1
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Kanda D, Tokushige A, Ohmure K, Shimono H, Tabata H, Ito N, Kubozono T, Ohishi M. Impact of serum cholinesterase on calcified nodules in patients with stable coronary artery disease. Coron Artery Dis 2024:00019501-990000000-00272. [PMID: 39373114 DOI: 10.1097/mca.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
BACKGROUND Calcified nodules (CNs) are an advanced stage of coronary calcification that can have significant clinical implications. We investigated factors associated with CNs, the etiology of which is not fully understood. METHODS We retrospectively evaluated 619 patients with stable coronary artery disease who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). CNs in the culprit lesion were evaluated via IVUS, and all-cause mortality and major cardiovascular and cerebrovascular events (MACCEs) were compared between the CN and non-CN groups. RESULTS The CN group (n = 40 patients) had a significantly lower survival rate and a higher incidence of MACCE than the non-CN group (P = 0.020 and P < 0.001, respectively). Multivariate logistic regression analysis models revealed that chronic kidney disease and serum cholinesterase (ChE) level were associated with CN formation [odds ratio (OR): 3.15, 95% confidence interval (CI): 1.30-7.69, P = 0.001 and OR: 0.94, 95% CI: 0.88-0.99, P = 0.042]. The optimal cutoff of serum ChE level as per the receiver operating characteristic curve was 309 units/l (Area under the curve = 0.67, sensitivity = 93%, specificity = 40%, P = 0.001). The low-ChE group divided according to the optimal cutoff value showed significantly higher cumulative incidence of MACCEs after PCI than the high-ChE group as per Kaplan-Meier analysis. CONCLUSION The presence of CNs is significantly associated with a poor prognosis and MACCE after PCI among patients with stable coronary artery disease. Serum ChE levels may affect CN formation.
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Affiliation(s)
- Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Saito Y, Kobayashi Y. Advances in Technology and Technique in Percutaneous Coronary Intervention: A Clinical Review. Intern Med 2024:4505-24. [PMID: 39343561 DOI: 10.2169/internalmedicine.4505-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Percutaneous coronary intervention (PCI) has become the standard procedure for patients with angina and acute coronary syndrome. From the perspective of technology and technique, PCI has advanced over the last four decades, resulting in considerably improved clinical outcomes in patients with coronary artery disease in the current era. In this review article, we summarize recent advances, promising technologies, and areas for research in the field of PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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3
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Krittanawong C, Rizwan A, Khawaja M, Newman N, Escobar J, Virk HUH, Alam M, Al-Azzam F, Yong CM, Jneid H. The Current State of Coronary Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Interventions. Curr Cardiol Rep 2024; 26:919-933. [PMID: 38985226 DOI: 10.1007/s11886-024-02090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW The optimal revascularization strategy for coronary artery disease depends on various factors, such as disease complexity, patient characteristics, and preferences. Including a heart team in complex cases is crucial to ensure optimal outcomes. Decision-making between percutaneous coronary intervention and coronary artery bypass grafting must consider each patient's clinical profile and coronary anatomy. While current practice guidelines offer some insight into the optimal revascularization approach for the various phenotypes of coronary artery disease, the evidence to support either strategy continues to evolve and grow. Given the large amount of contemporary data on revascularization, this review aims to comprehensively summarize the literature on coronary artery bypass grafting and percutaneous coronary intervention in patients across the spectrum of coronary artery disease phenotypes. RECENT FINDINGS Contemporary evidence suggests that for patients with triple vessel disease, coronary artery bypass grafting is preferred over percutaneous coronary intervention due to better long-term outcomes, including lower rates of death, myocardial infarction, and target vessel revascularization. Similarly, for patients with left main coronary artery disease, both percutaneous coronary intervention and coronary artery bypass grafting can be considered, as they have shown similar efficacy in terms of major adverse cardiac events, but there may be a slightly higher risk of death with percutaneous coronary intervention. For proximal left anterior descending artery disease, both percutaneous coronary intervention and coronary artery bypass grafting are viable options, but coronary artery bypass grafting has shown lower rates of repeat revascularization and better relief from angina. The Synergy Between PCI with Taxus and Cardiac Surgery score can help in decision-making by predicting the risk of adverse events and guiding the choice between percutaneous coronary intervention and coronary artery bypass grafting. European and American guidelines both agree with including a heart team that can develop and lay out individualized, optimal treatment options with respect for patient preferences. The debate between coronary artery bypass grafting versus percutaneous coronary intervention in multiple different scenarios will continue to develop as technology and techniques improve for both procedures. Risk factors, pre, peri, and post-procedural complications involved in both revascularization strategies will continue to be mitigated to optimize outcomes for those patients for which coronary artery bypass grafting or percutaneous coronary intervention provide ultimate benefit. Methods to avoid unnecessary revascularization continue to develop as well as percutaneous technology that may allow patients to avoid surgical intervention when possible. With such changes, revascularization guidelines for specific patient populations may change in the coming years, which can serve as a limitation of this time-dated review.
