Publications by authors named "MacCarthy P"
This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.
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- The FAME 3 trial investigated the effects of fractional flow reserve-guided PCI versus CABG in patients with 3-vessel coronary artery disease, focusing on major adverse cardiac and cerebrovascular events over 3 years.
- Out of 1,455 patients, 305 had chronic total occlusions (CTOs), with 61% undergoing attempted revascularization; however, outcomes showed no significant difference in adverse events between CTO and non-CTO groups for both PCI and CABG.
- While PCI was linked to a higher risk of adverse events compared to CABG in patients without CTOs, this risk difference was not observed in those with CTOs, indicating that CTO status did not notably affect treatment
Article Synopsis
- The study investigates the significance of cardiac troponin (cTn) levels in predicting mortality in patients with Takotsubo syndrome (TTS), analyzing data from the International Takotsubo Registry.
- It identifies that a cTn increase greater than 28.8 times the upper reference limit signals clinically relevant myocardial injury, correlating with a higher risk of mortality over 5 years (adjusted HR 1.58).
- The findings enhance understanding of patient risk profiles in TTS, emphasizing the need for increased monitoring and follow-up for those with significant troponin elevations.
Article Synopsis
- Percutaneous treatment for structural heart disease is advancing quickly, with the EAPCI's Core Curriculum defining crucial competencies for new interventional cardiologists specializing in this area.
- These specialists, trained in interventional cardiology, manage adult patients and perform various procedures, requiring skills in advanced imaging and planning software, with a focus on the aortic, mitral, and tricuspid valves.
- Comprehensive training in all three areas typically takes at least 18 months, supporting consistent education across Europe, which will eventually influence certifications and patient safety measures.
Background: Recent observations in silico and in vivo reported that, during proximal optimisation technique, drug-eluting stents (DES) elongate, challenging conventional wisdom. The interaction between plaque morphology and radial expansion is well established, but little is known about the impact of plaque morphology on elongation.
Aims: We aimed to assess the longitudinal mechanical behaviour of contemporary DES in vivo and evaluate the relationship between post-percutaneous coronary intervention (PCI) stent elongation and lesion morphology, as assessed with optical coherence tomography (OCT).
Transcatheter edge-to-edge repair (TEER) was first performed in 2003, and is now established across the developed world as an effective, minimally invasive treatment option for patients with mitral regurgitation (MR). Multiple large registries have established the efficacy of mitral TEER in patients with primary or degenerative MR in whom surgery is considered prohibitive or high risk, while ongoing randomised-controlled trials will determine its role in younger and lower- risk patients. In patients with secondary or functional MR, in whom mitral valve surgery is not routinely recommended, the pivotal COAPT trial showed a profound reduction in both mortality and heart failure hospitalisation in carefully selected patients.
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- The study investigated changes in demographics, risk factors, clinical presentations, and outcomes of takotsubo syndrome (TTS) patients from 2004 to 2021, using data from the InterTAK registry.
- Over the years, the proportion of male patients increased, and there was a rise in cases of midventricular TTS as well as significant growth in the incidence of physical triggers.
- There was also a notable increase in 60-day mortality rates, although no significant change in 1-year mortality when excluding early deaths was observed, indicating a complex evolution of TTS and its management in recent years.
Article Synopsis
- The percutaneous treatment of structural heart disease (SHD) is advancing quickly, with the EAPCI's Core Curriculum (CC) defining the necessary competencies for newly trained interventional cardiologists (IC).
- SHD interventional cardiologists manage adult patients throughout the entire treatment process, requiring skills in advanced imaging and planning software, as well as proficiency in procedures related to the aortic, mitral, and tricuspid heart valves.
- Completing specialized SHD training typically takes at least 18 months, though it can be shortened to 1 year for focused training on specific areas, with the goal of promoting standardized, high-quality training across Europe for better patient care and future certifications.
Article Synopsis
- The study tested the CREST model, a scoring system with five variables, to see how well it predicts the risk of circulatory aetiology death (CED) in patients who suffered an out-of-hospital cardiac arrest (OHCA), compared to the SCAI shock classification.
- Researchers analyzed data from a registry of 723 patients with cardiac-related OHCA to determine how well each model predicted CED within 30 days; they found a strong link between higher CREST scores and increased risk of CED.
- Results indicated that both the CREST model and the SCAI classification performed similarly, providing effective prediction for CED following OHCA, with no significant differences in their accuracy
The Navitor transcatheter heart valve (THV) is the latest iteration of the Portico self-expanding valve system. Early prospective studies have shown promising outcomes, however, there is a lack of complementary 'real-world' data. This study aimed to assess early safety and efficacy outcomes of the Navitor THV using registry data from 6 high-volume United Kingdom transcatheter aortic valve replacement (TAVR) centers.
