Aims To compare clinical outcome in Chronic kidney disease (CKD) patients receiving coronary stents according to stent type BMS versus DES and 1st generation versus 2nd generation DES. Methods and Results PubMed, Cinhal, Cochrane, Embase, and Web of Science were searched for studies including CKD patients. CKD was defined as eGFR < 60 mL/min. We selected n = 35 articles leading to 376 169 patients, of which 76 557 CKD patients receiving BMS n = 35,807, 1st generation DES n = 37,650, or 2nd generation DES n = 3100. Patient receiving DES, compared to BMS, had a 18% lower all-cause mortality (RR 0.82, 95%CI 0.71-0.94). The composite of death or myocardial infarction (MI) was lower in DES patients (RR 0.78, 95%CI 0.67-0.91), as was stent thrombosis (ST) (RR 0.57, 95%CI 0.34-0.95), target vessel/lesion revascularization (TVR/TLR) (RR 0.69, 95%CI 0.57-0.84) and death for cardiovascular cause (RR 0.43, 95%CI 0.25-0.74). We also found a gradient between 1st and 2nd generation DES, through BMS. Second, compared to 1st generation DES, were associated with further relative risk (RR) reduction of -18% in of all-cause death, and lower incidence of stent-related clinical events: -39% RR of ST risk; -27 RR of TVR/TLR risk. Conclusions DES in CKD patients undergoing PCI were superior to BMS in reducing major adverse clinical events. This was possibly explained, by a lower risk of stent-related events as ST and TVR or TLR. Second, compared to 1st generation DES may furtherly reduce clinical events.

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Transcatheter mitral valve repair (TMVr) using the MitraClip system (Abbott Vascular, Inc.) has emerged as a possible therapeutic intervention in patients with heart failure and reduced left ventricular (LV) ejection fraction (HFrEF) with significant functional mitral regurgitation (FMR), being effective in reducing symptoms and improving clinical outcomes in selected patients. [1][2][3] Pulmonary hypertension (PH) is commonly found in patients with HFrEF and FMR. Baseline PH negatively affects prognosis in patients undergoing surgical mitral valve intervention 4 and TMVr. [5][6][7] However, data on MitraClip procedure in patients with FMR and PH are scarce and most haemodynamic studies on MitraClip were performed during or shortly after the procedure, in patients under general anaesthesia, inotropes and vasopressors drugs. [8][9][10] This study aimed at evaluating the haemodynamic impact of MitraClip in conscious patients with HFrEF, significant FMR and PH, comparing the results in patients with different types of PH. | METHODSOur registry prospectively enrolled all consecutive HFrEF patients affected by moderate-to-severe or severe (3+ or 4+/4+) FMR, who consecutively underwent MitraClip intervention between December 2012 and September 2019. FMR was defined as MR caused by noncomplete leaflet coaptation due to LV remodelling.An analysis of right heart catheterization (RHC) was performed in conscious patients at baseline and 6 months after MitraClip as an outpatient procedure. Trans-thoracic and trans-oesophageal echocardiography were repeated at the same times.Before right heart catheterization (RHC) and echocardiographic evaluations and final Heart Team discussion, all patients underwent coronary angiography and eventually percutaneous coronary intervention as part of the protocol for transcatheter procedure feasibility and eligibility evaluation. All patients enrolled were on optimal medical therapy at the moment of the Heart Team discussion.MitraClip procedure was performed as previously described 11 ; procedural success was defined as residual MR ≤2, in absence of failure (abortion of the procedure and conversion to open surgery), at the end of the procedure. 12 Pulmonary hypertension was defined as mean PAP (mPAP) ≥25 mmHg at RHC. Endpoints of interest were longitudinal haemodynamic variables measured or computed during repeated RHC, as previously reported. 13 According to European Guidelines, we divided patients according to PH type: combined post-and pre-capillary-PH (Cpc-PH) was defined as mPAP ≥25 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, diastolic pulmonary gradient (DPG) ≥7 mmHg and/or pulmonary vascular resistance (PVR) >3 WU; isolated post-capillary-PH (Ipc-PH) as mPAP ≥25 mmHg, PAWP >15 mmHg, DPG <7 mmHg and/or PVR ≤3 WU.The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki, patients signed an informed consent, and data collection was approved by our Ethical Committee.Categorical variables were expressed as count (percentage) and compared with Fishe...