Correlates of Hemodynamic Instability During Non-Emergent Percutaneous Coronary Intervention: Refining High-Risk Criteria for Utilizing Mechanical Circulatory Support.

Background: Previous studies using high-risk criteria to select patients for mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI) have not consistently shown a benefit in reducing adverse outcomes. Identifying correlates for intra-procedural hemodynamic instability (HI) may improve patient selection for MCS.

Methods: Consecutive, hemodynamically stable patients undergoing non-emergent PCI between 2018 and 2022 were reviewed.

Machine Learning in Intravascular Ultrasound: Validating Automated Lesion Assessment for Complex Coronary Interventions.

Background: Intravascular ultrasound (IVUS) is essential for assessing complex coronary lesions, but remains underutilized in part due to difficulties in image interpretation. The AVVIGO IVUS Automated Lesion Assessment (ALA) software, which uses machine learning (ML) for automatic segmentation, promises to simplify lesion assessment. This study evaluated the agreement in stent size selection between ALA, an independent core laboratory (CL), and an expert interventional cardiologist (IC) for complex lesions.

Lack of Racial Disparities in Cangrelor Therapy in Patients Presenting With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Background: Cangrelor is an intravenous P2Y12 receptor antagonist that exerts rapid and potent antiplatelet effects. It is associated with a reduction in the indcidence of ischemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Aims: The aim of our study was to investigate the racial disparities and their impact on outcomes among patients with ACS who were treated with cangrelor during PCI.

Epicardial Fat Tissue: A Potential Marker for Coronary Microvascular Dysfunction.

Background: Coronary microvascular dysfunction (CMD), which mimics symptoms of obstructive coronary artery disease, has significant prognostic implications. While epicardial adipose tissue normally has a protective role, increased epicardial adipose tissue is associated with inflammation and may contribute to CMD. However, a direct correlation remains unclear.

Examining the relationship between monocytes and monocyte-derived ratios in post-percutaneous coronary intervention patients and their impact on coronary artery disease progression.

Background: Inflammation plays a key role in the progression and instability of coronary atherosclerosis. Monocytes and their ratios with eosinophils and lymphocytes serve as valuable markers for assessing inflammation. We explored blood monocyte levels and their related ratios in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) or significant de novo lesions (DNL).

Coronary microvascular dysfunction endotypes: IMR tips and tricks.

Coronary microvascular dysfunction (CMD) is an important clinical disease spectrum which has gained widespread attention due to chronic anginal symptoms, and worse clinical outcomes, with or without obstructive coronary artery disease (CAD). Coronary microcirculatory dysfunction is due to a wide array of mechanisms such as inflammation, platelet aggregation, vessel wall collagen deposition, imbalance of nitric oxide, free radicals, and sympathetic/parasympathetic simulation. As noted in this supplement, CMD can occur as a primary disease or co-exist with multi-array of diverse cardiac conditions such as CAD (old infarct), hypertrophic cardiomyopathy, Takotsubo cardiomyopathy, hypertension, or infiltrative diseases.

The Prevalence of Coronary Microvascular Dysfunction in Patients With Type 2 Diabetes Mellitus.

Patients with type 2 diabetes mellitus (DM) are more susceptible to microvascular complications. However, whether DM is associated with coronary microvascular dysfunction (CMD) is unclear. This observational study used data from the Coronary Microvascular Disease Registry (CMDR) (NCT05960474) and included patients with angina and no obstructive coronary artery disease (ANOCA) who underwent invasive CMD evaluation using the CoroVentis CoroFlow System (Abbott Vascular, Santa Clara, CA).

Impact of pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock.

Acute myocardial infarction (AMI) remains one of the most common causes for cardiogenic shock (CS), with high inpatient mortality (40-50 %). Studies have reported the use of pulmonary artery catheters (PACs) in decompensated heart failure, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS.

Non-atherosclerotic coronary causes of myocardial infarction in women.

Ischemic heart disease is the most common cardiovascular cause of death in women worldwide. Obstructive coronary atherosclerosis is the primary cause of myocardial infarction (MI), however, non-atherosclerotic mechanisms of MI, such as spontaneous coronary artery dissection, vasospasm, microvascular dysfunction, embolization, inflammation, coronary anomalies, infectious and infiltrative causes are increasingly being recognized. Emerging data suggest that women are two to five times more likely to have an MI in the absence of coronary atherosclerosis compared to men, but they continue to remain underdiagnosed and undertreated, partly due to underdiagnosis and limited understanding of these mechanisms.

What Are the Implications of Choosing a TAVR-First Strategy in the Lifetime Management of Aortic Stenosis?: A Critical Review of TAVR-Explant- and Redo-TAVR.

