Cardiovascular Revascularization Medicine最新文献

{"title":"“A stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction”","authors":"Rafael Mila ,&nbsp;Juan Albistur ,&nbsp;María Valdez ,&nbsp;Gimena Loza ,&nbsp;Juan Torrado ,&nbsp;Juan Bachini ,&nbsp;Soledad Murguía ,&nbsp;Federico Acquistapace ,&nbsp;Natalia Nóbile ,&nbsp;Victoria Briano ,&nbsp;Alvaro Niggemeyer ,&nbsp;Pedro Trujillo ,&nbsp;Nicolás Niell ,&nbsp;Ariel Durán ,&nbsp;Fernando Alfonso ,&nbsp;Victor Dayan","doi":"10.1016/j.carrev.2024.09.001","DOIUrl":"10.1016/j.carrev.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The DANAMI-3 DEFER study demonstrated that deferring stent implantation in ST-elevation myocardial infarction (STEMI) is safe, although not superior to immediate stenting. It is possible that an individualized revascularization strategy in STEMI, achieved through appropriate patient selection, could be feasible and effective.</div></div><div><h3>Methods</h3><div>This prospective, non-randomized study included 198 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between October 2019 and November 2021. Patients were assigned to either the deferred stenting (DS) group (<em>n</em> = 19) or the control group (C) undergoing immediate stenting (<em>n</em> = 179) based on a multimodal approach integrating coronary angiography, intravascular imaging, physiological assessments, and clinical judgment. The primary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).</div></div><div><h3>Results</h3><div>The DS group showed a significantly lower rate of stent implantation (10.5 % vs. 97.7 %, <em>p</em> &lt; 0.001) and a higher use of thrombus aspiration (89.5 % vs. 30.7 %, <em>p</em> &lt; 0.001) and glycoprotein IIb/IIIa inhibitors (31.6 % vs. 6.7 %, p &lt; 0.001) compared to the C group. No significant differences were observed between the groups in terms of all-cause mortality (5.3 % vs. 8.9 %, <em>p</em> = 0.59) or MACCE (10.5 % vs. 8.4 %, <em>p</em> = 0.71).</div></div><div><h3>Conclusions</h3><div>This study demonstrates the feasibility of implementing individualized reperfusion strategies in STEMI within a real-world clinical setting. The findings, while limited by the study design, generate valuable hypotheses that warrant further investigation to refine patient selection criteria and optimize outcomes.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 90-97"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298649","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":"Complete intramyocardial coronary artery","authors":"Gianluca Rigatelli ,&nbsp;Giuseppe Marchese ,&nbsp;Andrea Bertolini ,&nbsp;Ervis Hiso ,&nbsp;Marco Zuin","doi":"10.1016/j.carrev.2025.01.011","DOIUrl":"10.1016/j.carrev.2025.01.011","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 127-128"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256708","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: Observational data on timing of invasive angiography in NSTEMI","authors":"William S. Weintraub","doi":"10.1016/j.carrev.2025.03.013","DOIUrl":"10.1016/j.carrev.2025.03.013","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 105-106"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721944","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":"Beyond the guidelines: expert perspectives on the management of AMI-related cardiogenic shock from the Cardiovascular Research Technologies (CRT) 2025 meeting","authors":"Lior Lupu ,&nbsp;Gregg W. Stone ,&nbsp;Lindsey Cilia ,&nbsp;Holger Thiele ,&nbsp;Ramesh Daggubati ,&nbsp;Dean J. Kereiakes ,&nbsp;Tanveer Rab ,&nbsp;Michael J. Rinaldi ,&nbsp;George W. Vetrovec ,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2025.05.005","DOIUrl":"10.1016/j.carrev.2025.05.005","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 3-7"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081296","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":"Beyond the guidelines: Forging a new chapter in medical education at CRT 2025","authors":"Ron Waksman","doi":"10.1016/j.carrev.2025.05.004","DOIUrl":"10.1016/j.carrev.2025.05.004","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 1-2"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095492","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":"Imaging-guided PCI improves outcomes in patients with multivessel disease a meta-analysis of randomized and observational trials comparing treatment of ACS","authors":"Jessica Saganowich ,&nbsp;Jacob Powell ,&nbsp;Timothy A. Mixon ,&nbsp;Jose Emilio Exaire ,&nbsp;Hisao Otsuki ,&nbsp;William Fearon ,&nbsp;R. Jay Widmer","doi":"10.1016/j.carrev.2024.09.003","DOIUrl":"10.1016/j.carrev.