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Teixeira L, Ferreira ROM, Navalha DDP, Pasqualotto E, Fae IG, Gibicoski T, Chavez MP, Talavera A, Athayde G, Chamie D. Intravascular imaging-guided vs. angiography-guided percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials in high-risk patients and complex coronary anatomies. Int J Cardiol 2024; 416:132510. [PMID: 39222885 DOI: 10.1016/j.ijcard.2024.132510] [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] [Received: 07/25/2024] [Revised: 08/14/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite a large body of evidence supporting the use of intravascular imaging (IVI) to guide percutaneous coronary intervention (PCI), concerns exist about its universal recommendation. The selective use of IVI to guide PCI of complex lesions and patients is perceived as a rational approach. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). Embase, PubMed, and Cochrane were systematically searched for RCTs that compared IVI-guided PCI with angiography-guided PCI in high-risk patients and complex coronary anatomies. The primary outcome was major adverse cardiac events (MACE). A random-effects model was used to calculate the risk ratios (RRs) with 95 % confidence intervals (CIs). RESULTS A total of 15 RCTs with 14,109 patients were included and followed for a weighted mean duration of 15.8 months. IVI-guided PCI was associated with a decrease in the risk of MACE (RR: 0.65; 95 % CI: 0.56-0.77; p < 0.01), target vessel failure (TVF) (RR: 0.66; 95 % CI: 0.52-0.84; p < 0.01), all-cause mortality (RR: 0.71; 95 % CI: 0.55-0.91; p < 0.01), cardiovascular mortality (RR: 0.47; 95 % CI: 0.34-0.65; p < 0.01), stent thrombosis (RR: 0.55; 95 % CI: 0.38-0.79; p < 0.01), myocardial infarction (RR: 0.81; 95 % CI: 0.67-0.98; p = 0.03), and repeated revascularizations (RR: 0.70; 95 % CI: 0.58-0.85; p < 0.01) compared with angiography. There was no significant difference in procedure-related complications (RR: 1.03; 95 % CI: 0.75-1.42; p = 0.84) between groups. CONCLUSIONS Compared with angiographic guidance alone, IVI-guided PCI of complex lesions and high-risk patients significantly reduced all-cause and cardiovascular mortality, MACE, TVF, stent thrombosis, myocardial infarction, and repeat revascularization.
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Affiliation(s)
| | | | - Denilsa D P Navalha
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, United States of America
| | | | | | - Tathiane Gibicoski
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Armando Talavera
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, United States of America
| | | | - Daniel Chamie
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, United States of America
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Ozaki Y, Tobe A, Onuma Y, Kobayashi Y, Amano T, Muramatsu T, Ishii H, Yamaji K, Kohsaka S, Ismail TF, Uemura S, Hikichi Y, Tsujita K, Ako J, Morino Y, Maekawa Y, Shinke T, Shite J, Igarashi Y, Nakagawa Y, Shiode N, Okamura A, Ogawa T, Shibata Y, Tsuji T, Hayashida K, Yajima J, Sugano T, Okura H, Okayama H, Kawaguchi K, Zen K, Takahashi S, Tamura T, Nakazato K, Yamaguchi J, Iida O, Ozaki R, Yoshimachi F, Ishihara M, Murohara T, Ueno T, Yokoi H, Nakamura M, Ikari Y, Serruys PW, Kozuma K. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024. Cardiovasc Interv Ther 2024; 39:335-375. [PMID: 39302533 PMCID: PMC11436458 DOI: 10.1007/s12928-024-01036-y] [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: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 09/22/2024]
Abstract
Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tevfik F Ismail
- King's College London, London, UK
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Junya Ako
- Department of Cardiology, Kitasato University Hospital, Sagamihara, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Shiwa, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yasumi Igarashi
- Division of Cardiology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Yoshihisa Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan
| | - Takayuki Ogawa
- Division of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshisato Shibata
- Division of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | | | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Teruyasu Sugano
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hideki Okayama
- Division of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saeko Takahashi
- Division of Cardiology, Tokushukai Shonan Oiso Hospital, Oiso, Japan
| | | | - Kazuhiko Nakazato
- Department of Cardiology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Reina Ozaki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fuminobu Yoshimachi
- Department of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ueno
- Division of Cardiology, Marin Hospital, Fukuoka, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Chaus A, Uretsky BF. Flow Matters: Optimizing Invasive Coronary Physiology to Improve Long-Term Outcomes. Cardiovasc Drugs Ther 2024; 38:971-972. [PMID: 39153115 DOI: 10.1007/s10557-024-07617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Adib Chaus
- Advocate Lutheran General Hospital, Park Ridge, IL, 60068, USA
| | - Barry F Uretsky
- Central Arkansas Veterans Health System, Little Rock, AR, 72205, USA.
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Latsios G, Koliastasis L, Toutouzas K, Tsioufis K. Recognizing and preventing complications regarding bioresorbable scaffolds during coronary interventions. World J Cardiol 2024; 16:508-511. [DOI: 10.4330/wjc.v16.i9.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] Open
Abstract
The evolution of coronary intervention techniques and equipment has led to more sophisticated procedures for the treatment of highly complex lesions. However, as a result, the risk of complications has increased, which are mostly iatrogenic and often include equipment failure. Stent dislodgement warrants vigilance for the early diagnosis and a stepwise management approach is required to either expand or retrieve the lost stent. In the era of bioresorbable scaffolds that are not radiopaque, increased caution is required. Intravascular imaging may assist in detecting the lost scaffold in cases of no visibility fluoroscopically. Adequate lesion preparation is the key to minimizing the possibility of equipment loss; however, in the case that it occurs, commercially available and improvised devices and techniques may be applied.
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Affiliation(s)
- George Latsios
- Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Leonidas Koliastasis
- Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Konstantinos Toutouzas
- Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Kostas Tsioufis
- Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
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Wagener M, Onuma Y, Sharif R, Coen E, Wijns W, Sharif F. Features and Limitations of Robotically Assisted Percutaneous Coronary Intervention (R-PCI): A Systematic Review of R-PCI. J Clin Med 2024; 13:5537. [PMID: 39337024 PMCID: PMC11432210 DOI: 10.3390/jcm13185537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Ischaemic heart disease is one of the major drivers of cardiovascular death in Europe. Since the first percutaneous coronary intervention (PCI) in 1977, developments and innovations in cardiology have made PCI the treatment of choice for stenotic coronary artery disease. To address the occupational hazards related to chronic exposure to radiation and wear and tear from heavy lead-based radioprotective aprons, the concept of robotically assisted PCI (R-PCI) was introduced in 2005. Aim: To explore the features and limitations of R-PCI, we first discuss the concept and evolution of R-PCI platforms and then systematically review the available clinical data. Methods: A systematic review has been performed across the Pubmed, Embase and Cochrane databases in order to assess the efficacy and safety of R-PCI. Secondary endpoints, such as operator and patient exposure to radiation, contrast volume used and procedural time, were assessed when available. Results: In selected patients, R-PCI provides high technical and clinical success rates, ranging from 81 to 98.8% and from 93.3 to 100%, respectively. In-hospital and 1-year MACE rates ranged from 0 to 10.4% and 4.8 to 10.5%, respectively. R-PCI is able to significantly reduce the operator's exposure to radiation. Further research analysing the patient's and cath lab staff's exposure to radiation is needed. Therapy escalation with R-PCI seems to be limited to complex lesions. R-PCI procedures add approximately 10 min to the procedural time. Conclusions: The efficacy and safety of R-PCI have been proven, and R-PCI is able to significantly reduce occupational hazards for the first operator. The lack of adoption in the community of interventional cardiologists may be explained by the fact that current generations of R-PCI platforms are limited by their incompatibility with advanced interventional devices and techniques needed for escalation in complex interventions.
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Affiliation(s)
- Max Wagener
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
- Department of Cardiology, University Hospital Galway, Newcastle Road, H91 YR71 Galway, Ireland
| | - Yoshinobu Onuma
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
- CORRIB Research Centre for Advanced Imaging and Core laboratory, H91 TK33 Galway, Ireland
| | - Ruth Sharif
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Eileen Coen
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - William Wijns
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Faisal Sharif
- College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
- Department of Cardiology, University Hospital Galway, Newcastle Road, H91 YR71 Galway, Ireland
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7
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Hong SJ, Lee SJ, Lee SH, Lee JY, Cho DK, Kim JW, Kim SM, Hur SH, Heo JH, Jang JY, Koh JS, Won H, Lee JW, Hong SJ, Kim DK, Choe JC, Lee JB, Kim SJ, Yang TH, Lee JH, Hong YJ, Ahn JH, Lee YJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y, Kim BK. Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention for patients with complex lesions (OCCUPI): an investigator-initiated, multicentre, randomised, open-label, superiority trial in South Korea. Lancet 2024; 404:1029-1039. [PMID: 39236729 DOI: 10.1016/s0140-6736(24)01454-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Despite the detailed imaging information provided by optical coherence tomography (OCT) during percutaneous coronary intervention (PCI), clinical benefits of this imaging technique in this setting remain uncertain. The aim of the OCCUPI trial was to compare the clinical benefits of OCT-guided versus angiography-guided PCI for complex lesions, assessed as the rate of major adverse cardiac events at 1 year. METHODS This investigator-initiated, multicentre, randomised, open-label, superiority trial conducted at 20 hospitals in South Korea enrolled patients aged 19-85 years for whom PCI with drug-eluting stents was clinically indicated. After diagnostic angiography, clinical and angiographic findings were assessed to identify patients who met the criterion of having one or more complex lesions. Patients were randomly assigned 1:1 to receive PCI with OCT guidance (OCT-guidance group) or angiography guidance without OCT (angiography-guidance group). Web-response permuted-block randomisation (mixed blocks of four or six) was used at each participating site to allocate patients. The allocation sequence was computer-generated by an external programmer who was not involved in the rest of the trial. Outcome assessors were masked to group assignment. Patients, follow-up health-care providers, and data analysers were not masked. PCI was done according to conventional standard methods with everolimus-eluting stents. The primary endpoint was major adverse cardiac events (a composite of cardiac death, myocardial infarction, stent thrombosis, or ischaemia-driven target-vessel revascularisation), 1 year after PCI. The primary analysis was done in the intention-to-treat population. The margin used to establish superiority was 1·0 as a hazard ratio. This trial is registered with ClinicalTrials.gov (NCT03625908) and is completed. FINDINGS Between Jan 9, 2019, and Sept 22, 2022, 1604 patients requiring PCI with drug-eluting stents for complex lesions were randomly assigned to receive either OCT-guided PCI (n=803) or angiography-guided PCI (n=801). 1290 (80%) of 1604 patients were male and 314 (20%) were female. The median age of patients at randomisation was 64 years (IQR 57-70). 1588 (99%) patients completed 1-year follow-up. The primary endpoint occurred in 37 (5%) of 803 patients in the OCT-guided PCI group and 59 (7%) of 801 patients in the angiography-guided PCI group (absolute difference -2·8% [95% CI -5·1 to -0·4]; hazard ratio 0·62 [95% CI 0·41 to 0·93]; p=0·023). Rates of stroke, bleeding events, and contrast-induced nephropathy were not significantly different across the two groups. INTERPRETATION Among patients who required drug-eluting stent implantation for complex lesions, OCT guidance resulted in a lower incidence of major adverse cardiac events at 1 year compared with angiography guidance. These findings indicate the existence of a therapeutic benefit of OCT as an intravascular imaging technique for PCI guidance in patients with complex coronary lesions. FUNDING Abbott Vascular and Cardiovascular Research Center. TRANSLATION For the Korean translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyup Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Young Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Jin Won Kim
- Division of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Sang Min Kim
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Jung Ho Heo
- Division of Cardiology, Kosin University Gospel Hospital, Busan, South Korea
| | - Ji-Yong Jang
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jin Sin Koh
- Division of Cardiology, Gyeongsang National University Jinju Hospital, Jinju, South Korea
| | - Hoyoun Won
- Division of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
| | - Jun-Won Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Soon Jun Hong
- Division of Cardiology, Korea University Anam Hospital, Seoul, South Korea
| | - Dong-Kie Kim
- Division of Cardiology, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Jeong Cheon Choe
- Division of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jin Bae Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Soo-Joong Kim
- Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Jung-Hee Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Young Joon Hong
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong-Hwa Ahn
- Division of Cardiology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Division of Cardiology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, South Korea.
