Search

A 58-year-old male with prior history of mechanical aortic valve replacement (AVR) in 2009 for severe symptomatic aortic regurgitation in a bicuspid aortic valve, and since 2013 a new-onset severe asymptomatic primary mitral regurgitation (MR) due to prolapse of the anterior mitral valve leaflet (AMVL) presented himself with acute heart failure. Based on current guidelines recommendations, this patient was not eligible for transcutaneous mitral valve edge-to-edge repair (TEER), as well he was found as too high risk for conventional mitral valve repair. However, as a last resort TEER was undertaken with an unconventional strategy, which resulted in resolution of the MR and improvement of clinical, biochemical findings.

Background Multisite artery disease is considered a ‘malignant’ type of atherosclerotic disease associated with an increased cardiovascular risk, but the impact of multisite artery disease on clinical outcomes after percutaneous coronary intervention (PCI) is unknown. Methods Patients enrolled in the large, prospective e-Ultimaster study were grouped into (1) those without known prior vascular disease, (2) those with known single-territory vascular disease, and (3) those with known two to three territories (i.e coronary, cerebrovascular, or peripheral) vascular disease (multisite artery disease). The primary outcome was coronary target lesion failure (TLF), defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 1-year. Inverse propensity score weighted (IPSW) analysis was performed to address differences in baseline patient and lesion characteristics. Results Of the 37 198 patients included in the study, 62.3% had no prior known vascular disease, 32.6% had single-territory vascular disease, and 5.1% had multisite artery disease. Patients with known vascular disease were older and were more likely to be men and to have more co-morbidities. After IPSW, the TLF rate incrementally increased with the number of diseased vascular beds (3.16%, 4.44%, and 6.42% for no, single, and multisite artery disease, respectively, P Conclusions Patients with previously known vascular disease experienced an increased risk of adverse cardiovascular events and mortality post-PCI. This risk is highest among patients with multisite artery disease. Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02188355.

Purpose: We sought to investigate the relationship between global ischemia and clinical outcome in patients with stable coronary disease. Methods: This FAME 2 sub-analysis was conducted in 607 patients (pts) with at least one diseased major coronary artery, and receiving medical therapy (MT) alone (441 pts in the randomized trial and 166 pts with follow-up in the registry). We analyzed the rate of a composite of cardiovascular death, myocardial infarction, and ischemia-driven target lesion revascularization (MACE) in relation to a FAME 2 global ischemic risk score, defined as the sum of the individual risks of MACE for each target lesion and calculated as following: ∑1.3(1-FFRlesion)/0.05. Results: At least one MACE occurred in 95 pts (15.7%) at a median follow-up of 172 (80-284) days. Mean FAME 2 score was significantly higher in pts with MACE than in pts w/o MACE (16.2±18.7 vs. 9.4±12.1, p