Some patients with aortic stenosis may require multiple valve interventions in their lifetime, and choosing transcatheter aortic valve replacement (TAVR) as the initial intervention may be appealing to many. If their transcatheter heart valve degenerates later in life, most will hope to undergo redo-TAVR. However, if redo-TAVR is not feasible, some may have to undergo surgical explantation of their transcatheter heart valve (TAVR-explant).

Adverse Events and Failure Modes Related to Impella RP/RP Flex: Insights From FDA MAUDE Database.

Background: Impella RP and RP Flex can provide right ventricular (RV) support in numerous clinical situations. Notably, the redesigned RP Flex allows for an internal jugular approach compared to the femoral venous approach with RP.

Aims: We investigated the type and frequency of device-related complications as reported in the US Food and Drug Administration (FDA) Manufacturer and User Facility Experience (MAUDE) for both Impella RP and RP Flex to see if there are any differences.

Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction.

Background: Coronary microvascular dysfunction (CMD) is an important cause of angina with nonobstructive coronary arteries (ANOCA). It is unclear whether CMD is associated with arrhythmia.

Aims: This study aimed to evaluate the prevalence of arrhythmias in patients with ANOCA and CMD compared to those in patients with ANOCA without CMD.

Long-Term Clinical Outcomes of Biodegradable- Versus Durable-Polymer-Coated Everolimus-Eluting Stents in Real-World Post-Marketing Study.

Background: Long-term clinical data on biodegradable-polymer (BP) drug-eluting stents (DES) are limited. The objective of this study was to assess the long-term safety and efficacy of the BP-DES SYNERGY compared to XIENCE V, a durable-polymer (DP)-DES.

Methods: We compared patients treated with BP-DES or DP-DES at our center from 2008 to 2020.

The impact of ventricular remodeling on quality-of-life outcomes after Transcatheter aortic valve replacement.

Background: Among patients with aortic stenosis, ventricular remodeling by hypertrophy can limit the augmentation of flow with exertion, even after valve intervention. However, the effect of hypertrophy on quality of life (QoL) improvement has not been studied. We aimed to determine the effect of ventricular hypertrophy on QoL outcomes after transcatheter aortic valve replacement (TAVR).

Different treatment modalities for underexpanded stents-Effectiveness and outcomes: A practical guide.

Underexpanded stents are a dreaded complication of percutaneous coronary intervention (PCI) and are a major predictor of stent thrombosis and in-stent restenosis. Lesion preparation and plaque modification before stent implantation are essential to prevent stent underexpansion and optimize the technical outcomes of PCI. Once stent underexpansion occurs, the treatment options are limited.

Impact of left bundle branch block or permanent pacemaker after transcatheter aortic valve replacement on mid-term left ventricular ejection fraction.

Background: Conduction disturbances have uncertain implications for long-term left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR). We aimed to examine LVEF changes in patients up to two years post-TAVR.

Methods: We examined patients who underwent TAVR between 2012 and 2020 and underwent echocardiography follow-up.

High-risk percutaneous coronary intervention with or without mechanical circulatory support: Will Impella show superiority in the PROTECT IV randomized trial?

Background: PROTECT IV is a current enrolling randomized controlled trial evaluating high-risk percutaneous coronary intervention (HR-PCI) with prophylactic Impella versus no Impella to reduce the composite primary endpoint of all-cause death, stroke, myocardial infarction (MI), or cardiovascular hospitalization. In a PROTECT IV-like cohort of patients who underwent HR-PCI without Impella, we aimed to report the rate of major adverse events to determine whether the trial is adequately powered.

Methods And Results: A total of 700 patients meeting similar inclusion/exclusion criteria of PROTECT IV who underwent HR-PCI without Impella at a single tertiary center from 2008 to 2022 were included in the analysis.

Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may experience delays in appropriate management and adverse outcomes. We examined the racial differences in the outcomes for patients with SCAD who underwent PPCI for STEMI.

Bioprosthetic Aortic Valve Thrombosis: Definitions, Clinical Impact, and Management: A State-of-the-Art Review.

Bioprosthetic aortic valve thrombosis is frequently detected after transcatheter and surgical aortic valve replacement due to advances in cardiac computed tomography angiography technology and standardized surveillance protocols in low-surgical-risk transcatheter aortic valve replacement trials. However, evidence is limited concerning whether subclinical leaflet thrombosis leads to clinical adverse events or premature structural valve deterioration. Furthermore, there may be net harm in the form of bleeding from aggressive antithrombotic treatment in patients with subclinical leaflet thrombosis.