Interventional Therapies and Management in Coronary Artery Disease

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 30967

Special Issue Editors


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Guest Editor
1. 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Kraków, Poland
2. Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
Interests: coronary artery disease; acute coronary syndromes; percutaneous coronary interventions; antiplatelet therapy; cardiac imaging
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland
2. Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Cracow, Poland
3. Interventional Cardiology Department, District Hospital, 37-450 Stalowa Wola, Poland
Interests: aortic stenosis; coronary artery obstruction; percutaneous coronary intervention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Coronary artery disease is the leading cause of death worldwide, and numerous research studies are conducted to improve treatment strategies and, finally, patients’ outcome. During recent years, we have observed rapid progress in invasive and non-invasive diagnostics as well as in pharmacotherapy and interventional (percutaneous and surgical) techniques.

It is our pleasure to invite you to contribute to the Special Issue on “Interventional Therapies and Management in Coronary Artery Disease” which is focused on several aspects of coronary artery disease in chronic and acute coronary syndromes patients. Authors are invited to submit original research studies, state-of-the-art reviews, short contributions, and case reports. This Special Issue is mostly focused on invasive and non-invasive coronary diagnostics, pharmacotherapy, coronary revascularization with percutaneous coronary interventions and surgical techniques, epidemiology, and outcome studies.

Prof. Dr. Tomasz Rakowski
Dr. Łukasz Rzeszutko
Guest Editors

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Keywords

  • coronary artery disease
  • myocardial ischemia
  • myocardial viability
  • chronic coronary syndromes
  • acute coronary syndromes
  • MINOCA
  • INOCA
  • coronary revascularization
  • percutaneous coronary interventions
  • coronary artery surgical revascularization
  • coronary artery bypass grafting
  • cardiac imaging

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Published Papers (11 papers)

