Revascularization Strategy In Patients Research Articles

Coronary artery bypass grafting vs. percutaneous coronary intervention in severe ischaemic cardiomyopathy: long-term survival.

The optimal revascularization strategy in patients with ischaemic cardiomyopathy remains unclear with no contemporary randomized trial data to guide clinical practice. This study aims to assess long-term survival in patients with severe ischaemic cardiomyopathy revascularized by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and Melbourne Interventional Group registries (from January 2005 to 2018), patients with severe ischaemic cardiomyopathy [left ventricular ejection fraction (LVEF) <35%] undergoing PCI or isolated CABG were included in the analysis. Those with ST-elevation myocardial infarction and cardiogenic shock were excluded. The primary outcome was long-term National Death Index-linked mortality up to 10 years following revascularization. Risk adjustment was performed to estimate the average treatment effect using propensity score analysis with inverse probability of treatment weighting (IPTW). A total of 2042 patients were included, of whom 1451 patients were treated by CABG and 591 by PCI. Inverse probability of treatment weighting-adjusted demographics, procedural indication, coronary artery disease extent, and LVEF were well balanced between the two patient groups. After risk adjustment, patients treated by CABG compared with those treated by PCI experienced reduced long-term mortality [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.45-0.79, P = .001] over a median follow-up period of 4.0 (inter-quartile range 2.2-6.8) years. There was no difference between the groups in terms of in-hospital mortality [adjusted odds ratio (aOR) 1.42, 95% CI 0.41-4.96, P = .58], but there was an increased risk of peri-procedural stroke (aOR 19.6, 95% CI 4.21-91.6, P < .001) and increased length of hospital stay (exponentiated coefficient 3.58, 95% CI 3.00-4.28, P < .001) in patients treated with CABG. In this multi-centre IPTW analysis, patients with severe ischaemic cardiomyopathy undergoing revascularization by CABG rather than PCI showed improved long-term survival. However, future randomized controlled trials are needed to confirm the effect of any such benefits.

In-hospital recurrent stroke in ipsilateral carotid web patients undergoing thrombectomy.

Carotid artery web is a possible cause of ischemic stroke, especially in young patients who lack conventional risk factors. The immediate and long-term outcomes are not well studied. We aimed to determine the association between an ipsilateral carotid web and in-hospital stroke recurrence. We analyzed data from adult patients admitted with an acute anterior circulation large vessel occlusion at a Comprehensive Stroke Center between July 2015 and March 2023. The primary outcome was in-hospital stroke recurrence and secondary outcome was in-hospital recurrent LVO. Multivariable logistic regression was performed to examine the association between ipsilateral carotid web and recurrent ischemic stroke and recurrent LVO. Of the 1463 patients with anterior circulation large vessel occlusion, 27 (1.8%) had an ipsilateral carotid artery web. Patients with carotid web were younger (median age (IQR), 60 years (53-67 years) versus 74 years (62-84 years), P < 0.01) and less likely to be Caucasian (60% vs. 80%, p = 0.014). Of the 27 patients with carotid web, 18 (70%) had no identifiable competing stroke mechanism. When compared to patients without ipsilateral carotid web, those with an ipsilateral carotid web had a higher risk of recurrent ischemic stroke (adjusted RR: 4.38, 95% CI: 1.38-13.85) and recurrent ipsilateral large vessel occlusion (adjusted RR: 4.49, 95% CI: 1.41-14.21). Carotid webs are an under recognized cause of acute large vessel occlusion and are associated with higher risk of early recurrence. Studies are needed to validate our findings and test early revascularization strategies in patients with symptomatic carotid artery webs.

Comparative Assessment of Treatment Outcomes of Various Myocardial Revascularization Strategies in Patients with Diffuse Coronary Artery Disease

Comparative Assessment of Treatment Outcomes of Various Myocardial Revascularization Strategies in Patients with Diffuse Coronary Artery Disease

Outcomes According to Coronary Disease Complexity and Optimal Thresholds to Guide Revascularization Approach: FAME 3 Trial

