Cardiovascular Revascularization Medicine最新文献

{"title":"Flow characteristics of reperfusion sheaths when utilizing large bore mechanical circulatory support devices","authors":"Imran Naeem Aziz ,&nbsp;Ahmad Jabri ,&nbsp;Ying Xu ,&nbsp;Seth Bilazarian ,&nbsp;Dana Bentley ,&nbsp;Amir Kaki ,&nbsp;Allison Dupont ,&nbsp;William O'Neill ,&nbsp;Herbert D. Aronow ,&nbsp;Alejandro Lemor ,&nbsp;Hady Lichaa ,&nbsp;Alexander G. Truesdell ,&nbsp;Mir B. Basir","doi":"10.1016/j.carrev.2025.03.017","DOIUrl":"10.1016/j.carrev.2025.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Reperfusion sheaths are commonly utilized to prevent acute limb ischemia<span> (ALI) when using large bore mechanical circulatory support devices, though little is known about flow characteristics of these sheaths.</span></div></div><div><h3>Methods</h3><div>The purpose of this assessment was to characterize the flow rates of various femoral to femoral (fem-fem) bypass circuits. We devised a test setup that maintains a preset input pressure for test devices to enable an accurate comparison of bypass techniques.</div></div><div><h3>Results</h3><div><span><span>Negligible flow rate increases were observed in active or passive ipsilateral and contralateral circuits when donor or receiver sheaths were sequentially increased in size. When using a contralateral fem-fem bypass circuit, the use of a Merit Prelude Pro 8F sheath paired with a 5F Arrow reperfusion sheath provided 167 ml/min of flow. If the reperfusion sheath was exchanged to a 6F sheath the flow rate was 169 ml/min, 175 ml/min with a 7F sheath and 179 ml/min with an 8F sheath, a total difference of 7 %. When maintaining a 6F reperfusion sheath as a constant, the use an ipsilateral fem-fem bypass circuit using an Abiomed 14F Low profile sheath provided 215 ml/min of flow, a 27 % higher flow than a contralateral 8F circuit. The use of an active pressure bypass system using an </span>18F </span>ECMO<span><span> cannula provided 356 ml/min, </span>a 66 % higher flow than a 14F ipsilateral fem-fem bypass and 110 % higher flow than an 8F contralateral fem-fem bypass.</span></div></div><div><h3>Conclusion</h3><div>Flow rate through a fem-fem bypass circuit is contingent upon the smallest diameter along the pathway which is typically the side port of the sheath. There are negligible changes in flow rate based on increasing donor or receiver sheath sizes. Novel, purpose-built reperfusion sheath taking these flow characteristics into account are needed to improve such systems.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 57-62"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755183","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-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials","authors":"Chidubem Ezenna ,&nbsp;Mrinal Murali Krishna ,&nbsp;Meghna Joseph ,&nbsp;Vinicius Pereira ,&nbsp;Prasana Ramesh ,&nbsp;Mahmoud Ismayl ,&nbsp;Michael G. Nanna ,&nbsp;Andrew M. Goldsweig","doi":"10.1016/j.carrev.2024.12.004","DOIUrl":"10.1016/j.carrev.2024.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>The optimal revascularization strategy for patients with myocardial infarction (MI) and </span>multivessel coronary artery disease (CAD) remains an area of research and debate. </span>Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.</div></div><div><h3>Objective</h3><div>To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials<span> (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis<span> (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).</span></span></div></div><div><h3>Result</h3><div><span>The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57–0.92; </span><em>p</em> = 0.009), cardiac death (RR 0.73; 95%CI 0.55–0.97; <em>p</em> = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44–0.84; <em>p</em><span> = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.</span></div></div><div><h3>Conclusion</h3><div>FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.</div></div><div><h3>Social media abstract</h3><div>4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death &amp; repeat revascularization than culprit-only #PCI.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 31-40"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899154","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":"Comparison of angiogram-based physiological assessment system sizing tool and intravascular ultrasound imaging measurements","authors":"Kazuhiro Dan ,&nbsp;Guy Witberg ,&nbsp;Fumiharu Itabashi ,&nbsp;Takuya Maeda ,&nbsp;Yuetsu Kikuta ,&nbsp;Kouya Okabe ,&nbsp;Toru Tanigaki ,&nbsp;Mamoru Nanasato ,&nbsp;Yutaka Hikichi ,&nbsp;Hiroyoshi Yokoi ,&nbsp;Ran Kornowski ,&nbsp;Hitoshi Matsuo","doi":"10.1016/j.carrev.2025.03.012","DOIUrl":"10.1016/j.carrev.2025.03.012","url":null,"abstract":"<div><h3>Background</h3><div>The diagnostic performance<span> of an angiogram-based physiological assessment system (FFRangio™, CathWorks) has been already demonstrated. Besides performing a functional assessment, the FFRangio system provides a 3-dimensional quantitative coronary angiogram-based sizing tool (FFRangioST) to measure lumen diameter and vessel length. We aim to compare the measurements obtained using FFRangioST against measurements obtained with intravascular ultrasound (IVUS) in patients undergoing percutaneous coronary intervention (PCI).