Key Points
Quantitative flow reserve (QFR) allows for functional assessment of stenosis in a vessel using angiography, allowing estimation of the residual QFR (rQFR) after simulated stenting.
Use of ...rQFR was able to predict post‐PCI FFR ≤ 0.80 and using a rQFR≤0.89 cut‐off was correlated with an increased need for repeat target vessel revascularization.
Angiographic FFR tools provide rapid, safe, and complete coronary hemodynamics and will likely supplant wire‐based measurements once fully validated and properly marketed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Neutralizing antibodies are thought to be crucial for HIV vaccine protection, but studies in animal models suggest that high antibody concentrations are required. This is a major potential hurdle for ...vaccine design. However, these studies typically apply a large virus inoculum to ensure infection in control animals in single-challenge experiments. In contrast, most human infection via sexual encounter probably involves repeated exposures to much lower doses of virus. Therefore, animal studies may have provided an overestimate of the levels of antibodies required for protection in humans. We investigated whether plasma concentrations of antibody corresponding to relatively modest neutralization titers in vitro could protect macaques from repeated intravaginal exposure to low doses of a simian immunodeficiency virus-HIV chimera (SHIV) that uses the CC chemokine receptor 5 (CCR5) co-receptor. An effector function-deficient variant of the neutralizing antibody was also included. The results show that a substantially larger number of challenges is required to infect macaques treated with neutralizing antibody than control antibody-treated macaques, and support the notion that effector function may contribute to antibody protection. Overall, the results imply that lower amounts of antibody than previously considered protective may provide benefit in the context of typical human exposure to HIV-1.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Better together? Maybe not with CTO‐PCI Seto, Arnold H.; Tehrani, David M.
Catheterization and cardiovascular interventions,
March 1, 2023, 2023-03-00, 20230301, Volume:
101, Issue:
4
Journal Article
Peer reviewed
Open access
Key points
Double‐scrubbing or multioperator chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been postulated to enhance procedural success and efficiency in complex ...procedures.
The present study shows no difference in success rates with single‐ or multioperator CTO‐PCI, and less efficiency in terms of time, contrast, and radiation despite single‐operators having more complex cases.
Multioperator CTO‐PCI provides ongoing training and experience in complex procedures rather than any benefits in procedural success or efficiency, and should be utilized mainly when additional training is required.
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Key Points
Similar to the era of bare‐metal stents, there is increased risk of myocardial infraction and target vessel revascularization in the presence of stent overlap when using drug‐eluting ...stents (DES).
This increased risk of events was present regardless of DES generation or polymer delivery system type.
These findings highlight the importance of pre‐intervention planning with imaging‐guided percutaneous coronary intervention.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
A stitch in time saves… uncontrollable blood loss Seto, Arnold H.; Tehrani, David M.
Catheterization and cardiovascular interventions,
September 2021, 2021-09-00, 20210901, Volume:
98, Issue:
3
Journal Article
Peer reviewed
Key Points
Suture‐based vascular closure devices are highly effective but can fail because of operator, patient, and procedure factors.
This report from the FDA MAUDE database of device failures ...included half where such failure led to bleeding or vascular injury requiring surgical or endovascular repair, and death in two patients.
This real‐world data is limited by self‐reporting and an unclear volume of procedures but may help operators understand the failure modes and potential consequences.
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Key Points
Radial artery occlusion is a function of anticoagulation, compression time, compression pressure, and vascular injury from sheath size and puncture attempts.
This study showed that ...increased levels of anticoagulation during transradial cases is associated with a higher incidence of occlusive hemostasis, increasing the risk of radial artery occlusion.
Reductions in compression time as made possible by adjunctive hemostatic patches may obviate the need for high doses of heparin.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Key Points
The SCAI Shock Classification formalized definitions of cardiogenic shock and is prognostic for mortality.
This retrospective analysis found that AKI was prognostic for mortality in ...patients at risk of or in early shock, but was paradoxically associated with lower mortality in SCAI Shock D or E.
Survival bias explains this result and the risks in other mental shortcuts made in science and society.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Key Points
Intravascular ultrasound reduces MACE, target vessel revascularization, and stent thrombosis in percutaneous coronary intervention, but limited data exist for ST‐segment elevation ...myocardial infarction (STEMI) patients.
This analysis from the Nationwide Readmissions Database suggests that intravascular ultrasound (IVUS) use at the time of STEMI is associated with lower rates of readmission due to acute MI and mortality at 11 months.
There are multiple reasons to believe that the effect of IVUS would be beneficial in STEMI, and this study contributes some circumstantial evidence.
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