1,720,995 research outputs found
Update on provisional technique for bifurcation interventions
No full textA series of scientific evidence supports the concept that provisional side-branch stenting should be the preferred strategy for percutaneous coronary inter- vention of bifurcation coronary lesions. However, to date, many interventional cardiologists still consider this technique unsuitable for complex bifurcation lesions. This is mainly due to the fact that provisional stenting may be performed in different ways and several techni- cal refinements may influence the procedural outcome. We here systematically overviewed the arguments which should be considered during the following steps of the provisional strategy: branch wiring, side-branch predilation, “crossover” stenting, proximal optimization, kissing balloon and the side-branch rescue techniques. We suggest that provisional stenting should be regarded as a highly flexible technique which, with specific tech- nical tricks, may allow us to safely treat patients with wide spectrum of bifurcated lesion complexity
An update on radial approach for percutaneous coronary intervention in patients with chronic total occlusion
No full textRadial approach is the emerging arterial access for percutaneous coronary interventions (PCIs) in patients with coronary artery disease. Among the different subset of complex targets for PCI, chronic total occlusion (CTO) still represent a challenge for the interventional cardiologist. Is radial approach suitable for PCIon CTO? Aseries of data collected in selected centers with high volume of transradial procedures supported the change from elective transfemoral approach to systematic transradial approach. In this paper, we tried to provide an update on the technical aspects and the theoretical data which may be useful during the planning of CTOprocedures. Overall, a full knowledge of upper limb vascular anatomy, arterial sheaths/guiding catheters selections, transradial PCItechnique and CTOlesion management skill is pivotal to safely offer CTO patients the potential benefit of reduced bleeding risks through radial access adoption
Predicting the no-reflow phenomenon following successful percutaneous coronary intervention
No full textIn the setting of acute myocardial infarction, early and adequate reopening of an infarct-related artery is not necessarily followed by a complete restoration of myocardial perfusion. This condition is usually defined as 'no-reflow'. The pathophysiology of no-reflow is multifactorial since extravascular compression, microvascular vasoconstriction, embolization during percutaneous coronary intervention, and platelet and neutrophil aggregates are involved. In the clinical arena, angiographic findings and easily available clinical parameters can predict the risk of no-reflow. More recently, several studies have demonstrated that biomarkers, especially those related to the pathogenetic components of no-reflow, could also have a prognostic role in the prediction and in the full understanding of the multiple mechanisms of this phenomenon. Thus, in this article, we investigate the role of several biomarkers on admission in predicting the occurrence of no-reflow following successful percutaneous coronary interventio
Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in Apical Ballooning or Tako-Tsubo Syndrome
No full textAims To study coronary microvascular dysfunction as possible pathogenetic mechanism in Apical Ballooning Syndrome (ABS). Methods and results Fifteen ABS patients (all women, 68 +/- 14 years) underwent myocardial contrast echocardiography at baseline during adenosine infusion (140 microg/kg/min) and at 1-month follow-up and compared with a group of anterior ST-elevation myocardial infarction (STEMI) patients with similar clinical characteristics. Myocardial perfusion was assessed by contrast score index (CSI) and endocardial length of contrast defect (contrast defect length, CDL), whereas myocardial dysfunction by wall motion score index (WMSI), endocardial length of contractile dysfunction (wall motion defect length, WMDL), and LV ejection fraction (LVEF). At baseline, no difference in myocardial perfusion and dysfunction were present between the two groups. During adenosine challenge, while no changes were observed in STEMI group, in ABS patients CSI, CDL, WMSI, and WMDL significantly decreased compared with baseline (P < 0.001 vs. baseline for all parameters) and LVEF significantly increased (P = 0.01 vs. baseline). At 1-month follow-up, myocardial perfusion and dysfunction completely recovered in ABS patients (P < 0.001 vs. baseline for all parameters), whereas no significant changes were observed in STEMI group. Conclusion Our data strongly suggest that in ABS, irrespectively of its underlying aetiology, acute and reversible coronary microvascular vasoconstriction could represent a common pathophysiological mechanism
Intravascular imaging for percutaneous coronary intervention on bifurcation and unprotected left main lesions: a systematic review and meta-analysis
