Background: Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice.
Background: There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.
In the United States, new surgical heart valves can be approved on the basis of objective performance criteria (OPC). In contrast, the US Food and Drug Administration traditionally requires stricter criteria for transcatheter heart valve (THV) approval, including randomized, clinical trials. Recent US Food and Drug Administration approval of new-generation THVs based on single-arm studies has generated interest in alternative study approaches for THV device approval. This review evaluates whether THV device approval could follow a pathway analogous to that of surgical heart valves by incorporating OPC and provides several considerations and recommendations. Factors to be taken into account in the construction of OPC include the maturity of THV technology, variability in transcatheter aortic valve replacement practice, end points included as OPC, follow-up terms for specific OPC, patient populations to which these OPC apply, and (statistical) methods for OPC development. We recommend that approval of THV devices in the United States for low- and intermediate-risk patients or for new indications should provisionally rely on data from randomized, clinical trials. However, it is recommended that formal OPC be applied for approval of new-generation THVs for use in high- and extreme-risk patient populations.
Background: DAPT with aspirin and a P2Y12 receptor inhibitor is an essential component of the treatment of patients with acute coronary syndromes (ACS) and those undergoing PCI. DAPT after ACS reduces death and MI compared with aspirin alone, both in patients treated with PCI and in those who are managed conservatively. After elective PCI for stable coronary disease, DAPT reduces ischemic events and stent thrombosis (ST). However, these benefits come at the cost of increased risk of bleeding, raising the question about how to best balance efficacy and safety in determining the duration of DAPT.
Decades have passed since studies comparing coronary artery bypass grafting (CABG) with medical therapy for multivessel coronary disease indicated a survival advantage of surgery in the subset of patients with significant left ventricular impairment. These investigations changed the prevailing clinical impression such that severe left ventricular (LV) dysfunction might be an indication for revascularization as opposed to a relative contraindication. Although the studies might currently be deemed obsolete by many measures, they continue to inform societal guidelines with regard to CABG and LV dysfunction. Recently, the long-term outcomes after the Surgical Treatment for Ischemic Heart Failure (STICH) trial have reinforced the potential benefits of surgical revascularization in patients with congestive heart failure and an ejection fraction of < 35%. Over the intervening period, numerous trials have compared percutaneous coronary intervention (PCI) with CABG in patients with stable angina and multivessel disease. Aside from diabetes mellitus, the trials by and large have demonstrated equivalence in the end points of death and myocardial infarction. So can one extrapolate equivalence for PCI with CABG in patients with LV dysfunction? The short answer is no. There is scant direct evidence from randomized trials comparing the 2 methods of revascularization because patients with congestive heart failure or severe LV dysfunction have typically been underrepresented or excluded.
Background: Guidelines recommend coronary artery bypass graft surgery (CABG) over percutaneous coronary intervention (PCI) for multivessel disease and severe left ventricular systolic dysfunction. However, CABG has not been compared with PCI in such patients in randomized trials.
Background: The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach.
Background: Provisional stenting is effective for anatomic simple bifurcation lesions. Double kissing crush stenting reduces the 1-year rate of target lesion revascularization. This study aimed to investigate the 5-year clinical results of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions).
Background: There are only limited studies reporting clinical outcomes after bioresorbable vascular scaffold (BVS; Absorb; Abbott Vascular, Santa Clara, CA) implantation for coronary chronic total occlusions (CTO). The aim of this study was to evaluate the real-world feasibility and safety of BVS implantation for the treatment of CTO.
Background: Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited.
Background: Data regarding the long-term efficacy and safety of everolimus-eluting bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents are limited. This meta-analysis aimed to compare the long-term outcomes with both devices.
Background: There is considerable debate on the management of patients with low-gradient severe aortic stenosis (LG-AS), defined as aortic valve area <1 cm2 with peak aortic jet velocity <=4.0 m/s, and mean aortic pressure gradient <=40 mm Hg.
Background: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment–elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve–guided complete revascularization.
Background: There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society).
Background: Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations.
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