</span></div></div><div><h3>Methods</h3><div>We analyzed data from consecutive patients who underwent IVUS-guided PCI after FFRangio physiological assessment and FFRangioST assessment of lesion diameters and length from the Japan FFRangio clinical outcome registry (ClinicalTrials.gov. NCT05648396). For each lesion undergoing PCI, the correlation and mean difference for lesion length (LL), proximal reference diameter (RD) and distal RD as measured by FFRangioST/IVUS were assessed using pairwise comparisons, Pearson's correlation and Bland-Altman plots.</div></div><div><h3>Results</h3><div>Our cohort included 121 lesions from 115 patients. The FFRangio value in this cohort was 0.60 ± 0.1 (mean ± standard deviation). Mean LL (mm) was 31.1 ± 13.9 and 30.3 ± 14.3 by FFRangioST and IVUS, respectively. Correlation between the LL measurements was <em>r</em> = 0.986 (<em>p</em> &lt; 0.001). Proximal RD (mm) was 2.6 ± 0.5 and 3.2 ± 0.6 by FFRangioST and IVUS, respectively, with correlation of <em>r</em> = 0.756 (p &lt; 0.001). Distal RD (mm) was 2.2 ± 0.5 and 2.7 ± 0.5 by FFRangioST and IVUS, respectively, with correlation of <em>r</em> = 0.832 (p &lt; 0.001). After inflating the original FFRangioST diameter value by 25 %, the average difference between the IVUS and FFRangioST measurements was 0.02 mm and −0.02 mm, for proximal and distal RD, respectively.</div></div><div><h3>Conclusion</h3><div>FFRangioST measurement has an excellent correlation with lesion length and high degree of correlation with a predictable coefficient (25 % inflation) with proximal and distal reference diameters when compared with IVUS measurement in PCI.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 80-85"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732217","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":"Five-year clinical outcomes of STEMI patients treated with a pre-specified bioresorbable vascular scaffold implantation technique: Final results of the BVS STEMI STRATEGY-IT","authors":"Elisabetta Moscarella ,&nbsp;Gianluca Campo ,&nbsp;Massimo Leoncini ,&nbsp;Salvatore Geraci ,&nbsp;Elisa Nicolini ,&nbsp;Bernardo Cortese ,&nbsp;Bruno Loi ,&nbsp;Vincenzo Guiducci ,&nbsp;Salvatore Saccà ,&nbsp;Attilio Varricchio ,&nbsp;Paolo Vicinelli ,&nbsp;Gianfranco De Candia ,&nbsp;Davide Personeni ,&nbsp;Paolo Calabrò ,&nbsp;Salvatore Brugaletta ,&nbsp;Azeem Latib ,&nbsp;Maurizio Tespili ,&nbsp;Alfonso Ielasi","doi":"10.1016/j.carrev.2024.11.003","DOIUrl":"10.1016/j.carrev.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT).</div></div><div><h3>Methods</h3><div>The BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (<span><span>NCT02601781</span><svg><path></path></svg></span><span><span>). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven </span>target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter).</span></div></div><div><h3>Results</h3><div>502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1–0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007).</div></div><div><h3>Conclusions</h3><div>This study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 10-14"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639071","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":"Procedural factors influencing successful coronary sinus reducer implantation for refractory angina: A single-centre experience","authors":"Kevin Cheng ,&nbsp;Husein Rajabali ,&nbsp;Sian-Tsung Tan ,&nbsp;Anantharaman Ramasamy ,&nbsp;Mohammad Almajali ,&nbsp;Christos Papageorgiou ,&nbsp;Rogelio Bensan ,&nbsp;Bruce Barton ,&nbsp;Jonathan Hill ,&nbsp;Ranil de Silva","doi":"10.1016/j.carrev.2024.11.014","DOIUrl":"10.1016/j.carrev.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Coronary sinus reducer (CSR) implantation is emerging as a novel effective percutaneous therapy for patients with refractory angina. Limited data exists examining the factors influencing successful CSR implantation. As CSR implantation becomes more widely adopted, a greater understanding of the procedural challenges which operators encounter is required.</div></div><div><h3>Aim</h3><div>To evaluate the patient and procedural characteristics influencing successful CSR implantation.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of consecutive patients with refractory angina undergoing clinically indicated CSR implantation (February 2016 to August 2024) at a high-volume implanting centre in the UK. Patient and procedural characteristics affecting procedural difficulty were systematically analysed. Procedural difficulty was determined by 1) increasing total procedural time or 2) features of challenging equipment handling such as bellying, swan-necking or complete equipment fallout from the coronary sinus (CS).