Catheterization and Cardiovascular Interventions最新文献

{"title":"Head-to-Head Comparison of Learning Curves Between QFR and FFRangio Software Users","authors":"Adil Salihu,&nbsp;Jade Zulauff,&nbsp;Mehdi Ali Gadiri,&nbsp;Anais Metzinger,&nbsp;Joanne Muller,&nbsp;Ioannis Skalidis,&nbsp;David Meier,&nbsp;Nathalie Noirclerc,&nbsp;Sarah Mauler-Wittwer,&nbsp;Aurelia Zimmerli,&nbsp;Olivier Muller,&nbsp;Stephane Fournier","doi":"10.1002/ccd.31384","DOIUrl":"10.1002/ccd.31384","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quantitative flow ratio (QFR) and FFRangio are angiography-based technologies used to perform functional assessment of coronary lesions from angiographic images, validated across multiple clinical studies. There is limited information on the learning curves associated with each technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aims to compare the learning curves of QFR and FFRangio in evaluating coronary stenoses, focusing on changes in analysis speed and accuracy compared to invasive measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A team of five blinded investigators, including two nurses, one medical student, and one physician in training, underwent identical standardized training on both technologies. The time taken for each analysis and the computed FFR values were documented and compared against the invasive gold standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 270 lesions (54 coronary lesions in 44 patients) were retrospectively analyzed. The median invasive FFR value was 0.88 [IQR 0.5, 0.9]. The median time for analysis with QFR and FFRangio was 245 [IQR 62, 319] and 252 [IQR 82, 315] s, respectively (<i>p</i> = 0.171). Both QFR and FFRangio demonstrated a significant reduction in the time required for analysis as experience increased (<i>p</i> &lt; 0.01). Regarding accuracy, the median difference with invasive FFR for QFR and FFRangio was 0.06 [IQR: 0, 0.12] and 0.06 [IQR: 0, 0.12], respectively (<i>p</i> = 0.620). Both technologies reached a performance plateau early on, exhibiting comparable results throughout the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Initial training in QFR and FFRangio enables quick attainment of maximal performance, but further practice primarily enhances analysis speed while maintaining accuracy, for both software.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"692-697"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Mechanical Circulatory Support in Acute Myocardial Infarction Related Cardiogenic Shock","authors":"Bing Wei Thaddeus Soh,&nbsp;Carlos Sebastian Gracias,&nbsp;Afshan Dean,&nbsp;Jathinder Kumar,&nbsp;Solomon Asgedom,&nbsp;Sajjad Matiullah,&nbsp;Patrick Owens","doi":"10.1002/ccd.31369","DOIUrl":"10.1002/ccd.31369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute myocardial infarction-related cardiogenic shock (AMICS) is a severe complication associated with exceedingly high mortality rates. While mechanical circulatory support (MCS) has emerged as a potential intervention, the evidence base for independent MCS use remains weak. In contrast, systematic reviews of observational studies have revealed significant mortality reduction when a combination of MCS was used: VA-ECMO in conjunction with a left ventricular (LV) unloading device (Impella or IABP). The ongoing dilemma concerning the selection between two LV unloading devices (VA-ECMO + Impella vs. VA-ECMO + IABP) warrants further investigation and clarification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This is the first systematic review and meta-analysis assessing the short-term efficacy and safety of VA-ECMO + Impella versus VA-ECMO + IABP in treatment of AMICS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was performed on the EMBASE, MEDLINE, and Cochrane databases. Studies reporting the short-term (30-day/inpatient) mortality and complications of adult patients with AMICS treated with VA-ECMO + Impella and VA-ECMO + IABP were included. Subgroup analysis was performed including studies with ACS predominant CS (CS etiology 100% by AMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four observational studies with 14,247 patients were included. There was no significant difference in mortality between VA-ECMO + Impella and VA-ECMO + IABP (56.5% vs. 66.5%; OR, 0.90; 95% CI, 0.79−1.02; <i>p</i> = 0.09). However, VA-ECMO + Impella was associated with significantly lower