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Mamas MA, Mintz GS. Optical coherence tomography imaging for complex percutaneous coronary intervention. Lancet 2024; 404:994-995. [PMID: 39236728 DOI: 10.1016/s0140-6736(24)01593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Mamas A Mamas
- Centre for Prognosis Research, Keele University, Stoke-on-Trent ST5 5BG, UK.
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
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9
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Amin AM, Khlidj Y, Abuelazm M, Sayed A, Khan U, Elewidi MM, Tanashat M, Elharti H, Ellabban MH, Alassiri AK, Alsaed M, Abdelazeem B, Kawsara A. Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a systematic review and bayesian network meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2024; 24:483. [PMID: 39261775 PMCID: PMC11389231 DOI: 10.1186/s12872-024-04105-5] [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: 04/04/2024] [Accepted: 08/07/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has become one of the most commonly performed interventional life-saving procedures worldwide. Intravascular Imaging (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) have initially evolved to guide PCI compared with angiography. However, this technology is not universally employed in all PCI procedures, and there is ongoing controversy regarding its additional benefits to patient outcomes. We aim to estimate the efficacy and safety of imaging modalities during PCI, allowing pre-, per, and post-intervention assessment of coronary vascularization. METHODS A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs), which were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used R, version 4.2.0. Effect sizes will be presented as odds ratios with accompanying 95% credible intervals. PROSPERO ID CRD42024507821. RESULTS Our study, encompassing 36 RCTs with a total of 17,572 patients, revelead that compared to conventional angiography, IVUS significantly reduced the risk of major adverse cardiovascular events (MACE) (OR: 0.71 [95% CrI: 0.56 to 0.87]) but not OCT (OR: 0.91 [95% CrI: 0.62 to 1.39]), IVUS and OCT significantly reduced the risk of cardiac death (OR: 0.50 [95% CrI: 0.33 to 0.76]) and (OR: 0.55 [95% CrI: 0.31 to 0.98]), respectively, IVUS significantly reduced the risk of target vessel-related revascularization (OR: 0.60 [95% CrI: 0.48 to 0.75]) but not OCT (OR: 0.86 [95% CrI: 0.60 to 1.19]), IVUS and OCT significantly reduced the risk of stent thrombosis (OR: 0.50 [95% CrI: 0.28 to 0.92]) and (OR: 0.48 [95% CrI: 0.22 to 0.98]), respectively, IVUS significantly reduced the risk of re-stenosis (OR: 0.65 [95% CrI: 0.46 to 0.88]) but not OCT (OR: 0.55 [95% CrI: 0.15 to 1.99]), neither IVUS (OR: 0.97 [95% CrI: 0.71 to 1.38]) nor OCT (OR: 0.75 [95% CrI: 0.49 to 1.22]) were associated with statistically significant reductions in all-cause mortality, neither IVUS (OR: 0.70 [95% CrI: 0.45 to 1.32]) nor OCT (OR: 0.81 [95% CrI: 0.47 to 1.59]) were associated with statistically significant reductions in target vessel failure, neither IVUS (OR: 0.88 [95% CrI: 0.43 to 2.44]) nor OCT (OR: 0.81 [95% CrI: 0.37 to 2.04]) were associated with statistically significant reductions in target lesion failure, and neither IVUS (OR: 0.82 [95% CrI: 0.60 to 1.06]) nor OCT (OR: 0.84 [95% CrI: 0.59 to 1.19]) were associated with statistically significant reductions in myocardial infarction. CONCLUSION Intravascular imaging-guided, including IVUS and OCT, improved the postinterventional outcomes of PCI, notably suggesting their advantage over traditional angiography with no significant difference between IVUS and OCT.
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Affiliation(s)
| | - Yehya Khlidj
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | | | - Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Ubaid Khan
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | - Mohamad Alsaed
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Akram Kawsara
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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10
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Abu-Much A, Grines CL, Chen S, Batchelor WB, Zhao D, Falah B, Maini AS, Redfors B, Bellumkonda L, Bharadwaj AS, Moses JW, Truesdell AG, Zhang Y, Zhou Z, Baron SJ, Lansky AJ, Basir MB, O'Neill WW, Cohen DJ. Clinical outcomes among patients with mitral valve regurgitation undergoing Impella-supported high-risk PCI. Int J Cardiol 2024; 417:132555. [PMID: 39270940 DOI: 10.1016/j.ijcard.2024.132555] [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] [Received: 05/22/2024] [Revised: 07/26/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity. METHODS Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR. Immediate PCI-related complications, major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 90 days and death at 1-year were assessed. RESULTS From March 2017 to March 2020, 631 patients who underwent Impella-supported HRPCI in the PROTECT III study had evaluable MR severity at baseline. Patients with severe MR had lower body mass indices, lower left ventricular ejection fractions (LVEFs), and were more frequently diagnosed with heart failure. The incidence of immediate PCI-related complications was similar between groups. Unadjusted 90-day MACCE and 1-year mortality rates were numerically higher in patients with severe MR compared to the other study groups yet without reaching statistical significance. In multivariable analyses, there was no significant association between the presence of severe MR for 90-day MACCE or 1-year mortality compared with other degrees of MR (adj. HR = 1.71, 95% CI [0.73, 3.98], p = 0.21; adj. HR = 1.79, 95% CI [0.86, 3.74], p = 0.12, respectively). CONCLUSIONS Impella-supported HRPCI patients with moderate or severe MR exhibited a higher prevalence of heart failure, lower LVEF, and longer hospital stays. Patients with severe MR showed numerically higher unadjusted rates of 90-day MACCE and 1-year mortality compared to other groups, however these differences did not reach statistical significance even after adjustment for potential confounders. CLINICAL TRIAL INFORMATION Trial Name: The Global cVAD Study (cVAD) ClinicalTrial.govIdentifier:NCT04136392 URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2.
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Affiliation(s)
- Arsalan Abu-Much
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, GA, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Cornell Weill Medical Center/New York-Presbyterian, New York, NY, USA
| | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Duzhi Zhao
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Batla Falah
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Aneel S Maini
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Aditya S Bharadwaj
- Department of Cardiology, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Jeffrey W Moses
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; St. Francis Hospital, Roslyn, NY, USA
| | - Alexander G Truesdell
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA; Virginia Heart, Falls Church, VA, USA
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Barts Heart Centre, London and Queen Mary University of London, London, UK
| | - Mir B Basir
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; St. Francis Hospital, Roslyn, NY, USA.
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11
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Gregson J, Pocock SJ, Anker SD, Bhatt DL, Packer M, Stone GW, Zeller C. Competing Risks in Clinical Trials: Do They Matter and How Should We Account for Them? J Am Coll Cardiol 2024; 84:1025-1037. [PMID: 39232630 DOI: 10.1016/j.jacc.2024.06.023] [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] [Received: 04/17/2024] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 09/06/2024]
Abstract
During patient follow-up in a randomized trial, some deaths may occur. Where death (or noncardiovascular death) is not part of an outcome of interest it is termed a competing risk. Conventional analyses (eg, Cox proportional hazards model) handle death similarly to other censored follow-up. Patients still alive are unrealistically assumed to be representative of those who died. The Fine and Gray model has been used to handle competing risks, but is often used inappropriately and can be misleading. We propose an alternative multiple imputation approach that plausibly accounts for the fact that patients who die tend also to be at high risk for the (unobserved) outcome of interest. This provides a logical framework for exploring the impact of a competing risk, recognizing that there is no unique solution. We illustrate these issues in 3 cardiovascular trials and in simulation studies. We conclude with practical recommendations for handling competing risks in future trials.
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Affiliation(s)
- John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, German Center for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA; Imperial College, London, United Kingdom
| | - Gregg W Stone
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Tufaro V, Jaffer FA, Serruys PW, Onuma Y, van der Steen AFW, Stone GW, Muller JE, Marcu L, Van Soest G, Courtney BK, Tearney GJ, Bourantas CV. Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research. JACC Cardiovasc Interv 2024; 17:1963-1979. [PMID: 39260958 DOI: 10.1016/j.jcin.2024.07.007] [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] [Received: 11/13/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI. Prototypes combining 2 or even 3 imaging probes with complementary attributes have been developed, and several multimodality systems have already been used in patients, with near-infrared spectroscopy intravascular ultrasound-based studies showing promising results for the identification of high-risk plaques. Moreover, postmortem histology studies have documented that hybrid imaging catheters can enable more accurate characterization of plaque morphology than standalone imaging. This review describes the evolution in the field of hybrid intracoronary imaging; presents the available multimodality catheters; and discusses their potential role in PCI guidance, vulnerable plaque detection, and the assessment of endovascular devices and emerging pharmacotherapies targeting atherosclerosis.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Gregg W Stone
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York, USA
| | - James E Muller
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Gijs Van Soest
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brian K Courtney
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Conavi Medical Inc, Toronto, Ontario, Canada
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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13
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Zeng M, Chu M, Xu L, Yi B, Yu W, Sun Q, Zhang Y, Liu Y, Zhao C, Weng Z, He L, Qin Y, Xu Y, Liu H, Wang N, Feng X, Koniaeva E, Mohammad D, Hu S, Tu S, Yu B, Jia H. Value of Combined Optical Coherence Tomography and Optical Flow Ratio Measurements After Percutaneous Coronary Intervention. Can J Cardiol 2024:S0828-282X(24)00938-3. [PMID: 39245340 DOI: 10.1016/j.cjca.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Optical flow ratio (OFR) is a novel computational fractional flow reserve derived from optical coherence tomography (OCT). However, the impact of combining post-stenting morphology (OCT) and physiology (OFR) remains largely unknown. METHODS OCT and OFR were analysed at an independent core laboratory. Target lesion failure (TLF) was defined as the composite of cardiac death, target lesion myocardial infarction, and target lesion revascularisation. Suboptimal stent deployment was identified with at least 1 TLF-related OCT or OFR characteristic. RESULTS A total of 448 patients with acute coronary syndrome (459 vessels) were assessed. Stent expansion < 80%, minimal stent area < 4.5 mm2, and stent edge lipid-rich plaque and OFR < 0.90 were independent predictors of TLF (all P < 0.001). Patients with OCT-suboptimal (adjusted hazard ratio [aHR] 7.88, 95% CI 2.73-22.72,-P < 0.001) or OFR-suboptimal (aHR 5.78, 95% CI 2.54-13.14; P < 0.001) stent deployment showed significantly higher risk of TLF compared with those with optimal stent deployment, with a significant interaction (Pinteraction < 0.001). OCT and OFR both-suboptimal stent deployment was confirmed as an independent predictor of TLF (aHR 9.39, 95% CI 4.25-20.76; P < 0.001). CONCLUSIONS Combined OCT and OFR conferred an optimal reclassification of stent deployment, which may aid in decision making regarding a tailored PCI strategy for optimal stent deployment.
