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  • 1
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    Online Resource
    Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 6 ( 2022-12), p. 3920-3930
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 6 ( 2022-12), p. 3920-3930
    Abstract: The pulmonary artery catheter (PAC)‐derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial work, but this term was subsequently omitted. We hypothesized that the original CPI formula (CPI RAP ) is superior to current CPI for risk stratification in CS. Methods and results A single‐centre cohort of 80 consecutive Society for Cardiovascular Angiography and Interventions (SCAI) B‐D CS patients with available PAC records was included. Overall in‐hospital mortality was 21.3%. Results showed CPI RAP to be the strongest haemodynamic predictor of in‐hospital death ( p adj  = 0.038), outperforming CPI [area under the receiver operating characteristic (ROC) curves: 0.726 and 0.673, P ‐for‐difference = 0.025]. When the population was stratified according to the identified CPI RAP (0.28 W/m 2 ) and accepted CPI (0.32 W/m 2 ) thresholds, the cohort with discordant indexes (low CPI RAP and high CPI) comprised a group of 13 patients featuring a congested phenotype with frequent right ventricle or biventricular involvement. In this group, in‐hospital mortality was high (30.8%) similar to those with concordant low CPI and CPI RAP . Conclusion Incorporating RAP in CPI calculation (CPI RAP ) improves the prognostic yield in patients with CS SCAI B‐D. A cut‐off of 0.28 W/m 2 identifies patients at higher risk of in‐hospital mortality. The improved prognostic value of CPI RAP may derive from identification of patients with more intravascular congestion who may experience substantial in‐hospital mortality, uncaptured by the commonly used CPI equation.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.6
    DOI: 10.1002/ehf2.14093
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2814355-3
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  • 2
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    Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes
    Wiley ; 2020
    In:  Catheterization and Cardiovascular Interventions Vol. 96, No. 1 ( 2020-07), p. 1-9
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 96, No. 1 ( 2020-07), p. 1-9
    Abstract: To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. Background Clinical impact of structural features of contemporary stents remains to be defined. Methods All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum‐chromium vs. cobalt‐chromium), polymer (bioresorbable vs. durable), number of crowns ( 〈 8 vs. ≥8) and number of connectors ( 〈 3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. Results Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12–18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj‐HR] 0.62, 95% confidence interval (CI) 0.39–0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32–0.93, p = .02). This independent relationship was lost for stents with diameter 〈 2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus‐family eluted drug with outcomes was observed. Conclusions Among a range of contemporary very thin stent models, an increased number of connectors improved device‐related outcomes in this investigated high‐risk procedural setting.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v96.1
    DOI: 10.1002/ccd.28667
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 3
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    Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 2 ( 2021-02)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 2 ( 2021-02)
    Abstract: The PARIS risk score (PARIS‐rs) and percutaneous coronary intervention complexity (PCI‐c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. Methods The predictive performances of the PARIS‐rs (categorized as low, intermediate, and high) and PCI‐c (according to guideline‐endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. Results After 16 (12–22) months, increasing PARIS‐rs (8.8% vs. 14.1% vs. 27.4%, p   〈  .001) and PCI‐c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI] , and target vessel revascularization), driven by MI/death for PARIS‐rs and target lesion revascularization/stent thrombosis for PCI‐c (area under the curves for MACE: PARIS‐rs 0.60 vs. PCI‐c 0.52, p ‐for‐difference  〈  .001). PCI‐c accuracy for MACE was higher in low‐clinical‐risk patients; while PARIS‐rs was more accurate in low‐procedural‐risk patients. ≥12‐month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS‐rs patients, (adjusted‐hazard ratio 0.42 [95% CI: 0.22–0.83], p = .012), with no benefit in low to intermediate PARIS‐rs patients. No incremental benefit with longer DAPT was observed in complex PCI. Conclusions In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure‐related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.2
    DOI: 10.1002/ccd.28972
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 4
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    Impact of diabetes on long‐term outcomes of bifurcation percutaneous coronary intervention. An analysis from the BIFURCAT registry
    Wiley ; 2023
    In:  Catheterization and Cardiovascular Interventions Vol. 102, No. 4 ( 2023-10), p. 620-630
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 102, No. 4 ( 2023-10), p. 620-630