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Affiliation(s)
| | - Affan Rizwan
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Muzamil Khawaja
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Noah Newman
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Johao Escobar
- Division of Cardiology, Harlem Cardiology, NY, 10035, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals, Cleveland Medical Center, Cleveland, USA
| | - Mahboob Alam
- Division of Cardiology, The Texas Heart Institute, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fu'ad Al-Azzam
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Celina M Yong
- VA Palo Alto Medical Center, Department of Medicine, Stanford, University and Stanford Cardiovascular Institute, Palo AltoStanford, CACA, USA
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Houston, TX, 77030, USA
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4
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Fukase T, Dohi T, Nishio R, Takeuchi M, Takahashi N, Chikata Y, Endo H, Doi S, Nishiyama H, Okai I, Iwata H, Koga S, Okazaki S, Miyauchi K, Daida H, Minamino T. Association between apolipoprotein C-III levels and coronary calcification detected by intravascular ultrasound in patients who underwent percutaneous coronary intervention. Front Cardiovasc Med 2024; 11:1430203. [PMID: 39234605 PMCID: PMC11371589 DOI: 10.3389/fcvm.2024.1430203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
There are few reports on the association between apolipoprotein C-III (ApoC-III) and coronary calcification using intravascular modalities. This study aimed to investigate the impacts of ApoC-III levels on coronary calcification using grayscale intravascular ultrasound (IVUS). Consecutive 263 culprit lesions for 202 patients who underwent percutaneous coronary intervention using grayscale IVUS were included in this study and divided into four groups based on quartile ApoC-III values. This study assessed plaque characteristics, including severe calcification (>180° arc) at the minimum lumen area site and presence of calcified nodules within the culprit lesion using grayscale IVUS, and evaluated whether ApoC-III levels were associated with coronary calcified plaques. The highest ApoC-III quartile [Quartile 4 (Q4)] had a higher proportion of complex lesions, calcified plaques, severe calcification, calcified nodules, plaque burden, and total atheroma volume than the lowest ApoC-III quartile [Quartile 1 (Q1)]. Additionally, multivariable logistic regression analysis showed that Q4 was significantly associated with severe calcification and calcified nodules, with Q1 as the reference (odds ratio [OR]: 2.70, 95% confidence intervals [CIs]: 1.04-7.00, p = 0.042; and OR: 3.72, 95% CIs 1.26-11.0, p = 0.017, respectively). Furthermore, ApoC-III level (1-mg/dl increase) was a strong significant predictor of severe calcification (OR: 1.07, 95% CIs: 1.00-1.15, p = 0.040) and calcified nodules (OR: 1.09, 95% CIs: 1.01-1.19, p = 0.034) according to the multivariable logistic regression analysis. This study is the first to verify that elevated ApoC-III levels are associated with the development of severe calcification and progression to calcified nodules as detected by grayscale IVUS.
