mortality out to 30-days.</div></div><div><h3>Conclusions</h3><div>VA-ECMO carried a considerable risk of neurological complications. Mortality and duration of hemodynamic support was not associated with stroke risk. Awareness regarding stroke risk is imperative in facilitating early identification and management of ischemic and hemorrhagic stroke. Research involving clinical trials and multicenter studies are necessary to empower centers in mitigating this source of significant morbidity and mortality in patients on mechanical circulatory support.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"72 ","pages":"Pages 1-7"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584690","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}