Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention?

Fezzi, Simone; Ding, Daixin; Mahfoud, Felix; Huang, Jiayue; Lansky, Alexandra J.; Tu, Shengxian; Wijns, William

doi:10.1038/s41569-024-01014-0

Cited by 5 publications

(2 citation statements)

References 117 publications

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“…Despite undeniable improvements in revascularization techniques and pharmacological management of coronary artery disease, clinicians are often faced with patients presenting with disabling chronic refractory angina although all therapeutic options have been applied in the treatment protocol. Paradoxically, as revascularization techniques and armamentarium evolve, the number of patients with severe refractory angina and a predictable long life expectancy is steadily increasing [8,9], and there is an urgent clinical need for novel therapies to alleviate symptoms and improve the quality of life in this group of patients. Evidence for the safety and efficacy of SCR in non-optional patients with refractory angina pectoris is still accumulating, but the vast majority of it comes from small-number observational registries or few randomized trials [10][11][12][13][14][15][16][17][18][19], which is reflected in the relatively low level of recommendation in revascularization guidelines [20].…”

Section: Discussionmentioning

confidence: 99%

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris - Mid-Term Results of the Real-Life Cohort

Włodarczak,

Rola,

Jastrzębski

et al. 2024

Preprint

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Background: Despite continuous improvements in revascularization techniques, refractory angina without potential revascularization options remains a relevant clinical issue with significant impact on patient’s quality of life. Recently, a novel device, the Coronary Sinus Reducer (CSR), has been introduced into clinical practice as a therapeutic option for patients with disabling angina pectoris. In this single-center, observational study, we evaluated the mid-term (3-month) safety and efficacy of the CSR in a real-world cohort. Methods: The study population consisted of 55 patients with refractory angina without potential revascularization options, predominantly men (87.3%) with a high cardiovascular risk factor burden and advanced angina (baseline CCS angina class 3.15 ± 0.6). In terms of procedure safety, all patients underwent successful device deployment with only one periprocedural complication. Results: At the 3-month follow-up we observed statistically significant improvement in angina control measured CCS class and SAQ-7 Total questionnaire along with increased abolition of physical limitation – 6-MWT (233.3 ± 107.1 vs 305.2 ± 126.8; p&lt;0.0001). Additionally, we observed significant improvement in terms of quality of life measurements SF-36, the EQ-5D-5L questionnaire, and the EQ-VAS. Conclusions: Our real-world data suggest that CSR implantation is a relatively safe procedure and appears to be particularly effective in relieving angina symptoms and improving quality of life in subjects with refractory angina.

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Section: Discussionmentioning

confidence: 99%

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris - Mid-Term Results of the Real-Life Cohort

Włodarczak,

Rola,

Jastrzębski

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Despite undeniable improvements in revascularization techniques and the pharmacological management of coronary artery disease, clinicians are often faced with patients presenting with disabling chronic refractory angina, although all therapeutic options have been applied in the treatment protocol. Paradoxically, as revascularization techniques and armamentarium evolve, the number of patients with severe refractory angina and a predictable long life expectancy is steadily increasing [8,9], and there is an urgent clinical need for novel therapies to alleviate symptoms and improve the quality of life in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris—Mid-Term Results of the Real-Life Cohort

Włodarczak,

Rola,

Jastrzębski

et al. 2024

JCM

View full text Add to dashboard Cite

Background: Despite continuous improvements in revascularization techniques, refractory angina without potential revascularization options remains a relevant clinical issue with significant impact on the patient’s quality of life. Recently, a novel device, the Coronary Sinus Reducer (CSR), has been introduced into clinical practice as a therapeutic option for patients with disabling angina pectoris. In this single-center, observational study, we evaluated the mid-term (3-month) safety and efficacy of the CSR in a real-world cohort. Methods: The study population consisted of 55 patients with refractory angina without potential revascularization options, who were predominantly men (87.3%) with a high cardiovascular risk factor burden and advanced angina (baseline CCS angina class 3.15 ± 0.6). In terms of procedure safety, all patients underwent successful device deployment with only one periprocedural complication. Results: At the 3-month follow-up, we observed a statistically significant improvement in angina control measured CCS class and SAQ-7 total questionnaire along with increased abolition of physical limitation—6-MWT (233.3 ± 107.1 vs. 305.2 ± 126.8; p < 0.0001). Additionally, we observed significant improvement in terms of quality of life measurements SF-36, the EQ-5D-5L questionnaire, and the EQ-VAS. Conclusions: Our real-world data suggest that CSR implantation is a relatively safe procedure and appears to be particularly effective in relieving angina symptoms and improving quality of life in subjects with refractory angina.

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Integrated Assessment of Coronary Physiology Based on Coronary Angiography in Heart Transplant Patients

Fezzi,

Pesarini,

Guerrieri

et al. 2024

Cathet Cardio Intervent

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BackgroundEarly detection of cardiac allograft vasculopathy after heart transplant (HTx) with invasive coronary angiography is challenging.AimsThe study aimed to determine if computational techniques able to assess epicardial lesions, by means of Murray's law‐based quantitative flow ratio (μFR), and microvascular physiology, by means of angiography microvascular resistance (AMR), enhance risk stratification in HTx patients with nonsignificant coronary artery disease.MethodsThe cohort consisted of 86 consecutive HTx patients (200 epicardial vessels) with stenosis < 50% at baseline. μFR ≤ 0.80 indicated coronary ischemia, while AMR ≥ 2.5 suggested microvascular dysfunction. Clinical events were assessed over a median follow‐up of 43 months, focusing on the relationship between μFR and target vessel failure (TVF), and between AMR and heart failure (HF) hospitalizations.ResultsAt baseline, mean μFR was 0.94 ± 0.08, with eight vessels (4.0%) disclosing flow‐limiting lesions, while AMR was 2.4 ± 0.7, with 80 vessels/40 patients (40.0%/46.5%) having microvascular dysfunction. TVF‐related segments were associated with lower mean μFR values (0.89 ± 0.14 vs. 0.95 ± 0.05; p < 0.007) compared TVF‐free segments. At the receiver operating characteristic curve a μFR ≤ 0.93 demonstrated an area under the curve of 0.632 (95% CI: 0.562–0.699) in predicting TVF occurrence, showing an accuracy of 76.0%, a sensitivity of 46.9%, a specificity of 81.6%, a negative predictive value of 89.0%, and a positive predictive value of 32.6%. μFR ≤ 0.93 showed a significant interaction with TVF occurrence at 43 months (32.6% vs. 11.0%; HR: 2.96; 95% CI: 1.26–6.96; p = 0.013). Microvascular dysfunction showed a significant interaction with HF hospitalizations occurence (AMR: 2.8 ± 4.4 vs. 2.4 ± 4.5; p = 0.001; CMD: 27.5% vs. 4.3%; HR: 7.36; 95% CI: 2.45–22.07; p = 0.002).ConclusionsAngiography‐derived epicardial and microvascular physiology computation may improve risk stratification of heart transplanted patients.

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Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention?

Cited by 5 publications

References 117 publications

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris - Mid-Term Results of the Real-Life Cohort

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris - Mid-Term Results of the Real-Life Cohort

Safety and Effectiveness of Coronary Sinus Reducer in the Therapy of Refractory Angina Pectoris—Mid-Term Results of the Real-Life Cohort

Integrated Assessment of Coronary Physiology Based on Coronary Angiography in Heart Transplant Patients

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