</div></div><div><h3>Results</h3><div>102 out of 105 (97 %) patients underwent a successful CSR implant at the first attempt. Patients had a high rate of previous revascularisation (PCI: 85 %; CABG 64 %) and diabetes (58 %). Significant improvements in Canadian Cardiovascular Society (CCS) class were observed with 36 % of patients improving by ≥2 CCS classes and 71 % improving by ≥1 CCS class. A C- or non-C-shape of the CS was not associated with differences in procedural time (<em>P</em> = 0.52). However, the presence of both a valve and ridge in the CS was associated with significantly longer procedural times (<em>P</em> = 0.03). A ridge, alone or together with a valve, predicted features of procedural difficulty, such as bellying (ridge – OR: 2.69, <em>P</em> = 0.02; valve and ridge – OR: 4.58, <em>P</em> = 0.0006) and swan-necking (ridge – OR: 5.43, <em>P</em> = 0.001; valve and ridge – OR: 4.74, <em>P</em> = 0.002). Bellying, swan-necking, and complete fallout of equipment from the CS were associated with longer procedural times, but also with each other, suggesting their utility as indicators of procedural complexity.</div></div><div><h3>Conclusion</h3><div>In our experience, CSR implantation is safe and associated with high rates of procedural success. However, patient and procedural factors can influence the difficulty of CSR implantation. The presence of a ridge may make implantation more challenging. Bellying, swan-necking and complete equipment fallout may indicate increased procedural complexity. Greater awareness of these features will encourage operators to remain vigilant and adapt their implantation strategy when encountering challenging cases.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 65-72"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824638","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: Catheter-based therapy for intermediate risk pulmonary embolism: are we moving in the right direction?","authors":"George Chrysant","doi":"10.1016/j.carrev.2025.04.032","DOIUrl":"10.1016/j.carrev.2025.04.032","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 55-56"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053480","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 pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock","authors":"Mohit Pahuja ,&nbsp;Kalyan R. Chitturi ,&nbsp;Aakash Tuli ,&nbsp;Abhinav Saxena ,&nbsp;Adam Johnson ,&nbsp;Akhil S. Kallur ,&nbsp;Cheng Zhang ,&nbsp;Hank Rappaport ,&nbsp;Corey Shea ,&nbsp;Jason P. Wermers ,&nbsp;Hayder D. Hashim ,&nbsp;Nelson L. Bernardo ,&nbsp;Lowell F. Satler ,&nbsp;Itsik Ben-Dor ,&nbsp;Samer S. Najjar ,&nbsp;Farooq H. Sheikh ,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2024.12.010","DOIUrl":"10.1016/j.carrev.2024.12.010","url":null,"abstract":"<div><div><span><span><span>Acute myocardial infarction (AMI) remains one of the most common causes for </span>cardiogenic shock<span> (CS), with high inpatient mortality (40–50 %). Studies have reported the use of pulmonary artery catheters (PACs) in </span></span>decompensated heart failure<span>, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS. In this retrospective study from a large healthcare system (MedStar Health, 10 hospitals) from 2014 to 2021, patients were grouped according to presentation as ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) and on the basis of SCAI classification. In-hospital mortality was assessed among patients with and without PACs using propensity-matched analysis. A total of 2585 patients were included, of whom 797 had STEMI and 1788 had NSTEMI. Overall, 517 patients underwent PAC placement; PAC utilization rates were 19.7 % in the STEMI group and 20.4 % in the NSTEMI group. Overall, among patients with AMI-CS, we observed that in-hospital mortality was higher in patients who did not receive PACs during hospitalization (35.9 % vs 25.9 %, </span></span><em>p</em> &lt; 0.001). After propensity-matching 484 patients in the PAC group to 484 in the no-PAC group, the no-PAC group still showed higher mortality (34.9 % vs 26.7 %, <em>p</em><span> = 0.005). Utilization of MCS devices was higher in patients with PAC. In conclusion, our results suggest an advantage in utilizing PACs in AMI-CS patients to identify early CS stages and offer appropriate therapies. Therefore, PACs should be routinely used in for this population.