Coronary Artery Intervention Research Articles

Clinical outcomes of physiology-guided coronary revascularization in patients undergoing TAVR

Abstract Background Coronary artery disease frequently coexists with severe aortic valve stenosis (AS). Although an fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in native coronary artery has been shown to be associated with better clinical outcomes as compared with an angiography-guided PCI, it is unknown whether this applies to severe AS patients. Purpose The purpose of this study was to compare the outcomes of different revascularization strategies between FFR-guided and angiography-guided PCI in AS patients undergoing transcatheter aortic valve replacement (TAVR). Methods In this retrospective analysis, we included 401 patients with severe AS undergoing TAVR who had coexisting coronary artery disease at invasive coronary angiography. A total of 156 patients was considered to have significant coronary artery lesions (>50% of diameter stenosis) due to the visual estimation. Patients were divided into 2 groups: physiology-guided (n=96, PCI performed in case of FFR ≤0.80 or diameter stenosis ≥90%) and angiography-guided PCI (n=60, PCI performed based on angiographic evaluation). Patients were clinically followed up and evaluated for the occurrence of major adverse cardiac and cerebrovascular event (MACCE; defined as a composite of death, non-fatal myocardial infarction, target vessel failure, and cerebrovascular accident) and major bleeding event defined as ≥VARC-3 type 2. Results Most lesions (62/96; 65%) in the physiology-guided group had negative results and were deferred. During a median follow-up of 743 [from 400 to 1,186] days, physiology-guided group had a significantly lower rate of MACCE compared with the angiography-guided groups (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.20-0.83; P<0.01). In addition, physiology-guided group showed a lower major bleeding event rate compared with the angiography-guided group (adjusted HR, 0.12; 95% CI, 0.04-0.40; P<0.01). Conclusion Physiology-guided PCI resulted in better clinical outcomes and lower bleeding events than angiography-guided PCI in patients with AS undergoing TAVR.

Coronary rotational atherectomy in patients with severe aortic stenosis

Abstract Introduction Rotational atherectomy (RA) has been shown to be safe and effective in patients with severe calcified coronary arteries lesions. However, clinical data on the use of RA in patients with concomitant severe aortic stenosis (AS patients) are lacking. Escalation to RA for coronary lesion preparation in patients undergoing transcatheter aortic valve implantation (TAVI) is still controversial, given their impaired haemodynamic status and possible higher risk of complications. We reported the clinical outcomes of AS patients undergoing RA and TAVI from a prospective clinical registry and compared their outcome with patients undergoing RA with no severe aortic valve stenosis (non-AS patients). Methods We retrieved data of all consecutively enrolled patients in a single centre registry from January 2016 up to October 2021. All AS patients who underwent RA prior to TAVI within a six-month period were included for our analysis. We compared the AS patients with all patients without severe aortic stenosis (non-AS patients) who underwent RA during the same period. Data were analysed to assess rates of in-hospital major adverse cardiovascular event (MACE) in AS vs non-AS patients. MACE was defined as composite of cardiac death, myocardial infarction, and target lesion revascularisation. Procedural characteristics as well as in-hospital outcomes and complications were also examined to detect differences between both patient groups. We then performed univariate and multivariate analyses using binary logistic regression with the presence of severe aortic stenosis as a dependent variable for MACE. Results A total of 472 patients underwent RA. Of those, 38 (8.05%) had severe AS and received TAVI within six months after index RA. Compared with the AS-patients, more non-AS patients presented with acute coronary syndrome (2.6% vs 19.8 %; p<0.009). Left main coronary artery intervention was documented in 36.8% of the AS-patients and in 25.1% of the non-AS patients. Mechanical circulatory support during the procedures was low (10 %) in both groups and was used only in two patients from the AS group. The procedural success was 97% and did not differ between both patients’ groups. There was no difference of in-hospital MACE between the AS and non-AS patients (7.9% vs 8.8%; p=0.418). Procedural rates of complications related to RA such as slow flow, coronary dissection, coronary perforation, or trapped burr did not differ between both patient groups. Adverse outcomes of RA were not affected by the presence of severe AS in the univariate analysis (OR 1.12; 95% CI [0.33-3.91]; p=0.857). Conclusion RA in patients with severe AS undergoing TAVI is feasible, and in-hospital adverse events were comparable to non-AS patients. Adequate lesion preparation of calcified coronary arteries should be implemented regardless of the presence of severe AS.