    Abstract: It is still unclear the impact of diabetes mellitus (DM) in complex coronary lesions treated with percutaneous coronary intervention (PCI) which themselves are at increased incidence of adverse events. Methods BIFURCAT registry encompassed patients treated with PCI for coronary bifurcation lesion from the COBIS III and the RAIN registry. The primary endpoint was the occurrence of major cardiovascular adverse event (MACE), a composite and mutual exclusive of all‐cause death or myocardial infarction (MI) or target‐lesion revascularization (TLR). A total of 5537 patients were included in the analysis and 1834 (33%) suffered from DM. Results After a median follow‐up of 21 months, diabetic patients had a higher incidence of MACE (17% vs. 9%, p   〈  0.001), all‐cause mortality (9% vs. 4%, p   〈  0.001), TLR (5% vs. 3%, p  = 0.001), MI (4% vs. 2%, p   〈  0.001), and stent thrombosis (ST) (2% vs. 1%, p  = 0.007). After multivariate analysis, diabetes remained significantly associated with MACE (hazard ratio [HR]: 1.37; confidence interval [CI] : 1.13–1.65; p  = 0.001), all‐cause death (HR: 1.65; 95% CI: 1.24–2.19, p  = 0.001), TLR (HR: 1.45; CI: 1.03–2.04; p  = 0.031) and ST (HR: 1.73, CI: 1.04–2.88; p  = 0.036), but not with MI (HR: 1.34; CI: 0.93–1.92; p  = 0.11). Among diabetics, chronic kidney disease (HR: 2.99; CI: 2.21–4.04), baseline left ventricular ejection fraction (HR: 0.98; CI: 0.97–0.99), femoral access (HR: 1.62; CI: 1.23–2.15), left main coronary artery (HR: 1.44; CI: 1.06–1.94), main branch diameter (HR: 0.79; CI: 0.66–0.94) and final kissing balloon (HR: 0.70; CI: 0.52–0.93) were independent predictors of MACE at follow‐up. Conclusions Patients with DM treated with PCI for coronary bifurcations have a worse prognosis due to higher incidence of MACE, all‐cause mortality, TLR and ST compared to the non‐diabetics.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v102.4
    DOI: 10.1002/ccd.30802
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 5
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    Bedside intra‐aortic balloon pump insertion in cardiac intensive care unit: A single‐center experience
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 99, No. 7 ( 2022-06), p. 1976-1983
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 99, No. 7 ( 2022-06), p. 1976-1983
    Abstract: In contemporary Cardiac Intensive Care Unit (CICU), bedside intra‐aortic balloon pump (IABP) insertion under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock (CS). Currently available data on this approach are limited. Aim This study aimed to assess the feasibility and safety of bedside IABP insertion, as compared to fluoroscopic‐guided insertion in the Catheterization Laboratory (CathLab), and to describe the clinical features of patients receiving bedside IABP insertion using a standardized technique in real‐world CICU practice. Methods We prospectively evaluated all patients admitted the CICU who received transfemoral IABP between June 2020 and October 2021. The overall study cohort was divided according to implant strategy in bedside and CathLab groups. The primary outcome was correct radiographic IABP positioning at the first bedside chest X‐ray obtained after insertion. Secondary outcomes included IABP‐related complications. Results Among 115 patients, bedside IABP insertion was performed in 35 (30.4%) cases, mainly presenting with CS‐related to acute decompensated heart failure (ADHF) (68.6 vs 33.8%; p   〈  0.001), with lower LVEF, higher proportion of right ventricular involvement and higher need of inotropes/vasopressors, compared to those receiving CathLab insertion. Bedside IABP insertion resulted feasible and safe, with similar rates of correct IABP positioning (82.9 vs. 82.5%; p  = 0.963) and IABP‐related major vascular complications (5.7 vs. 5.0%; p  = 0.874), as compared to CathLab positioning. Conclusion This study suggests the feasibility and safety of bedside IABP insertion, which could be of relevant interest in patients with ADHF‐related CS who may not need coronary angiography or other urgent CathLab procedures.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v99.7
    DOI: 10.1002/ccd.30197
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 6
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    Increased prevalence of high‐risk coronary plaques in metabolic dysfunction associated stetatotic liver disease patients: A meta‐analysis
    Wiley ; 2024
    In:  European Journal of Clinical Investigation
    Details
    In: European Journal of Clinical Investigation, Wiley
    Abstract: Metabolic dysfunction associated steatotic liver disease (MASLD) is associated with an increased risk of coronary artery disease. Computed Tomography Coronary Angiography (CTCA) can assess both the extent and the features of coronary plaques. We aimed to gather evidence about the prevalence and features of coronary plaques among MASLD patients. Methods PubMed, Scopus, and Google Scholar databases were searched for randomized controlled trials and adjusted observational studies assessing the prevalence and features of coronary plaques by means of CTCA in MASLD patients as compared with a control group. The prevalence of coronary stenosis (defined as 〉 30% and 〉 50% diameter of stenosis), of increasing coronary artery calcium (CAC) score and of high‐risk features (namely low‐attenuation plaques, napkin ring sign, spotty calcification and positive remodelling) in MASLD patients were the endpoints of interest. Results Twenty‐four observational studies were included. MASLD was associated with an increased prevalence of critical coronary stenosis compared with controls (odds ratio [OR] 1.54, 95%CI 1.23–1.93). Increased values of CAC score were observed in MASLD patients (OR 1.35, 95%CI 1.02–1. 78 and OR 2.26, 95%CI 1.57–3.23 for CAC score 0–100 and 〉 100, respectively). An increased risk of ‘high‐risk’ coronary plaques was observed in MASLD patients (OR 2.13, 95%CI 1.42–3.19). As high‐risk features plaques, a higher prevalence of positive remodelling and spotty calcification characterize MASLD patients (OR 2.92, 95%CI 1.79–4.77 and OR 2.96, 95%CI 1.22–7.20). Conclusions Patients with MASLD are at increased risk of developing critical coronary stenosis and coronary plaques characterized by high‐risk features as detected by CTCA.
    Type of Medium: Online Resource
    ISSN: 0014-2972 , 1365-2362
    URL: Article
    DOI: 10.1111/eci.14188
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2004971-7
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