BackgroundCoronary disease complexity is commonly used to guide revascularization strategy in patients with multivessel disease (MVD). ObjectivesThe aim of this study was to assess the interactive effects of coronary complexity on percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) outcomes and identify the optimal threshold at which PCI can be considered a reasonable option. MethodsA total of 1,444 of 1,500 patients with MVD from the FAME (Fractional Flow Reserve versus Angiography for Multi-vessel Evaluation) 3 randomized trial were included in the analysis (710 CABG vs 734 PCI). SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were transformed into restricted cubic splines, and logistic regression models were fitted, with multiplicative interaction terms for revascularization strategy. Optimal thresholds at which PCI is a reasonable alternative to CABG were determined on the basis of Cox regression model performance. ResultsThe mean SYNTAX score (SS) was 25.9 ± 7.1. SS was associated with 1-year major adverse cardiac and cerebrovascular events among PCI patients and 3-year death, myocardial infarction, and stroke among CABG patients. Significant interactions were present between revascularization strategy and SS for 1- and 3-year composite endpoints (P for interaction <0.05 for all). In Cox regression models, outcomes were comparable between CABG and PCI for the 3-year primary endpoint for SS ≤24 (P = 0.332), with 44% of patients below this threshold and 32% below the conventional SS threshold of ≤22. ConclusionsIn patients with MVD without left main disease, PCI and CABG outcomes remain comparable up to SS values in the mid- rather than low 20s, which allows the identification of a greater proportion of patients in whom PCI may be a reasonable alternative to CABG.

Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis.

Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis (AS). Since coronary artery disease (CAD) is common among these patients, it is crucial to choose the best method and timing of revascularization. This study aims to compare different timing strategies of percutaneous coronary intervention (PCI) in patients with severe AS undergoing TAVI to clarify whether PCI timing affects the patients' outcomes or not. A frequentist network meta-analysis was conducted comparing three different revascularization strategies in patients with CAD undergoing TAVI. The 30-day all-cause mortality, in-hospital mortality, all-cause mortality at 1 year, 30-day rates of myocardial infarction (MI), stroke, and major bleeding, and the need for pacemaker implantation at 6 months were analyzed in this study. Our meta-analysis revealed that PCI during TAVI had higher 30-day mortality (RR = 2.46, 95% CI = 1.40-4.32) and in-hospital mortality (RR = 1.70, 95% CI = [1.08-2.69]) compared to no PCI. Post-TAVI PCI was associated with higher 1-year mortality compared to other strategies. While no significant differences in major bleeding or stroke were observed, PCI during TAVI versus no PCI (RR = 3.63, 95% CI = 1.27-10.43) showed a higher rate of 30-day MI. Our findings suggest that among patients with severe AS and CAD undergoing TAVI, PCI concomitantly with TAVI seems to be associated with worse 30-day outcomes compared with no PCI. PCI after TAVI demonstrated an increased risk of 1-year mortality compared to alternative strategies. Choosing a timing strategy should be individualized based on patient characteristics and procedural considerations.

Emergent coronary revascularization with percutaneous coronary intervention and coronary artery bypass grafting in patients receiving extracorporeal cardiopulmonary resuscitation.

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue for refractory cardiac arrest, of which acute coronary syndrome is a common cause. Data on the coronary revascularization strategy in patients receiving ECPR remain limited. The ECPR databases from two referral hospitals were screened for patients who underwent emergent revascularization. The baseline characteristics were matched 1:1 using propensity score between patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI). Outcomes, including success rate of weaning from extracorporeal membrane oxygenation (ECMO), hospital survival, and midterm survival in hospital survivors, were compared between CABG and PCI. After matching, most of the patients (95%) had triple vessel disease. Compared with PCI (n = 40), emergent CABG (n = 40) had better early outcomes, in terms of the rates of successful ECMO weaning (71.1% vs 48.7%, P = 0.05) and hospital survival (56.4% versus 32.4%, P = 0.04). After a mean follow-up of 2 years, both revascularization strategies were associated with favourable midterm survival among hospital survivors (75.3% after CABG vs 88.9% after PCI, P = 0.49), with a trend towards fewer reinterventions in patients who underwent CABG (P = 0.07). In patients who received ECPR because of triple vessel disease, the hospital outcomes were better after emergent CABG than after PCI. More evidence is required to determine the optimal revascularization strategy for patients who receive ECPR.