A Rare Case of Ischemic Optic Chiasmopathy Following Left Ventricular Dysfunction in a Patient with Coronary Artery Disease

We report a case of transient bitemporal hemianopia following a hypotensive episode in a patient of coronary artery disease (CAD). A 51-year-old male presented with anterior wall myocardial infarction (AWMI) and underwent percutaneous coronary artery intervention (PCI). On the second day post procedure, he developed an acute ischemic event following a cardioembolic infarct to the left middle cerebral artery (MCA) region. Over the next few days, the patient had persistent drop in blood pressure, during which he developed a transient bitemporal hemianopia, which improved after blood pressure correction, consistent with ischemic chiasmopathy. As such in literature, ischemic optic chiasmopathy is a very rare entity. This case report emphasizes that clinicians should consider that sustained hypotension associated with a cardiac event may lead to transient ischemic phenomenon such as the witnessed visual impairment due to hypoperfusion of the optic chiasm.

TCT-109 Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention

TCT-109 Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention

Quality of Life in Patients With Unstable Angina Before and After Percutaneous Coronary Intervention: A Single-Center Pilot Study Using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) Questionnaire.

Background Unstable angina (UA) has a negative impact on patients' quality of life. Percutaneous coronary intervention (PCI) is a commonly recommended treatment that exhibits positive therapeutic effects and enhances quality of life. This study aimed to compare the alterations in quality of life and related factors before and after PCI in UA patients. Methods Alongitudinal follow-up study was conducted on 48 patients with UA before and one month after undergoing PCI. The European Quality of Life (EuroQol) 5-Dimension 5-Level (EQ-5D-5L) scale was utilized to measure the quality of life of patients. Results The study revealed a significant improvement in the quality of life score after one month of coronary artery intervention compared to the pre-intervention stage: the quality of life score before the intervention was 0.73 ± 0.32, whereas it increased to 0.89 ± 0.20 after one month (p<0.001). Sex, occupation, and troponin T were associated with changes in quality of lifeone month after the coronary artery intervention. Conclusion The pilot study demonstrated a notable enhancement in the quality of life among patients with UA following coronary intervention. Additionally, sex, occupation, and troponin T were identified as factors associated with this improvement.

Outcomes of Thoracic Aortic Interventions in Marfan Syndrome in the State of Texas Over Eleven Years.

Marfan Syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions in the Marfan Syndrome population in the state of Texas from 2009-2019. A retrospective review of the Texas Inpatient Discharge Dataset from 1/1/2009-31/12/2019. Discharges from acute care hospitals with a Marfan Syndrome diagnosis by International Classification of Diseases 9/10 codes and a procedure code for thoracic aortic intervention were analyzed utilizing descriptive, univariate, and multivariable regression statistics. There were 4,641 Marfan Syndrome discharges identified, of whom 644(13.9%) underwent thoracic aortic intervention. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223(34.6%). Thirty-three(5.1%) had a concomitant coronary artery intervention. There were 30(4.7%) in-hospital mortalities, 126(19.6%) diagnoses of acute renal failure, 52(8.1%) had mechanical ventilation >96 hours, and the median length of stay was 10[IQR : 7-16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality (OR : 3.69[IQR : 1.15-11.90], p = 0.029) and acute renal failure (OR : 2.66[IQR : 1.19-5.94], p = 0.017). Aortic dissections/ruptures were associated with acute renal failure (OR : 1.73[IQR : 1.14-2.63], p = 0.010), ventilation >96 hours (OR : 2.19[IQR : 1.21-3.97], p = 0.010), and 15% longer length of stay (95% CI : 2.4-29.1%, p = 0.038). Thoracic aortic interventions are frequent amongst the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines, and preventative management of Marfan Syndrome aortopathy.

