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Background: The optimal approach to guide percutaneous coronary intervention (PCI) has yet to be defined. The aim of this study was to compare functional driven (fractional flow reserve) versus intravascular imaging (intravascular ultrasound, IVUS, and/or optical coherence tomography, OCT) versus standard (coronary angiography only, CA)-guided PCI.
Methods: Randomized controlled trials (RCTs) and propensity score weight-matched studies (PSWMs) comparing FFR versus IVUS versus OCT versus CA-guided PCI were included. Major adverse cardiovascular event (MACE; a composite end point of death or myocardial infarction [MI] or revascularization) was the primary endpoint, whereas definite stent thrombosis (ST) and single components of MACE were the secondary ones. Primary analyses were performed including only RCTs, secondary also with PSWMs.
Results: Thirty-three studies were included in the analysis, 16 RCTs and 17 PSWMs. After 2 (1-3) years, IVUS performed better for MACE than CA (odds ratio [OR] 0.75 0.52-0.88), whereas there was just a trend for FFR (OR 0.81, 0.64-1.02). These results were mainly driven by reduced risk of all cause death, MI (FFR OR 0.74:0.57-0.99 and IVUS OR 0.82:0.54-0.94) and revascularization. IVUS reduced ST while FFR did not, and at meta-regression analysis, there was a trend for superiority of IVUS versus FFR to reduce subsequent MI in acute coronary syndrome (ACS) patients. The present results were consistent also after adding studies with PSWMs.
Conclusions: Functional and intravascular imaging approaches seem to perform similarly in term of clinical outcomes, while both performed better compared with the standard approach. Imaging showed a potential benefit for ACS patients. The present results stress the need for a wider use of functional or imaging driven PCI.
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http://dx.doi.org/10.1002/ccd.28410 | DOI Listing |
Calcific coronary artery disease intervention is associated with uniformly worse short-term procedural and long-term clinical results compared with treatment of non-calcified lesions. Multiple intravascular imaging tools currently exist to aid the identification and detailed characterization of intracoronary calcium, and guide appropriate follow-on management strategies. Several unique device therapies, to include angioplasty, atherectomy, and lithotripsy may be employed to enhance lesion preparation, stent implantation and optimization, and improve patient outcomes.
View Article and Find Full Text PDFJ Med Case Rep
December 2024
Shifa International Hospital/Shifa Tameer e Millat University, Islamabad, Pakistan.
Background: Angiosarcoma is a rapidly proliferating vascular tumor that originates in endothelial cells of vessels. Rarely, it can be associated with consumptive coagulopathy due to disseminated intravascular coagulation eventually leading to thrombocytopenia and microangiopathic hemolytic anemia. This specific manifestation is termed Kasabach-Merritt syndrome.
View Article and Find Full Text PDFJ Int Med Res
December 2024
Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, People's Republic of China.
Objective: This study aimed to compare the efficacy and safety of intravascular ultrasound (IVUS)-guided coronary intravascular lithotripsy and rotational atherectomy in treating severe coronary artery calcification.
Methods: A retrospective analysis of 60 patients who underwent percutaneous coronary intervention at the General Hospital of Ningxia Medical University from October 2022 to August 2023 was conducted. The patients were divided into two groups: 30 received IVUS-guided coronary intravascular lithotripsy and 30 underwent IVUS-guided rotational atherectomy.
Case Rep Cardiol
December 2024
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
A 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion.
View Article and Find Full Text PDFPLoS One
December 2024
Fondazione Istituto di Ricerca Pediatrica Città della Speranza (IRP), Padova, Italy.
The zebrafish (Danio rerio) is a valuable model organism for studying human biology due to its easy genetic manipulation and small size. It is optically transparent and shares genetic similarities with humans, making it ideal for studying developmental processes, diseases, and drug screening via imaging-based approaches. Solid malignant tumors often contain hypoxic areas that stimulate the release of extracellular vesicles (EVs), lipid-bound structures released by cells into the extracellular space, that facilitate short- and long-range intercellular communication and metastatization.
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