Reperfusion and Revascularisation Strategies in Patients with ST-Segment Elevated Myocardial Infarction and Heart Failure with Reduced Ejection Fraction at a Tertiary-Level Cardiac Centre in Regional North Queensland

Reperfusion and Revascularisation Strategies in Patients with ST-Segment Elevated Myocardial Infarction and Heart Failure with Reduced Ejection Fraction at a Tertiary-Level Cardiac Centre in Regional North Queensland

LB-11 | Revascularization Strategies in Patients with Peripheral Arterial Disease Involving the Femoropopliteal Arteries: A Pooled Analysis of Individual Patient Data

LB-11 | Revascularization Strategies in Patients with Peripheral Arterial Disease Involving the Femoropopliteal Arteries: A Pooled Analysis of Individual Patient Data

Abstract 3023: Association Of Lipoprotein(a) With Adverse Events Following Revascularization For Chronic Limb Threatening Ischemia: A Subgroup Analysis Of The BEST-CLI Trial

Background: Elevated lipoprotein(a) (Lp[a]) levels are implicated in the development of peripheral artery disease (PAD) and in major adverse limb events (MALE) across a range of PAD severity. The association between Lp(a) level and adverse events in patients with chronic limb threatening ischemia (CLTI) remains uncertain. Research Questions: Does Lp(a) level associate with MALE and death in patients with CLTI undergoing revascularization? Goals/Aims: To assess the association of Lp(a) level with MALE and death in patients with CLTI undergoing revascularization. Methods: The BEST-CLI trial was a randomized trial assessing the optimal revascularization strategy in patients with CLTI. A subgroup of patients underwent lipid and Lp(a) assessment during the study period and were included. The primary outcome was the first death or MALE event (above-ankle amputation or major reintervention). Hazard ratios were calculated using Cox proportional hazards models, adjusting for age, sex, statin use, and glomerular filtration rate. Results: A total of 192 patients (median [IQR] age, 67.5 [62.1, 74.2] years; 139 men [72.4%]) were included in the cohort. Median Lp(a) level was 26.8 [10.8, 65.1] with normal Lp(a) levels (&lt;30 mg/dL) observed in 104 patients, high levels (30-111 [the 90 th percentile] mg/dL) in 68 patients, and very high levels (&gt;111 mg/dL) in 20 patients. The primary outcome occurred in 75 (39.1%) patients, including 42 (40.4%), 25 (36.8%), and 8 (40.0%) patients with normal, high, and very high Lp(a) levels. There was no association between Lp(a) and the primary outcome (HR 1.00, 95% CI 0.99-1.02, Figure 1). A significant association between Lp(a) and death (HR 1.03, 95% CI 1.01-1.05) was noted. Results did not vary by randomized revascularization procedure. Conclusion: In this cohort, Lp(a) predicts death but not limb events in patients with CLTI. Larger studies are needed to understand the role of Lp(a) in patients with CLTI undergoing revascularization.

Consensus statement-graft treatment in cardiovascular bypass graft surgery.

Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. "No-Touch" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.

Five-year outcomes in patients with multivessel coronary artery disease undergoing surgery or percutaneous intervention

The outcomes from real-life clinical studies regarding the optimal revascularization strategy in patients with multivessel coronary artery disease (MVD) are still poorly investigated. In this retrospective study we assessed 5-year outcomes: primary, secondary endpoints and quality of life of 1035 individuals with severe coronary artery disease (CAD) treated either with coronary artery bypass grafting (CABG)—356 patients or percutaneous coronary intervention (PCI)—679 patients according to the recommendation of a local Heart Team (HT). At 5 years no significant difference in overall mortality and rates of myocardial infarctions (MI) were observed between CABG and PCI cohorts (11.0% vs. 13.4% for PCI, P = 0.27 and 9.6% vs. 12.8% for PCI, P = 0.12, respectively). The incidence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by increased rates of repeat revascularization (RR) were higher in PCI-cohort than in CABG-group (56.1% vs. 40.4%, P < 0.01 and 26.8% vs. 12.6%, P < 0.01, respectively), while CABG-patients experienced stroke more often (7.3% vs. 3.1% for PCI, P < 0.01). In real-life practice with long-term follow-up, none of the two revascularization modalities implemented following HT decisions showed overwhelming superiority: occurrence of death and MI were similar, rates of RR favoured CABG, while incidence of strokes advocated PCI.