Predictive value of CHA2 DS2 -VASc score for in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI.

This study aimed to explore the predictive value of CHA2 DS2 -VASc score for in-hospital major adverse cardiac events (MACEs) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary artery intervention. A total of 746 STEMI patients were divided into four groups according to CHA2 DS2 -VASc score (1, 2-3, 4-5, >5). The predictive ability of the CHA2 DS2 -VASc score for in-hospital MACE was made. Subgroup analysis was made between gender differences. In a multivariate logistic regression analysis model including creatinine, total cholesterol, and left ventricular ejection fraction, CHA2 DS2 -VASc score was an independent predictor of MACE as a continuous variable (adjusted odds ratio: 1.43, 95% confidence interval [CI]: 1.27-1.62, p < .001). As a category variable, using the lowest CHA2 DS2 -VASc score of 1 as a reference, CHA2 DS2 -VASc score 2-3, 4-5, >5 groups for predicting MACE was 4.62 (95% CI: 1.94-11.00, p = .001), 7.74 (95% CI: 3.18-18.89, p < .001), and 11.71 (95% CI: 4.14-33.15, p < .001). The CHA2 DS2 -VASc score was also an independent risk factor for MACE in the male group, either as a continuous variable or category variable. However, CHA2 DS2 -VASc score was not a predictor of MACE in the female group. The area under the curve value of the CHA2 DS2 -VASc score for predicting MACE was 0.661 in total patients (74.1% sensitivity and 50.4% specificity [p < .001]), 0.714 in the male group (69.4% sensitivity and 63.1% specificity [p < .001]), but there was no statistical significance in the female group. CHA2 DS2 -VASc score could be considered as a potential predictor of in-hospital MACE with STEMI, especially in males.

Systematic Review and Meta-analysis of Radial or Femoral Access for Carotid Stenting.

There is agrowing interest in performing coronary artery and neurovascular interventions via the radial artery; however, few studies have examined the outcomes of transradial carotid stenting. Therefore, our study aimed to compare cerebrovascular outcomes and crossover rates in carotid stenting between transradial and traditional transfemoral approaches. Asystematic review was performed by searching three electronic databases from inception to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, random effect meta-analysis was used to pool the odds ratios (ORs) for stroke, transient ischemic attack, major adverse cardiac events, death, major vascular access site complications, and procedure crossover rates between the transradial and transfemoral approaches. A total of 6 studies were included involving a total of n = 567transradial and n = 6176transfemoral procedures. The ORs for stroke, transient ischemic attack, and major adverse cardiac events were 1.43 (95% confidence interval, CI 0.72-2.86, I2 = 0), 0.51 (95% CI 0.17-1.54, I2 = 0), and 1.08 (95% CI 0.62-1.86, I2 = 0), respectively. Neither the major vascular access site complication rate (OR 1.11, 95% CI 0.32-3.87, I2 = 0) nor crossover rate (OR 3.94, 95% CI 0.62-25.11, I2 = 57%) showed statistically significant differences between the two approaches. The modest quality of the data suggested comparable procedural outcomes between the transradial and transfemoral approaches when performing carotid stenting; however, high level evidence regarding postoperative brain images and risk of stroke in transradial carotid stenting are lacking. Therefore, it is reasonable for interventionists to weigh up the risks of neurological events and potential benefits, including fewer access site complications, before choosing the radial or femoral arteries as access sites. Future large-scale randomized controlled trials are imperative.