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Affiliation(s)
- Ming Zeng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Liangxiao Xu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Boling Yi
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qianhui Sun
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yixuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yue Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chen Zhao
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ziqian Weng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Luping He
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuhan Qin
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huimin Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ning Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xue Feng
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ekaterina Koniaeva
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Diler Mohammad
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sining Hu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
| | - Haibo Jia
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, National Key Laboratory of Frigid Zone Cardiovascular Diseases, and Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
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14
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Adriaenssens T, Sinnaeve P. Stent sizing in imaging-guided percutaneous coronary intervention: potential benefits of a more cautious approach. EUROINTERVENTION 2024; 20:e1053-e1055. [PMID: 39229835 PMCID: PMC11352536 DOI: 10.4244/eij-e-24-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Affiliation(s)
- Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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15
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Otake H, Kubo T, Hibi K, Natsumeda M, Ishida M, Kataoka T, Takaya T, Iwasaki M, Sonoda S, Shinke T, Nakazawa G, Takahashi Y, Ioji T, Akasaka T, Investigators OA. Optical frequency domain imaging-guided versus intravascular ultrasound-guided percutaneous coronary intervention for acute coronary syndromes: the OPINION ACS randomised trial. EUROINTERVENTION 2024; 20:e1086-e1097. [PMID: 39219363 PMCID: PMC11352543 DOI: 10.4244/eij-d-24-00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The clinical benefits of optical frequency domain imaging (OFDI)-guided percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain unclear. AIMS We sought to compare intravascular ultrasound (IVUS)- and OFDI-guided PCI in patients with ACS. METHODS OPINION ACS is a multicentre, prospective, randomised, non-inferiority trial that compared OFDI-guided PCI with IVUS-guided PCI using current-generation drug-eluting stents in ACS patients (n=158). The primary endpoint was in-stent minimum lumen area (MLA), assessed using 8-month follow-up OFDI. RESULTS Patients presented with ST-segment elevation myocardial infarction (55%), non-ST-segment elevation myocardial infarction (29%), or unstable angina pectoris (16%). PCI procedural success was achieved in all patients, with comparably low periprocedural complications rates in both groups. Immediately after PCI, the minimum stent area (p=0.096) tended to be smaller for OFDI versus IVUS guidance. Proximal stent edge dissection (p=0.012) and irregular protrusion (p=0.03) were significantly less frequent in OFDI-guided procedures than in IVUS-guided procedures. Post-PCI coronary flow, assessed using corrected Thrombolysis in Myocardial Infarction frame counts, was significantly better in the OFDI-guided group than in the IVUS-guided group (p<0.001). The least squares mean (95% confidence interval [CI]) in-stent MLA at 8 months was 4.91 (95% CI: 4.53-5.30) mm2 and 4.76 (95% CI: 4.35-5.17) mm2 in the OFDI- and IVUS-guided groups, respectively, demonstrating the non-inferiority of OFDI guidance (pnon-inferiority<0.001). The average neointima area tended to be smaller in the OFDI-guided group. The frequency of major adverse cardiac events was similar. CONCLUSIONS Among ACS patients, OFDI-guided PCI and IVUS-guided PCI were equally safe and feasible, with comparable in-stent MLA at 8 months. OFDI guidance may be a potential option in ACS patients. This study was registered in the Japan Registry of Clinical Trials (jrct.niph.go.jp: jRCTs052190093).
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Affiliation(s)
- Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Natsumeda
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Toru Kataoka
- Division of Cardiology, Bell-land General Hospital, Sakai, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuya Ioji
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center, Nishinomiya, Japan
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16
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Kim Y, Park H, Yoon HJ, Suh J, Kang SH, Lim YH, Jang DH, Park JH, Shin ES, Bae JW, Lee JH, Oh JH, Kang DY, Kweon J, Jo MW, Park DW, Kim YH, Ahn JM. Fully automated quantitative coronary angiography versus optical coherence tomography guidance for coronary stent implantation (FLASH): Study protocol for a randomized controlled noninferiority trial. Am Heart J 2024; 275:86-95. [PMID: 38723880 DOI: 10.1016/j.ahj.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/05/2024] [Accepted: 05/05/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Artificial intelligence-based quantitative coronary angiography (AI-QCA) has been developed to provide a more objective and reproducible data about the severity of coronary artery stenosis and the dimensions of the vessel for intervention in real-time, overcoming the limitations of significant inter- and intraobserver variability, and time-consuming nature of on-site QCA, without requiring extra time and effort. Compared with the subjective nature of visually estimated conventional CAG guidance, AI-QCA guidance provides a more practical and standardized angiography-based approach. Although the advantage of intravascular imaging-guided PCI is increasingly recognized, their broader adoption is limited by clinical and economic barriers in many catheterization laboratories. METHODS The FLASH (fully automated quantitative coronary angiography versus optical coherence tomography guidance for coronary stent implantation) trial is a randomized, investigator-initiated, multicenter, open-label, noninferiority trial comparing the AI-QCA-assisted PCI strategy with optical coherence tomography-guided PCI strategy in patients with significant coronary artery disease. All operators will utilize a novel, standardized AI-QCA software and PCI protocol in the AI-QCA-assisted group. A total of 400 patients will be randomized to either group at a 1:1 ratio. The primary endpoint is the minimal stent area (mm2), determined by the final OCT run after completion of PCI. Clinical follow-up and cost-effectiveness evaluations are planned at 1 month and 6 months for all patients enrolled in the study. RESULTS Enrollment of a total of 400 patients from the 13 participating centers in South Korea will be completed in February 2024. Follow-up of the last enrolled patients will be completed in August 2024, and primary results will be available by late 2024. CONCLUSION The FLASH is the first clinical trial to evaluate the feasibility of AI-QCA-assisted PCI, and will provide the clinical evidence on AI-QCA assistance in the field of coronary intervention. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT05388357.
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Affiliation(s)
- Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Hanbit Park
- Department of Medicine, Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyuck-Jun Yoon
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jon Suh
- Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Hyo Lim
- Department of Internal Medicine, Division of Cardiology, Hanyang University College of Medicine, Seoul, Korea
| | - Duck Hyun Jang
- Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Bucheon, Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Division of Cardiology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Hyok Oh
- Department of Cardiology and Medical Research Institute, Pusan, Pusan National University, National University Hospital, Busan, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihoon Kweon
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Hong D, Kim SE, Lee SH, Lee SJ, Lee JY, Kim SM, Lee SY, Kwon W, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Gwon HC, Hahn JY, Lee JM. Current evidence for prognostic benefit of intravascular imaging-guided percutaneous coronary intervention in chronic total occlusion intervention. Korean J Intern Med 2024; 39:702-716. [PMID: 38419334 PMCID: PMC11384243 DOI: 10.3904/kjim.2023.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024] Open
Abstract
Although percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has been increasing in recent years, CTO PCI is still one of the most challenging procedures with relatively higher rates of procedural complications and adverse clinical events after PCI. Due to the innate limitations of invasive coronary angiography, intravascular imaging (IVI) has been used as an adjunctive tool to complement PCI, especially in complex coronary artery disease. Considering the complexity of CTO lesions, the role of IVI is particularly important in CTO intervention. IVI has been a useful adjunctive tool in every step of CTO PCI including assisted wire crossing, confirmation of wire location within CTO segment, and stent optimization. The meticulous use of IVI has been one of the greatest contributors to recent progress of CTO PCI. Nevertheless, studies evaluating the role of IVI during CTO PCI are limited. The current review provides a comprehensive overview of the mechanistic advantages of IVI in CTO PCI, summarizes previous studies and trials, and presents future perspective of IVI in CTO PCI.
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Affiliation(s)
- David Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Jae Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Woochan Kwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Garzon S, Bezerra F, Mariani J, Bandeira W, Prado G, Rueda V, Almeida B, Lemos P. Comparison of intravascular lithotripsy and rotational atherectomy for the treatment of heavily calcified coronary lesions: the STIFF ( S tenoses with calcificaTIon treated with angioplasty e FF ected with dedicated interventional tools) study. Coron Artery Dis 2024; 35:445-450. [PMID: 38411184 DOI: 10.1097/mca.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Percutaneous coronary interventions in heavily calcified coronary lesions are associated with technical difficulties and the worse prognosis. Lesion preparation is important to reduce complications and improve outcomes. The aim of this study is to compare the results of rotational atherectomy (RA) and intravascular lithotripsy (IVL) at achieving optimal stent implantation using intravascular ultrasound criteria. METHODS Retrospective, single-center study comparing patients with heavily calcified coronary lesions that underwent percutaneous coronary interventions using RA or IVL. RESULTS IN TOTAL 25 patients (13 in the RA group and 12 in the IVL group) were included. Reference vessel diameter was similar between the groups [2.59 (2.51-3.63) mm in the RA group vs. 2.79 (2.59-3.16) mm in the IVL group; P = 0.89], as were minimal lumen area [1.02 (0.80-1.23) mm vs. 1.40 (1.01-1.40) mm; P = 0.43] and diameter stenosis [60.4% (52.3-72.3) vs. 56.1% (47.8-61.3); P = 0.56). The final minimal lumen area was significantly larger in the IVL group [7.6 mm 2 (5.8-8.6) vs. 5.4 mm 2 (4.5-6.2); P = 0.01] as were lumen area gain [4.1 mm 2 (2.6-5.9) vs. 2.3 mm 2 (1.4-3.6); P = 0.01] and final stent volume [491.2 mm 3 (372.2-729.8) vs. 326.2 mm 3 (257.1-435.4); P = 0.03]. In the RA group, 69.2% of the patients achieved the preestablished intravascular ultrasound-based criteria for successful stent implantation, vs. 100% of the patients in the IVL group ( P = 0.04). CONCLUSION Patients in the IVL group achieved the Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation trial criteria of successful stent implantation more frequently than those treated with RA.
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Affiliation(s)
- Stefano Garzon
- Interventional Cardiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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19
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Kang DY, Lee SH, Lee SW, Lee CH, Kim C, Jang JY, Mehta N, Oh JH, Cho YR, Yoon KH, Ahn SG, Lee JH, Cho DK, Kim Y, Kim J, Cho GH, Lee KS, Park H, Vural M, Lim YH, Park KH, Lee BK, Lee JY, Park HW, Yoon YH, Lee JH, Lee SY, Park KW, Kang J, Kim HK, Kang SH, Park JH, Choi IC, Yu CS, Yun SC, Park DW, Hong MK, Park SJ, Kim JS, Ahn JM. Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery. J Am Coll Cardiol 2024:S0735-1097(24)08196-8. [PMID: 39217573 DOI: 10.1016/j.jacc.2024.08.024] [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] [Received: 07/30/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Current guidelines recommend the perioperative continuation of aspirin in patients with coronary drug-eluting stents (DES) undergoing noncardiac surgery. However, supporting evidence is limited. OBJECTIVES This study aimed to compare continuing aspirin monotherapy vs temporarily holding all antiplatelet therapy before noncardiac surgery in patients with previous DES implantation. METHODS We randomly assigned patients who had received a DES >1 year previously and were undergoing elective noncardiac surgery either to continue aspirin or to discontinue all antiplatelet agents 5 days before noncardiac surgery. Antiplatelet therapy was recommended to be resumed no later than 48 hours after surgery, unless contraindicated. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, or stroke between 5 days before and 30 days after noncardiac surgery. RESULTS A total of 1,010 patients underwent randomization. Among 926 patients in the modified intention-to-treat population (462 patients in aspirin monotherapy group and 464 patients in the no-antiplatelet therapy group), the primary composite outcome occurred in 3 patients (0.6%) in the aspirin monotherapy group and 4 patients (0.9%) in the no antiplatelet group (difference, -0.2 percentage points; 95% CI: -1.3 to 0.9; P > 0.99). There was no stent thrombosis in either group. The incidence of major bleeding did not differ significantly between groups (6.5% vs 5.2%; P = 0.39), whereas minor bleeding was significantly more frequent in the aspirin group (14.9% vs 10.1%; P = 0.027). CONCLUSIONS Among patients undergoing low-to-intermediate risk noncardiac surgery >1 year after stent implantation primarily with a DES, in the setting of lower-than-expected event rates, we failed to identify a significant difference between perioperative aspirin monotherapy and no antiplatelet therapy with respect to ischemic outcomes or major bleeding. (Perioperative Antiplatelet Therapy in Patients With Drug-eluting Stent Undergoing Noncardiac Surgery [ASSURE-DES]; NCT02797548).
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Affiliation(s)
- Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Hyup Lee
- Division of Cardiology, Severance Hospital, Seoul, Korea
| | - Se-Whan Lee
- Pyeongtaek St Mary's Hospital, Pyeongtaek, Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Choongki Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Ji-Yong Jang
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Nihar Mehta
- Division of Cardiology, Jaslok Hospital, Mumbai, India
| | - Jun-Hyok Oh
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Young Rak Cho
- Division of Cardiology, Dona-A University Hospital, Busan, Korea
| | - Kyung Ho Yoon
- Division of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jung-Hee Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, Korea
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Yongcheol Kim
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Jeongsu Kim
- Cardiovascular Center, Haeundae Bumin Hospital, Busan, Korea
| | - Gyeong Hun Cho
- Division of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Kyu-Sup Lee
- Division of Cardiology, The Catholic University of Korea Daejeon St Mary's Hospital, Daejeon, Korea
| | - Hanbit Park
- Division of Cardiology, Gangneung Asan Hospital, Gangneung, Korea
| | - Mutlu Vural
- Division of Cardiology, Bagcilar Education and Training Hospital, Istanbul, Türkiye
| | - Young-Hyo Lim
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
| | - Kyoung-Ha Park
- Division of Cardiology, Hallym University Sacred Heart Hospital, Seoul, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Jong-Young Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hyun-Woo Park
- Division of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Seung-Yul Lee
- Division of Cardiology, CHA University Bundang Medical Center, Bundang, Korea
| | - Kyung Woo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Jeehoon Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Si-Hyuck Kang
- Division of Cardiology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Jae-Hyoung Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Hospital, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Hospital, Seoul, Korea.
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim H, Lee JG, Jeong GJ, Lee G, Min H, Cho H, Min D, Lee SW, Cho JH, Cho S, Kang SJ. Deep learning model for intravascular ultrasound image segmentation with temporal consistency. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03221-9. [PMID: 39190112 DOI: 10.1007/s10554-024-03221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024]
Abstract
This study was conducted to develop and validate a deep learning model for delineating intravascular ultrasound (IVUS) images of coronary arteries.Using a total of 1240 40-MHz IVUS pullbacks with 191,407 frames, the model for lumen and external elastic membrane (EEM) segmentation was developed. Both frame- and vessel-level performances and clinical impact of the model on 3-year cardiovascular events were evaluated in the independent data sets. In the test set, the Dice similarity coefficients (DSC) were 0.966 ± 0.025 and 0.982 ± 0.017 for the lumen and EEM, respectively. Even at sites of extensive attenuation, the frame-level performance was excellent (DSCs > 0.96 for the lumen and EEM). The model (vs. the expert) showed a better temporal consistency for contouring the EEM. The agreement between the model- vs. the expert-derived cross-sectional and volumetric measurements was excellent in the independent retrospective cohort (all, intra-class coefficients > 0.94). The model-derived percent atheroma volume > 52.5% (area under curve 0.70, sensitivity 71% and specificity 67%) and plaque burden at the minimal lumen area site (area under curve 0.72, sensitivity 72% and specificity 66%) best predicted 3-year cardiac death and nonculprit-related target vessel revascularization, respectively. In the stented segment, the DSCs > 0.96 for contouring lumen and EEM were achieved. Applied to the 60-MHz IVUS images, the DSCs were > 0.97. In the external cohort with 45-MHz IVUS, the DSCs were > 0.96. The deep learning model accurately delineated vascular geometry, which may be cost-saving and support clinical decision-making.
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Affiliation(s)
- Hyeonmin Kim
- Pohang University of Science and Technology (POSTECH), Seoul, Korea
- Mediwhale Inc., Seoul, Korea
| | - June-Goo Lee
- Biomedical Engineering Research Center, Asan Medical Center, College of Medicine, Asan Institute for Life Sciences, University of Ulsan, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gyu-Jun Jeong
- Biomedical Engineering Research Center, Asan Medical Center, College of Medicine, Asan Institute for Life Sciences, University of Ulsan, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | | | - Hyunseok Min
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, Korea
| | - Hyungjoo Cho
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, Korea
| | | | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, Korea
| | - Jun Hwan Cho
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Sungsoo Cho
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic- ro 43-gil, Songpa-gu, Seoul, Korea.
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21
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Saboe A, Sari MT, Yahya AF, Akbar MR. Coronary artery size based on intravascular ultrasound in Southeast Asia population. Egypt Heart J 2024; 76:109. [PMID: 39172284 PMCID: PMC11341788 DOI: 10.1186/s43044-024-00543-w] [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: 07/02/2024] [Accepted: 08/11/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND One of the downsides of percutaneous coronary intervention (PCI) is stent failure which could be related to stent underexpansion. Hence, PCI based on an accurate coronary artery size obtained from intracoronary imaging is tremendously important. Until now, there is no data about all coronary artery dimensions in the Southeast Asian population performed by intravascular ultrasound (IVUS). The coronary artery size of 153 patients with chronic coronary syndrome (CCS) in acute or chronic settings who underwent percutaneous coronary intervention (PCI) with IVUS was examined. The mean artery size and its predictors were analyzed. RESULTS There were 153 patients with 633 coronary artery segments: the mean left main (LM) external elastic membrane (EEM) diameter and cross-sectional area (CSA) were 5.02 ± 0.43 mm and 19.93 ± 3.48 mm2, proximal left anterior descending artery (LAD) 4.25 ± 0.42 mm and 14.34 ± 2.85 mm2, the mid-LAD 3.86 ± 0.39 mm and 11.70 ± 2.24 mm2, the distal LAD 3.32 (2.83-4.30) mm and 8.77(6.23-14.99) mm2, the proximal left circumflex artery (LCX) 3.91 ± 0.42 mm and 12.07 ± 2.53 mm2, the distal LCX 3.51 ± 0.47 mm and 9.90 (5.09-14.20) mm2, the proximal right coronary artery (RCA) 4.50 ± 0.48 mm and 16.14 ± 3.43 mm2, the mid-RCA 4.16 ± 0.420 mm and 13.74 ± 2.72 mm2, the distal RCA 3.81 ± 0.41 mm and 11.59 ± 2.46 mm2, respectively. Body surface area (BSA) is an independent predictor for the majority of epicardial coronary arteries with a positive linear relationship. CONCLUSIONS The mean artery size of the Indonesian population was comparable with previous studies. The knowledge of coronary artery size will help the clinician to have a reference for intervention, especially when no intravascular imaging is available.
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Affiliation(s)
- Aninka Saboe
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Jalan Eyckman 38, Bandung, 40161, Indonesia.
| | - Minsy Titi Sari
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Jalan Eyckman 38, Bandung, 40161, Indonesia
| | - Achmad Fauzi Yahya
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Jalan Eyckman 38, Bandung, 40161, Indonesia
| | - Muhammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Jalan Eyckman 38, Bandung, 40161, Indonesia
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22
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Piedimonte G, Cerrato E, Rolfo C, Nunez Gil IJ, Azzalini L, Mangione R, Maiellaro F, Boi A, Riganelli D, Sardone A, Bruno F, Scudiero F, Vizzari G, Carciotto G, Calderone D, Borgi M, Cancro FP, Sanchez I, Leoncini M, Sagazio E, Colombo F, Rosso G, Chechi T, Zecchino S, Pavani M, Franzè A, Zanda G, Bosco M, Hernandez JMDLT, Micari A, Galasso G, Versaci F, Tamburino C, Patti G, La Manna A, Tomassini F, Varbella F. Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE registry outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00633-X. [PMID: 39181812 DOI: 10.1016/j.carrev.2024.08.013] [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: 06/18/2024] [Revised: 07/31/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting. OBJECTIVES To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS). METHODS Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE). RESULTS The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years. CONCLUSIONS Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.
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Affiliation(s)
- Giulio Piedimonte
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
| | - Enrico Cerrato
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Cristina Rolfo
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ivan J Nunez Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Riccardo Mangione
- Division of Cardiology, Policlinico University G.Rodolico-San Marco, Catania, Italy
| | | | - Alberto Boi
- Division of Cardiology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Donovan Riganelli
- Division of Cardiology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Andrea Sardone
- Division of Cardiology, Sant'Elia Hospital, Caltanissetta, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Fernando Scudiero
- Cardiology Unit, Medical Sciences Department, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Giampiero Vizzari
- Department of Clinical and Experimental Medicine, Interventional Cardiology Unit, "G. Martino" University Hospital of Messina, Italy
| | - Gabriele Carciotto
- Department of Clinical and Experimental Medicine, Interventional Cardiology Unit, "G. Martino" University Hospital of Messina, Italy
| | - Dario Calderone
- Department of Invasive Cardiology, San Luca Hospital - Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Marco Borgi
- Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Francesco Paolo Cancro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Ivan Sanchez
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Gabriele Rosso
- Division of Cardiology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Tania Chechi
- Division of Cardiology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Simone Zecchino
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Marco Pavani
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Alfonso Franzè
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Greca Zanda
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Manuel Bosco
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, Interventional Cardiology Unit, "G. Martino" University Hospital of Messina, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | | | - Corrado Tamburino
- Division of Cardiology, Policlinico University G.Rodolico-San Marco, Catania, Italy
| | - Giuseppe Patti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessio La Manna
- Division of Cardiology, Policlinico University G.Rodolico-San Marco, Catania, Italy
| | - Francesco Tomassini
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit - Infermi Rivoli Hospital, Rivoli (Turin), Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
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23
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Zhang D, Yan R, Wang HY, Zhang R, Zhao Z, Gao G, Yang M, Wang H, Liu S, Fu R, Yin D, Zhu C, Feng L, Yang Y, Dou K. Technological Advances Are Associated With Better Clinical Outcomes of Percutaneous Coronary Intervention in Patients With Unprotected Left Main Disease. J Am Heart Assoc 2024; 13:e033929. [PMID: 39119974 DOI: 10.1161/jaha.123.033929] [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] [Received: 12/09/2023] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Few large-scale studies have evaluated the effectiveness of percutaneous coronary intervention (PCI) technological advances in the treatment of patients with unprotected left main coronary artery disease (LM-CAD). We aim to identify independent factors that affect the prognosis of PCI in patients with unprotected LM-CAD and to assess the impact of PCI technological advances on long-term clinical outcomes. METHODS AND RESULTS A total of 4512 consecutive patients who underwent unprotected LM-CAD PCI at Fuwai Hospital from 2004 to 2016 were enrolled. Multivariable Cox proportional hazards model was used to identify which techniques can independently affect the incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, or target vessel revascularization). The incidence of 3-year MACEs was 9.0% (406/4512). Four new PCI techniques were identified as the independent protective factors of MACEs, including second-generation drug-eluting stents (hazard ratio [HR], 0.61 [95% CI, 0.37-0.99]), postdilatation (HR, 0.75 [95% CI, 0.59-0.94]), final kissing balloon inflation (HR, 0.78 [95% CI, 0.62-0.99]), and using intravascular ultrasound (HR, 0.78 [95% CI, 0.63-0.97]). The relative hazard of 3-year MACEs was reduced by ≈50% with use of all 4 techniques compared with no technique use (HR, 0.53 [95% CI, 0.32-0.87]). CONCLUSIONS PCI technological advances including postdilatation, second-generation drug-eluting stent, final kissing balloon inflation, and intravascular ultrasound guidance were associated with improved clinical outcomes in patients who underwent unprotected LM-CAD PCI.
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Affiliation(s)
- Dong Zhang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital Capital Medical University, National Center for Children's Health Beijing China
| | - Hao-Yu Wang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Rui Zhang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Zhiyong Zhao
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Guofeng Gao
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Min Yang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Hao Wang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Shuai Liu
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Rui Fu
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Dong Yin
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Chenggang Zhu
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Lei Feng
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Yuejin Yang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
| | - Kefei Dou
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- State Key Laboratory of Cardiovascular Disease Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
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24
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Castiello DS, Piccolo R, Esposito G. Is Diabetes Still a Risk Factor for Percutaneous Coronary Intervention-Related Outcomes in the Era of Imaging-Guided Percutaneous Coronary Intervention? Am J Cardiol 2024; 225:1-3. [PMID: 38788823 DOI: 10.1016/j.amjcard.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Affiliation(s)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
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25
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Lugo-Gavidia LM, Alcocer-Gamba MA, Martinez-Cervantes A. Challenges and Advances in Interventional Cardiology for Coronary Artery Disease Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1323. [PMID: 39202606 PMCID: PMC11356482 DOI: 10.3390/medicina60081323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024]
Abstract
The development of percutaneous coronary intervention (PCI) has been one of the greatest advances in cardiology and has changed clinical practice for patients with coronary artery disease (CAD). Despite continuous improvements in operators' experience, techniques, and the development of new-generation devices, significant challenges remain in improving the efficacy of PCI, including calcification, bifurcation, multivascular disease, stent restenosis, and stent thrombosis, among others. The present review aims to provide an overview of the current status of knowledge of endovascular revascularization in CAD, including relevant trials, therapeutic strategies, and new technologies addressing particular scenarios that can impact the prognosis of this vulnerable population.