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>This meta-analysis sought to investigate if IVUS-guided PCI (IVUS-PCI) can improve outcomes compared to standard PCI and CABG in patients with multivessel CAD.</div></div><div><h3>Background</h3><div>Coronary artery disease (CAD) is traditionally revascularized by either percutaneous coronary intervention (PCI) or coronary artery bypass (CABG) with a historical benefit of CABG over PCI in multivessel CAD. Intravascular ultrasound-guided PCI (IVUS-PCI) may improve outcomes compared to angiography alone.</div></div><div><h3>Methods</h3><div>We undertook a systematic search using PubMed, MEDLINE, EMBASE, Web of Science, and Ovid from 2017 through 2022. We included randomized controlled trials and observational trials comparing PCI vs CABG for multivessel CAD evaluated by two independent reviewers. We extracted baseline data and major adverse cardiovascular events (MACE; death from any cause, MI, stroke, or repeat revascularization) at one year. Three trials were selected based on study arm criteria: FAME 3, BEST, and Syntax II.</div></div><div><h3>Results</h3><div>IVUS-PCI significantly reduced death from any cause (OR 0.45, CI 0.272–0.733, <em>p</em> = 0.001), repeat revascularization (OR 0.62, CI 0.41–0.95, <em>p</em> = 0.03), and showed a non-significant reduction in MACE (OR 0.74, CI 0.54–1.01, <em>p</em> = 0.054) when compared to CABG. IVUS-PCI significantly reduced MACE (OR 0.52, CI 0.38–0.72, <em>p</em> &lt; 0.001) and showed a non-significant reduction in death (OR 0.66, CI 0.36–1.18, <em>p</em> = 0.16) and numerically reduced repeat revascularization (OR 0.66, CI95 0.431–1.02, <em>p</em> = 0.06) when compared to PCI without IVUS.</div></div><div><h3>Conclusion</h3><div>IVUS-PCI reduces cardiovascular outcomes in patients with multivessel disease compared to CABG and angiographically-guided PCI at one year. These results reinforce the importance of IVUS-PCI in complex CAD and provide evidence for improved PCI outcomes compared to CABG for multivessel CAD.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 84-89"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336995","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":"Abbreviated ticagrelor based dual antiplatelet therapy in acute coronary syndrome: A systematic review and meta-analysis","authors":"Wissam Harmouch ,&nbsp;Ravi Thakker ,&nbsp;Mirza Umair Khalid ,&nbsp;Wissam Khalife ,&nbsp;Neal Kleiman ,&nbsp;Umamahesh Rangasetty ,&nbsp;Waleed Tallat Kayani ,&nbsp;Hani Jneid ,&nbsp;Bashar Al-Hemyari ,&nbsp;Ayman Elbadawi","doi":"10.1016/j.carrev.2024.09.005","DOIUrl":"10.1016/j.carrev.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Few randomized clinical trials have evaluated the safety and efficacy of abbreviated ticagrelor based dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS); however, these trials were underpowered to detect differences in hard clinical outcomes.</div></div><div><h3>Methods</h3><div>A systematic search of MEDLINE, Cochrane, and Scopus databases was performed through June 2024, for trials that compared abbreviated (≤3-months) versus standard 12-months ticagrelor based DAPT in ACS. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular death, myocardial infarction, stent thrombosis, ischemic stroke, and major bleeding. Endpoints were measured at 12-months after DAPT initiation. Data were pooled using random-effects model. Effect measure utilized was risk ratio (RR). Heterogeneity was assessed via Chi-squared and Higgin’s I² test. RevMan 5.0 (Cochrane Collaboration, Oxford, United Kingdom) was utilized to perform statistical analysis.</div></div><div><h3>Results</h3><div>Five trials were included in this analysis with 21,407 patients assessed. ULTIMATE-DAPT, T-PASS, and GLOBAL LEADERS-ACS assessed 1-month DAPT duration while TICO and TWILIGHT-ACS assessed 3-months DAPT duration. The average age was 62.7 years and 22.7 % were women. ACS presentations included non-ST elevation myocardial infarction (40.1 %), unstable angina (35.2 %), and ST-segment elevation myocardial infarction (31.5 %). Abbreviated ticagrelor based DAPT was associated with lower risk of all-cause mortality (RR 0.78; 95 % Confidence Interval (CI) 0.62–0.98, I² = 0 %) compared with standard duration DAPT. There was no difference between groups in cardiovascular death (RR 0.65; 95 % CI 0.41–1.03, I² = 0 %), myocardial infarction (RR 1.04; 95 % CI 0.85–1.27, I² = 0 %), stent thrombosis (RR 0.97; 95 % CI 0.64–1.45, I² = 0 %), or ischemic stroke (RR 0.90; 95 % CI 0.62–1.30, I² = 0 %). Abbreviated DAPT was associated with lower risk of major bleeding (RR 0.50; 95 % CI 0.38–0.66, I² = 46 %).</div></div><div><h3>Conclusion</h3><div>Our analysis includes the totality of randomized data evaluating the merits of abbreviated ticagrelor based DAPT after ACS. The salient study finding was the observed reduced risk of all-cause mortality and major bleeding with abbreviated DAPT approach.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 64-70"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336976","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":"Comparing outcomes of endovascular intervention vs bypass surgery for patients with chronic/critical limb ischemia","authors":"Prasana Ramesh ,&nbsp;Mohamed Zghouzi ,&nbsp;Roshan Bista ,&nbsp;Neel N. Patel ,&nbsp;Chidubem Ezenna ,&nbsp;Timir K. Paul ,&nbsp;Aravinda Nanjundappa","doi":"10.1016/j.carrev.2025.02.017","DOIUrl":"10.1016/j.carrev.2025.02.017","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Limb Threat Ischemia (CLTI) is a severe form of peripheral arterial disease characterized by various symptoms including nonhealing wounds, ulcers and gangrene ultimately leading to a possible amputation. Therefore, revascularization either through endovascular intervention (EVI) or surgical bypass (SB) is an important step in management. Literature review of various studies including Randomized clinical trials (RCTs), Meta-analysis and observational studies show varied results with some studies suggesting better outcomes with EVI while majority of the others favors superiority of SB. Our Systematic review and meta-analysis aims to ascertain underlying differences between the approaches.</div></div><div><h3>Methods</h3><div>We performed a Meta-analysis of observational studies and RCTs following the PRISMA guidelines. We searched Pubmed, and Cochrane databases. After removing duplicates and studies that did not meet the inclusion criteria, 9 studies were included which comprised of 4 RCTs and 5 observational studies. Outcomes measured include limb salvage, amputation free survival and Mortality. Random effects were applied to calculate Odds ratio (OR) and 95 % confidence Intervals (CI).</div></div><div><h3>Results</h3><div>A total of 6375 patients from 9 studies were included. The pooled analysis from the meta-analysis comparing Endovascular intervention vs Surgical Bypass showed no statistically significant difference between the outcomes. The Pooled OR was 0.990(95%CI 0.913–1.073). Additionally the heterogeneity among the studies was moderate (i² = 34.7 %) suggesting some variability in the study results but not enough to conclude a significant difference. Additionally subgroup analysis was performed for above-knee and infra popliteal interventions which yielded statistically similar results.</div></div><div><h3>Conclusions</h3><div>Based on the results above, neither endovascular intervention nor bypass surgery showed superiority over the other for outcomes such as limb salvage, mortality and amputation free survival. Therefore, effectiveness of both interventions for revascularization is comparable.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 107-115"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630942","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":"Efficacy of drug-coated balloon angioplasty for coronary chronic total occlusion: A systematic review and meta-analysis","authors":"Filippo Luca Gurgoglione ,&nbsp;Sara Malakouti ,&nbsp;Bharat Khialani ,&nbsp;Jasim Hasan ,&nbsp;Jacinthe Khater ,&nbsp;Giovanni Occhipinti ,&nbsp;Davide Donelli ,&nbsp;Bernardo Cortese","doi":"10.1016/j.carrev.2025.04.002","DOIUrl":"10.1016/j.carrev.2025.04.002","url":null,"abstract":"<div><div>Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is associated with worse outcomes compared to non-CTO lesions. Whether the implantation of drug-eluting stents (DES) is the cornerstone treatment after successful recanalization of CTO, recent evidence tested the clinical performance of DCB-based PCI, alone or in concert with DES (hybrid DCB/DES approach), in this context. We aimed to conduct a comprehensive, up-to-date systematic review and summary-level meta-analysis of clinical studies comparing outcomes of DCB-based versus DEB-only angioplasty for coronary CTOs.