National Trends of Percutaneous Mechanical Support Utilization During Percutaneous Coronary Interventions in Chronic Total Occlusion

Coronary chronic total occlusion (CTO) is common in patients with multivessel coronary artery disease. Percutaneous coronary artery (PCI) interventions have shown favorable outcomes in patients with CTO. Nevertheless, the data regarding the utilization of mechanical circulatory support in CTO PCIs is not well established. We sought to investigate the trends in utilization and periprocedural complications in this population. Using the National Inpatient Sample database from 2011 to 2019, we identified patients diagnosed with CTO who underwent PCI. We investigated the presence of a linear trend in the utilization of mechanical circulatory support (MCS) during those procedures and the associated periprocedural complications using the Cochran-Armitage method. A total of 208,123 patients who were diagnosed with CTO and underwent PCI from 2011 to 2019, of which in 6,319 patients MCS was used during the procedure. Patients in the MCS group were older (67.4 vs 66.4 years), less likely to be women (24.0% vs 26.4%), and equally likely to be African-American (9.4% vs 8.8%) with a higher burden of co-morbidities in terms of coronary artery disease, congestive heart failure, and atrial fibrillation (p<0.001 for all). Using the Cochrane-Armitage method, we found a statistically significant linear uptrend in the utilization of MCS from 269 (1.4%) to 990 cases (7.0%) from 2011 to 2019. Using multivariable logistic regression, female gender, renal failure, alcohol abuse, coagulopathy, and fluid and electrolyte disorders were identified as independent predictors of mortality in CTO PCI procedures assisted with MCS (p≤0.007). In conclusion, the utilization of MCS in CTO PCI procedures has been increasing over the years. Female gender and renal failure are independently associated with a higher mortality risk.

PCI or CABG for left main coronary artery disease: the SWEDEHEART registry.

An observational nationwide all-comers prospective register study to analyse outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in unprotected left main coronary artery (LMCA) disease. All patients undergoing coronary angiography in Sweden are registered in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. Between 01/01/2005 and 12/31/2015, 11 137 patients with LMCA disease underwent CABG (n = 9364) or PCI (n = 1773). Patients with previous CABG, ST-elevation myocardial infarction (MI) or cardiac shock were excluded. Death, MI, stroke, and new revascularization during follow-up until 12/31/2015 were identified using national registries. Cox regression with inverse probability weighting (IPW) and an instrumental variable (IV), administrative region, were used. Patients undergoing PCI were older, had higher prevalence of comorbidity but lower prevalence of three-vessel disease. PCI patients had higher mortality than CABG patients after adjustments for known cofounders with IPW analysis (hazard ratio [HR] 2.0 [95% confidence interval (CI) 1.5-2.7]) and known/unknown confounders with IV analysis (HR 1.5 [95% CI 1.1-2.0]). PCI was associated with higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE; death, MI, stroke, or new revascularization) than CABG, with IV analysis (HR 2.8 [95% CI 1.8-4.5]). There was a quantitative interaction for diabetic status regarding mortality (P = 0.014) translating into 3.6 years (95% CI 3.3-4.0) longer median survival time favouring CABG in patients with diabetes. In this non-randomized study, CABG in patients with LMCA disease was associated with lower mortality and fewer MACCE compared to PCI after multivariable adjustment for known and unknown confounders.

Cost Change of Elective Percutaneous Coronary Artery Intervention for Chronic Coronary Syndrome in Japan From 2010 to 2019.

Because of revisions to insurance reimbursement costs, medical fees have changed for investigations and percutaneous coronary intervention (PCI) treatment of chronic coronary syndrome (CCS). In this retrospective study, we investigated these changes and their effects on mortality and cardiovascular events. We included 1,483 patients who underwent elective PCI for CCS between April 2010 and September 2019. The primary outcomes were changes in PCI procedure fees and all included hospitalization fees due to the biennial revisions of reimbursement costs across 5 time periods (~2 years each). Secondary outcomes were rates of survival and freedom from major adverse cerebral and cardiovascular events (MACCE) in each time period. Patient characteristics were generally unchanged over the study period; however, treatment procedures changed significantly, with changes in the approach site (from transfemoral to transradial access; P<0.0001) and final device (from bare-metal stents to drug-eluting stents; P<0.0001), and an increase in the use of imaging modalities (P<0.0001). Medical fee parameters (primary outcomes) decreased significantly from 2010 to 2019 (P<0.001): PCI procedure fees decreased by 25%, whereas all included hospitalization fees decreased by 20%. There were no significant differences in survival or freedom-from-MACCE rates between periods. Because of revisions to reimbursement prices, there were rapid and significant decreases in PCI procedure and hospitalization fees for CCS. These changes had no effect on mortality or cardiovascular events.