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 41-46"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068857","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: Side ports and stopcocks, not sheath size: flow determinants in reperfusion circuits","authors":"Sumit R. Kumar,&nbsp;Ian C. Gilchrist","doi":"10.1016/j.carrev.2025.04.036","DOIUrl":"10.1016/j.carrev.2025.04.036","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"78 ","pages":"Pages 63-64"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057270","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":"The efficacy of the remote monitoring system following transcatheter aortic valve replacement.","authors":"Takuya Ogami, Cezar S Staniloae, Hany Habib, Michael Querijero, Stephanie Gaudio, Mathew R Williams","doi":"10.1016/j.carrev.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.017","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of aortic valve disease. However, delayed complications after hospital discharge and readmission remain in an issue following TAVR. We aimed to evaluate the impact of remote monitoring systems on clinical outcomes after TAVR.</p><p><strong>Methods: </strong>All patients who underwent TAVR from September 2014 through January 2019 were included retrospectively. Additionally, all patients, clinically indicated for TAVR from 9/1/2018 through 8/30/2021, were screened, and patients who agreed were prospectively enrolled. Medtronic Care Management Service (MCMS) was used to monitor patients following TAVR after discharge (Medtronic, Minneapolis, MN).</p><p><strong>Results: </strong>A total of 1078 patients were included. Among them, 843 (78.2 %) patients were discharged with MCMS (MCMS group) and 235 (21.8 %) patients were discharged without (non-MCMS group). Overall, the mean age was 81.5 years, and mean STS-PROM was 5.53 %. Baseline conduction defect was observed in 427 (39.6 %). Peripheral artery disease was more common in the MCMS group while a history of myocardial infarction was more likely seen in the non-MCMS group. After propensity-score matching, length of hospital stays was significantly shorter in the MCMS group (1.42 days vs. 1.82 days in the non-MCMS group, p < 0.001). Readmission rates and new permanent pacemaker insertion rates were similar between the two groups. All-cause mortality, 30-day and 90-day mortality were comparable between the groups.</p><p><strong>Conclusions: </strong>MCMS was easily applicable to a clinical practice and may reduce length of hospital stays in patients undergoing TAVR without increasing readmission or mortality.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008558","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":"The Houston Methodist CTO-PCI Registry: Contemporary risk profile, procedural characteristics, and outcomes of patients undergoing percutaneous coronary intervention for chronic total occlusion.","authors":"Chloe Kharsa, Gal Sella, Mangesh Kritya, Yasser M Sammour, Rody G Bou Chaaya, Jerrin Philip, Muhammad Haisum Maqsood, William A Zoghbi, Neal S Kleiman, Alpesh R Shah","doi":"10.1016/j.carrev.2025.08.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.08.014","url":null,"abstract":"<p><strong>Background: </strong>Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world data from the Houston Methodist CTO PCI Registry to characterize procedural success, safety, and mid- to long-term outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 507 patients undergoing CTO PCI between 2018 and 2023. Baseline clinical characteristics, procedural details, and outcomes including procedural success, in-hospital complications, and follow-up events were evaluated. Multivariable logistic regression identified predictors of procedural success.</p><p><strong>Results: </strong>The cohort had a mean age of 65.3 ± 10.0 years, 20.9 % women, and a high prevalence of comorbidities (hypertension 96.1 %, diabetes 49.7 %). The mean J-CTO score was 1.8 ± 1.1. Procedural success was achieved in 81.2 % of cases, with low in-hospital mortality (0.4 %) and complication rates. Annual success rates improved from 72.7 % in 2018 to a peak of 86.7 % in 2020, reflecting growing operator experience and evolving techniques. Multivariable analysis showed that age (OR 0.97, 95 % CI [0.95-1.00]; p = 0.03), cumulative air kerma (OR 1.00, 95 % CI [1.00-1.00]; p = 0.003) and lesion length (OR 1.05, 95 % CI [1.03-1.07], p < 0.001) were independent predictors of success. KM analysis revealed a 2-year overall survival of 91.4 %, freedom from clinically driven target lesion revascularization (TLR) of 93.6 % at 2 years, and event-free survival from target lesion failure (TLF) of approximately 85 % at 2 years. At a median follow-up of 745 days, all-cause mortality was 9.2 %, and TLR occurred in 2.4 % of patients.</p><p><strong>Conclusion: </strong>CTO PCI can be performed safely with high success rates and favorable mid- to long-term outcomes in a complex population. Procedural success is primarily driven by lesion-specific factors rather than clinical comorbidities. These findings support the continued evolution and application of CTO PCI in appropriately selected patients.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974194","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}