Abstract TMP66: Ipsilateral Carotid Web is Associated With Higher Risk of Recurrent Stroke in Patients With Large Vessel Occlusion Undergoing Thrombectomy

Introduction: Carotid artery webs are a rare cause of embolic stroke of undetermined source, especially among the young without conventional risk factors. However, despite its detriment, the rate of stroke recurrence is not well studied. We aimed to understand the likelihood of stroke recurrence in patients with a confirmed symptomatic carotid web. Methods: We analyzed data from adult patients admitted with anterior large vessel occlusion at Rhode Island Hospital from July 2015 to March 2023. The assessment of carotid webs was conducted by a group of endovascular neurosurgeons and vascular neurologists by reviewing the vessel imaging. Any identified carotid webs on vascular imaging were reviewed by an independent vascular neurologist for adjudication. Chi square and fisher’s exact tests were used for the comparison of groups. After adjusting for age, admission NIHSS, known atrial fibrillation, and site of occlusion, multivariate logistic regression modeling was performed for in-hospital recurrence ischemic stroke. Results: Of the 1225 patients with anterior circulation large vessel occlusion, 22(1.80%) had ipsilateral carotid artery web. Patients with carotid web were younger than those without carotid web (73% &lt;65 years). Patients with ipsilateral carotid web had a higher risk of recurrent stroke compared to those without ipsilateral carotid web (OR 3.35, 95% CI,1.043373-10.7041, p = 0.042). Conclusion: Carotid webs are an under recognized cause of acute large vessel occlusion and are associated with higher risk of early recurrence. Studies are needed to validate our findings and test early revascularization strategies in patients with symptomatic carotid artery webs.

Efficacy and safety of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multivessel disease: a systematic review and network meta-analysis

Efficacy and safety of different revascularization strategies in patients with non-ST-segment elevation myocardial infarction with multivessel disease: a systematic review and network meta-analysis

Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review.

Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.

Drug-coated balloons: A better revascularization strategy in patients with multivessel coronary artery disease undergoing one-stop hybrid coronary revascularization surgery.

The optimal revascularization strategy for non-left anterior descending coronary artery (LAD) lesions during one-stop hybrid coronary revascularization (HCR) surgery lacks current evidence. This study aimed to compare the outcomes of the drug-coated balloon (DCB) and drug-eluting stent (DES) strategies in patients with non-small non-LAD lesions undergoing one-stop HCR. A total of 141 consecutive patients with multivessel coronary artery disease (MVCAD) undergoing one-stop HCR between June 1, 2018 and March 1, 2022 were retrospectively included in this study. In-hospital outcomes and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were observed. Kaplan-Meier curve analysis was used to evaluate the MACCE-free survival rate. The Cox proportional hazard model was used to identify risk factors of mid-term MACCE. Thirty-eight and 103 patients received only DCB or DES therapy, respectively, in this study. There were no significant differences in demographic characteristics and laboratory parameters between the two groups. The in-hospital MACCE rate in the DES group was numerically higher than that in the DCB group (9.7% vs. 5.3%, respectively), but the difference was not statistically significant (P = 0.4). The incidence of MACCE after patients' discharge was significantly higher in the DES group (22% vs. 5.3%, respectively, P = 0.02) during a median follow-up of 20 months. After multivariable Cox proportional hazard analysis, DCB therapy was independently associated with reduced risk of mid-term MACCE (hazard ratio, 0.21; 95% confidence interval, 0.06-0.91; P = 0.04). For patients with MVCAD undergoing one-stop HCR, DCB therapy may be the optimal revascularization strategy for non-small non-LAD coronary artery lesions with a significantly lower rate of mid-term MACCE.

Predicting the Development of Thrombosis of the Femoral-Popliteal Bypass in the Long-Term Follow-Up Period