Небіволол – бета-адреноблокатор з вазодилатаційними властивостями: досягнення і перспективи застосування

Огляд присвячений клінічному застосуванню β-адреноблокатора з вазодилатаційними властивостями – небівололу. Розглянуто основні фармакологічні властивості та характеристики препарату, його кардіоселективність та механізми вазодилатаційної дії. Показано особливості застосування небівололу в лікуванні есенціальної артеріальної гіпертензії, ішемічної хвороби серця та серцевої недостатності. Препарат не має діабетогенної дії при тривалому застосуванні, сприятливо впливає на показники ліпідного та вуглеводного обмінів. У хворих з ішемічною хворобою серця продемонстровано його антиангінальну й антиішемічну дію та зниження частоти рецидивів після виконання операцій на коронарних артеріях. Препарат добре толерується та має високу ефективність у зниженні показників смертності в пацієнтів віком понад 70 років з хронічною серцевою недостатністю, незалежно від фракції викиду лівого шлуночка. У лікуванні ішемічної хвороби серця при цукровому діабеті 2-го типу перевагу надають β-адреноблокаторам з вазодилатаційними властивостями. При необструктивних ураженнях коронарних артерій з-поміж β-адреноблокаторів перевагу надають небівололу для лікування мікросудинної стенокардії. У пацієнтів з артеріальною гіпертензією небіволол, крім антигіпертензивного ефекту, має сприятливий вплив на функцію ендотелію, метаболічний профіль, центральну гемодинаміку, якість життя пацієнтів, а також кращий профіль побічних ефектів.

Comparison of Coronary Artery Bypass Grafting Outcomes in patients with and without Prior Percutaneous Coronary Artery Intervention

Percutaneous coronary intervention (PCI) is a crucial treatment for patients with coronary artery disease (CAD), especially high-risk patients like advanced age, diabetes, chronic kidney disease, left main lesions, and multi vessel CAD. Objective: To compare coronary artery bypass grafting outcomes in patients with and without prior percutaneous coronary artery intervention. Methods: This retrospective 5-year cross-sectional study was conducted on 2579 patients operated for CABG in between August 1st, 2017, and December 31st, 2021 in a tertiary care hospital. All patients who underwent CABG were included in study, and comparison was done in patients with or without PCI. Data analysis were done by using SPSS version 23. p&lt;0.05 was set statistically significant. Results: The results of perfusion and cross clamp time in operative room, use of IABP and reopening rates in both groups showed no statistically significant difference. The incidence of post-operative atrial fibrillation in group A is 4% Vs 1.5% in group B with significant p value of 0.028. Prolong ventilation, perioperative stroke and reintubation rates comparison in both groups were with non-significant p values. In hospital mortality was 4.5% in group A and 3.7% in group B with p-value of 0.370 which is non-significant. Conclusions: Patients with prior percutaneous coronary intervention can undergo CABG surgery with similar mortality rates as those with no prior PCI. The only significant difference in morbidity is post-operative risk of atrial fibrillation which is more in prior PCI patients’ group.

Current achievements and prospects for the use of nebivolol in the treatment of patients with cardiovascular diseases

A literature review deals with the clinical use of nebivol as a beta-blocker (BB) with vasodilating properties. The principal pharmacological properties and characteristics of the drug, its cardioselectivity and mechanisms of vasodilation are presented. The special place of nebivolol in the treatment of essential arterial hypertension (AH), coronary heart disease (CHD) and heart failure (HF) is outlined. The drug does not possess a diabetogenic activity with a long-term use, and impacts favourably on the parameters of lipid and carbohydrate metabolism. In CHD patients, nebivolol demonstrates the anti-anginal and anti-ischemic activities, and reduces the frequency of angina recurrence after coronary artery interventions. The drug is well tolerated and characterized by a high effectiveness with respect to the reduction of mortality rates in patients with chronic HF over 70 years of age, regardless of the left ventricular ejection fraction. Vasodilating BB are preferred in the treatment of CHD patients with type 2 diabetes. In case of non-obstructive coronary lesions, nebivolol is chosen among existing BBs for the treatment of microvascular angina. The use of nebivolol in AH patients, in addition to the antihypertensive effect, is characterized by a favorable impact on the function of endothelium, the metabolic profile, central hemodynamics, health-related quality of life of patients, as well as more favorable profile of side effects.