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- The International Liaison Committee on Resuscitation called for a trial to assess if quicker delivery to a cardiac arrest center reduces deaths compared to standard care after a cardiac arrest.
- The ARREST trial randomly assigned patients who regained circulation after an out-of-hospital cardiac arrest to either expedited delivery to a cardiac center or the nearest emergency department.
- Of the 862 enrolled patients, the study found that out of those analyzed, 30-day mortality rates were noted, with a significant number of participants being male (68%) compared to female (32%).
Background: The MIRACLE score is the only risk score that does not incorporate and can be used for selection of therapies after out-of-hospital cardiac arrest (OHCA).
Objectives: This study sought to compare the discrimination performance of the MIRACLE score, downtime, and current randomized controlled trial (RCT) recruitment criteria in predicting poor neurologic outcome after out-of-hospital cardiac arrest (OHCA).
Methods: We used the EUCAR (European Cardiac Arrest Registry), a retrospective cohort from 6 centers (May 2012-September 2022).
Background: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI.
Methods: FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide.
Mitral interventions remain technically challenging owing to the anatomical complexity and heterogeneity of mitral pathologies. As such, multi-disciplinary pre-procedural planning assisted by advanced cardiac imaging is pivotal to successful outcomes. Modern imaging techniques offer accurate 3D renderings of cardiac anatomy; however, users are required to derive a spatial understanding of complex mitral pathologies from a 2D projection thus generating an 'imaging gap' which limits procedural planning.
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- Researchers developed a machine learning model to predict in-hospital death risk in Takotsubo syndrome (TTS) patients using data from over 3,400 individuals.
- The model included 31 clinical variables and achieved strong performance results, with AUC values indicating high accuracy in identifying patients at risk of death.
- Clustering analysis revealed six distinct patient groups with varying in-hospital death rates, demonstrating the model's ability to stratify risk profiles effectively.
Objectives: The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV).
Background: Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI.
Methods: This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV.
Background: We aimed to develop a machine learning algorithm to predict the presence of a culprit lesion in patients with out-of-hospital cardiac arrest (OHCA).
Methods: We used the King's Out-of-Hospital Cardiac Arrest Registry, a retrospective cohort of 398 patients admitted to King's College Hospital between May 2012 and December 2017. The primary outcome was the presence of a culprit coronary artery lesion, for which a gradient boosting model was optimized to predict.
Background: Out-of-hospital cardiac arrest is a common cause of morbidity and mortality, and ethnic variation in outcomes is recognised. We investigated ethnic and socioeconomic differences in arrest circumstances, rates of coronary artery disease, treatment, and outcomes in resuscitated OOHCA.
Methods: Patients with resuscitated OOHCA of suspected cardiac aetiology were included in the King's Out-of-Hospital Cardiac Arrest Registry between 1-May-2012 and 31-December-2020.
Background: With expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important.
Aims: We aimed to evaluate long-term valve function and incidence of severe structural valve deterioration (SVD) among patients ≥ 10-years post-TAVI and with echocardiographic follow-up at least 5-years postprocedure.
Methods: Data on patients who underwent TAVI from 2007 to 2011 were obtained from the UK TAVI registry.
Background: Transcatheter therapies are a recognized alternative intervention in patients with severe mitral regurgitation who are at high surgical risk. The purpose of this study was to characterize patients screened for transcatheter mitral valve replacement (TMVR), establish the clinical and anatomic reasons for unsuitability, and determine clinical course and early outcomes.
Methods: International multicentre registry was conducted of consecutive patients screened for TMVR at 12 centres in Europe, the United States, and Canada between April 2015 and September 2018.
Background: The DISRUPT-CAD study series demonstrated feasibility and safety of intravascular lithotripsy (IVL) in selected patients, but applicability across a broad range of clinical scenarios remains unclear.
Aims: This study aims to evaluate the procedural and clinical outcomes of IVL in a high-risk real-world cohort, compared to a regulatory approval cohort.
Methods: Consecutive patients treated with IVL and percutaneous coronary intervention at our center from May 2016 to April 2020 were included.
Single arterial access closure of post-infarction ventricular septal defect: A case series.
Catheter Cardiovasc Interv
January 2023
Background: Post-infarction ventricular septal defect (PIVSD) carries a very poor prognosis. Surgical repair offers reasonable outcomes in patients who survive the initial healing period. Percutaneous device implantation remains a potentially effective earlier alternative.
View Article and Find Full Text PDFAims: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken.
Methods And Resuts: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres.