Long-term prognostic value of quantitative-flow-ratio-concordant revascularization in stable coronary artery disease

OBJECTIVES

Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease.

BACKGROUND

Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto.

METHODS

Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint.

RESULTS

A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64).

CONCLUSION

Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.

Safety of leadless pacemaker implantation in very eldery patients in a one-center study

Funding Acknowledgements

Type of funding sources: None.

Introduction

Leadless pacemakers (LPM) have demonstrated safety in patients with multiple commorbidities. Very elderly patients have multiple commorbidities and are more prone to develop complications in pacemaker implants.

Purpose

We present our experience with LPM in a subgroup of very elderly patients.

Methods

We present a prospective clinical trial that including all consecutive LPM implantation from June 1 2015 to December 25 2021. We divide the patients in two groups according to age: older or younger than 85 y/o. Clinical and electrical, characteristics, as well as related complications and electrical parameters were compared between the two groups according to age.

Results

A total of 300 LPM were implanted and divided in two groups: 231 patients of less than 85 y/o and 69 patients ≥85 y/o. Clinical and electrical characteristics were described in table 1. Mean follow-up was of 36 months. There were 7 complications, all during the implantation procedure and there were no significant differences in complications between both groups . Electrical performance had no differences between the patients and was stable at long-term follow-up. (Figure 2)

Conclusions

There were no significant differences in complications or electrical performance between both groups and LPM were safe at long-term follow-up in very elderly patients with multiple commorbidities.

Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

BACKGROUND

Functional mitral regurgitation (FMR) is a common finding among patients with heart failure (HF) and it is related to adverse events. Outcomes in patients undergoing transcatheter mitral valve repair (TMVR) are still a matter of debate. We performed a meta-analysis to assess mid- and long-term outcomes of patients with FMR treated with MitraClip® compared to medical management.

METHODS

We conducted an electronic database search of all published data PubMed Central, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar databases. The primary end-point was all-cause mortality. The secondary end-points were hospitalizations for HF, need for heart transplantation or left ventricular assist device, unplanned mitral valve surgery, myocardial infarction and stroke.

RESULTS

Five studies (n = 1513 patients) were included in the analysis. The summary estimate including all the available studies showed a statistically significant reduction in all-cause mortality favoring MitraClip® (HR 0.56, CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]). A significant reduction in the indication for advanced HF therapies (OR 0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery (OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that underwent TMVR. No differences in the incidence of myocardial infarction or stroke were found between both groups of treatment. No publication bias was detected.

CONCLUSION

TMVR with MitraClip® system was related to a significant reduction in all-cause mortality, hospitalizations for HF and the need for HF transplant, left ventricular assist device or unplanned surgery beyond 1-year follow up.