Publications by authors named "Margaret McEntegart"

Ischemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the current evidence for coronary revascularization in ICM, including consideration of the different modalities of coronary artery bypass grafting and percutaneous coronary intervention. In addition to a contemporary assessment of the literature, we aim to provide real-world insights and perspectives to guide clinical decision-making in this heterogeneous and complex patient population.

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Background: Coronary artery disease (CAD) is the leading cause of death for women, yet they remain underrepresented in interventional CAD studies. Women have been shown to be at increased risk of mortality and major adverse events after percutaneous coronary intervention (PCI). The poorer outcomes are likely because women are typically diagnosed with CAD late, at an older age, with more comorbidities, and with more challenging anatomy including smaller vessels and higher prevalence of coronary artery calcification.

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Article Synopsis
  • The study investigates the link between atherosclerosis (plaque buildup in arteries) and types of myocardial ischemia (insufficient blood flow to the heart) in patients without significant coronary artery blockage (INOCA).
  • It employs advanced invasive tests to assess coronary microvascular function and quantifies plaque burden using the Gensini score, which takes into account the severity of artery blockage.
  • Findings reveal that higher Gensini scores correlate with poorer microvascular function, and different INOCA endotypes (like microvascular angina and vasospastic angina) show variations in plaque scores, indicating the complexity of heart conditions in patients without obvious artery blockage.
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Dissection and re-entry techniques are essential to achieve safe and effective chronic total occlusion recanalization. Several studies have demonstrated similar outcomes following extraplaque stenting compared with intraplaque stenting. Dissection techniques most often involve the use of knuckled wires to progress within and beyond the chronic total occlusion segment.

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The prevalence of calcification in obstructive coronary artery disease is on the rise. Percutaneous coronary intervention of these calcified lesions is associated with increased short-term and long-term risks. To optimize percutaneous coronary intervention results, there is an expanding array of treatment modalities geared toward calcium modification prior to stent implantation.

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  • Chronic total occlusion (CTO) in coronary arteries poses significant challenges during percutaneous coronary interventions (PCI), often requiring advanced methods and tools like microcatheters.
  • The BIOMICS study tested a new microcatheter (BioMC) in 100 patients with ischemic symptoms undergoing CTO-PCI, focusing on its ability to successfully facilitate guide wire placement and monitoring for safety issues like cardiac death or myocardial infarction.
  • Results showed a 75% success rate in achieving the primary efficacy goal and only 2% incidence of severe safety events, indicating that the new microcatheter is both effective and safe in treating CTO.
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  • Patients with chronic kidney disease (CKD) undergoing ultra-low contrast percutaneous coronary intervention (PCI) show minimal changes in kidney function post-procedure and have favorable one-year outcomes.
  • A study analyzed 100 CKD patients who received less than 30 mL of contrast during PCI, finding no significant difference in eGFR after the procedure and a low requirement for renal replacement therapy (RRT).
  • The research concludes that ultra-low contrast PCI is a safe option for advanced CKD patients, potentially preserving renal function and facilitating future kidney transplants.
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  • The study analyzed over 11,500 chronic total occlusion percutaneous coronary intervention (CTO-PCI) procedures across North America and other regions from 2017 to 2023.
  • North American CTO patients were generally older and had more health issues, such as diabetes and hypertension, as well as more complex lesions compared to non-North American patients.
  • Despite differences in procedure techniques and patient complexity, the overall success rates and rates of major adverse cardiovascular events were similar between North American and non-North American centers.
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Drug-coated balloons (DCBs) are specialized coronary devices comprised of a semicompliant balloon catheter with an engineered coating that allows the delivery of antiproliferative agents locally to the vessel wall during percutaneous coronary intervention. Although DCBs were initially developed more than a decade ago, their potential in coronary interventions has recently sparked renewed interest, especially in the United States. Originally designed to overcome the limitations of conventional balloon angioplasty and stenting, they aim to match or even improve upon the outcomes of drug-eluting stents without leaving a permanent implant.

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Background: Complete revascularization of coronary artery disease has been linked to improved outcomes in patients with preserved left ventricular (LV) function.

Objectives: This study sought to identify the impact of complete revascularization in patients with severe LV dysfunction.

Methods: Patients enrolled in the REVIVED-BCIS2 (Revascularization for Ischemic Ventricular Dysfunction) trial were eligible if baseline/procedural angiograms and viability studies were available for analysis by independent core laboratories.

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Chronic total occlusions (CTOs) of coronary arteries can be found in the context of chronic or acute coronary syndromes; sometimes they are an incidental finding in those apparently healthy individuals undergoing imaging for preoperative risk assessment. Recently, the invasive management of CTOs has made impressive progress due to sophisticated preinterventional assessment, including advanced non-invasive imaging, the availability of novel and dedicated tools for CTO percutaneous coronary intervention (PCI), and experienced interventionalists working in specialised centres. Thus, it is crucial that referring physicians who see patients with CTO be aware of recent developments and of the initial evaluation requirements for such patients.

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Article Synopsis
  • The study examines outcomes of percutaneous coronary intervention (PCI) for de novo ostial right coronary artery (RCA) lesions, which have previously shown poor outcomes.
  • Researchers utilized intravascular ultrasound (IVUS) to categorize 170 identified RCA stenoses into three morphological types: isolated ostial lesions, ostial lesions with calcified nodules (CN), and ostial lesions with diffuse disease.
  • Results indicated that patients with CN had a significantly higher two-year target lesion failure (TLF) rate compared to those with diffuse disease, while isolated lesions resulted in no events, highlighting that lesion morphology is crucial for predicting clinical outcomes.
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  • Intravascular ultrasound studies reveal that about 25% of the left anterior descending (LAD) arteries have a myocardial bridge, which can affect stent performance.
  • This study aimed to explore the relationship between myocardial bridges and chronic total occlusions (CTOs) in LAD lesions, as well as their impact on clinical outcomes after treatment.
  • Results indicated that myocardial bridges were more frequent in LAD CTOs, and stents that extended into these bridges were linked to higher rates of target lesion failure compared to stents not extending into them.
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Background: People who are transgender may utilize masculinizing or feminizing gender-affirming hormonal therapy. Testosterone and oestrogen receptors are expressed throughout the cardiovascular system, yet the effects of these therapies on cardiovascular risk and outcomes are largely unknown. We report the case of a young transgender man with no discernible cardiovascular risk factors presenting with an acute coronary syndrome.

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Background: Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study.

Aim: To examine the contemporary CTO PCI practice.

Methods: We performed an online, anonymous, international survey of CTO PCI operators.

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Background: We investigated the usefulness of invasive coronary function testing to diagnose the cause of angina in patients with no obstructive coronary arteries.

Methods: Outpatients referred for coronary computed tomography angiography in 3 hospitals in the United Kingdom were prospectively screened. After coronary computed tomography angiography, patients with unobstructed coronary arteries, and who consented, underwent invasive endotyping.

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Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs.

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  • The study investigates the causes of in-stent restenosis (ISR) in the right coronary artery (RCA), particularly focusing on mechanical and biological mechanisms.
  • Using intravascular ultrasound (IVUS), researchers classified ISR lesions and found that 50% were due to mechanical issues like stent fractures or deformations, while 53% were related to biological factors like neointimal hyperplasia.
  • The one-year target lesion failure rate was 11.5%, with significantly higher event rates (41.4%) for mechanically caused ISRs that were managed without new stents, highlighting the need for better treatment strategies.
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Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning.

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