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Affiliation(s)
- Tatsuya Fukase
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Ryota Nishio
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hiroki Nishiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Seiji Koga
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
- Department of Radiological Technology, Faculty of Health Science, Juntendo University Graduate School, Bunkyo-ku, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Chiyoda-ku, Japan
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5
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Katagiri Y, Kitani S, Takenouchi G, Suzuki T, Hirai T, Ishikawa K, Kasai Y, Miyazaki M, Yamasaki K, Kuroda K, Hosoi Y, Yamaki M, Yamazaki S, Igarashi Y. Prospective investigation of calcium score in optical coherence tomography-guided revascularization to identify lesions with low risk for stent under expansion: the CORAL study. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01028-y. [PMID: 39020108 DOI: 10.1007/s12928-024-01028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
The optical coherence tomography (OCT)-based calcium scoring system was developed to guide optimal lesion preparation strategies for percutaneous coronary intervention (PCI) of calcified lesions. However, the score was derived retrospectively, and a prospective investigation is lacking. The CORAL (UMIN000053266) study was a single-arm, prospective, multicenter study that included patients with calcified lesions with OCT-calcium score of 1-2 to investigate whether these lesions could be optimally treated with a balloon-only preparation strategy using a non-compliant/scoring/cutting balloon. The primary endpoint was strategy success (successful stent placement with a final percent diameter stenosis [%DS] < 20% and Thrombolysis In Myocardial Infarction flow grade III without crossover to rotational atherectomy/orbital atherectomy/intravascular lithotripsy [RA/OA/IVL]). A superiority analysis for the primary endpoint was performed by comparing the study cohort with a performance goal of 83.3%. One hundred and eighteen patients with 130 lesions were enrolled. The mean age was 79.0 ± 10.3 years, and 79 patients (66.9%) were male. The OCT-calcium score was 1 for 81 lesions (62.3%) and 2 for 49 lesions (37.7%). The %DS improved from 47.0 ± 14.8% preprocedure to 11.1 ± 5.6% postprocedure. Stent expansion ≥ 70% was achieved in 90.2%. The strategy success rate was 93.1% (95% confidence interval: 87.3-96.8), and superiority against the performance goal was achieved without any crossover to RA/OA/IVL (P = 0.0027). The OCT-calcium score could identify mild/moderately calcified lesions treatable by PCI with the balloon-first strategy using a non-compliant/scoring/cutting balloon for predilatation, with a high strategy success rate. These results support the intravascular imaging-based treatment algorithm for calcified lesions proposed by CVIT.
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Affiliation(s)
- Yuki Katagiri
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan.
| | - Shunsuke Kitani
- Department of Cardiology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Go Takenouchi
- Department of Cardiology, Sapporo Tokushukai Hospital, Sapporo, Japan
| | - Takahide Suzuki
- Department of Cardiology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Toshihiro Hirai
- Department of Cardiology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Kohei Ishikawa
- Department of Cardiology, Sapporo Tokushukai Hospital, Sapporo, Japan
| | - Yutaro Kasai
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Mamoru Miyazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Ken Kuroda
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Yuichiro Hosoi
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Masaru Yamaki
- Department of Cardiology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-Jo Higashi 14-Chome, Higashi-Ku, Sapporo, 065-0033, Japan
| | - Yasumi Igarashi
- Department of Cardiology, Sapporo Kosei General Hospital, Sapporo, Japan
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6
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Kereiakes DJ. Editorial: Intravascular lithotripsy for post-implant stent under-expansion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:24-25. [PMID: 37949718 DOI: 10.1016/j.carrev.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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7
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van Oort MJH, Al Amri I, Bingen BO, Cordoba-Soriano JG, Karalis I, Sanz-Sanchez J, Oliveri F, van der Kley F, Jukema JW, Jurado-Roman A, Montero-Cabezas JM. Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:16-23. [PMID: 37923647 DOI: 10.1016/j.carrev.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p < 0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2;p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2;p = 0.064) in late- and immediate-IVL were comparable. CONCLUSIONS IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.
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Affiliation(s)
- Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Juan G Cordoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ioannis Karalis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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8
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Riley RF, Patel MP, Abbott JD, Bangalore S, Brilakis ES, Croce KJ, Doshi D, Kaul P, Kearney KE, Kerrigan JL, McEntegart M, Maehara A, Rymer JA, Sutton NR, Shah B. SCAI Expert Consensus Statement on the Management of Calcified Coronary Lesions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101259. [PMID: 39132214 PMCID: PMC11307856 DOI: 10.1016/j.jscai.2023.101259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
The prevalence of calcification in obstructive coronary artery disease is on the rise. Percutaneous coronary intervention of these calcified lesions is associated with increased short-term and long-term risks. To optimize percutaneous coronary intervention results, there is an expanding array of treatment modalities geared toward calcium modification prior to stent implantation. The Society for Cardiovascular Angiography and Interventions, herein, puts forth an expert consensus document regarding methods to identify types of calcified coronary lesions, a central algorithm to help guide use of the various calcium modification strategies, tips for when using each treatment modality, and a look at future studies and trials for treating this challenging lesion subset.