mortality in patients with ACS predominant CS (53.2% vs. 67.7%; OR, 0.72; 95% CI, 0.62−0.85; <i>p</i> &lt; 0.0001). VA-ECMO + Impella was concomitantly associated with a significantly higher risk of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When comparing LV unloading devices in patients with AMICS requiring a combination of MCS, VA-ECMO + Impella was superior in mortality reduction only in the cohort where 100% of CS was caused by AMI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"650-661"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Central and Noncentral Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Valve Edge-To-Edge Repair","authors":"Peijian Wei,&nbsp;Shuyi Feng,&nbsp;Fengwen Zhang,&nbsp;Hang Li,&nbsp;Donglin Zhuang,&nbsp;Hong Jiang,&nbsp;Guangzhi Zhao,&nbsp;Jing Dong,&nbsp;Cheng Wang,&nbsp;Wenbin Ouyang,&nbsp;Shouzheng Wang,&nbsp;Fang Fang,&nbsp;Xiangbin Pan","doi":"10.1002/ccd.31359","DOIUrl":"10.1002/ccd.31359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mitral valve transcatheter edge-to-edge repair (M-TEER) was initially indicated for central degenerative mitral regurgitation (DMR) lesions, but advancements in technology have enabled successful treatment in an increasing number of noncentral DMR patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aims to compare procedural outcomes and prognosis between noncentral DMR patients, outside clinical trial anatomical criteria, and central DMR patients undergoing M-TEER.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Drug-refractory moderate-to-severe DMR patients treated with M-TEER at Fuwai Hospital from January 2021 to February 2024 were retrospectively analyzed. Patients were categorized into central (<i>N</i> = 77) and noncentral (<i>N</i> = 59) lesion groups. Baseline characteristics, procedural outcomes, and prognoses were collected and compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no significant differences in baseline characteristics and preoperative echocardiographic parameters between the groups except for left ventricular ejection fraction. Both groups exhibited similar procedural success rates (central: 93.51% vs. noncentral: 91.53%, <i>p</i> = 0.92) with comparable procedural complication rates. The ideal M-TEER success rate at discharge for noncentral DMR patients was similar to that for central DMR patients (83.05% vs. 71.43%, <i>p</i> = 0.11). Kaplan–Meier analysis indicated similar 3-year recurrence-free survival rates (noncentral: 94.9% vs. central: 90.3%, <i>p</i> = 0.46). Cox regression analysis identified higher discharge mitral valve gradient and a leaflet-to-annulus index ≤ 1.2 as independent risk factors for recurrence or death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Noncentral DMR patients undergoing M-TEER achieve similar procedural success rates without increased risk of complications compared to central DMR patients. The seemingly higher success rate in noncentral DMR patients may be due to the smaller impact on valve area, warranting further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"707-719"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Coronary Interventional Treatment of Left Main Trifurcation Lesion: A Case Report","authors":"Yi Lu,&nbsp;Xinyi Yan,&nbsp;Qing Qing Wu,&nbsp;Xiaorong Hu","doi":"10.1002/ccd.31381","DOIUrl":"10.1002/ccd.31381","url":null,"abstract":"<div>\u0000 \u0000 <p>Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, particularly among complex high-risk and indicated patients (CHIP). Revascularization is often beneficial for these patients; however, it requires thorough risk stratification and close multidisciplinary collaboration between cardiologists and cardiac surgeons to optimize outcomes. Personalized treatment plans, including percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), are crucial in this context. In this report, we present a case of a 70-year-old man with left main trunk bifurcation lesions, referred to as <i>a</i> “Four Forks Lesion,” who was successfully revascularized using a PCI strategy, resulting in a favorable prognosis.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"720-724"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ruptured Sinus of Valsalva Aneurysm: Transcatheter Closure Through Retrograde Approach","authors":"Manjunath Bagur,&nbsp;Prem Alva,&nbsp;Shivakumar N","doi":"10.1002/ccd.31366","DOIUrl":"10.1002/ccd.31366","url":null,"abstract":"<div>\u0000 \u0000 <p>The ruptured sinus of Valsalva aneurysm (RSOV), a rare but well-recognized clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers. It causes profound hemodynamic effects, especially when the rupture is acute. Like most other left-to-right shunts, it was only a matter of time before this rare defect also became amenable to transcatheter closure (TCC). Since the first report of TCC of RSOV by Cullen et al. in 1994 using the Rashkind umbrella, in recent times, there has been a spate of case reports, brief communications, and interesting case presentations at interventional meetings using the much more user-friendly and effective devices. We report a case of a 59-year-old female diagnosed with RSOV (noncoronary cusp to right atrium) treated with device closure by using a vascular plug through a retrograde approach without resorting to the usual antegrade technique involving the formation of an arteriovenous loop.</p>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"673-676"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Below-the-Knee Runoff in Patients With Lower Extremity Artery Disease Who Underwent Endovascular Therapy Using Drug-Coated Balloons in Femoropopliteal Lesions","authors":"Takehiro Yamada,&nbsp;Takahiro Tokuda,&nbsp;Naoki Yoshioka,&nbsp;Akio Koyama,&nbsp;Ryusuke Nishikawa,&nbsp;Kiyotaka Shimamura,&nbsp;Takuya Tsuruoka,&nbsp;Hiroki Mitsuoka,&nbsp;Yusuke Sato,&nbsp;Takuma Aoyama","doi":"10.1002/ccd.31375","DOIUrl":"10.1002/ccd.31375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of below-the-knee (BK) runoff after drug-coated balloon (DCB) treatment in femoropopliteal (FP) lesions has not been well investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective multicenter observational study enrolled 291 consecutive patients with lower extremity artery disease who underwent endovascular therapy with DCBs for FP lesions between January 2018 and December 2021. Patients were classified into four groups based on the BK runoff. Outcome measures included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR) and amputation, and overall survival rates at 24 months. The predictors of restenosis at 24 months were also investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 43, 98, 117, and 33 patients were classified into three, two, one, and no BK runoff groups, respectively. In three, two, one, and no BK runoff groups, the primary patency rates were 72.1%, 67.3%, 61.4%, and 44.1% (<i>p</i> = 0.028); freedom from CD-TLR rates were 87.1%, 78.8%, 71.7%, and 47.1% (<i>p</i> &lt; 0.001); freedom from amputation rates were 95.2%, 97.9%, 92.8%, and 91.5% (<i>p</i> = 0.499); and overall survival rates were 89.4%, 83.2%, 76.6%, and 61.2% (<i>p</i> = 0.007), respectively, at 24 months. Multivariate analysis showed that chronic limb-threatening ischemia, no BK runoff, Lutonix use, and residual stenosis &gt; 30% were independent predictors of primary patency loss at 24 months. The risk score, calculated as the number of predictors, reflected the risk of restenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>No BK runoff was associated with worse midterm primary patency, freedom from CD-TLR, and overall survival rates than at least one BK runoff.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"698-706"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Aortic Balloon Pump: Overall and Temporal Trends of Comparative Effectiveness in a National Registry","authors":"Ben Cohen,&nbsp;Eran Kalmanovich,&nbsp;Leor Perl,&nbsp;Gabi Greenberg,&nbsp;Roy Beigel,&nbsp;Tal Ovdat,&nbsp;Ran Kornowski,&nbsp;Katia Orvin","doi":"10.1002/ccd.31372","DOIUrl":"10.1002/ccd.31372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although the latest studies failed to prove the benefit of routine intra-aortic balloon pump (IABP) use in patients with acute myocardial infarction (MI) presenting with cardiogenic shock, the benefit of IABP utilization in selected cases in “real world” practice is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We sought to follow temporal trends in IABP use in a real-world cohort of acute coronary syndrome (ACS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated IABP utilization and patient outcomes from the Acute Coronary Syndrome in Israel Survey (ACSIS) between the years 2000 and 2021. Temporal trends and outcomes with IABP at two time periods were set: early (before 2012) and late (after 2012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 18,662 ACS patients, 3.7% received IABP. The rate of IABP use was 4.5% in the early period and decreased to ~2.5% in the late period (<i>p</i> &lt; 0.001). Patients treated with IABP in the early period had more frequently reduced ejection fraction (64.5% vs. 53.2%, <i>p</i> &lt; 0.01) and presented mostly with ST-elevation MI (71.0% vs. 62.4%, <i>p</i> = 0.04). Cardiogenic shock on admission and in-hospital occurred equally in both periods (14.6% vs. 17.1%, <i>p</i> = 0.66; 42.8% vs. 41.9%, <i>p</i> = 0.90, respectively). Thirty-day mortality and MACE were comparable between time periods (28% vs. 30.7%, <i>p</i> = 0.547; 43.6% vs. 44.1%, <i>p</i> = 0.978, respectively) however bleeding complications were significantly higher in the later period (4.8% vs. 11.2%, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our real-world ACS data demonstrated a 50% reduction in the utilization of IABP among acute MI patients in the last decade. A comparable poor prognosis with IABP across time periods, suggest sustainable worse outcome in routine albeit selective clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"662-672"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Ability of the Academic Research Consortium High Bleeding Risk Criteria in Patients Undergoing Percutaneous Coronary Intervention According to Body Mass Index","authors":"Michael Gao,&nbsp;Alessandro Spirito,&nbsp;Samantha Sartori,&nbsp;Birgit Vogel,&nbsp;Mauro Gitto,&nbsp;Angelo Oliva,&nbsp;Kenneth F. Smith,&nbsp;Joseph Sweeny,&nbsp;Prakash Krishnan,&nbsp;Pedro Moreno,&nbsp;Parasuram Melarcode Krishnamoorthy,&nbsp;Annapoorna Kini,&nbsp;George Dangas,&nbsp;Samin K. Sharma,&nbsp;Roxana Mehran","doi":"10.1002/ccd.31322","DOIUrl":"10.1002/ccd.31322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether the high bleeding risk (HBR) criteria of the Academic Research Consortium (ARC) have a consistent predictive ability across different categories of body mass index (BMI) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients undergoing percutaneous coronary intervention (PCI) between 2012 and 2019 at Mount Sinai Hospital (New York, USA) were stratified into five BMI categories (18.5–24.9 kg/m² [normoweight], 25–29.9 kg/m² [overweight], 30–34.9 kg/m² [Class I obesity], 35–39.9 kg/m² [Class II obesity], and BMI ≥ 40 kg/m² [Class III obesity]) and by HBR status. The primary outcome was major bleeding at 1 year after PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 16,123 patients, normoweight, overweight, class I, class II, and class III obesity were found in 23.7%, 41%, 24.5%, 9.3%, 4.8% of patients, respectively. Fulfillment of the ARC-HBR criteria ranged between 34.4% and 48.5% across these BMI categories. One-year rates of major bleeding was 6% in normoweight patients (reference), 4.1% in overweight (adj.HR 0.73, 95% CI 0.60–0.88), 3.5% in class I (adj.HR 0.62, 95% CI 0.49–0.77), 4.2% in class II (adj.HR 0.72, 95% CI 0.54–0.96), and 4.9% in class III (adj.HR 0.83, 95% CI 0.58–1.18) obesity. Consistently across the 5 BMI categories, the fulfillment of ARC-HBR criteria was related with &gt; 4% rates of major bleeding at 1-year and with ≥ 2 times risk increase of major bleeding (<i>p</i>_int = 0.177).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of the ARC-HBR criteria predicted a significantly increased risk of major bleeding consistently in each BMI category.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"681-691"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological Performance of Drug-Coated Balloons in Small Coronary Arteries PICCOLETO II μFR","authors":"Simone Fezzi,&nbsp;Aurora Trevisanello,&nbsp;Dario Buccheri,&nbsp;Marco Borgi,&nbsp;Pedro Silva Orrego,&nbsp;Giuseppe Biondi Zoccai,&nbsp;Bernardo Cortese","doi":"10.1002/ccd.31376","DOIUrl":"10.1002/ccd.31376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Drug-coated balloons (DCB) are emerging as an alternative to permanent implants for managing de novo coronary artery disease, particularly in small vessels (SVD). This sub-analysis of the PICCOLETO II study aimed to compare the performance of DCB and DES in terms of Murray's law-based quantitative flow ratio (μFR) changes between baseline, post-percutaneous coronary intervention (PCI), and follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with a clinical indication for PCI were assigned to receive either Xience DES or Elutax SV/Emperor DCB. Coronary angiograms were blindly analyzed by an independent Core Laboratory (Consorzio Futuro in Ricerca, University of Ferrara, Italy).