Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis

Background: Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods: Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results: Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value \u3c 0.0001, 95% CI 1.69-5.32); diameter decrease in the stenotic area after IVL session was -5.23 mm (95 CI -22.6-12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06-1.63; p \u3c 0.00001) and 1.34 mm2 (95% CI 0.71-1.43; p \u3c 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD -0.22; 95% CI -0.40-0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions: Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions

Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis

Background Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions

Cardiovascular Outcomes and Trends of Transcatheter vs. Surgical Aortic Valve Replacement Among Octogenarians With Heart Failure: A Propensity Matched National Cohort Analysis

Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF. Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83-89) and 82 (81-84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p \u3c 0.001), CVA (2.5% vs. 3.6%; p = 0.009), SCA (9.9% vs. 20.2%; p \u3c 0.001), AKI (17.4% vs. 40.8%); p \u3c 0.001), major transfusion (26.4% vs 67.3%; p \u3c 0.001), CS (1.8% vs 9.8%; p \u3c 0.001), and MCS (0.8% vs 7.3%; p \u3c 0.001) when compared to SAVR-HF. Additionally, post-procedural stroke and major bleeding showed no significant difference. The median unmatched total charges for TAVR-HF and SAVR-HF were 194,561$and 246,100$ respectively. Conclusion: In this nationwide observational analysis, TAVR is associated with an improved safety profile for octogenarians with heart failure (both preserved and reduced ejection fraction) compared to SAVR

Cardiovascular Outcomes of Transradial Versus Transfemoral Percutaneous Coronary Intervention in End-Stage Renal Disease: A Regression-Based Comparison

Background: Limited data is available on the comparison of outcomes of transradial (TR) and transfemoral (TF) access for percutaneous coronary intervention (PCI) in patients with end-stage stage renal disease (ESRD). Methods: Online databases were queried to compare cardiovascular outcomes among TR. and TF in ESRD patients. The outcomes assessed included differences in mortality, cerebrovascular accidents (CVA), periprocedural myocardial infarction (MI), bleeding, transfusion, and periprocedural cardiogenic shock (CS). Unadjusted odds ratios (OR) were calculated using a random-effect effect model. Results: A total of 6 studies including 7,607 patients (TR-PCI = 1,288; TF-PCI = 6,319) were included. The overall mean age was 67.7 years, while the mean age for TR-PCI and TF-PCI was 69.7 years and 67.9 years, respectively. TR-PCI was associated with lower incidence of mortality (OR 0.46 95 % CI 0.30-0.70, p \u3c 0.05, I2 0.00 %), bleeding (OR 0.45 95 % CI 0.29, 0.68, p \u3c 0.05, I2 3.48 %), and transfusion requirement (OR 0.52 95 % CI 0.40, 0.67, p \u3c 0.05, I2 0.00 %) (Fig. 1). There were no differences among TR-PCI and TF-PCI for periprocedural MI, periprocedural CS, and CVA outcomes. Conclusion: TR access was associated with lower mortality, bleeding, and transfusion requirement as compared to TF access in patients with ESRD undergoing PCI

Partial vena cava occlusion (VCO) to counteract refractory heart failure: A new era in interventional heart failure strategy.

Background: Patients with acute decompensated heart failure are prone to recurrent exacerbation leading to poor quality of life when they do not respond to an optimal medical regimen. Due to the lack of linear positive inotropy response to increasing preload in heart failure patients, increasing preload is associated with poor outcomes. Partial occlusion of either IVC or SVC is a proposed novel treatment that can improve cardiac function or quality of life by altering preload/pressure in heart failure (HF) patients unresponsive to diuretics. Methods: PubMed, Ovid (MEDLINE), and Cochrane database we searched using the MeSH terms including Superior vena cava occlusion, Inferior vena cava occlusion, Heart failure exacerbation. The inclusion criteria included studies that enrolled patients \u3e 18 years with diagnosed NYHA II-IV HF with reduced ejection fraction (HFrEF) on optimal medical treatment (OMT). Results: The analysis involved two studies with 14 patients; the mean age was 64.4 ± 10 and 100% males. The difference in the mean pulmonary pressures between pre-and-post VCO devices were 1.56 (95% CI 0.66-2.46, p-value = 0.006). There was no heterogeneity among the study of mean pulmonary pressures. With the use of VC occlusion devices, the mean difference in pulmonary artery systolic pressure decreased by 1.70 (95% CI 0.68-2.71, p-value = 0.001) (Fig. 1B). The heterogeneity of mean pressure was minimal 14%. Conclusion: In conclusion, VCO can help decrease pulmonary pressure that can indirectly prevent heart failure exacerbations and possibly hospitalization in this cohort of patients

Comparative safety of percutaneous ventricular assist device and intra-aortic balloon pump in acute myocardial infarction-induced cardiogenic shock

Background The relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in patients with cardiogenic shock after acute myocardial infarction remain unknown.Methods Multiple databases were searched to identify articles comparing pVAD and IABP. An unadjusted OR was used to calculate hard clinical outcomes and mortality differences on a random effect model.Results Seven studies comprising 26 726 patients (1110 in the pVAD group and 25 616 in the IABP group) were included. The odds of all-cause mortality (OR 0.57, 95% CI 0.47 to 0.68, p=&lt;0.00001) and need for revascularisation (OR 0.16, 95% CI, 0.07 to 0.38, p=&lt;0.0001) were significantly reduced in patients receiving pVAD compared with IABP. The odds of stroke (OR 1.12, 95% CI 0.14 to 9.17, p=0.91), acute limb ischaemia (OR=2.48, 95% CI 0.39 to 15.66, p=0.33) and major bleeding (OR 0.36, 95% CI 0.01 to 25.39, p=0.64) were not significantly different between the two groups. A sensitivity analysis based on the exclusion of the study with the largest weight showed no difference in the mortality difference between the two mechanical circulatory support devices.Conclusions In patients with acute myocardial infarction complicated by cardiogenic shock, there is no significant difference in the adjusted risk of all-cause mortality, major bleeding, stroke and limb ischaemia between the devices. Randomised trials are warranted to investigate further the safety and efficacy of these devices in patients with cardiogenic shock