Aim of study. The development of a program for predicting thrombosis with subsequent amputation of a limb in the long-term period after femoral-popliteal bypass (FPB).Material and methods. This is a retrospective open comparative study performed from January 10, 2016 to December 25, 2019 at Research Institute – Professor S.V. Ochapovsky Regional Clinical Hospital No. 1 of the Ministry of Health of the Krasnodar Territory, Krasnodar, which included 473 patients who underwent FPB. Depending on the type of bypass, five groups were formed: Group 1 (n=266), reversed vein (great saphenous vein (GSV); Group 2 (n=59), autovenous vein (GSV), prepared in situ; Group 3 (n=66), autovenous vein (GSV), prepared ex situ; Group 4 (n=9) synthetic graft (Jotec, Germany); Group 5 (n=73), veins of the upper limb (forearm and shoulder). In all cases of observation, multislice computed tomography with angiography revealed an extensive (25 cm or more) atherosclerotic occlusive lesion of the superficial femoral artery, corresponding to type D according to the transatlantic consensus (TASC II). The long-term followup period was 16.6±10.3 months.Results. During the hospital postoperative period, all complications developed in groups 1, 2, 3 and 5. However, no significant intergroup statistical differences were found. In the long-term follow-up period, according to the mortality rate (group 1: 4.6%; group 2: 1.7%; group 3: 4.6%; group 4: 0%; group 5: 2.8%; p=0.78), myocardial infarction (group 1: 1.9%; group 2: 0%; group 3: 1.5%; group 4: 0%; group 5: 0%; p=0.62), ischemic stroke (group 1: 0.8%; group 2: 1.7%; group 3: 1.5%; group 4: 0%; group 5: 0%; p=0.8) and bybass thrombosis (group 1: 14.5%; group 2: 19.3%; group 3: 18.5%; group 4: 44.4%; group 5: 19.7%; p=0.16), no significant intergroup differences were identified. However, the largest number of limb amputations (group 1: 4.2%; group 2: 5.3%; group 3: 9.2%; group 4: 22.2%; group 5: 1.4%; p=0.03) and the maximum composite endpoint (sum of all complications) (group 1: 26.0%; group 2: 28.1%; group 3: 35.4%; group 4: 66.7%; group 5: 23 .9%; p=0.05) were observed after the use of a synthetic graft. Using “random forest” analysis, a model and computer program was created that allows, the risk (low, medium, high) of developing bypass thrombosis to be assessed interactively, based on clinical, anamnestic, demographic and perioperative data, with subsequent amputation after FPB in the long-term follow-up period.Conclusions. Revascularization strategy for patients with extended atherosclerotic lesions of the femoropopliteal segment should be determined individually and only by a multidisciplinary council. The conduit of choice for femoral-popliteal bypass surgery is an autovenous graft. Synthetic prostheses can only be used in the absence of the latter. To identify a group of patients with a high risk of thrombosis of the femoral-popliteal bypass and limb amputation in the long-term follow-up period, the created risk stratification program for the development of these complications can be used. Precision supervision of these patients in the postoperative period will make it possible to prevent these adverse events in time.

Myocardial salvage and infarct characteristics in patients with ST-elevation myocardial infarction classified by ORBI risk score

Abstract Background The Observatoire Régional Breton sur l'Infarctus (ORBI) [1] risk score was developed to predict in-hospital cardiogenic shock (CS) development in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. The association between infarct characteristics determined by cardiac magnetic resonance imaging (CMR) and ORBI risk classification have not previously been reported in patients with STEMI. Methods The Third DANish Study of Optimal Acute Treatment of Patients With ST-Segment Elevation Myocardial Infarction (DANAMI 3) trial investigated multiple revascularization strategies in patients with STEMI. CS on admission was an exclusion criterion, thus only low and intermediate scores were included. Stratification into ‘low’ (0-7) and ‘intermediate-high’ (&amp;gt;=8) ORBI risk score was performed (n=1,396), and CMR data from admission and three months follow-up at the largest participating centre were analysed using logistic- and Cox-regression (n=534, 38%). Results A total of 1,149 (82%) were ‘low’ risk, and 247 (18%) ‘intermediate-high’ risk. Patients with ‘intermediate-high’ risk were older (median age 71 (interquartile range (IQR) 61-78) vs. 60 (52-68), p&amp;lt;0.001), and more had an admission systolic blood pressure &amp;lt; 90 mm Hg (4.9% vs. 1.4%, p=0.002), and heart rate &amp;gt; 100 bpm (30% vs. 5%, p&amp;lt;0.001). Left ventricular ejection fraction was lower at discharge (40% (30-50%) vs. 50% (45-55%), p&amp;lt;0.001), and more had an anterior infarction (61% vs. 38%, p&amp;lt;0.001) compared to ‘low’ risk patients. Moreover, median peak troponin was higher (5010 ng/L (2195-9930) vs. 2820 ng/L (1138-5805), p&amp;lt;0.001). Aside from hypertension (52% vs. 39%, p&amp;lt;0.001), there were no differences in factors not covered by the ORBI score. In patients with ‘intermediate-high’ risk, both median acute and final infarct size were larger compared to those with ‘low’ risk (21% (12-28%) vs. 15% (7-24%), p=0.004, and 15% (10-26%) vs. 10% (4-17%), p&amp;lt;0.001). Median final salvage index was lower (0.66 (0.47-0.76) vs. 0.69 (0.55-0.87), p=0.048). ‘Intermediate-high’ risk was associated with higher odds of an above-median acute infarct size (odds ratio (OR) 2.02 (95% confidence interval (CI) 1.13-3.68) p=0.019), final infarct size (OR 3.00 (1.65-5.37), p&amp;lt;0.001), and lower odds of an above-median final salvage index (OR 0.52 (0.29-0.91), p=0.026). One-year mortality was higher in patients with ‘intermediate-high’ (9.7% (95%CI 5.9-13)) compared to "low" risk patients (1.9% (1.1-2.7), p&amp;lt;0.001). In univariate analyses, ‘intermediate-high’ risk was associated with a higher mortality risk (hazard ratio 5.31 (95%CI 2.98-9.48), p&amp;lt;0.001). Conclusions In patients with STEMI, an intermediate-high ORBI risk score of &amp;gt;=8 was associated with larger infarct size and less myocardial salvage, and a 5-time higher mortality risk relative to the overall favorable outcomes in those with a low-risk score.Kaplan-Meier Plot, one-year survival

