Journal of Interventional Cardiology

Background. Cardiologists are today exposed to a growing dose of ionising radiation in their practice. Radiation awareness and correct management of X-ray use are the cornerstone to comply with the principles of exposure optimization and justification. Methods and Results. An investigator-initiated international voluntary-based survey including 28 questions was conducted across 19 European countries. 228 cardiologists participated in the survey. Invasive cardiology subspecialties were the most represented (83.6%). Radiation exposure is the cause of personal protective equipment-related orthopaedic injuries (personally or in coworkers) or anxiety in 68.5% and 62.9% of cases, respectively. 38.4% of participants have encountered difficulties in having their institutions recognizing periods off work for exceeding radiation exposure limit (16.3% usually and 22.1% on rare occasions). Gender was not associated with any difference in the answers. Age older than 40 years old was associated with an increased knowledge of personal dosimeter data (71.6% vs. 51.3%, ). Invasive cardiologists more frequently suffer from orthopaedic injuries (73.0% vs. 44.8%, ) and show greater participation to radioprotection courses (78.4 vs. 27.6%, ). Conclusion. European cardiologists show appropriate awareness of the risks associated with X-ray use in medical practice and of the principles guiding a proper management of radiation hazard. However, there is still room for improvement, and institutions should promote risk education policies, which are the basis for the creation and diffusion of a community consciousness on radiation hazard.

Background. Studies have demonstrated poor prognosis in cancer patients who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Cancer patients receiving PCI are at increased risk of in-stent thrombosis, bleeding, hospital readmissions, and cardiovascular and noncardiovascular mortality when compared to patients without cancer. It is unclear if the poor outcomes in cancer patients are related to the stent type utilized for PCI. This meta-analysis attempts to identify differences in efficacy and safety outcomes when comparing drug-eluting stents (DESs) with bare metal stents (BMSs) in cancer patients. Methods. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. The primary outcomes of interest were in-stent thrombosis, bleeding, and mortality. Results. Four studies comprising of 54,414 patients met the inclusion criteria. There was no difference in in-stent thrombosis (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.58–1.07), bleeding events (OR: 1.38; 95% CI: 0.77–2.49), or in-hospital mortality (OR: 1.92; 95% CI: 0.83–4.43) when comparing cancer patients who underwent PCI with DES vs BMS. Conclusions. This meta-analysis demonstrates no difference in mortality, bleeding, or in-stent thrombosis between revascularization with BMS vs DES in patients with cancer and CAD. Cancer patients included in this meta-analysis experienced higher rates of mortality, bleeding, and in-stent thrombosis after PCI compared to all-comers described in the literature.

Background. The need for minimally invasive Bentall surgery for the treatment of aortic lesions with aortic insufficiency is increasing; however, comparative studies on the safety of the minimally invasive Bentall procedure and sternotomy Bentall procedure are lacking. Methods. Clinical data of 56 patients who underwent the Bentall procedure performed by the same surgical team at our center between December 2018 and December 2021 were retrospectively analyzed and followed up for 6 months after discharge. After dividing the patients into a right anterior chest minimally invasive Bentall surgery (RAT-Bentall) group (n = 13) and a conventional sternotomy Bentall surgery (C-Bentall) group (n = 43), intraoperative and early postoperative clinical data and echocardiography at 6 months after discharge were compared. Results. Compared with the C-Bentall group, the RAT-Bentall group had a lower postoperative visual analogue scale (VAS) pain score [(3.00 ± 2.08) VS (5.77 ± 1.84), ] and a shorter CSICU hospital stay [(1.90 ± 0.52) VS (2.51 ± 1.58) d, ] and postoperative hospital stay [(7.62 ± 1.81) VS (10.42 ± 2.45) d, ]. The incidence of postoperative complications and echocardiographic at 6-month follow-up after discharge was not statistically different between the two groups. Conclusion. The RAT-Bentall procedure is safe and effective. Compared with the sternotomy Bentall procedure, it can reduce postoperative pain as well as patients’ CSICU and postoperative hospital stay. Therefore, this technology is worth promoting and applying.