Outcomes of intravascular imaging in Orbital Atherectomy; Insight from the National Readmissions Database

The impact of intravascular imaging guidance [intravascular ultrasound (IVUS)/optical coherence tomography (OCT)] on clinical outcomes in patients undergoing orbital atherectomy (OA) and percutaneous intervention (PCI) are not well characterized. The Nationwide Readmissions Database (NRD) from 2015 to 2019 was used to select all cases of OA. The adjusted odds ratios (aOR) of in-hospital, 30-day, and 180-day hospitalization outcomes between patients who underwent PCI with OA vs without intravascular imaging were calculated using a propensity-matched analysis. A total of 15,681 patients undergoing PCI after OA (12,649 with no-imaging, 3032 with imaging) were identified. Due to a significant difference in the baseline characteristics, a matched sample of 3008 in the no-imaging group and 3032 in the imaging group was selected. On adjusted analysis, the odds of all-cause in-hospital mortality (aOR 0.68, 95% CI 0.54-0.86) were significantly lower in patients undergoing IVUS/OCT guided OA and PCI compared with those having PCI without imaging. There was no difference in the rate of in-hospital stroke (aOR 0.86, 95% CI 0.51-1.45) and major bleeding (aOR 0.87, 95% CI 0.65-1.16) between the two groups. There was no significant difference in the 30- and 180-day odds of readmission, major bleeding, coronary dissection, pericardial effusion, and AKI between the two groups. IVUS and OCT use during PCI with OA for patients with calcified coronary artery disease appear to be associated with reduced in-hospital mortality at index admission. Prospective trials are necessary to determine the long-term benefits of imaging with PCI

HYBRID CORONARY REVASCULARIZATION VERSUS CORONARY ARTERY BYPASS GRAFT IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE A META-ANALYSIS

BackgroundHybrid coronary artery revascularization (HCR) refers to complete or near complete revascularization using the combination of single vessel CABG and PCI of other significant coronary lesions. The short-term outcomes of HCR compared to CABG alone is unknown.MethodsOnline databases were queried with various combinations of keywords to identify relevant articles. Major adverse cardiovascular events (MACE) and its components were compared using a random effect model to calculate unadjusted odds ratios (OR).ResultsA total of 36 studies comprising 213,053 patients (HCR 4,276, CABG 208,777) were included. The odds of MACE (OR 1.22; 95% CI 0.86-1.74; P=0.27), repeat MI (OR 1.02; 95% CI 0.66-1.60; P=0.91), cerebrovascular events (OR 0.82; 95% CI 0.55-1.24; P=0.35), all cause mortality (OR 1.13; 95% CI 0.72-1.79; P=0.59), AKI (OR 1.09; 95% CI 0.55-2.19; P=0.8), hemodialysis (OR 0.49; 95% CI 0.14-1.66; P=0.25), postoperative Afib (OR 0.76; 95% CI 0.53-1.09; P=0.13), complete revascularization (OR 0.97; 95% CI 0.62-1.52; P=0.9), and TVR (OR 2.68; 95% CI 0.47-15.25; P=0.27) were not different between the two groups. Although the odds of blood transfusion requirement was significantly lower in the HCR group (OR 0.37; 95% CI 0.31-0.44; P<0.001), the need for repeat operation due to bleeding was similar between the two groups (OR 1.03; 95% CI 0.75-1.42; P=0.84).ConclusionClinical outcomes of HCR and CABG were comparable for patients with MCAD, with no difference in mortality or major adverse events

In‐hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease

BackgroundThe outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown.MethodsUsing the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups.ResultsA total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50–0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50–0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events.ConclusionEVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity

Trends and outcomes of transcatheter aortic valve implantation in aortic insufficiency: A nationwide readmission database analysis

Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with aortic insufficiency (AI) with insufficient data on its safety. The Nationwide Readmissions Database (NRD) was queried to identify patients undergoing TAVI for AI. Net clinical events (composite of in-hospital mortality, stroke, major bleeding) and procedural complications were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 185,703 (AI 3873, aortic stenosis [AS] 181,830) patients were included in the analysis. Due to a significant difference in the baseline characteristics, a matched sample of 7929 patients (AI 3873, AS 4056) was selected. At index admission, the adjusted odds of in-hospital NACE (aOR 2.0, 95% CI 1.59-2.51), mortality (aOR 3.06, 95% CI 2.38-5.47), major bleeding (aOR 1.53, 95% CI 1.13-2.06) and valvular complications (aOR 9.48, 95% CI 6.73-13.38) were significantly higher in patients undergoing TAVI for AI compared with those undergoing TAVI for AS. However, there was no significant difference in the incidence of NACE, mortality, stroke, major bleeding, and need for permanent pacemaker implantation at 30- and 180-days follow-up. TAVI in AI was associated with a higher risk of periprocedural NACE, mortality, and major bleeding. The risk of these complications attenuated at 30- and 180-day readmission