Full text linkBackground The efficacy of intravascular imaging (IVI) guidance for percutaneous coronary intervention (PCI) represents a contemporary hot topic. PCI in patients with bifurcation coronary lesions and unprotected left main lesions offers specific challenges that, theoretically, may particularly benefit from IVI.Objective To compare the clinical outcomes between IVI and angiography guidance for PCI in bifurcation and unprotected left main lesions.Methods Randomised clinical trials (RCTs) comparing IVI (with either intravascular ultrasound or optical coherence tomography) with angiography to guide PCI in patients with bifurcation and unprotected left main lesions were searched in PubMed and Cochrane Central Register of Controlled Trials. Two investigators independently extracted study data. Risk ratios (RRs) were calculated using the random-effects model with inverse variance weighting and the 95% CIs with the modified Knapp-Hartung-Sidik-Jonkman method. The primary outcome was target vessel failure (TVF).Results A total of seven RCTs were included, collecting data on 2494 patients in the analysis for bifurcation lesions and 1107 patients in the analysis for unprotected left main lesions. The mean follow-up duration ranged from 12 to 36 months. Compared with angiography guidance, IVI guidance significantly reduced TVF both in bifurcation lesions (RR 0.70, 95% CI 0.53 to 0.92) and unprotected left main lesions (RR 0.55, 95% CI 0.36 to 0.84). The number needed to treat to prevent one TVF with IVI was 27 in bifurcation lesions PCI and 11 in unprotected left main PCI.Conclusion In patients undergoing PCI on bifurcation and unprotected left main lesions, IVI guidance significantly reduces the risk of TVF compared with angiography guidance.PROSPERO registration number CRD42024580321
Positron emission tomography in acute coronary syndromes
No full textSeveral imaging techniques have been used to assess cardiac structure and function, to understand pathophysiology, and to guide clinical decision making in the setting of acute coronary syndromes (ACS). Over the last years, cardiac positron emission tomography (PET) has affirmed its role in this setting. Indeed, the combined quantitative assessment of myocardial metabolism and perfusion has allowed to better understand the functional status of infarcted and non-infarcted myocardium, thus improving our knowledge of myocardial response to necrosis. More recently, several studies, taking advantage of previous observations in patients with cancer, have shown that PET could also provide important information on the mechanisms of vascular instability through the early identification of activated inflammatory cells in the atherosclerotic plaque. These findings are opening the way to more effective forms of prevention of acute vascular syndromes in high-risk patients; furthermore, new more sensitive and specific tracers for the identification of vascular inflammation are under development. In this review, we describe the potential and limitations of PET in the assessment of AC
COLCHICINE IN ACUTE CORONARY SYNDROMES: A META-ANALYSIS OF 12.602 PATIENTS
No full text: Inflammation is a leading cause of ischaemic heart disease. Aim of the present study is to assess whether treatment with colchicine in patients with ACS is associated with improved cardiovascular outcomes. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) of patients with acute or recent ACS and treated with colchicine versus placebo. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials databases were searched. The primary endpoint was composite of cardiovascular death, recurrent myocardial infarction (MI), stroke or urgent/unplanned revascularization. Other endpoints were individual components of the primary endpoint, all-cause death, non-cardiovascular death, and diarrhea. PROSPERO ID CRD42025648254. Three RCTs were included, involving 12,602 patients. There was no significant difference in the primary composite endpoint between the colchicine and placebo groups (OR 0.82, 95% CI 0.63-1.07, P=0.15). Analysis of individual components of the primary endpoint also revealed no significant differences between the colchicine vs. placebo groups: cardiovascular deaths (P=0.89), recurrent MI (P=0.17), strokes (P=0.27), urgent/unplanned revascularizations (P=0.14), all-cause death (P=0.95), non-cardiovascular death (P=0.98), and diarrhea (P=0.08). At the leave-one-out analysis, the exclusion of the CLEAR trial resulted in a significant reduction in primary endpoint (P=0.005). At further sensitivity analyses, the exclusion of patients who did not receive an initial twice-daily dose regimen and the exclusion of patients enrolled after COVID-19 pandemic resulted in a significant reduction in MACE (P=0.01 and P=0.001, respectively), reflecting heterogeneity among studies. The present meta-analysis raises new questions over the indication, timing and dosing of colchicine in patients with recent MI
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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