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Research

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13 pages, 2401 KiB  
Article
Role of Antiplatelet Therapy in Patients with Severe Coronary Artery Disease Undergoing Coronary Artery Endarterectomy within Coronary Artery Bypass Surgery
by Ilir Balaj, Heinz Jakob, Ali Haddad, Fanar Mourad, Assad Haneya, Ebrahim Ali, Noura Ryadi, Matthias Thielmann, Arjang Ruhparwar and Sharaf-Eldin Shehada
J. Cardiovasc. Dev. Dis. 2023, 10(3), 112; https://doi.org/10.3390/jcdd10030112 - 7 Mar 2023
Viewed by 3049
Abstract
Background—Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel’s media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed [...] Read more.
Background—Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel’s media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed to review outcomes of patients undergoing CEA within bypass surgery who received either single-APT (SAPT) or dual-APT (DAPT). Methods—We retrospectively evaluated 353 consecutive patients undergoing CEA within isolated coronary artery bypass grafting (CABG) in the period 01/2000–07/2019. After surgery, patients received either SAPT (n = 153), or DAPT (n = 200) for six months then lifelong SAPT. Endpoints included early, late survival, and freedom from major-adverse-cardiac and cerebrovascular events (MACCE), which were defined as incidence of stroke, myocardial infarction, need for coronary intervention (PCI or CABG) or death for any cause. Results—Patients’ mean age was 67 ± 9.3 years; they were predominantly male 88.1%. Both DAPT- and SAPT-groups had the same extent of CAD (mean SYNTAX-Score-II: 34.1 ± 11.6 vs. 34.4 ± 17.2, p = 0.91). Postoperatively, no difference between DAPT- and SAPT-groups was reported in the incidence of low-cardiac-output syndrome (5% vs. 9.8%, p = 0.16), revision for bleeding (5% vs. 6.5% p = 0.64), 30-day mortality (4.5% vs. 5.2%, p = 0.8) or MACCE (7.5% vs. 11.8%, p = 0.19). Imaging follow-up reported significantly higher CEA and total grafts patency (90% vs. 81.5% and 95% vs. 81%, p = 0.017) in DAPT patients. Late outcomes within 97.4 ± 67.4 months show lower incidence of overall mortality (19 vs. 51%, p < 0.001) and MACCE (24.5 vs. 58.2%, p < 0.001) in the DAPT patients when compared with SAPT patients. Conclusions—Coronary endarterectomy allows revascularization in end-stage CAD when the myocardium is still viable. The use of dual APT after CEA for at least six months seems to improve mid-to-long-term patency rates and survival, and reduced the incidence of major adverse cardiac and cerebrovascular events. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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18 pages, 2891 KiB  
Article
Intracoronary Administration of Microencapsulated HGF in a Reperfused Myocardial Infarction Swine Model
by Virginia Blanco-Blázquez, Claudia Báez-Díaz, Francisco Miguel Sánchez-Margallo, Irene González-Bueno, Helena Martín, Rebeca Blázquez, Javier G. Casado, Alejandra Usón, Julia Solares, Itziar Palacios, Rob Steendam and Verónica Crisóstomo
J. Cardiovasc. Dev. Dis. 2023, 10(2), 86; https://doi.org/10.3390/jcdd10020086 - 17 Feb 2023
Cited by 1 | Viewed by 2175
Abstract
Therapy microencapsulation allows minimally invasive, safe, and effective administration. Hepatocyte growth factor (HGF) has angiogenic, anti-inflammatory, anti-apoptotic, and anti-fibrotic properties. Our objective was to evaluate the cardiac safety and effectiveness of intracoronary (IC) administration of HGF-loaded extended release microspheres in an acute myocardial [...] Read more.
Therapy microencapsulation allows minimally invasive, safe, and effective administration. Hepatocyte growth factor (HGF) has angiogenic, anti-inflammatory, anti-apoptotic, and anti-fibrotic properties. Our objective was to evaluate the cardiac safety and effectiveness of intracoronary (IC) administration of HGF-loaded extended release microspheres in an acute myocardial infarction (AMI) swine model. An IC infusion of 5 × 106 HGF-loaded microspheres (MS+HGF, n = 7), 5 × 106 placebo microspheres (MS, n = 7), or saline (SAL, n = 7) was performed two days after AMI. TIMI flow and Troponin I (TnI) values were assessed pre- and post-treatment. Cardiac function was evaluated with magnetic resonance imaging (cMR) before injection and at 10 weeks. Plasma cytokines were determined to evaluate the inflammatory profile and hearts were subjected to histopathological evaluation. Post-treatment coronary flow was impaired in five animals (MS+HGF and MS group) without significant increases in TnI. One animal (MS group) died during treatment. There were no significant differences between groups in cMR parameters at any time (p > 0.05). No statistically significant changes were found between groups neither in cytokines nor in histological analyses. The IC administration of 5 × 106 HGF-loaded-microspheres 48 h post-AMI did not improve cardiac function, nor did it decrease inflammation or cardiac fibrosis in this experimental setting. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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12 pages, 1369 KiB  
Article
Comparison of Fractional Flow Reserve with Resting Non-Hyperemic Indices in Patients with Coronary Artery Disease
by Barbara Zdzierak, Wojciech Zasada, Agata Krawczyk-Ożóg, Tomasz Rakowski, Stanisław Bartuś, Andrzej Surdacki and Artur Dziewierz
J. Cardiovasc. Dev. Dis. 2023, 10(2), 34; https://doi.org/10.3390/jcdd10020034 - 18 Jan 2023
Cited by 4 | Viewed by 2480
Abstract
Guidelines recommend using hyperemic (FFR) and non-hyperemic (iFR/RFR) methods of evaluating coronary artery stenoses in patients with coronary artery disease. However, in some cases, achieved results indicating significant ischemia may differ between those methods. Thus, we sought to identify predictors of such a [...] Read more.
Guidelines recommend using hyperemic (FFR) and non-hyperemic (iFR/RFR) methods of evaluating coronary artery stenoses in patients with coronary artery disease. However, in some cases, achieved results indicating significant ischemia may differ between those methods. Thus, we sought to identify predictors of such a discrepancy. Data were collected on all consecutive patients with chronic coronary syndrome hospitalized between 2020 and 2021. For 279 patients (417 vessels), results for both FFR and iFR/RFR were available. Values of ≤0.80 for FFR and ≤0.89 for iFR/RFR were considered positive for ischemia. Discordant measurements of FFR and iFR/RFR were observed in 80 (19.2%) patients. Atrial fibrillation was the only predictor of the overall FFR and iFR/RFR discordance - OR (95%CI) 1.90 (1.02–3.51); p = 0.040. The chance of positive FFR and negative iFR/RFR decreased independently with age - OR (95%CI) 0.96 (0.93–0.99); p = 0.024. On the contrary, insulin-treated diabetes mellitus was the predictor of negative FFR and positive iFR/RFR discrepancy - OR (95%CI) 4.61 (1.38–15.40); p = 0.013. In everyday clinical practice, iFR/FFR correlates well with FFR. However, discordance between these methods is quite common. Physicians should be aware of the risk of such discordance in patients with atrial fibrillation, advanced age, and insulin-treated diabetes mellitus. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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12 pages, 1295 KiB  
Article
Intravascular Ultrasound Guidance Is Associated with a Favorable One-Year Target Vessel Failure Rate and No Residual Myocardial Ischemia after the Percutaneous Treatment of Very Long Coronary Artery Lesions
by Povilas Budrys, Arvydas Baranauskas and Giedrius Davidavicius
J. Cardiovasc. Dev. Dis. 2022, 9(12), 445; https://doi.org/10.3390/jcdd9120445 - 9 Dec 2022
Cited by 1 | Viewed by 1896
Abstract
Background: Studies have shown that percutaneous coronary intervention (PCI) in long coronary artery lesions (≥30 mm) is associated with more frequent target vessel failure (TVF), and a significant proportion of patients have lesions that continue to induce ischemia after PCI (FFR ≤ 0.8). [...] Read more.