Background. Colchicine has shown potential cardioprotective effects owing to its broad anti-inflammatory properties. We performed a meta-analysis to assess its safety and efficacy in secondary prevention in patients with established coronary artery disease (CAD). Methods. We searched Ovid Healthstar, MEDLINE, and Embase (inception to May 2022) for randomized controlled trials (RCTs) evaluating the cardiovascular effects of colchicine compared with placebo or usual care in patients with CAD. Study-level data on efficacy and safety outcomes were pooled using the Peto method. The primary outcome was the composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke. Results. A total of 8 RCTs were included with a follow-up duration of ≥1 month, comprising a total of 12,151 patients. Compared with placebo or usual care, colchicine was associated with a significant risk reduction in the primary outcome (odds ratio (OR) 0.70, 95% CI 0.60 to 0.83, ; ). Risks of MI (OR 0.75, 95% CI 0.62 to 0.91, ; ), stroke (OR 0.47, 95% CI 0.30 to 0.74, ; ), and unplanned coronary revascularization (OR 0.67, 95% CI 0.55 to 0.82, ; ) were all reduced in the colchicine group. Rates of CV and all-cause mortality did not differ between the two groups, but there was an increase in noncardiac deaths with colchicine (OR 1.54, 95% CI 1.10 to 2.15, ; ). The occurrence of all other adverse events was similar between the two groups, including GI reactions (OR 1.06, 95% CI 0.94 to 1.20, ; ) and infections (OR 1.04, 95% CI 0.84 to 1.28, ; ). Conclusions. Colchicine therapy may reduce the risk of future cardiovascular events in patients with established CAD; however, there remains a concern about non-CV mortality. Further trials are underway that will shed light on non-CV mortality and colchicine NCT03048825, and NCT02898610.

Aims. To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) on periprocedural pulmonary hypertension (PH) and 3-month all-cause mortality in patients with aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) and to develop a nomogram for predicting the mortality for these patients. Methods and Results. 124 patients undergoing TAVR were categorized into three groups according to systolic pulmonary artery pressure (sPAP): Group I (no PH, n = 61) consisted of patients with no pre- and post-TAVR PH; Group II (improved PH, n = 35) consisted of patients with post-TAVR systolic pulmonary artery pressure (sPAP) decreased by more than 10 mmHg compared to pre-TAVR levels; and Group III (persistent PH, n = 28) consisted of patients with post-TAVR sPAP no decrease or less than 10 mmHg, or new-onset PH after the TAVR procedure. The risk of all-cause mortality within 3 months tended to be higher in Group II (11.4%) and Group III (14.3%) compared to Group I (3.3%) (). The multinomial logistic regression analysis demonstrated a positive correlation between NLR and both improved PH (OR: 1.182, 95% CI: 1.036–1.350, ) and persistent PH (OR: 1.181, 95% CI: 1.032–1.352, ). Kaplan–Meier analysis revealed a significant association between higher NLR and increased 3-month all-cause mortality (16.1% vs. 3.1% in lower NLR group, ). The multivariable Cox regression analysis confirmed that NLR was an independent predictor for all-cause mortality within 3 months, even after adjusting for clinical confounders. A nomogram incorporating five factors (BNP, heart rate, serum total bilirubin, NLR, and comorbidity with coronary heart disease) was developed. ROC analysis was performed to discriminate the ability of the nomogram, and the AUC was 0.926 (95% CI: 0.850–1.000, ). Conclusions. Patients with higher baseline NLR were found to be at an increased risk of periprocedural PH and all-cause mortality within 3 months after TAVR.

Background. The global rise of chronic diseases, especially cardiovascular disease (CVD), poses a significant public health challenge, being a leading cause of death and disability worldwide. In Iran, the surge in CVD incidence and its risk factors, along with a decrease in the age of onset, has notably increased the reliance on coronary artery bypass grafting (CABG) as a life-saving intervention. Staged hybrid coronary revascularization (HCR), which combines percutaneous coronary intervention with delayed CABG, offers a novel approach for patients with complex coronary artery disease, potentially improving survival and reducing complications. Considering the newness of this treatment method and the limitations of previous studies, we investigated the results of staged HCR in acute ST-elevation myocardial infarction (STEMI) patients in this study. Methods. This observational study was performed on consecutive patients with acute STEMI who underwent staged HCR and were referred to Valiasr and Razi hospitals in Birjand from 2015 to 2022. The required information (demographic information, angiography result, and operation side effects) was collected in a checklist. If necessary, the patients were contacted by phone. After collecting the data, they were entered into SPSS version 16 software. Results. This study was conducted on 33 patients with a mean age of 64.88 ± 9.24 years (69.7% male). The average hospital stay was 11.6 ± 8.9 days (3 to 72 days). The mean ejection fraction and syntax score were 36.5% ± 10.2% and 31.21 ± 6.7, respectively. Following surgery and during hospitalization, arrhythmias were observed, including 33.3% with premature ventricular contractions, 18.1% with atrial fibrillation, and 3.1% with ventricular tachycardia. The average number of pack cells (red blood cells that have been separated for blood transfusion) and creatinine changes before and after hybrid surgery were 640.9 ± 670.9 cc and 0.055 ± 0.07. In the follow-up, 9.09% of patients had late mortality, 6.1% of patients had urinary tract infections during hospitalization, 6.1% of patients had surgical site infections, 3.1% needed dialysis, and none of the studied patients had premature death or need for reintervention. Conclusions. The results of our study indicated that staged HCR performed early after an ACS is not associated with significant mortality or complications. Therefore, it is advisable to consider staged HCR as a surgical option in appropriate cases.