Prediction of the development of contrast‑induced nephropathy following percutaneous coronary artery intervention by machine learning

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients with coronary artery disease undergoing elective percutaneous coronary intervention(PCI). We developed a machine learning-based risk stratification model to predict contrast-induced nephropathy after PCI. A study retrospectively enrolling 240 patients eligible for PCI from December 2017 to May 2020 was performed. CIN was defined as a rise in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 h after surgery. Eight machine learning methods were performed based on clinical variables. Shapley Additive exPlanation values were also used to interpret the best-performing prediction models. Development of CIN was found in 37 patients(16.5%) after PCI. There were 11 significant predictors of CIN, including uric acid, peripheral vascular disease, cystatin C, creatine kinase-MB, haemoglobin, N-terminal pro-brain natriuretic peptide, age, diabetes, systemic immune-inflammatory index, total protein, and low-density lipoprotein. Regarding the efficacy of the machine learning model that accurately predicted CIN, SVM exhibited the most outstanding AUC value of 0.784. The SHAP and radar plots were used to illustrate the positive and negative effects of the 11 features attributed to the SVM. Machine learning models have the potential to identify the risk of CIN for elective PCI patients.

Percutaneous coronary intervention with Impella support with and without intra-aortic balloon in cardiogenic shock patients

ObjectiveTo assess the clinical characteristics and in-hospital bleeding complications and major adverse cardiac and cerebrovascular events (MACCE) associated with the use of Impella alone or the combination of an intra-aortic balloon pump (IABP) with Impella in cardiogenic shock (CS) patients undergoing percutaneous coronary intervention (PCI). MethodsAll CS patients who underwent PCI and were treated with an Impella mechanical circulatory support (MCS) device were identified. Patients were divided into two groups: having MCS support with Impella alone or with both, IABP and Impella simultaneously (dual MCS group). Bleeding complications were classified by a modified Bleeding Academic Research Consortium (BARC) classification. Major bleeding was defined as BARC≥3 bleeding. MACCE was the composite of in-hospital death, myocardial infarction, cerebrovascular events and major bleeding complications. ResultsBetween 2010 and 2018 a total of 101 patients were treated at six tertiary care New York hospitals with either Impella (n = 61) or dual MCS with Impella and IABP (n = 40). Clinical characteristics were similar for both groups. Dual MCS patients presented more often with a STEMI (77.5 % vs. 45.9 %, p = 0.002) and had left main coronary artery intervention (20.3 % vs. 8.6 %, p = 0.03). Major bleeding complications (69.4 % vs. 74.1 %, p = 0.62) and MACCE rates (80.6 % vs. 79.3 %, p = 0.88) were very high but similar in both groups, however access site bleeding complications were lower in patients treated with dual MCS. In-hospital mortality was 29.5 % for the Impella group and 25.0 % for the dual MCS group (p = 062). Access site bleeding complications were lower in in patients treated with dual MCS (5.0 % vs. 24.6 %, p = 0.01). ConclusionIn CS patients undergoing PCI with either the Impella device alone or with Impella and IABP, major bleeding complications and MACCE rates were high but not significantly different between the two groups. In hospital mortality was relatively low in both MCS groups despite the high-risk characteristics of these patients. Future studies should assess the risks and benefits of the simultaneous use of these two MCS in CS patients undergoing PCI.