Background: Studies have shown that percutaneous coronary intervention (PCI) in long coronary artery lesions (≥30 mm) is associated with more frequent target vessel failure (TVF), and a significant proportion of patients have lesions that continue to induce ischemia after PCI (FFR ≤ 0.8). We investigated the impact of intravascular ultrasound (IVUS) on the functional PCI result and one-year TVF rate after the percutaneous treatment of long coronary artery lesions. Methods: A total of 80 patients underwent IVUS-guided PCI in long coronary artery lesions. The PCI results were validated with IVUS and FFR. Procedural outcomes were the proportion of patients with: (1) optimal physiology result (post PCI FFR value ≥ 0.9); (2) optimal anatomy result (all IVUS PCI optimization criteria met); and (3) optimal physiology and anatomy result. The clinical outcome was TVF during a one-year follow-up (target vessel (TV)-related death, TV myocardial infarction, ischemia-driven TV revascularization). Results: The mean stented segment length was 62 mm. The target vessel (TV) was the left anterior descending artery in 82.5% of cases. There were no patients with residual ischemia (FFR ≤ 0.8) after PCI. Optimal coronary flow (FFR ≥ 0.9) was achieved in 37.5%; optimal anatomy, as assessed by IVUS, was achieved in 68.4%; and both optimal flow and anatomy were achieved in 25% of patients. Target vessel failure during the 12-month follow-up was 2.5%. Conclusions: In the percutaneous treatment of very long coronary artery lesions, the use of IVUS guidance is associated with a low TVF rate during a one-year follow-up and no residual myocardial ischemia, as assessed by FFR. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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12 pages, 2073 KiB  
Article
Clinical Characteristics Predicting Worse Long-Term Outcomes in Patients with Myocardial Infarction and Non-Obstructive Coronary Arteries (MINOCA)
by Piotr Szolc, Łukasz Niewiara, Paweł Kleczyński, Krzysztof Bryniarski, Elżbieta Ostrowska-Kaim, Kornelia Szkodoń, Piotr Brzychczy, Krzysztof Żmudka, Jacek Legutko and Bartłomiej Guzik
J. Cardiovasc. Dev. Dis. 2022, 9(9), 286; https://doi.org/10.3390/jcdd9090286 - 26 Aug 2022
Cited by 5 | Viewed by 2720
Abstract
Non-obstructive coronary artery disease occurs in 3.5–15% of patients presenting with acute myocardial infarction. This group of patients has a poor prognosis. Identification of factors that predict worse outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) is therefore important. Patients with a [...] Read more.
Non-obstructive coronary artery disease occurs in 3.5–15% of patients presenting with acute myocardial infarction. This group of patients has a poor prognosis. Identification of factors that predict worse outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) is therefore important. Patients with a diagnosis of MINOCA (n = 110) were enrolled in this single-center, retrospective registry. Follow-up was performed 12, 24 and 36 months after discharge. The primary composite endpoint was defined as myocardial infarction, coronary revascularization, stroke or TIA, all-cause death, or hospital readmission due to any cardiovascular event. The mean age of the study group was 64.9 (± 13.5) years and 38.2% of patients were male. The occurrence of the primary composite endpoint was 36.4%. In a COX proportional hazards model analysis, older age (p = 0.027), type 2 diabetes (p = 0.013), history of neoplasm (p = 0.004), ST-segment depression (p = 0.018) and left bundle branch block/right bundle branch block (p = 0.004) by ECG on discharge, higher Gensini score (p = 0.022), higher intraventricular septum (p = 0.007) and posterior wall thickness increases (p = 0.001) were shown to be risk factors for primary composite endpoint occurrence. Our study revealed that several factors such as older age, type 2 diabetes, ST-segment depression and LBBB/RBBB in ECG on discharge, higher Gensini score, and myocardial hypertrophy and history of neoplasm may contribute to worse clinical outcomes in MINOCA patients. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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7 pages, 389 KiB  
Article
Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction
by Michał Węgiel, Paweł Kleczyński, Artur Dziewierz, Łukasz Rzeszutko, Andrzej Surdacki, Stanisław Bartuś and Tomasz Rakowski
J. Cardiovasc. Dev. Dis. 2022, 9(5), 145; https://doi.org/10.3390/jcdd9050145 - 5 May 2022
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Abstract
(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) [...] Read more.
(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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10 pages, 1038 KiB  
Article
Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge
by György Bárczi, Dávid Becker, Nóra Sydó, Zoltán Ruzsa, Hajnalka Vágó, Attila Oláh and Béla Merkely
J. Cardiovasc. Dev. Dis. 2022, 9(5), 129; https://doi.org/10.3390/jcdd9050129 - 25 Apr 2022
Cited by 4 | Viewed by 2410
Abstract
Although myocardial bridging (MB) has been intensively investigated using different methods, the effect of bridge morphology on long-term outcome is still doubtful. We aimed at describing the anatomical differences in coronary angiography between symptomatic and non-symptomatic LAD myocardial bridges and to investigate the [...] Read more.
Although myocardial bridging (MB) has been intensively investigated using different methods, the effect of bridge morphology on long-term outcome is still doubtful. We aimed at describing the anatomical differences in coronary angiography between symptomatic and non-symptomatic LAD myocardial bridges and to investigate the influence of clinical and morphological factors on long-term mortality. In our retrospective, long-term, single center study we found relevant MB on the left anterior descendent (LAD) coronary artery in 146 cases during a two-year period, when 11,385 patients underwent coronary angiography due to angina pectoris. Patients were divided into two groups: those with myocardial bridge only (LAD-MBneg, n = 78) and those with associated obstructive coronary artery disease (LAD-MBpos, n = 68). Clinical factors, morphology of bridge by quantitative coronary analysis and ten-year long mortality data were collected. The LAD-MBneg group was associated with younger age and decreased incidence of diabetes mellitus, as well as with increased minimal diameter to reference diameter ratio (LAD-MBneg 54.5 (13.1)% vs. LAD-MBpos 46.5 (16.4)%, p = 0.016), while there was a tendency towards longer lesions and higher vessel diameter values compared to the LAD-MBpos group. The LAD-MBpos group was associated with increased mortality compared to the LAD-MBneg group. The analysis of our data showed that morphological parameters of LAD bridge did not influence long-term mortality, either in the overall population or in the LAD-MBneg patients. Morphological parameters of LAD bridge did not influence long-term mortality outcomes; therefore, it suggests that anatomical differences might not predict long-term outcomes and should not influence therapy. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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12 pages, 1626 KiB  
Article
Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position
by Pimpan Usawasuraiin, Borwon Wittayachamnankul, Boriboon Chenthanakij, Juntima Euathrongchit, Phichayut Phinyo and Theerapon Tangsuwanaruk
J. Cardiovasc. Dev. Dis. 2022, 9(4), 100; https://doi.org/10.3390/jcdd9040100 - 27 Mar 2022
Cited by 3 | Viewed by 4834
Abstract
Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was [...] Read more.
Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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Review

