Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, co...Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the "hepatic dome", presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.展开更多
BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidel...BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.展开更多
Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifes...Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.展开更多
The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering importan...The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.展开更多
Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.T...Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.展开更多
The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary interve...The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.展开更多
The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DA...The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.展开更多
Coronary bifurcation lesions(CBLs)account for 15%-20%of all percutaneous coronary interventions.The complex nature of these lesions is responsible for poorer procedural,early and late outcomes.This complex lesion subs...Coronary bifurcation lesions(CBLs)account for 15%-20%of all percutaneous coronary interventions.The complex nature of these lesions is responsible for poorer procedural,early and late outcomes.This complex lesion subset has received great attention in the interventional cardiac community,and multiple stenting techniques have been developed.Of these,the provisional stenting technique is most often the default strategy;however,the elective double stenting(EDS)technique is preferred in certain subsets of complex CBLs.The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials;however,this technique consists of many steps and requires training.Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes.Intravascular imaging is necessary to determine the interventional strategy and postinterventional results.This review discusses the basic concepts,contemporary percutaneous interventional technical approaches,new methods,and controversial treatment issues of CBLs.展开更多
BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-...BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-ECMO have not previously been studied.AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO.METHODS In the present observational cohort study,61 patients who received VA-ECMOsupported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled.The endpoint characteristics such as all-cause mortality,repeated cardiovascular diseases,and cardiac death were examined.RESULTS Among 61 patients,three failed stent implantation due to chronic total occlusions with severely calcified lesions.One patient showed VA-ECMO intolerance because of high left ventricular afterload.PCI was successfully performed in 57 patients(93.4%).The in-hospital mortality was 23.0%,and the overall survival was 45.9%,with a median follow-up period of 38.6(8.6-62.1)mo.CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.展开更多
Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosi...Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.展开更多
Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify t...Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify the risk factors related to patient and procedure which could be used as predictors of complications after sheath removal post PCI. Methods: The study used a prospective non-experimental correlational descriptive. Design: The sample was chosen conveniently from three different hospitals and included 118 patients who were subjected to PCI. Results: Three models were used to predict complications. In the first model, none of the baseline variables were predictive of complications. In the second model, the only type of procedure (diagnostic, stent or balloon) was predictive of complications. In the third model, compression time was found to be a risk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical professionals are in a vital position to prevent, detect and manage PCI complications at the earliest possible opportunity. It is a must to assess and categorize patients in accordance with their risk level to develop post PCI and post sheath removal complications, in order to plan management strategies to decrease the health costs and the suffering.展开更多
Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital...Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.展开更多
Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general popu...Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.展开更多
Percutaneous coronary intervention (PCI) is commonly used in the surgical treatment of patients with various types of cardiac diseases. Some patients require long-term anticoagulation in the presence of deep vein thro...Percutaneous coronary intervention (PCI) is commonly used in the surgical treatment of patients with various types of cardiac diseases. Some patients require long-term anticoagulation in the presence of deep vein thrombosis, atrial fibrillation and mechanical heart valves, and inappropriate anticoagulation during the perioperative period may lead to bleeding events or thrombotic events. In this paper, the importance of anticoagulation in the practical application of percutaneous coronary intervention (PCI) is first introduced, and then the various drug regimens used in the perioperative anticoagulation of percutaneous coronary intervention are explored in detail in the light of current research advances, with a view to providing guidance for clinical practice.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to e...Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.展开更多
BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.A...BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.展开更多
Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outco...Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.展开更多
OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
文摘Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the "hepatic dome", presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.
基金was given by a 2017 Research Grant of the Italian Society of Interventional Cardiology (SICI-GISE)
文摘BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.
文摘Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.
文摘The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.
文摘Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.
文摘The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.
文摘The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.
文摘Coronary bifurcation lesions(CBLs)account for 15%-20%of all percutaneous coronary interventions.The complex nature of these lesions is responsible for poorer procedural,early and late outcomes.This complex lesion subset has received great attention in the interventional cardiac community,and multiple stenting techniques have been developed.Of these,the provisional stenting technique is most often the default strategy;however,the elective double stenting(EDS)technique is preferred in certain subsets of complex CBLs.The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials;however,this technique consists of many steps and requires training.Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes.Intravascular imaging is necessary to determine the interventional strategy and postinterventional results.This review discusses the basic concepts,contemporary percutaneous interventional technical approaches,new methods,and controversial treatment issues of CBLs.
文摘BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-ECMO have not previously been studied.AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO.METHODS In the present observational cohort study,61 patients who received VA-ECMOsupported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled.The endpoint characteristics such as all-cause mortality,repeated cardiovascular diseases,and cardiac death were examined.RESULTS Among 61 patients,three failed stent implantation due to chronic total occlusions with severely calcified lesions.One patient showed VA-ECMO intolerance because of high left ventricular afterload.PCI was successfully performed in 57 patients(93.4%).The in-hospital mortality was 23.0%,and the overall survival was 45.9%,with a median follow-up period of 38.6(8.6-62.1)mo.CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.
文摘Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
文摘Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify the risk factors related to patient and procedure which could be used as predictors of complications after sheath removal post PCI. Methods: The study used a prospective non-experimental correlational descriptive. Design: The sample was chosen conveniently from three different hospitals and included 118 patients who were subjected to PCI. Results: Three models were used to predict complications. In the first model, none of the baseline variables were predictive of complications. In the second model, the only type of procedure (diagnostic, stent or balloon) was predictive of complications. In the third model, compression time was found to be a risk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical professionals are in a vital position to prevent, detect and manage PCI complications at the earliest possible opportunity. It is a must to assess and categorize patients in accordance with their risk level to develop post PCI and post sheath removal complications, in order to plan management strategies to decrease the health costs and the suffering.
文摘Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.
文摘Introduction
Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.
文摘Percutaneous coronary intervention (PCI) is commonly used in the surgical treatment of patients with various types of cardiac diseases. Some patients require long-term anticoagulation in the presence of deep vein thrombosis, atrial fibrillation and mechanical heart valves, and inappropriate anticoagulation during the perioperative period may lead to bleeding events or thrombotic events. In this paper, the importance of anticoagulation in the practical application of percutaneous coronary intervention (PCI) is first introduced, and then the various drug regimens used in the perioperative anticoagulation of percutaneous coronary intervention are explored in detail in the light of current research advances, with a view to providing guidance for clinical practice.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
文摘Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.
文摘BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.
文摘Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