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 232 patients, 59 were included in this analysis. Pre-PCI μFR was comparable between groups (0.65 ± 0.29 vs. 0.58 ± 0.25; <i>p</i> = 0.20). Post-PCI, the DCB group had a lower acute functional gain compared to DES (+0.21 vs. +0.31; <i>p</i> = 0.064), with lower μFR values (0.86 ± 0.36 vs. 0.89 ± 0.3; <i>p</i> = 0.074). At 6-month follow-up, μFR values were similar between groups (0.84 ± 0.29 vs. 0.84 ± 0.31, <i>p</i> = 0.93), with a comparable late functional loss (−0.02 vs. −0.05; <i>p</i> = 0.93). Angiographic late lumen loss was significantly lower in the DCB group (−0.03 vs. +0.29 mm; <i>p</i> = 0.027).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DCB-based PCI showed a trend toward less favorable immediate post-PCI functional result but a comparable performance at follow-up, suggesting its potential in treating de novo SVD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"643-649"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing FFR-Guided Complete Revascularization and Conservative Management for Non-Culprit Lesions in STEMI Patients With Multivessel Disease: A Systematic Review and Meta-Analysis","authors":"Ahmed R. Gonnah,&nbsp;Ahmed K. Awad,&nbsp;Ahmed E. Helmy,&nbsp;Ahmed B. Elsnhory,&nbsp;Omar Shazly,&nbsp;Saad A. Abousalima,&nbsp;Aser Labib,&nbsp;Hussein Saoudy,&nbsp;Ayman K. Awad,&nbsp;David H. Roberts","doi":"10.1002/ccd.31379","DOIUrl":"10.1002/ccd.31379","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, the optimal management strategy for non-culprit lesions is a subject of ongoing debate. There has been an increasing use of physiology-guidance to assess the extent of occlusion in non-culprit lesions, and hence the need for stenting. Fractional flow reserve (FFR) is commonly used as a technique. This analysis compares FFR versus conservative management in the management of non-culprit lesions in STEMI patients with multivessel disease.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A comprehensive literature search was conducted on databases from inception to May 25, 2024. We conducted a random-effects meta-analysis using RevMan version 5.3.0, employing the Der-Simonian and Laird method to combine the data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The analysis of five RCTs including 3759 patients revealed a significantly lower incidence of major adverse cardiovascular events (composite of all-cause mortality, non-fatal myocardial infarction and the need for repeat revascularization [PCI or CABG]) in the FFR group compared to the conservative management group (RR = 0.65, 95% CI: 0.44−0.96, &lt;i&gt;p&lt;/i&gt; = 0.03). The revascularization rates were significantly lower in the FFR group (RR = 0.53, 95% CI: 0.43−0.66, &lt;i&gt;p&lt;/i&gt; &lt; 0.00001). Additionally, unplanned hospitalization leading to urgent repeat revascularization and any cause hospitalization were significantly lower in the FFR group (RR = 0.72, 95% CI: 0.56−0.94, &lt;i&gt;p&lt;/i&gt; = 0.01), and (RR = 0.62, 95% CI: 0.46−0.84, &lt;i&gt;p&lt;/i&gt; = 0.002), respectively. The FFR group had a higher risk of definite stent thrombosis (RR = 2.26, 95% CI: 1.10−4.64, &lt;i&gt;p&lt;/i&gt; = 0.03). No significant differences were observed between the two groups in mortality, hospitalization for heart failure, or myocardial infarction. Similarly, bleeding rates, cerebrovascular accidents (CVAs), and contrast-induced nephropathy (CIN) were comparable between both groups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Our findings support FFR-guided PCI to manage non-culprit lesions in STEMI patients with multivessel disease as it is potentially safe, with comparable rates of bleeding, CVAs and CIN. It also improves clinical outcomes, as well as reduces revascularization and hospitalization rates. The risk of stent thrombosis remains a concern, and hence the decision making for FFR-guided complete revascularization should take into account the complexity/risk of the procedure, as well as the patients' individual co-morbidities and preferences.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"633-642"},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}