Оценка фракционного резерва кровотока при эндоваскулярном лечении пациентов с хроническим коронарным синдромом и многососудистым поражением коронарного русла

To evaluate the impact of fractional flow reserve (FFR) assessment on the choice of the myocardial revascularization strategy in patients with ischemic heart disease and multivessel coronary artery disease and to compare the long-term outcomes of complete functional or anatomical revascularization.

Association between High Bleeding Risk and 2-Year Mortality in Patients with Chronic Limb-Threatening Ischemia.

Patients with chronic limb-threatening ischemia (CLTI) have a high bleeding risk (HBR) and mortality rate. The 2-year life expectancy is an important factor in deciding the appropriate treatment strategy. This study aimed to assess the influence of HBR on the prognosis of patients with CLTI. A total of 259 patients with CLTI who underwent endovascular therapy (EVT) (mean age, 76.2 years; male, 62.9%) between January 2018 and December 2019 were evaluated. The Academic Research Consortium for HBR (ARC-HBR) criteria were applied to each patient, and the ARC-HBR scores were calculated. The cut-off score for predicting all-cause mortality within two years was derived using a survival classification and regression tree (CART) model. Causes of death and the association between ARC-HBR scores and major bleeding events within two years were also investigated. Based on the CART model, patients were divided into three groups (low HBR score 0-1.0, 48 patients; moderate HBR score 1.5-3.0, 176 patients; and high HBR score ≥ 3.5, 35 patients). During the study period, 82 patients (39.6%) died due to cardiac (n=23) and non-cardiac causes (n=59). All-cause mortality increased significantly with increasing ARC-HBR scores. Cox multivariate analysis revealed a significant association between high ARC-HBR scores and the risk of all-cause mortality within two years. Major bleeding events increased significantly with increasing ARC-HBR scores. The ARC-HBR score could predict 2-year mortality in patients with CLTI who underwent EVT. Thus, this score can help determine the best revascularization strategy for patients with CLTI.

Coronary calcification in patients presenting with acute coronary syndromes: insights from the MATRIX trial.

The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACSs) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients presenting with acute ACS. The present study was a post hoc analysis of the MATRIX programme. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause mortality, myocardial infarction (MI), or stroke up to 365 days. Among the 8404 patients randomized in the MATRIX trial, data about coronary calcification were available in 7446 (88.6%) and therefore were included in this post hoc analysis. Overall, 875 patients (11.7%) presented with severe coronary calcification, while 6571 patients (88.3%) did not present severe coronary calcification on coronary angiography. Fewer patients with severe coronary calcification underwent percutaneous coronary intervention whereas coronary artery bypass grafting or medical therapy-only was more frequent compared with patients without severe calcification. At 1-year follow-up, MACE occurred in 237 (27.1%) patients with severe calcified coronary lesions and 985 (15%) patients without severe coronary calcified lesions [hazard ratio (HR) 1.91; 95% confidence interval (CI) 1.66-2.20, P < 0.001]. All-cause mortality was 8.6% in patients presenting with and 3.7% in those without severe coronary calcification (HR 2.38, 1.84-3.09, P < 0.001). Patients with severe coronary calcification incurred higher rate of MI (20.1% vs. 11.5%, HR 1.81; 95% CI 1.53-2.1, P < 0.001) and similar rate of stroke (0.8% vs. 0.6%, HR 1.35; 95% CI 0.61-3.02, P = 0.46). Patients with ACS and severe coronary calcification, as compared to those without, are associated with worse clinical outcomes irrespective of the management strategy.