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Affiliation(s)
| | | | - J. Dawn Abbott
- Lifespan Cardiovascular Institute, Providence, Rhode Island
| | | | | | | | - Darshan Doshi
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Margaret McEntegart
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Akiko Maehara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Cardiovascular Research Foundation, New York, New York
| | | | - Nadia R. Sutton
- Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
| | - Binita Shah
- NYU Grossman School of Medicine, New York, New York
- VA New York Harbor Healthcare System, New York, New York
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9
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Masuda S, Serruys PW, Ninomiya K, Kageyama S, Nozomi K, Gao C, Mack MJ, Holmes DR, Morice MC, Thuijs DJFM, Milojevic M, Davierwala PM, Garg S, Onuma Y. Impact of left ventricular ejection fraction on 10-year mortality in the SYNTAX trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:7-15. [PMID: 37414612 DOI: 10.1016/j.carrev.2023.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUNDS The impact of reduced left ventricular ejection fraction (LVEF) on very long-term prognosis following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) has been debated. The aim of this study was to investigate the impact of LVEF at baseline on 10-year mortality in the SYNTAX trial. METHODS Patients (n = 1800) were categorized into three sub-groups: reduced (rEF ≤ 40 %), mildly reduced (mrEF 41-49 %), and preserved LVEF (pEF ≥ 50 %). The SYNTAX score 2020 (SS-2020) was applied in patients with LVEF<50 % and ≥ 50 %. RESULTS Ten-year mortalities were 44.0 %, 31.8 %, and 22.6 % (P < 0.001) in patients with rEF (n = 168), mrEF (n = 179), and pEF (n = 1453). Although no significant differences were observed, the mortality with PCI was higher than with CABG in patients with rEF (52.9 % vs 39.6 %, P = 0.054) and mrEF (36.0 % vs. 28.6 %, P = 0.273), and comparable in pEF (23.9 % vs. 22.2 %, P = 0.275). Calibration and discrimination of the SS-2020 in patients with LVEF<50 % were poor, whilst they were reasonable in those with LVEF≥50 %. The proportion of patients eligible for PCI who had a predicted equipoise in mortality with CABG was estimated to be 57.5 % in patients with LVEF≥50 %. CABG was safer than PCI in 62.2 % of patients with LVEF<50 %. CONCLUSIONS Reduced LVEF was associated with an increased risk of 10-year mortality in patients revascularized either surgically or percutaneously. Compared to PCI, CABG was safe revascularization in patients with LVEF≤40 %. In patients with LVEF≥50 % individualized 10-year all-cause mortality predicted by SS-2020 was helpful in decision-making whilst the predictivity in patients with LVEF<50 % was poor.
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Affiliation(s)
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Kotoku Nozomi
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, China; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany; Department of Surgery, University of Toronto, Toronto, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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Sanz-Sanchez J, Garcia-Garcia HM, Branca M, Frigoli E, Leonardi S, Gagnor A, Calabrò P, Garducci S, Rubartelli P, Briguori C, Andò G, Repetto A, Limbruno U, Garbo R, Sganzerla P, Russo F, Lupi A, Cortese B, Ausiello A, Ierna S, Esposito G, Santarelli A, Sardella G, Varbella F, Tresoldi S, de Cesare N, Rigattieri S, Zingarelli A, Tosi P, van 't Hof A, Boccuzzi G, Omerovic E, Sabaté M, Heg D, Vranckx P, Valgimigli M. Coronary calcification in patients presenting with acute coronary syndromes: insights from the MATRIX trial. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:782-791. [PMID: 37812760 DOI: 10.1093/ehjacc/zuad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023]
Abstract
AIMS The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACSs) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients presenting with acute ACS. METHODS AND RESULTS The present study was a post hoc analysis of the MATRIX programme. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause mortality, myocardial infarction (MI), or stroke up to 365 days. Among the 8404 patients randomized in the MATRIX trial, data about coronary calcification were available in 7446 (88.6%) and therefore were included in this post hoc analysis. Overall, 875 patients (11.7%) presented with severe coronary calcification, while 6571 patients (88.3%) did not present severe coronary calcification on coronary angiography. Fewer patients with severe coronary calcification underwent percutaneous coronary intervention whereas coronary artery bypass grafting or medical therapy-only was more frequent compared with patients without severe calcification. At 1-year follow-up, MACE occurred in 237 (27.1%) patients with severe calcified coronary lesions and 985 (15%) patients without severe coronary calcified lesions [hazard ratio (HR) 1.91; 95% confidence interval (CI) 1.66-2.20, P < 0.001]. All-cause mortality was 8.6% in patients presenting with and 3.7% in those without severe coronary calcification (HR 2.38, 1.84-3.09, P < 0.001). Patients with severe coronary calcification incurred higher rate of MI (20.1% vs. 11.5%, HR 1.81; 95% CI 1.53-2.1, P < 0.001) and similar rate of stroke (0.8% vs. 0.6%, HR 1.35; 95% CI 0.61-3.02, P = 0.46). CONCLUSION Patients with ACS and severe coronary calcification, as compared to those without, are associated with worse clinical outcomes irrespective of the management strategy.