Cardiovascular Outcomes and Mortality After Bariatric Surgery in Patients With Nonalcoholic Fatty Liver Disease and Obesity

Bariatric surgery (BS) is associated with significantly reduced incidence of cardiovascular diseases and mortality in patients with obesity. However, whether BS can decrease major adverse cardiovascular events in patients with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. To investigate the association of BS with the incidence of adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity. This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 35 or greater and NAFLD (without cirrhosis) who underwent BS between January 1, 2005, and December 31, 2021, were included. Patients in the BS group were matched with patients who did not undergo surgery (non-BS group) according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. Patient follow-up ended on August 31, 2022, and data were analyzed in September 2022. Bariatric surgery vs nonsurgical care. The primary outcomes were defined as the first incidence of new-onset heart failure (HF), composite cardiovascular events (unstable angina, myocardial infarction, or revascularization, including percutaneous coronary intervention or coronary artery bypass graft), composite cerebrovascular disease (ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and a composite of coronary artery procedures or surgeries (coronary stenting, percutaneous coronary intervention, or coronary artery bypass). Cox proportional hazards models were used to estimate hazard ratios (HRs). Of 152 394 eligible adults, 4693 individuals underwent BS; 4687 patients who underwent BS (mean [SD] age, 44.8 [11.6] years; 3822 [81.5%] female) were matched with 4687 individuals (mean [SD] age, 44.7 [13.2] years; 3883 [82.8%] years) who did not undergo BS. The BS group had significantly lower risk of new-onset of HF (HR, 0.60; 95% CI, 0.51-0.70), cardiovascular events (HR, 0.53; 95% CI, 0.44-0.65), cerebrovascular events (HR, 0.59; 95% CI, 0.51-0.69), and coronary artery interventions (HR, 0.47; 95% CI, 0.35-0.63) compared with the non-BS group. Similarly, all-cause mortality was substantially lower in the BS group (HR, 0.56; 95% CI, 0.42-0.74). These outcomes were consistent at follow-up duration of 1, 3, 5, and 7 years. These findings suggest that BS was significantly associated with lower risk of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity.

Clinical Characteristics and Outcome of Percutaneous Coronary Intervention in Yemeni Patients.

Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings.

Assessment of Brain Natriuretic Peptide in Contrast-induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Coronary Artery Intervention

Assessment of Brain Natriuretic Peptide in Contrast-induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Coronary Artery Intervention

Safety and efficacy of using Judkins left 3.5 guiding catheters for transradial right coronary artery intervention.

There is limited data about the use of a Judkins left (JL) 3.5 guiding catheter for routine transradial right coronary artery (RCA) percutaneous coronary intervention (PCI). This study investigated the safety and efficacy of JL3.5 for RCA PCI. Patients with acute coronary syndrome (ACS) who underwent transradial RCA PCI between November 2019 and November 2020 at the Second Hospital of Shandong University were included. The study retrospectively compared JL 3.5 vs. other routine guiding catheters (GCs), including Judkins right (JR) 4.0 and Amplatz (left). Logistic multivariable analysis was used to analyze the factors associated with transradial RCA PCI success rate, in-hospital complications, and extra support. The study included 311 patients: 136 in the routine GC group and 175 in the JL 3.5 group. There were no significant differences between the two groups regarding in-hospital complications, extra support technics, or success. The multivariable analyses showed that coronary chronic total occlusion (CTO) was negatively associated with intervention success (OR = 0.06, 95% CI: 0.016-0.248, p < 0.001) but positively with extra support (OR = 8.74, 95% CI: 1.518-50.293, p = 0.015). Tortuosity was associated with extra support (OR = 16.50, 95% CI: 3.324-81.589, p = 0.001). In the JL 3.5 group, the left ventricular ejection fraction (OR = 1.11, 95% CI: 1.03-1.20, p = 0.006), CTO (OR = 0.07, 95% CI: 0.008-0.515, p = 0.009), and tortuosity (OR = 0.17, 95% CI: 0.03-0.95, p = 0.043) were independently associated with intervention success. JL 3.5 appears to be as safe and effective as the JR 4.0 and Amplatz (left) catheters for RCA PCI. When using the JL 3.5 catheter for RCA PCI, heart function, CTO, and tortuosity should be considered.