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13 pages, 685 KiB  
Review
The Cost Effectiveness of Coronary CT Angiography and the Effective Utilization of CT-Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease
by Rex A. Burch, Taha A. Siddiqui, Leila C. Tou, Kiera B. Turner and Muhammad Umair
J. Cardiovasc. Dev. Dis. 2023, 10(1), 25; https://doi.org/10.3390/jcdd10010025 - 7 Jan 2023
Cited by 3 | Viewed by 3020
Abstract
Given the high global disease burden of coronary artery disease (CAD), a major problem facing healthcare economic policy is identifying the most cost-effective diagnostic strategy for patients with suspected CAD. The aim of this review is to assess the long-term cost-effectiveness of coronary [...] Read more.
Given the high global disease burden of coronary artery disease (CAD), a major problem facing healthcare economic policy is identifying the most cost-effective diagnostic strategy for patients with suspected CAD. The aim of this review is to assess the long-term cost-effectiveness of coronary computed tomography angiography (CCTA) when compared with other diagnostic modalities and to define the cost and effective diagnostic utilization of computed tomography-fractional flow reserve (CT-FFR). A search was conducted through the MEDLINE database using PubMed with 16 of 119 manuscripts fitting the inclusion and exclusion criteria for review. An analysis of the data included in this review suggests that CCTA is a cost-effective strategy for both low risk acute chest pain patients presenting to the emergency department (ED) and low-to-intermediate risk stable chest pain outpatients. For patients with intermediate-to-high risk, CT-FFR is superior to CCTA in identifying clinically significant stenosis. In low-to-intermediate risk patients, CCTA provides a cost-effective diagnostic strategy with the potential to reduce economic burden and improve long-term health outcomes. CT-FFR should be utilized in intermediate-to-high risk patients with stenosis of uncertain clinical significance. Long-term analysis of cost-effectiveness and diagnostic utility is needed to determine the optimal balance between the cost-effectiveness and diagnostic utility of CT-FFR. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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16 pages, 803 KiB  
Review
The Merits, Limitations, and Future Directions of Cost-Effectiveness Analysis in Cardiac MRI with a Focus on Coronary Artery Disease: A Literature Review
by Taha A. Siddiqui, Kiran S. Chamarti, Leila C. Tou, Gregory A. Demirjian, Sarah Noorani, Sydney Zink and Muhammad Umair
J. Cardiovasc. Dev. Dis. 2022, 9(10), 357; https://doi.org/10.3390/jcdd9100357 - 17 Oct 2022
Cited by 5 | Viewed by 2967
Abstract
Cardiac magnetic resonance (CMR) imaging has a wide range of clinical applications with a high degree of accuracy for many myocardial pathologies. Recent literature has shown great utility of CMR in diagnosing many diseases, often changing the course of treatment. Despite this, it [...] Read more.
Cardiac magnetic resonance (CMR) imaging has a wide range of clinical applications with a high degree of accuracy for many myocardial pathologies. Recent literature has shown great utility of CMR in diagnosing many diseases, often changing the course of treatment. Despite this, it is often underutilized possibly due to perceived costs, limiting patient factors and comfort, and longer examination periods compared to other imaging modalities. In this regard, we conducted a literature review using keywords “Cost-Effectiveness” and “Cardiac MRI” and selected articles from the PubMed MEDLINE database that met our inclusion and exclusion criteria to examine the cost-effectiveness of CMR. Our search result yielded 17 articles included in our review. We found that CMR can be cost-effective in quality-adjusted life years (QALYs) in select patient populations with various cardiac pathologies. Specifically, the use of CMR in coronary artery disease (CAD) patients with a pretest probability below a certain threshold may be more cost-effective compared to patients with a higher pretest probability, although its use can be limited based on geographic location, professional society guidelines, and differing reimbursement patterns. In addition, a stepwise combination of different imaging modalities, with conjunction of AHA/ACC guidelines can further enhance the cost-effectiveness of CMR. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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Other