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Affiliation(s)
- Jorge Sanz-Sanchez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Hector M Garcia-Garcia
- Interventional Cardiology, MedStar Washington Hospital Center, 10 Irving St NW, Washington, DC 2001, USA
| | | | | | - Sergio Leonardi
- Coronary Care Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Paolo Calabrò
- Division of Cardiology, 'Sant'Anna e San Sebastiano' Hospital, Caserta, Italy
- Department of Translational Medicine, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| | - Stefano Garducci
- Cardiology Department, A.O. Ospedale Civile di Vimercate, Vimercate, Italy
| | - Paolo Rubartelli
- Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
| | - Carlo Briguori
- Cardiology Department, Clinica Mediterranea, Naples, Italy
| | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico 'Gaetano Martino', University of Messina, Messina, Italy
| | - Alessandra Repetto
- Coronary Care Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberto Garbo
- Maria Pia Hsopital, GVM Care & Research, Turin, Italy
| | - Paolo Sganzerla
- Cardiology Department, AO Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Arturo Ausiello
- Cardiology Department, Casa di Cura Villa Verde, Taranto, Italy
| | - Salvatore Ierna
- Cardiology Department, Ospedale Sirai, Carbonia, Carbonia, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Gennaro Sardella
- Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - Fernando Varbella
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy
| | - Simone Tresoldi
- Cardiology Department, Azienda Ospedaliera Ospedale di Desio, Desio, Italy
| | | | - Stefano Rigattieri
- Interventional Cardiology Unit, Sandro Pertini Hospital Rome, Rome, Italy
| | - Antonio Zingarelli
- Cardiology Department, IRCCS Azienda Ospedaliera Universitaria San Martino, San Martino, Italy
| | - Paolo Tosi
- Cardiology Department, Mater Salutis Hospital, Legnago, Italy
| | - Arnoud van 't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | | | - Elmir Omerovic
- Cardiology Department, Ahlgrenska University Hospital, Göteborg, Sweden
| | - Manel Sabaté
- Hospital Clinic, University of Barcelona, Thorax Institute, Department of Cardiology, Barcelona, Spain
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
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Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Fujita H. Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification. Cardiovasc Interv Ther 2023; 38:375-380. [PMID: 37542662 DOI: 10.1007/s12928-023-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
The concept of lifetime management has not been discussed in the field of percutaneous coronary intervention (PCI), because the durability of drug-eluting stent (DES) is considered to be long enough for most patients. Furthermore, even if in-stent restenosis occurs, the treatment for in-stent restenosis is simple in most cases. On the other hand, the long-term clinical outcomes after DES implantation are worse in severely calcified coronary lesions than in non-calcified lesions. Moreover, the treatment for in-stent calcified restenosis or restenosis due to stent underexpansion is not simple. The concept of lifetime management of severely calcified lesions may be necessary like that of aortic stenosis. Recently, several algorithms have been published in PCI to severely calcified lesions, partly because of the emergence of IVL. These algorithms focus on the selection of cracking and debulking devices for the preparation of stenting. However, the optimal stent expansion does not guarantee the long-term patency, when the target lesion includes calcified nodules. Stent restenosis due to calcified nodules is difficult to manage. In this review article, we propose the algorithm for severely calcified lesions focused on the shape of calcification. We do not need to hesitate stenting when multiple cracks on circumferential calcification are observed by intravascular imaging devices. However, DCB may be an option as final device in some situations, when lifetime management of severely calcified lesions is considered.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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12
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Kereiakes DJ. Editorial: Super High-Pressure Balloons: Where Do They Fit in the Calcium Toolbox? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:31-32. [PMID: 36925337 DOI: 10.1016/j.carrev.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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13
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Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Angiographic Coronary Calcification: A Simple Predictor of Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. J Atheroscler Thromb 2023; 30:990-1001. [PMID: 36273917 PMCID: PMC10406646 DOI: 10.5551/jat.63856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