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Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Mexican Academic Consortium for Clinical Data Acquisition SC, Sinaloa 80230, Mexico
- Dobney Hypertension Centre, Medical School, University of Western Australia, Perth 6000, Australia
| | - Marco Antonio Alcocer-Gamba
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Instituto de Corazón de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
| | - Araceli Martinez-Cervantes
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
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26
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Karamasis GV, Katsikis A, Konstantinou K, Clesham GJ, Kelly PA, Jagathesan R, Prati F, Bourantas CV, Davies JR, Keeble TR. Clinical Impact of Intracoronary Imaging in the Management of Stent Thrombosis. J Clin Med 2024; 13:4667. [PMID: 39200809 PMCID: PMC11355795 DOI: 10.3390/jcm13164667] [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: 01/17/2024] [Revised: 07/26/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management of ST. Methods: The unadjusted study population was consecutive patients with definite ST presenting in a single tertiary cardiac centre and undergoing percutaneous coronary intervention (PCI). The presumed major mechanism of ST was assigned according to the real-time ICI interpretation by the PCI operator. Propensity score matching was performed with regard to ICI use to form the adjusted population and Kaplan-Meier analysis was applied to compare survival free of cardiac death (CD) or target lesion revascularization (TLR). Results: The unadjusted population included 130 ST patients, with the majority presenting with ST-elevation myocardial infarction (STEMI) (88%) and very late ST (86%). ICI was performed in 45 patients, of whom optical coherence tomography (OCT) was performed in 30 cases. When the individual ST mechanisms were viewed as groups, there was an interaction observed between type of treatment (stent vs. non-stent) and ST mechanism, with non-stent treatment being more prevalent in cases of underexpansion, malapposition, in-stent restenosis and mechanism uncertainty. After application of matching, two groups of 30 patients were formed. ICI-guided management resulted in better survival free of CD-TLR at 2 years (93% vs. 73%, p = 0.037). Conclusions: Intracoronary imaging guidance during PCI for ST had a direct impact on management (stent vs. non-stent) and resulted in a lower event rate at mid-term follow-up when propensity matched analysis was applied.
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Affiliation(s)
- Grigoris V. Karamasis
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
- 2nd Cardiology Department, University of Athens, University Hospital Attikon, 124 62 Haidari, Greece
| | - Athanasios Katsikis
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- Cardiology Department, 401 General Military Hospital of Athens, 115 25 Athens, Greece
| | - Klio Konstantinou
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Gerald J. Clesham
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Paul A. Kelly
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
| | - Rohan Jagathesan
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
| | - Francesco Prati
- Cardiology Department, S. Giovanni Hospital, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy;
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK;
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Mile End Road, London E1 4NS, UK
- Institute of Cardiovascular Sciences, University College London, Gower Street, London WC1E 6BT, UK
| | - John R. Davies
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Thomas R. Keeble
- Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK; (A.K.)
- School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
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27
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Fezzi S, Del Sole PA, Burzotta F, Leone AM, Ding D, Terentes-Printzios D, Trani C, Bonizzi L, Sgreva S, Andreaggi S, Huang J, Pesarini G, Tavella D, Prado G, Vicerè A, Oikonomou D, Gkini KP, Galante D, Tsioufis K, Vlachopoulos C, Wijns W, Ribichini F, Tu S, Scarsini R. Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02500-8. [PMID: 39102003 DOI: 10.1007/s00392-024-02500-8] [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] [Received: 05/28/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE). OBJECTIVES In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes. METHODS Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up. RESULTS Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33-58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410-3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167-0.614, p = 0.030). CONCLUSIONS Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.
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Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
- The Smart Sensors Laboratory and Curam, The Lambe Institute for Translational Medicine, Univesity of Galway, Galway, Ireland
| | - Paolo Alberto Del Sole
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daixin Ding
- The Smart Sensors Laboratory and Curam, The Lambe Institute for Translational Medicine, Univesity of Galway, Galway, Ireland
- Shanghai Jiao Tong University School of Medicine Affiliated Ren Ji Hospital, Shanghai, China
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Bonizzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Sara Sgreva
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Jiayue Huang
- The Smart Sensors Laboratory and Curam, The Lambe Institute for Translational Medicine, Univesity of Galway, Galway, Ireland
- Shanghai Jiao Tong University School of Medicine Affiliated Ren Ji Hospital, Shanghai, China
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Guy Prado
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Andrea Vicerè
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dimitrios Oikonomou
- First Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantia Paraskevi Gkini
- First Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Domenico Galante
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - William Wijns
- The Smart Sensors Laboratory and Curam, The Lambe Institute for Translational Medicine, Univesity of Galway, Galway, Ireland
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy.
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28
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Díez-Villanueva P, Jiménez-Méndez C, Cepas-Guillén P, Arenas-Loriente A, Fernández-Herrero I, García-Pardo H, Díez-Delhoyo F. Current Management of Non-ST-Segment Elevation Acute Coronary Syndrome. Biomedicines 2024; 12:1736. [PMID: 39200201 PMCID: PMC11352006 DOI: 10.3390/biomedicines12081736] [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: 06/30/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
Cardiovascular disease constitutes the leading cause of morbimortality worldwide. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a common cardiovascular condition, closely related to the ageing population and significantly affecting survival and quality of life. The management of NSTE-ACS requires specific diagnosis and therapeutic strategies, thus highlighting the importance of a personalized approach, including tailored antithrombotic therapies and regimens, combined with timely invasive management. Moreover, specific and frequent populations in clinical practice, such as the elderly and those with chronic kidney disease, pose unique challenges in the management of NSTE-ACS due to their increased risk of ischemic and hemorrhagic complications. In this scenario, comprehensive management strategies and multidisciplinary care are of great importance. Cardiac rehabilitation and optimal management of cardiovascular risk factors are essential elements of secondary prevention since they significantly improve prognosis. This review highlights the need for a personalized approach in the management of NSTE-ACS, especially in vulnerable populations, and emphasizes the importance of precise antithrombotic management together with tailored revascularization strategies, as well as the role of cardiac rehabilitation in NSTE-ACS patients.
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Affiliation(s)
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain;
| | - Pedro Cepas-Guillén
- Cardiology Department, Hospital Clinic, 08036 Barcelona, Spain; (P.C.-G.); (A.A.-L.)
| | | | - Ignacio Fernández-Herrero
- Cardiology Department, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (I.F.-H.); (F.D.-D.)
| | - Héctor García-Pardo
- Cardiology Department, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
| | - Felipe Díez-Delhoyo
- Cardiology Department, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (I.F.-H.); (F.D.-D.)
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29
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Lee JH, Ahn SG, Jeon HS, Lee JW, Youn YJ, Zhang J, Hu X, Wang J, Lee JM, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Yoon MH, Tahk SJ, Kim U, Ki YJ, Shin ES, Hwang D, Kang J, Kim HS, Koo BK. Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial. Korean Circ J 2024; 54:485-496. [PMID: 38956940 PMCID: PMC11306421 DOI: 10.4070/kcj.2024.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. METHODS This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. RESULTS The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). CONCLUSIONS The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02673424.
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Affiliation(s)
- Jung-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Ho Sung Jeon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinlong Zhang
- Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Division of Cardiology, Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jinyu Huang
- Division of Cardiology, Department of Internal Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Division of Cardiology, Department of Internal Medicine, Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- Division of Cardiology, Department of Internal Medicine, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- Division of Cardiology, Department of Internal Medicine, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lijiang Tang
- Division of Cardiology, Department of Internal Medicine, Zhejiang Hospital, Hangzhou, China
| | - Wenbing Jiang
- Division of Cardiology, Department of Internal Medicine, The Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou, China
| | - Xiaomin Chen
- Division of Cardiology, Department of Internal Medicine, Ningbo First Hospital, Ningbo, China
| | - Wenming He
- Division of Cardiology, Department of Internal Medicine, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Myeong-Ho Yoon
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Seung-Jea Tahk
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - You-Jeong Ki
- Division of Cardiology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Doyeon Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeehoon Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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Shin D, Hong D, Singh M, Lee SH, Sakai K, Dakroub A, Malik S, Maehara A, Shlofmitz E, Stone GW, Jeremias A, Shlofmitz RA, Lee JM, Hahn JY, Ali ZA. Intravascular imaging-guided percutaneous coronary intervention for heavily calcified coronary lesions: a systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1653-1659. [PMID: 38874673 DOI: 10.1007/s10554-024-03150-7] [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: 02/22/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
Although multiple randomized clinical trials (RCTs) have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography-guided PCI, its benefits specifically in calcified coronary lesions is unclear due to the small number of patients included in individual trials. We performed a meta-analysis of RCTs to investigate benefits of IVI-guided PCI compared with angiography-guided PCI in heavily calcified coronary lesions. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, target-vessel or target-lesion myocardial infarction, and target-vessel or target lesion revascularization. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated by using a random-effects meta-analysis based on the restricted maximum likelihood method. A search PubMed, EMBASE, and Cochrane Library from their inception to January 2024 identified 4 trials that randomized 1319 patients with angiographically moderate or severe or severe coronary calcification to IVI-guided (n = 702) vs. angiography-guided PCI (n = 617). IVI-guided PCI resulted in a significantly lower odds of MACE (OR 0.57, 95% CI 0.40-0.80) compared with angiography-guided PCI at a weighted median follow-up duration of 27.3 months. There was no evidence of heterogeneity among the studies (I2 = 0.0%), and included trials were judged to be low risk of bias. Compared with angiography-guided PCI, IVI-guided PCI was associated with a significantly lower MACE in angiographically heavily calcified coronary lesions.
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Affiliation(s)
- Doosup Shin
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - David Hong
- Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mandeep Singh
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Seung Hun Lee
- Department of Internal Medicine, Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Koshiro Sakai
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Sarah Malik
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Akiko Maehara
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA.
- Cardiovascular Research Foundation, New York, NY, USA.
- New York Institute of Technology, Old Westbury, NY, USA.
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31
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Lee OH, Heo SJ, Johnson TW, Kim Y, Cho DK, Kim JS, Kim BK, Choi D, Hong MK, Jang Y, Jeong MH. Optical coherence tomography-guided versus intravascular ultrasound-guided percutaneous coronary intervention in patients with acute myocardial infarction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:607-617. [PMID: 38110116 DOI: 10.1016/j.rec.2023.11.014] [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: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) yields clinical outcomes comparable to intravascular ultrasound (IVUS)-guided PCI in patients with stable ischemic heart disease. However, there is a scarcity of data comparing the clinical outcomes of OCT-guided and IVUS-guided PCI in the setting of acute myocardial infarction (AMI). We sought to compare the clinical outcomes of OCT-guided vs IVUS-guided PCI for patients with AMI in the era of second-generation drug-eluting stent (DES). METHODS We identified 5260 consecutive patients who underwent PCI with a second-generation DES for AMI under IVUS or OCT guidance from pooled data derived from a series of Korean AMI registries between 2011 and 2020. The primary endpoint was the 1-year rate of target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. RESULTS A total of 535 (10.2%) and 4725 (89.8%) patients were treated under OCT and IVUS guidance, respectively. The 1-year target lesion failure rates were comparable between the OCT and IVUS groups before and after propensity score matching (hazard ratio, 0.92; 95%CI, 0.42-2.05, P=.84). The OCT utilization rate did not exceed 5% of total patients treated with second-generation DES implantation during the study period. The primary factors for the selection of OCT over IVUS were the absence of chronic kidney disease, non-left main vessel disease, single-vessel disease, stent diameter <3mm, and stent length ≤ 25mm. CONCLUSIONS OCT-guided PCI in patients with AMI treated with a second-generation DES provided comparable clinical outcomes for 1-year target lesion failure compared with IVUS-guided PCI.
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Affiliation(s)
- Oh-Hyun Lee
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Yongcheol Kim
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
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Shi H, Hyasat K, Deshmukh T, Ada C, Chiha J, Asrress K, Liou K. Optimal Percutaneous Treatment Approach to Unprotected Ostial Left Anterior Descending Artery Disease: A Meta-Analysis and Systematic Review. Heart Lung Circ 2024; 33:1123-1135. [PMID: 38614944 DOI: 10.1016/j.hlc.2024.02.006] [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: 08/07/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The optimal management strategy for significant unprotected ostial left anterior descending artery (LAD) disease remains undefined. Merits of the two most common percutaneous approaches are considered in this quantitative synthesis. METHOD A meta-analysis was performed to compare ostial stenting (OS) and crossover stenting (CS) in the treatment of unprotected ostial LAD stenosis. The primary outcome is the disparity in target lesion revascularisation (TLR). The Mantel-Haenszel method was employed with random effect model, chosen a priori to account for heterogeneity among the included studies. RESULTS Seven studies comprising 1,181 patients were included in the analyses. Of these, 482 (40.8%) patients underwent CS. Overall, there was a statistically significant trend in favour of CS (odds ratio 0.51, 95% confidence interval 0.30-0.86, p=0.01) with respect to the rate of TLR at follow-up. This remained true when TLR involving the left circumflex artery (LCx) was considered, even when there was a greater need for unintended intervention to the LCx during the index procedure (odds ratio 6.68, 95% confidence interval: 1.69-26.49, p=0.007). Final kissing balloon inflation may reduce the need for acute LCx intervention. Imaging guidance appeared to improve clinical outcomes irrespective of approach chosen. CONCLUSIONS In the percutaneous management of unprotected ostial LAD disease, CS into the left main coronary artery (LMCA) appeared to reduce future TLR. Integration of intracoronary imaging was pivotal to procedural success. The higher incidence of unintended LCx intervention in the CS arm may be mitigated by routine final kissing balloon inflation, although the long-term implication of this remains unclear. In the absence of randomised trials, clinicians' discretion remains critical.
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Affiliation(s)
- Han Shi
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kais Hyasat
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tejas Deshmukh
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia
| | - Cuneyt Ada
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia; School of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Kaleab Asrress
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia; School of Medicine, Macquarie University, Sydney, NSW, Australia
| | - Kevin Liou
- Department of Cardiology, Bankstown Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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33
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Sarraf M, Allahwala UK, Nagaraja V. Optimal Percutaneous Treatment of Ostial Left Anterior Descending Artery-Crossing is the Route to Perfection! Heart Lung Circ 2024; 33:1077-1079. [PMID: 39127484 DOI: 10.1016/j.hlc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Mohammad Sarraf
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MA, USA
| | - Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Vinayak Nagaraja
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MA, USA.
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Ali ZA, Landmesser U, Maehara A, Shin D, Sakai K, Matsumura M, Shlofmitz RA, Leistner D, Canova P, Alfonso F, Fabbiocchi F, Guagliumi G, Price MJ, Hill JM, Akasaka T, Prati F, Bezerra HG, Wijns W, McGreevy RJ, McNutt RW, Nie H, Phalakornkule K, Buccola J, Stone GW. OCT-Guided vs Angiography-Guided Coronary Stent Implantation in Complex Lesions: An ILUMIEN IV Substudy. J Am Coll Cardiol 2024; 84:368-378. [PMID: 38759907 DOI: 10.1016/j.jacc.2024.04.037] [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] [Received: 03/29/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND ILUMIEN IV was the first large-scale, multicenter, randomized trial comparing optical coherence tomography (OCT)-guided vs angiography-guided stent implantation in patients with high-risk clinical characteristics and/or complex angiographic lesions. OBJECTIVES The authors aimed to specifically examine outcomes in the complex angiographic lesions subgroup. METHODS From the original trial population (N = 2,487), high-risk patients without complex angiographic lesions were excluded (n = 514). Complex angiographic lesion characteristics included: 1) long or multiple lesions with intended total stent length ≥28 mm; 2) bifurcation lesion with intended 2-stent strategy; 3) severely calcified lesion; 4) chronic total occlusion; or 5) in-stent restenosis. The study endpoints were: 1) final minimal stent area (MSA); 2) 2-year composite of serious major adverse cardiovascular events (MACEs) (cardiac death, target-vessel myocardial infarction [MI], or stent thrombosis); and 3) 2-year effectiveness, defined as target-vessel failure (TVF), a composite of cardiac death, target-vessel MI, or ischemia-driven target-vessel revascularization. RESULTS The postpercutaneous coronary intervention (PCI) MSA was larger in the OCT-guided (n = 992) vs angiography-guided (n = 981) group (5.56 ± 1.95 mm2 vs 5.26 ± 1.81 mm2; difference, 0.30; 95% CI: 0.14-0.47; P < 0.001). Compared with angiography-guided PCI, OCT-guided PCI resulted in a lower risk of serious MACE (3.1% vs 4.9%; HR: 0.63; 95% CI: 0.40-0.99; P = 0.04). TVF was not significantly different between groups (7.3% vs 8.8%; HR: 0.82; 95% CI: 0.59-1.12; P = 0.20). CONCLUSIONS In complex angiographic lesions, OCT-guided PCI led to a larger MSA and reduced the serious MACE, the composite of cardiac death, target-vessel MI, or stent thrombosis, compared with angiography-guided PCI at 2 years, but did not significantly improve TVF. (Optical Coherence Tomography Guided Coronary Stent Implantation Compared to Angiography: A Multicenter Randomized Trial in PCI; NCT03507777).
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Affiliation(s)
- Ziad A Ali
- St Francis Hospital and Heart Center, Roslyn, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; New York Institute of Technology, Old Westbury, New York, USA
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Deutsches Zentrum für Herz-Kreislaufforschung, Partner Site Berlin, Berlin, Germany
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Center for Interventional Cardiovascular Care, Columbia University, New York, New York, USA
| | - Doosup Shin
- St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Koshiro Sakai
- St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - David Leistner
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany; German Center for Cardiovascular Research (DZHK) Partner Site RheinMain, Frankfurt, Germany
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, CIBERCV, IIS-IP, Madrid, Spain
| | | | | | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
| | | | | | - Francesco Prati
- Saint Camillus International University of Health Sciences and CLI Foundation, Rome, Italy
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, University of Galway, Ireland
| | | | | | - Hong Nie
- Abbott Vascular, Santa Clara, California, USA
| | | | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Goldberg A, Shlofmitz E, Sosa F, Thomas S, Nguyen J, Tsioulias A, Fazal A, Shin D, Sakai K, Moses JW, Ali ZA, Shlofmitz RA, Jeremias A. BOOM: A novel bifurcation stent technique using optical coherence tomography co-registration. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00589-X. [PMID: 39097428 DOI: 10.1016/j.carrev.2024.07.012] [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: 06/05/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND/PURPOSE Bifurcation lesions comprise 20 % of percutaneous coronary interventions (PCI) and are associated with worse long-term outcomes. With an increasing percentage of patients presenting with complex anatomy, including bifurcation disease, there is a need for treatment strategies to optimize PCI outcomes. METHODS/MATERIALS We retrospectively analyzed 48 patients undergoing OCT guided bifurcation PCI using the 'Bifurcation and Ostial OCT Mapping' (BOOM) technique. The primary efficacy variable studied was stent precision following deployment, defined as the distance of the most proximal stent strut from the true ostium of the target vessel. Additionally, targeted follow-up occurred by phone at 6- and 12-months post procedure, where the frequency of myocardial infarction, target lesion revascularization, target vessel and non-target vessel revascularization, and mortality were collected. RESULTS A total of 40 (83.3 %) had an ostial lesion that required treatment while the remaining patients had true bifurcation disease. Most target lesions were in either the LAD or its branches (29 lesions (60.3 %)). With respect to stent positioning, the median absolute geographic miss, (i.e., stent protrusion into the main branch or lack of complete ostial stent coverage), was 0.75 mm. At 6 months, one patient required target lesion revascularization with no additional patients at 12 months. CONCLUSIONS BOOM is a safe and simple strategy that can be a useful technique to optimize precise stent placement for ostial and bifurcation lesions.
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Affiliation(s)
- Alec Goldberg
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America; Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Evan Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Fernando Sosa
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Susan Thomas
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - James Nguyen
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Anna Tsioulias
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Alysse Fazal
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Doosup Shin
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Koshiro Sakai
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Jeffery W Moses
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Ziad A Ali
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Richard A Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America
| | - Allen Jeremias
- St. Francis Hospital & Heart Center, Roslyn, New York, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
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Prati F, Biccirè FG, Budassi S, Di Pietro R, Albertucci M. Intracoronary imaging guidance of percutaneous coronary interventions: how and when to apply validated metrics to improve the outcome. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03188-7. [PMID: 39026054 DOI: 10.1007/s10554-024-03188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
Percutaneous coronary intervention (PCI) is still burdened by a substantial number of complications despite constant technological advances, including the advent of intracoronary imaging (ICI) techniques. ICI modalities have been instrumental for the understanding the mechanism of PCI failure. Thanks to the ability to detail the pre-intervention coronary anatomy and identify the features indicative of sub-optimal stent deployment, ICI techniques can be utilised to improve coronary interventions in different clinical scenarios. More recently large randomized clinical trials on ICI guidance confirmed the clinical effectiveness of this approach especially in complex high-risk interventions.
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Affiliation(s)
- Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, Rome, 00184, Italy.
- Centro per la Lotta contro l'Infarto - CLI Foundation, Rome, Italy.
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Flavio Giuseppe Biccirè
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, Rome, 00184, Italy
- Centro per la Lotta contro l'Infarto - CLI Foundation, Rome, Italy
- Sapienza University of Rome, Rome, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, Rome, 00184, Italy
| | - Riccardo Di Pietro
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, Rome, 00184, Italy
| | - Mario Albertucci
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Via dell'Amba Aradam, 8, Rome, 00184, Italy
- Centro per la Lotta contro l'Infarto - CLI Foundation, Rome, Italy
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Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Nakamura S, Suwa S, Fujita T, Kurita T, Sugawara S, Fujii K, Suematsu N, Isawa T, Matsuo H, Tanaka H, Shirota K, Hibi K, Kadota K, Ando K, Ono K, Kimura T. Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and Diabetes. Am J Cardiol 2024; 223:18-28. [PMID: 38740165 DOI: 10.1016/j.amjcard.2024.04.054] [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] [Received: 03/17/2024] [Revised: 04/14/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and diabetes. The Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention study multivessel cohort was a prospective, multicenter, single-arm trial enrolling 1,021 patients who underwent multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between those patients with and without diabetes. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 560 patients (54.8%) with diabetes and 461 patients (45.2%) without diabetes. The mean age was not different between the 2 groups (70.9 ± 9.7 vs 71.7 ± 10.4 years, p = 0.17). Patients with diabetes more often had chronic kidney disease and complex coronary artery disease, as indicated by the greater total number of stents and longer total stent length. The rate of meeting the OPTIVUS criteria was not different between the 2 groups (61.2% vs 60.7%, p = 0.83). The cumulative 1-year incidence of the primary end point was not different between the 2 groups (10.8% vs 9.8%, log-rank p = 0.65). After adjusting for confounders, the risk of diabetes relative to nondiabetes remained insignificant for the primary end point (hazard ratio 0.97, 95% confidence interval 0.65 to 1.44, p = 0.88). In conclusion, in patients who underwent multivessel IVUS-guided PCI and were managed with contemporary clinical practice, patients with diabetes had similar 1-year outcomes to patients without diabetes.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Takanari Fujita
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Sugawara
- Department of Cardiology, Nihonkai General Hospital, Yamagata Japan
| | - Kenji Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuhiro Suematsu
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tsuyoshi Isawa
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | | | - Hiroyuki Tanaka
- Department of Cariology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Kinya Shirota
- Division of Cardiology, Matsue Red Cross Hospital, Matsue, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
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Mitsis A, Eftychiou C, Kadoglou NPE, Theodoropoulos KC, Karagiannidis E, Nasoufidou A, Ziakas A, Tzikas S, Kassimis G. Innovations in Intracoronary Imaging: Present Clinical Practices and Future Outlooks. J Clin Med 2024; 13:4086. [PMID: 39064126 PMCID: PMC11277956 DOI: 10.3390/jcm13144086] [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: 05/30/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Engaging intracoronary imaging (IC) techniques such as intravascular ultrasound or optical coherence tomography enables the precise description of vessel architecture. These imaging modalities have well-established roles in providing guidance and optimizing percutaneous coronary intervention (PCI) outcomes. Furthermore, IC is increasingly recognized for its diagnostic capabilities, as it has the unique capacity to reveal vessel wall characteristics that may not be apparent through angiography alone. This manuscript thoroughly reviews the contemporary landscape of IC in clinical practice. Focused on current methodologies, the review explores the utility and advancements in IC techniques. Emphasizing their role in clarifying coronary pathophysiology, guiding PCI, and optimizing patient outcomes, the manuscript critically evaluates the strengths and limitations of each modality. Additionally, the integration of IC into routine clinical workflows and its impact on decision-making processes are discussed. By synthesizing the latest evidence, this review provides valuable insights for clinicians, researchers, and healthcare professionals involved in the dynamic field of interventional cardiology.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Nicosia 2029, Cyprus;
| | | | | | - Konstantinos C. Theodoropoulos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.C.T.); (A.Z.)
| | - Efstratios Karagiannidis
- Second Department of Cardiology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.K.); (A.N.); (G.K.)
| | - Athina Nasoufidou
- Second Department of Cardiology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.K.); (A.N.); (G.K.)
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (K.C.T.); (A.Z.)
| | - Stergios Tzikas
- Third Department of Cardiology, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - George Kassimis
- Second Department of Cardiology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.K.); (A.N.); (G.K.)
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Vergallo R, Patrono C. Weekly journal scan: intravascular imaging to guide percutaneous coronary intervention-ready for prime time? Eur Heart J 2024; 45:2183-2185. [PMID: 38703139 DOI: 10.1093/eurheartj/ehae242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, Genova 16132, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, Genova 16132, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Rome, Italy
- Center of Excellence on Ageing, CAST, 'G. d'Annunzio' University School of Medicine, Chieti, Italy
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Gao XF, Ge Z, Kong XQ, Chen X, Han L, Qian XS, Zuo GF, Wang ZM, Wang J, Song JX, Lin L, Pan T, Ye F, Wang Y, Zhang JJ, Chen SL. Intravascular Ultrasound vs Angiography-Guided Drug-Coated Balloon Angioplasty: The ULTIMATE Ⅲ Trial. JACC Cardiovasc Interv 2024; 17:1519-1528. [PMID: 38842991 DOI: 10.1016/j.jcin.2024.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Drug-coated balloon (DCB) angioplasty seems a safe and effective option for specific de novo coronary lesions. However, the beneficial effect of intravascular ultrasound (IVUS)-guided DCB angioplasty in de novo lesions remains uncertain. OBJECTIVES This study aimed to assess the benefits of IVUS guidance over angiography guidance during DCB angioplasty in de novo coronary lesions. METHODS A total of 260 patients with high bleeding risk who had a de novo coronary lesion (reference vessel diameter 2.0-4.0 mm, and lesion length ≤15 mm) were randomly assigned to either an IVUS-guided or an angioplasty-guided DCB angioplasty group. The primary endpoint was in-segment late lumen loss (LLL) at 7 months after procedure. The secondary endpoint was target vessel failure at 6 months. RESULTS A total of 2 patients in the angiography-guided group and 7 patients in the IVUS-guided group underwent bailout stent implantation (P = 0.172). The primary endpoint of 7-month LLL was 0.03 ± 0.52 mm with angiography guidance vs -0.10 ± 0.34 mm with IVUS guidance (mean difference 0.14 mm; 95% CI: 0.02-0.26; P = 0.025). IVUS guidance was also associated with a larger 7-month minimal lumen diameter (2.06 ± 0.62 mm vs 1.75 ± 0.63 mm; P < 0.001) and a smaller diameter stenosis (28.15% ± 13.88% vs 35.83% ± 17.69%; P = 0.001) compared with angiography guidance. Five target vessel failures occurred at 6 months, with 4 (3.1%) in the angiography-guided group and 1 (0.8%) in the IVUS-guided group (P = 0.370). CONCLUSIONS This study demonstrated that IVUS-guided DCB angioplasty is associated with a lower LLL in patients with a de novo coronary lesion compared with angiography guidance. (Intravascular Ultrasound Versus Angiography Guided Drug-Coated Balloon [ULTIMATE-III]; NCT04255043).
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Leng Han
- Department of Cardiology, Changshu No. 1 People's Hospital, Changshu, China
| | - Xue-Song Qian
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China
| | - Guang-Feng Zuo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhi-Mei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Juan Wang
- Department of Cardiology, Changshu No. 1 People's Hospital, Changshu, China
| | - Jia-Xian Song
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China
| | - Ling Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Pan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. https://twitter.com/NanjingFirst
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Modi B, Dutta S, Collison D, Lampadakis I, Sen S. After RIPCORD 2, FAME 3, FLOWER-MI and FUTURE: Has the Pressure Wire had its Day? Interv Cardiol 2024; 19:e09. [PMID: 39081828 PMCID: PMC11287625 DOI: 10.15420/icr.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/13/2024] [Indexed: 08/02/2024] Open
Abstract
Recent years have seen the publication of several high-profile, negative trials about pressure wires. This has coincided with a consistent increase in the ratio of angioplasty for acute coronary syndromes versus percutaneous coronary intervention in stable coronary artery disease, a greater use of intracoronary imaging during percutaneous coronary intervention and the continued evolution of computational fluid dynamics-derived estimations of fractional flow reserve from both CT and invasive coronary angiography. Consequently, many interventional cardiologists now wonder if the pressure wire will soon become obsolete. This head-to-head article provides a critical appraisal of recent trial data, discusses a potential evolution in how pressure wires are used and debates the motion that the device (and by extension, invasive assessment of coronary physiology) has now had its day.
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Affiliation(s)
- Bhavik Modi
- Glenfield Hospital, University Hospitals of Leicester NHS TrustLeicester, UK
- Department of Cardiovascular Sciences, University of LeicesterLeicester, UK
| | - Subhabrata Dutta
- Glenfield Hospital, University Hospitals of Leicester NHS TrustLeicester, UK
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National HospitalGlasgow, UK
- School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow, UK
| | | | - Sayan Sen
- Hammersmith Hospital, Imperial College Healthcare NHS TrustLondon, UK
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Samy M, Alali A, Elbasha K, Amoey D, Hemetsberger R, Kandil N, Elawady M, Allali A, Nef H, Toelg R, Richardt G, Mankerious N. Clinical outcomes of single- versus two-stent PCI technique in severely calcified true bifurcation lesions after rotational atherectomy. Clin Res Cardiol 2024; 113:1070-1080. [PMID: 38832996 DOI: 10.1007/s00392-024-02461-y] [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] [Received: 03/13/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Severely calcified coronary bifurcations complicate percutaneous coronary interventions (PCI) and often necessitate dedicated lesion preparation. We compared the outcomes of single- versus two-stent techniques for treating heavily calcified true bifurcation lesions following rotational atherectomy (RA). METHODS Among patients receiving RA for severely calcified true bifurcations at a single center, 59 were treated with a single stent, and another 59 received two stents. We analyzed in-hospital adverse outcomes and 1-year rates of the bifurcation-oriented composite endpoint (BOCE), defined as cardiac death, target bifurcation myocardial infarction (TB-MI), or target bifurcation revascularization (TBR). RESULTS The single-stent arm was associated with more in-hospital adverse outcomes (adj. OR, 6.13; 95% CI, 1.34-28.0; p = 0.019), driven by higher peri-procedural MI rates (18.6% vs. 5.1%, p = 0.043) and more side branch compromise (13.6% vs. 0%, p = 0.006). After 1 year, both techniques had comparable 1-year BOCE (adj. HR, 0.38; 95% CI, 0.12-1.23; p = 0.106). We observed a significant interaction between the treatment technique and the presence of LM bifurcation (p interaction = 0.012), favoring single-stent technique in patients with non-LM bifurcations (HR 0.14, 95% CI 0.03-0.68; p = 0.015). Notably, the single-stent technique had lower rates of TBR (2% vs. 15%, p log-rank = 0.026) after 1 year. CONCLUSION Patients with severely calcified true bifurcation lesions, treated with RA followed by a single stent implantation, had more in-hospital adverse outcomes compared to those treated with two stents. However, the superior outcomes of the two-stent technique did not translate into improved long-term results. In fact, the two-stent technique was even associated with higher rates of revascularization after 1 year.
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Affiliation(s)
- Mohamed Samy
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Ahmad Alali
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Danial Amoey
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Rayyan Hemetsberger
- Cardiology Department, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nader Kandil
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Mohamed Elawady
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt
| | - Abdelhakim Allali
- Cardiology Department, University Heart Center Lübeck, Lübeck, Germany
| | - Holger Nef
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Medical Faculty of the Christian-Albrechts-University of Kiel, Kiel, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt.
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Frederiks P, Castaldi G, McCutcheon K, Bennett J. Platinum chromium everolimus-eluting stents for the treatment of (complex) coronary artery disease; from SYNERGY™ to the MEGATRON™. Expert Rev Med Devices 2024; 21:601-611. [PMID: 38720513 DOI: 10.1080/17434440.2024.2353722] [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: 11/18/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The introduction of drug-eluting coronary stents (DES) into clinical practice in 2002 represented a major milestone in the treatment of obstructive coronary artery disease. Over the years, significant advances in polymer coating and in antiproliferative agent technology have further improved the safety and clinical performance of newer-generation DES. AREAS COVERED Development of platinum chromium (PtCr) alloys with high radial strength and high radiopacity have enabled the design of new, thin-strut, flexible, and highly trackable stent platforms, while simultaneously improving stent visibility. These advances have facilitated complex percutaneous treatment of a diverse population of patients in clinical practice. This review will provide an overview of the evolution in PtCr everolimus-eluting stents from PROMUS Element™ to SYNERGY™ to the recently introduced SYNERGY MEGATRON™. The clinical data will be summarized and put into perspective, especially focusing on the role of the SYNERGY™ and MEGATRON™ platforms in the treatment of complex coronary artery disease and high-risk patients. EXPERT OPINION The SYNERGY™ stent demonstrates favorable clinical efficacy and safety outcome data, and whilst the clinical data on MEGATRON™ are sparse, early experience is promising. The specific overexpansion capabilities, visibility, and radial strength of the MEGATRON™ are attractive features for complex coronary interventions.
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Affiliation(s)
- Pascal Frederiks
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gianluca Castaldi
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiology, Lady Pohamba Private Hospital, Windhoek, Namibia
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Achim A. How much data is enough data for imaging-guided PCI? Int J Cardiol 2024; 406:132057. [PMID: 38648914 DOI: 10.1016/j.ijcard.2024.132057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/02/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Alexandru Achim
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; University Heart Center Graz, Medical University of Graz, Graz, Austria.
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Li T, Lu FH, Zhao Q. Impact of specialized nursing outpatient case management on post-coronary artery bypass grafting patients. World J Clin Cases 2024; 12:3035-3044. [PMID: 38898858 PMCID: PMC11185361 DOI: 10.12998/wjcc.v12.i17.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events (MACE) and require readmission after Coronary Artery Bypass Grafting (CABG) surgery. This is often attributed to patients' unhealthy lifestyles and dietary habits, inadequate understanding of the disease, and poor disease management compliance. Thus, searching for more targeted nursing intervention models that can enhance patients' self-management abilities and reduce the risk of readmission after CABG surgery is significant. AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery. METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample. The patients were divided into two groups using an odd-even number grouping method. The control group received routine nursing care, while the case management group received specialized nursing outpatient case management. The differences in psychological status, adherence to medical treatment, self-care ability, knowledge mastery, quality of life scores, and the occurrence rate of MACE were compared between the two groups. RESULTS After the intervention, the case management group had lower scores on the self-rating depression scale and self-rating anxiety scale and lower MACE rate, as well as higher scores for adherence to a healthy diet, medication adherence, good lifestyle habits, regular exercise, and timely follow-up, higher scores on the Coronary Heart Disease Self-Management Scale, higher scores for managing adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general lifestyle, and treatment adherence, higher scores for understanding coronary heart disease, recognizing the importance of medication adherence, understanding self-care points after CABG surgery, and being aware of post-CABG precautions, higher scores for physical well-being, disease condition, general health, social-psychological well-being, and work-related aspects (P < 0.05). CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment, knowledge mastery, psychological well-being, and overall quality of life in patients after CABG surgery.