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9 pages, 569 KiB  
Brief Report
Effect of Coronary Sinus Reducer Implantation on Aerobic Exercise Capacity in Refractory Angina Patients—A CROSSROAD Study
by Miha Mrak, Nejc Pavšič, David Žižek, Luka Ležaić and Matjaž Bunc
J. Cardiovasc. Dev. Dis. 2023, 10(6), 235; https://doi.org/10.3390/jcdd10060235 - 26 May 2023
Cited by 4 | Viewed by 1636
Abstract
Coronary sinus reducer (CSR) implantation is a new treatment option for patients with refractory angina pectoris. However, there is no evidence from a randomized trial that would show an improvement in exercise capacity after this treatment. The aim of this study was to [...] Read more.
Coronary sinus reducer (CSR) implantation is a new treatment option for patients with refractory angina pectoris. However, there is no evidence from a randomized trial that would show an improvement in exercise capacity after this treatment. The aim of this study was to evaluate the influence of CSR treatment on maximal oxygen consumption and compare it to a sham procedure. Twenty-five patients with refractory angina pectoris (Canadian Cardiovascular Society (CCS) class II–IV) were randomized to a CSR implantation (n = 13) or a sham procedure (n = 12). At baseline and after 6 months of follow-up, the patients underwent symptom-limited cardiopulmonary exercise testing with an adjusted ramp protocol and assessment of angina pectoris using the CCS scale and Seattle angina pectoris questionnaire (SAQ). In the CSR group, maximal oxygen consumption increased from 15.56 ± 4.05 to 18.4 ± 5.2 mL/kg/min (p = 0.03) but did not change in the sham group (p = 0.53); p for intergroup comparison was 0.03. In contrast, there was no difference in the improvement of the CCS class or SAQ domains. To conclude, in patients with refractory angina and optimized medical therapy, CSR implantation may improve oxygen consumption beyond that of optimal medical therapy. Full article
(This article belongs to the Special Issue Interventional Therapies and Management in Coronary Artery Disease)
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