AIMS Coronary calcification detected by coronary angiography is a simple risk marker for long-term clinical outcomes in stable coronary artery disease. However, the significance of angiographic coronary calcification in the culprit lesion of acute myocardial infarction (AMI) has not been fully discussed. The purpose of this retrospective study was to assess the usefulness of angiographic coronary calcification as a risk marker for long-term clinical outcomes following percutaneous coronary intervention to the culprit lesions of AMI. METHODS We included 1209 patients with AMI and divided them into the none-mild calcification group (n=923) and the moderate-severe calcification group (n=286) according to angiographic coronary calcification in the culprit lesion of AMI. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, nonfatal MI, readmission for heart failure, and ischemia-driven target vessel revascularization. RESULTS The median follow-up duration was 542 (Q1: 182, Q3: 990) days. A total of 345 MACE were observed during the study period. The occurrence of MACE was significantly greater in the moderate-severe calcification group than in the none-mild calcification group (43.4% vs. 23.9%, p<0.001). In the multivariate Cox hazard model, moderate-severe calcification was significantly associated with MACE (hazard ratio 1.302, 95% confidence interval 1.011-1.677, p=0.041) after controlling multiple confounding factors. CONCLUSIONS Angiographically moderate to severe calcification in AMI culprit lesion was associated with long-term worse clinical outcomes. Angiographic coronary calcification can be a simple risk marker in patients after AMI.
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Affiliation(s)
- Shun Ishibashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Satoshi Asada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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14
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Caiazzo G, Di Mario C, Kedhi E, De Luca G. Current Management of Highly Calcified Coronary Lesions: An Overview of the Current Status. J Clin Med 2023; 12:4844. [PMID: 37510959 PMCID: PMC10381772 DOI: 10.3390/jcm12144844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
The amount of coronary calcium strongly correlates with the degree of atherosclerosis and, therefore, with the rate of future cardiac events. Calcified coronary lesions still represent a challenge for interventional cardiologists, bringing not only a higher risk of immediate complications during percutaneous coronary interventions (PCI), but also a higher risk of late stent failure due to under-expansion and/or malapposition, and therefore, have a relevant prognostic impact. Accurate identification of the calcified plaques together with the analysis of their distribution pattern within the vessel wall by intracoronary imaging is important to improve the successful treatment of these lesions. The aim of this review is to guide readers through the assessment of the calcified plaque distribution using intracoronary imaging in order to select the best devices and strategies for plaque debulking and lesion preparation.
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Affiliation(s)
- Gianluca Caiazzo
- ICCU, San Giuseppe Moscati Hospital, ASL CE, 81031 Aversa, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elvin Kedhi
- Erasmus Hospital, Université libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G Martino, 98124 Messina, Italy
- IRCCS Galeazzi-Sant'Ambrogio Hospital, 20157 Milan, Italy
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15
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Petousis S, Skalidis E, Zacharis E, Kochiadakis G, Hamilos M. The Role of Intracoronary Imaging for the Management of Calcified Lesions. J Clin Med 2023; 12:4622. [PMID: 37510737 PMCID: PMC10380390 DOI: 10.3390/jcm12144622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Interventional cardiologists in everyday practice are often confronted with calcified coronary lesions indicated for percutaneous transluminal coronary angioplasty (PTCA). PTCA of calcified lesions is associated with diverse technical challenges resulting in suboptimal coronary stenting and adverse long-term clinical outcomes. Angiography itself offers limited information regarding coronary calcification, and the adjuvant use of intracoronary imaging such as intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) can guide the treatment of calcified coronary lesions, optimizing the different stages of the procedure. This review offers a description of why, when, and how to use intracoronary imaging for PTCA of calcified coronary lesions in order to obtain the most favorable results. We used the PubMed and Google Scholar databases to search for relevant articles. Keywords were calcified coronary lesions, intracoronary imaging, IVUS, OCT, coronary calcium modification techniques, PTCA, and artificial intelligence in intracoronary imaging. A total of 192 articles were identified. Ninety-one were excluded because of repetitive or non-important information.