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Affiliation(s)
- Tong Li
- Department of Outpatient, Comprehensive Medical Service Center, The First Affiliated Hospital of Air Force University of Military Medicine, Xi’an 710032, Shaanxi Province, China
| | - Fang-Hui Lu
- Department of Outpatient, Comprehensive Medical Service Center, The First Affiliated Hospital of Air Force University of Military Medicine, Xi’an 710032, Shaanxi Province, China
| | - Qing Zhao
- Department of Outpatient, Comprehensive Medical Service Center, The First Affiliated Hospital of Air Force University of Military Medicine, Xi’an 710032, Shaanxi Province, China
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Garin D, Cook S, Togni M, Meier P, Wenaweser P, Puricel S, Arroyo D. Experience with a novel high frequency optical coherence tomography device for intracoronary imaging: a case series. Front Cardiovasc Med 2024; 11:1384222. [PMID: 38911518 PMCID: PMC11190299 DOI: 10.3389/fcvm.2024.1384222] [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: 02/08/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Intravascular imaging, especially optical coherence tomography (OCT), has significantly improved percutaneous coronary intervention (PCI), yet its routine clinical application faces challenges. This case series introduces the Gentuity® High-Frequency Optical Coherence Tomography (HF-OCT), a novel device designed to enhance intracoronary imaging with a significantly faster pullback and smaller catheter size, potentially offering enhanced navigability in complex lesions. We aimed to assess the image quality of Gentuity® HF-OCT in complex vessel conditions, as well as presenting a case series to illustrate the application of the device in various clinical scenarios. Methods In this case series, we included all patients who underwent intracoronary HF-OCT imaging at our center. The primary endpoint was image quality assessed by clear image length (CIL). Image quality was assessed in relation to (1) lesion severity assessed by minimum lumen area (MLA); (2) vessel size, differentiating between larger (diameter ≥ 4 mm) and smaller vessel segments; (3) pre- vs. post-PCI conditions, and (4) vessel tortuosity, categorized into none, moderate, and severe. Results Twenty-four HF-OCT runs from 14 patients were included. No significant differences in CIL were observed across lesion severity terciles (p = 0.449), between small and large vessel segments [mean CIL% difference 1.3%; confidence interval (CI), -9.3 to 11.8; p = 0.802], and pre- vs. post-PCI conditions (mean CIL difference -3.9 mm; CI, -14.0 to 6.1; p = 0.373). Vessel tortuosity significantly impacted image quality, with clear reductions in CIL observed in cases of moderate (74.8; CI, 73.5 to 76.0; vs. 63.9; CI, 56.2 to 71.5; p = 0.043) and severe tortuosity (74.8; CI, 73.5 to 76.0; vs. 65.0; CI, 62.1 to 67.9; p = 0.002) compared to vessels with no tortuosity. Overall, the HF-OCT demonstrated excellent catheter deliverability and crossability, with very satisfactory image quality and no significant adverse events. Conclusion The Gentuity® HF-OCT is a new OCT device capable of navigating both small- and large-diameter vessels, with similar image quality, but vessel tortuosity seems to have an impact on image quality. It appears to be as usable as conventional OCT for pre-PCI diagnosis and OCT-guided PCI, potentially bringing additional benefits in terms of deliverability, lesion crossover and ease of use in routine clinical practice.
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Affiliation(s)
| | | | | | | | | | | | - Diego Arroyo
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
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Kwon Y, Kim N, Kim CY, Kim DH, Shin H, Jung MS, Park JS, Park YJ, Park BE, Kim HN, Jang SY, Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Cha KS, Hur SH, Hwang JY, Jeong MH. Long-term clinical outcomes of image-guided percutaneous coronary intervention in acute myocardial infarction from the Korea Acute Myocardial Infarction Registry. PLoS One 2024; 19:e0304843. [PMID: 38838047 DOI: 10.1371/journal.pone.0304843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024] Open
Abstract
Imaging modalities for percutaneous coronary intervention (PCI), such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT), have increased in the current PCI era. However, their clinical benefits in acute myocardial infarction (AMI) have not been fully elucidated. This study investigated the long-term outcomes of image-guided PCI in patients with AMI using data from the Korean Acute Myocardial Infarction Registry. A total of 9,271 patients with AMI, who underwent PCI with second-generation drug-eluting stents between November 2011 and December 2015, were retrospectively examined, and target lesion failure (TLF) at 3 years (defined as the composite of cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization) was evaluated. From the registry, 2,134 patients (23.0%) underwent image-guided PCI (IVUS-guided: n = 1,919 [20.6%]; OCT-guided: n = 215 patients [2.3%]). Based on propensity score matching, image-guided PCI was associated with a significant reduction in TLF (hazard ratio: 0.76; 95% confidence interval: 0.59-0.98, p = 0.035). In addition, the TLF incidence in the OCT-guided PCI group was comparable to that in the IVUS-guided PCI group (5.3% vs 4.7%, p = 0.903). Image-guided PCI, including IVUS and OCT, is associated with favorable clinical outcomes in patients with AMI at 3 years post-intervention. Additionally, OCT-guided PCI is not inferior to IVUS-guided PCI in patients with AMI.
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Affiliation(s)
- Youngjoon Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Do-Hoon Kim
- Department of Nuclear Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Hyewon Shin
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
- Division of Biostatistics, Linical Korea Co., Ltd, Seoul, Republic of Korea
| | - Min-Su Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jong Sung Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yoon Jung Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bo Eun Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hong Nyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, Republic of Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Cardiovascular Medicine, Deagu, Republic of Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
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Choi KH, Park TK, Song YB, Lee JM, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Yang JH, Choi SH, Gwon HC, Hahn JY, Nam CW. Intravascular Imaging and Angiography Guidance in Complex Percutaneous Coronary Intervention Among Patients With Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417613. [PMID: 38913377 PMCID: PMC11197449 DOI: 10.1001/jamanetworkopen.2024.17613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/18/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Data are limited regarding the effects of intravascular imaging guidance during complex percutaneous coronary intervention (PCI) in patients with diabetes. Objective To compare the clinical outcomes of intravascular imaging-guided vs angiography-guided complex PCI in patients with or without diabetes. Design, Setting, and Participants This prespecified secondary analysis of a subgroup of patients in RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention), an investigator-initiated, open-label multicenter trial, analyzed enrolled patients who underwent complex PCI at 20 sites in Korea from May 2018 through May 2021. Eligible patients were randomly assigned in a 2:1 ratio to undergo either the intravascular imaging-guided PCI or angiography-guided PCI. Data analyses were performed from June 2023 to April 2024. Interventions Percutaneous coronary intervention was performed either under the guidance of intravascular imaging or angiography alone. Main Outcomes and Measures The primary end point was target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. Results Among the 1639 patients included in the analysis (mean [SD] age, 65.6 [10.2] years; 1300 males [79.3%]), 617 (37.6%) had diabetes. The incidence of TVF was significantly higher in patients with diabetes than patients without diabetes (hazard ratio [HR], 1.86; 95% CI, 1.33-2.60; P < .001). Among patients without diabetes, the intravascular imaging-guided PCI group had a significantly lower incidence of TVF compared with the angiography-guided PCI group (4.7% vs 12.2%; HR, 0.41 [95% CI, 0.25-0.67]; P < .001). Conversely, in patients with diabetes, the risk of TVF was not significantly different between the 2 groups (12.9% vs 12.3%; HR, 0.97 [95% CI, 0.60-1.57]; P = .90). There was a significant interaction between the use of intravascular imaging and diabetes for the risk of TVF (P for interaction = .02). Among patients with diabetes, only those with good glycemic control (hemoglobin A1c level ≤7.5%) and who achieved stent optimization by intravascular imaging showed a lower risk of future ischemic events (HR, 0.31; 95% CI, 0.12-0.82; P = .02). Conclusions and Relevance In this secondary analysis of a subgroup of patients in the RENOVATE-COMPLEX-PCI trial, intravascular imaging guidance reduced the risk of TVF compared with angiography guidance in patients without diabetes (but not in patients with diabetes) during complex PCI. In patients with diabetes undergoing complex PCI, attention should be paid to stent optimization using intravascular imaging and glycemic control to improve outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03381872.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyeong Ho Yun
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Yong Hwan Park
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil-Sang Song
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Incheon St Mary’s Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | - Yun-Hyeong Cho
- Division of Cardiology, Department of Internal Medicine, Hanyang University Myongji Hospital, Goyang, Korea
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kook-Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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Vergallo R, Galiuto L. Weekly journal scan: angina severity reduced by percutaneous coronary intervention in the ORBITA-2 trial. Eur Heart J 2024; 45:1874-1876. [PMID: 38596889 DOI: 10.1093/eurheartj/ehae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Largo R. Benzi, 10, 16132 Genova, Italy
| | - Leonarda Galiuto
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria S. Andrea, Rome, Italy
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50
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Hamed M, Mohamed S, Mahmoud M, Kahan J, Mohsen A, Rahman F, Kayani W, Alfonso F, Brilakis ES, Elgendy IY, Mamas MA, Elbadawi A. Intravascular Imaging-Guided Versus Coronary Angiography-Guided Complex PCI: A Meta-analysis of Randomized Controlled Trials. Cardiol Ther 2024; 13:379-399. [PMID: 38630393 PMCID: PMC11093926 DOI: 10.1007/s40119-024-00364-7] [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: 11/07/2023] [Accepted: 03/04/2024] [Indexed: 05/15/2024] Open
Abstract
INTRODUCTION Trials evaluating the role of intravascular imaging in percutaneous coronary intervention (PCI) for complex coronary artery disease have yielded mixed results. This study aimed to compare the outcomes of intravascular imaging specifically intravascular ultrasound (IVUS) with those from conventional coronary angiography in complex PCI. METHODS Comprehensive electronic search of MEDLINE, EMBASE, and Cochrane databases was performed until March 2023 for randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI. Complex PCI was defined per each study, and included PCI for American College of Cardiology/American Heart Association (ACC/AHA) type B2/C lesions, unprotected left main coronary artery disease, or multivessel stenting. The primary study outcome was major adverse clinical events (MACE). RESULTS The meta-analysis included 10 RCTs with a total of 6615 patients (3576 in the intravascular imaging group and 3039 in the coronary angiography group). The weighted mean-follow up was 28.9 months. Compared with coronary angiography, intravascular imaging reduced MACE (8% vs. 13.3%; relative risk [RR] 0.63; 95% confidence interval [CI] 0.54-0.73), cardiac death (RR 0.47; 95% CI 0.31-0.73), definite/probable stent thrombosis (RR 0.48; 95% CI 0.24-0.97), target vessel revascularization (RR 0.62; 95% CI 0.46-0.83), and target lesion revascularization (RR 0.61; 95% CI 0.47-0.79). There was no difference between both groups in all-cause death (RR 0.79; 95% CI 0.53-1.18) and myocardial infarction (RR 0.80; 95% CI 0.61-1.04). CONCLUSION In patients undergoing complex PCI, intravascular imaging-specifically IVUS-reduced MACE by decreasing the incidence of cardiac death, stent thrombosis, and target vessel and target lesion revascularization.
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Affiliation(s)
- Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheref Mohamed
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Mahmoud
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonathan Kahan
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University, Loma Linda, CA, USA
| | - Faisal Rahman
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Waleed Kayani
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd Medical Center, Longview, TX, USA.
- Texas A&M School of Medicine, Bryan, TX, USA.
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