</div><div>A systematic search was performed to identify all investigations comparing DCB-based versus DES-only angioplasty for coronary CTOs. The primary endpoint was the occurrence of target vessel failure (TVF), a composite outcome of cardiac death, nonfatal myocardial infarction and target vessel revascularization.</div><div>A total of 5 observational studies (2087 patients) were included in the analysis. The DCB-based PCI group experienced a trend towards a lower rate of TVF (0.45 % (112/25045) vs. 0.76 % (238/31336) person-months, IRR = 0.56 [95 % CI 0.28 to 1.10], I² = 81 %, <em>p</em> = 0.09) and cardiac death (0.05 % vs. 0.10 % person-months, IRR = 0.55 [95 % CI 0.27 to 1.10], I² = 0 %, p = 0.09), although a high extent of heterogeneity was observed. Other endpoints were not different between the two groups.</div><div>In the present meta-analysis, DCB-based PCI was associated with similar outcomes compared to second-generation DES PCI for the treatment of coronary CTOs. Future randomized controlled trials will provide more robust evidence on the effectiveness of DCB in treating coronary CTOs.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"75 ","pages":"Pages 137-143"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016654","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":"Validation of a novel scoring tool for assessment of the severity of coronary disease and ischaemia burden to predict major adverse cardiac events at 5 years in the 3V-FFR FRIENDS population.","authors":"Mohamed Kira, Hussein Bashar, Lavinia Gabara, Mohamed Aboulassad, Ahmed Elserwey, Pamela S Douglas, Nicholas Ng, Sang-Hyeon Park, Bon-Kwon Koo, Nick Curzen","doi":"10.1016/j.carrev.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.05.030","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic heart disease is the most prevalent form of cardiovascular disease (CVD) worldwide and imposes a substantial burden on healthcare systems. Identification of patients at high risk of events in a tailored primary prevention strategy is hindered by relatively blunt risk assessment tools. A novel scoring model that allows for rapid calculation of atheroma and ischaemia burden may facilitate earlier identification of high risk individuals. Our aim was to validate the ability of a novel candidate scoring model (Functional FFR Score 2, FFS2) to predict adverse clinical events, as a proof of concept, by applying it in a cohort of patients in whom coronary artery disease was assessed by means of invasive coronary angiography (ICA) and intracoronary pressure wire.</p><p><strong>Methods: </strong>We retrospectively applied the novel FFS2 to a population of patients in whom there was comprehensive anatomical and physiological data from ICA plus intracoronary measurement of fractional flow reserve (FFR), the 3V-FFR FRIENDS study. The FFS2 includes an anatomical and physiological component, each used to score severity. Receiver operating characteristics (ROC) analysis and area under curve (AUC) were performed for the total FFS2 score, and for its components. The best cut-off value was then used to classify patients into high and low score groups to assess association with updated 5-year major adverse cardiac events (MACE).</p><p><strong>Results: </strong>The FFS2 was applied on 616 patients from the 3V-FFR FRIENDS population, and was associated with MACE up to 5-years follow up (4.9 % Ischaemia-driven revascularisation, 1.6 % myocardial infarction (MI), and 1.3 % cardiac death), when patients were classified into \"high\" and \"low\" risk groups according to the best cut-off value of 11.5 following the initial ROC analysis of the total FFS2 score. The calculated hazard ratio (HR) was 2.87 (95 % CI 1.50-5.49, P = 0.002) for MACE and 3.75 (95 % CI 1.79-7.89, P < 0.001) for the ischaemia-driven revascularisation in the high risk group of patients.</p><p><strong>Conclusion: </strong>The novel FFS2 score, incorporating an assessment of total atheroma and ischaemia burden, is associated with the rate of MACE and ischaemia-driven revascularisation. Further testing of this scoring tool to primary prevention populations is now warranted.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318386","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}