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Affiliation(s)
- Stylianos Petousis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Emmanouil Skalidis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Evangelos Zacharis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - George Kochiadakis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Michalis Hamilos
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
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16
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McInerney A, Travieso A, Cubero H, Jerónimo-Baza A, Jimenez-Quevedo P, Tirado-Conte G, Nombela-Franco L, Macaya-Ten F, Salinas P, Rentería HM, Nuñez-Gil I, Fernandez-Ortiz A, Vaquerizo B, Macaya C, Escaned J, Gonzalo N. Mid-Term Angiographic and Intracoronary Imaging Results Following Intracoronary Lithotripsy in Calcified Coronary Artery Disease: Results From Two Tertiary Referral Centres. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:59-66. [PMID: 36878760 DOI: 10.1016/j.carrev.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Intracoronary lithotripsy (IVL) is a safe and effective treatment for coronary calcification. Angiographic and intracoronary imaging follow-up have not yet been described. We aimed to describe the mid-term angiographic outcomes following IVL. METHODS Patients successfully treated with IVL in two tertiary referral hospitals were included. Repeat angiography and intracoronary imaging was performed. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) analyses were performed using dedicated workstations. RESULTS Twenty patients were included; mean age 67.1 years, left anterior descending artery 55 %. Median IVL balloon size was 3.0 mm and a median of 60 pulses were delivered per vessel. Percentage stenosis by QCA was 60 % [IQR 51-70] reducing to 20 % post stenting (p < 0.001). On OCT, 88.9 % had circumferential calcium. IVL resulted in fractures in 88.9 %. Resulting minimum stent expansion was 91.75 % [IQR 81.5-108]. Follow-up was at a median of 22.7 months [IQR16.4-25.5]. Percentage stenosis by QCA was 22.5 % [IQR 14-30] and not significantly different from the index procedure (p > 0.05). Minimum stent expansion by OCT was 85 % [IQR 72-97]. Late luminal loss was 0.15 mm [IQR -0.25 to 0.69]. Binary angiographic instent restenosis (ISR) was 10 % (2 of 20 patients). OCT demonstrated a predominantly homogenous neointimal pattern with high backscatter. CONCLUSION Following successful IVL treatment, repeat angiography demonstrated preserved stent parameters in the majority of patients with favorable vascular healing properties by OCT. A binary restenosis rate of 10 % was observed. These results suggest durable results following IVL treatment of severe coronary calcification however larger studies are warranted.
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Affiliation(s)
- Angela McInerney
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Alejandro Travieso
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Héctor Cubero
- Departamento de Cardiología Intervencionista, Hospital del Mar, IMIM, Universidad Autónoma, Barcelona, Spain
| | - Adrián Jerónimo-Baza
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Gabriela Tirado-Conte
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Luis Nombela-Franco
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Fernando Macaya-Ten
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Pablo Salinas
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Hernan Mejia Rentería
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Iván Nuñez-Gil
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Antonio Fernandez-Ortiz
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Beatriz Vaquerizo
- Departamento de Cardiología Intervencionista, Hospital del Mar, IMIM, Universidad Autónoma, Barcelona, Spain
| | - Carlos Macaya
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Javier Escaned
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain.
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Savage P, Cox B, Shahmohammadi M, Foster J, Menown I. Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials. Adv Ther 2023; 40:2595-2625. [PMID: 37052800 PMCID: PMC10100625 DOI: 10.1007/s12325-023-02502-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context. METHODS The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. RESULTS A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated. CONCLUSION This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.
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Affiliation(s)
- Patrick Savage
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK.
| | - Brian Cox
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Michael Shahmohammadi
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Johnathan Foster
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Ian Menown
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
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Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther 2023; 38:141-162. [PMID: 36642762 PMCID: PMC10020250 DOI: 10.1007/s12928-022-00906-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidences regarding rotational atherectomy (RA) in 2020. Because the revascularization strategy to severely calcified lesions is the hottest topic in contemporary percutaneous coronary intervention (PCI), many evidences related to RA have been published since 2020. Latest advancements have been incorporated in this updated expert consensus document.
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Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshifumi Kashima
- Division of Interventional Cardiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | | | - Yuji Hamazaki
- Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Kereiakes DJ. Between a Rock and a Hard Place: Calcium Modification for Vascular Intervention. JACC Cardiovasc Interv 2022; 15:1875-1877. [PMID: 36137692 DOI: 10.1016/j.jcin.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Dean J Kereiakes
- Christ Hospital Heart and Vascular Institute and the Lindner Research Center, Cincinnati, Ohio, USA.
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20
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Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery. J Atheroscler Thromb 2022. [PMID: 36002255 DOI: 10.5551/jat.63667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Calcified nodule (CN) has been known as the advanced stage of coronary calcification. However, clinical outcomes following percutaneous coronary intervention (PCI) to CN remain unknown. This study aimed to compare clinical outcomes, including target lesion revascularization (TLR), between calcified coronary lesions with and without CN. METHODS Two hundred forty-nine lesions undergoing intravascular ultrasound-guided PCI with rotational atherectomy (RA) were enrolled and divided into the CN group (n=100) and the non-CN group (n=149) according to the presence of CN. The cumulative incidence of clinically driven TLR (CD-TLR) and the reasons for CD-TLR were compared between the CN and non-CN groups. RESULTS The incidence of CD-TLR was significantly higher in the CN group than in the non-CN group. In the landmark analysis at 1 year, the CN group showed a significantly higher incidence of CD-TLR within 1 year. However, the incidence of CD-TLR beyond 1 year was numerically lower in the CN group than in the non-CN group. In the multivariate Cox hazard model, CN was significantly associated with CD-TLR. In the CN group, in-stent CN was the major reason for CD-TLR (52%) and was observed mainly within 1 year (90%). CONCLUSIONS In the heavily calcified lesions requiring RA, CN was the factor associated with the higher rate of CD-TLR especially within 1 year. The timing of CD-TLR in lesions with CN may indicate that the process of CN protruding through the struts was progressed monthly.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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21
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A Novel Algorithm to Estimate the Significance Level of a Feature Interaction Using the Extreme Gradient Boosting Machine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042338. [PMID: 35206527 PMCID: PMC8871671 DOI: 10.3390/ijerph19042338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
Recent studies have revealed the importance of the interaction effect in cardiac research. An analysis would lead to an erroneous conclusion when the approach failed to tackle a significant interaction. Regression models deal with interaction by adding the product of the two interactive variables. Thus, statistical methods could evaluate the significance and contribution of the interaction term. However, machine learning strategies could not provide the p-value of specific feature interaction. Therefore, we propose a novel machine learning algorithm to assess the p-value of a feature interaction, named the extreme gradient boosting machine for feature interaction (XGB-FI). The first step incorporates the concept of statistical methodology by stratifying the original data into four subgroups according to the two interactive features. The second step builds four XGB machines with cross-validation techniques to avoid overfitting. The third step calculates a newly defined feature interaction ratio (FIR) for all possible combinations of predictors. Finally, we calculate the empirical p-value according to the FIR distribution. Computer simulation studies compared the XGB-FI with the multiple regression model with an interaction term. The results showed that the type I error of XGB-FI is valid under the nominal level of 0.05 when there is no interaction effect. The power of XGB-FI is consistently higher than the multiple regression model in all scenarios we examined. In conclusion, the new machine learning algorithm outperforms the conventional statistical model when searching for an interaction.
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22
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Baber U. Coronary Artery Calcification and Mortality After Revascularization: Look Beyond the Heart. JACC Cardiovasc Interv 2022; 15:205-207. [PMID: 34973905 DOI: 10.1016/j.jcin.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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