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espanolIntroduccion y objetivos: Los pacientes con lesiones coronarias largas, secuenciales o difusas tratadas percutaneamente continuan presentando un riesgo alto de eventos cardiovasculares a pesar de la mejoria de la seguridad y de la eficacia de los nuevos stents liberadores de farmacos. El objetivo de este estudio es analizar la utilidad del software SyncVision /iFR (SyncVision version 4.1.0.5, Philips Volcano, Belgica) para guiar la revascularizacion en este tipo de lesiones. Metodos: Estudio aleatorizado, multicentrico, controlado y abierto para comparar la revascularizacion guiada por SyncVision /iFR respecto a la revascularizacion guiada por angiografia en pacientes con lesiones coronarias largas, secuenciales o difusas (identificador de ClinicalTrials.gov: NCT04283734). Se incluira a 100 pacientes (aleatorizacion 1:1 no estratificada). El objetivo primario es la longitud total del stent implantado. Como objetivo secundario se ha establecido un combinado de muerte cardiaca, infarto de miocardio, trombosis definitiva o probable del stent, nueva revascularizacion de la lesion tratada en el procedimiento basal o nueva revascularizacion de la lesion analizada en el procedimiento basal, y la presencia de isquemia residual evaluada por tomografia computarizada por emision de foton simple a los 6 meses de seguimiento. El tiempo de seguimiento sera de 12 meses tras el procedimiento indice. Resultados: El estudio se encuentra actualmente en fase de reclutamiento, con los primeros 7 pacientes ya incluidos. Esperamos completar el reclutamiento en febrero de 2021 y el seguimiento en febrero de 2022. Conclusiones: El estudio iLARDI es el primer estudio aleatorizado para la evaluacion de la potencial utilidad de la revascularizacion guiada por Syncvision en lesiones coronarias largas, secuenciales y difusas. EnglishIntroduction and objectives: patients with long, sequential and diffuse coronary lesions who undergo a percutaneous coronary intervention remain at a high risk of suffering cardiovascular events despite the improved safety and efficacy of the new drug-eluting stents. The objective of this study was to analyze the utility of SyncVision/iFR-guided revascularization (SyncVision version 4.1.0.5, Philips Volcano, Belgium) in this type of lesions. Methods: Randomized, multicenter, controlled, and open-label trial designed to compare SyncVision/iFR-guided and angiography-guided revascularizations in patients with long, sequential or diffuse significant angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). A total of 100 patients will be randomized (1:1, no stratification). The primary endpoint is the average length of the stent implanted. The secondary endpoint is a composite of cardiac death, myocardial infarction, definitive or probable stent thrombosis, new target lesion revascularization or new target lesion failure; and the presence of residual ischemia as seen on single-photon emission computed tomography at the 6-month follow-up. Patients will be followed for 12 months after the procedure. Results: The trial is currently in the recruitment phase, and it has already recruited the first 7 patients. We expect to complete the recruitment phase by February 2021 and the follow-up by February 2022. Conclusions:The iLARDI study is the first randomized trial to assess the potential utility of SyncVision-guided revascularization in long, sequential and diffuse coronary lesions.

Introduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.

Introduction and objectives: patients with long, sequential and diffuse coronary lesions who undergo a percutaneous coronary intervention remain at a high risk of suffering cardiovascular events despite the improved safety and efficacy of the new drug-eluting stents. The objective of this study was to analyze the utility of SyncVision/iFR-guided revascularization (SyncVision version 4.1.0.5, Philips Volcano, Belgium) in this type of lesions. Methods: Randomized, multicenter, controlled, and open-label trial designed to compare SyncVision/iFR-guided and angiography-guided revascularizations in patients with long, sequential or diffuse significant angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). A total of 100 patients will be randomized (1:1, no stratification). The primary endpoint is the average length of the stent implanted. The secondary endpoint is a composite of cardiac death, myocardial infarction, definitive or probable stent thrombosis, new target lesion revascularization or new target lesion failure; and the presence of residual ischemia as seen on single-photon emission computed tomography at the 6-month follow-up. Patients will be followed for 12 months after the procedure. Results: The trial is currently in the recruitment phase, and it has already recruited the first 7 patients. We expect to complete the recruitment phase by February 2021 and the follow-up by February 2022. Conclusions: The iLARDI study is the first randomized trial to assess the potential utility of SyncVision-guided revascularization in long, sequential and diffuse coronary lesions.

Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) can be a particularly challenging lesion subset. The aim of this study was to analyze the technical aspects and outcomes of aorto-ostial CTO PCI in a multicenter registry.Patients undergoing aorto-ostial CTO PCI at 4 centers between February 2013 and December 2018 were included. Success rates, as well as procedural aspects and outcomes, were analyzed.A total of 103 patients were included. Mean age was 64±10 years and the mean J-CTO score was 3.1±1.1. Thirty-one lesions (30.4%) were flush ostial CTOs. Technical and procedural success were achieved in 79 (76.7%) and 78 (75.7%) of the patients, respectively. The retrograde approach was the most frequent successful crossing technique (n=49; 62.0%), especially in flush vs nonflush aorto-ostial CTOs (82.6% vs 53.5%; P=.02). The only variable independently associated with technical failure was the absence of interventional collaterals (OR, 12.38; 95%CI, 4.02-38.15; P.001). Coronary perforation occurred in 4 patients (3.9%) requiring covered stent implantation (without subsequent cardiac tamponade) and 2 patients (1.9%) had a stroke (one of which was a transient ischemic attack). During a median follow-up of 31 months, 3 (2.9%) patients died from cardiovascular causes and 13 (12.6%) required repeat target vessel revascularization.Aorto-ostial occlusions represent a challenging subset for PCI. However, an acceptable success rate with favorable outcomes during follow-up can be achieved by experienced operators. The presence of interventional collaterals allowing the use of the retrograde approach is key for achieving procedural success.

Resumen Introduccion y objetivos La intervencion coronaria percutanea (ICP) de oclusiones coronarias totales cronicas (OTC) aorto-ostiales constituye un reto como subgrupo. El objetivo de este estudio es analizar los aspectos tecnicos y resultados tras la ICP de OTC aorto-ostiales en un registro multicentrico. Metodos Se incluyo a los pacientes de 4 centros con una OTC aorto-ostial tratados con ICP entre febrero de 2013 y diciembre de 2018. Se analizaron las tasas de exito, los aspectos del procedimiento y los resultados. Resultados Se incluyo a 103 pacientes. La media de edad fue 64 ± 10 anos y la puntuacion J-OTC, 3,1 ± 1,1. Habia 31 OTC (30,4%) con ausencia total de munon. El exito tecnico y del procedimiento se obtuvo en 79 (76,7%) y 78 (75,7%) de los pacientes respectivamente. El abordaje retrogrado fue la tecnica de cruce exitosa mas frecuente (n = 49; 62,0%), especialmente en OTC sin munon (el 82,6 frente al 53,5%; p = 0,02). La ausencia de colaterales intervencionistas fue la unica variable asociada con fallo tecnico (OR = 12,38; IC95%, 4,02-38,15; p Conclusiones Las OTC aorto-ostiales representan un subgrupo tecnicamente complejo. Sin embargo, operadores expertos pueden obtener una tasa de exito aceptable con resultados favorables al seguimiento. La presencia de colaterales intervencionistas, que permiten el acceso retrogrado, parece ser clave para que el procedimiento sea exitoso.

espanolIntroduccion y objetivos: El proposito del estudio fue describir nuestra experiencia con el uso del indice diastolico instantaneo sin ondas (iFR) para la evaluacion fisiologica coronaria o el uso del software Syncvision/iFR (Syncvision version 4.1.0.5, Philips Volcano, Belgica) en todo tipo de pacientes. Metodos: Se incluyeron todos los pacientes consecutivos a quienes, entre enero de 2017 y diciembre de 2019, se realizo en nuestro centro una evaluacion fisiologica coronaria con iFR o con Syncvision/iFR. El valor de corte establecido para el iFR fue 0,89. El objetivo primario fue un compuesto de muerte cardiaca, infarto de miocardio, trombosis de stent probable o definitiva y nueva revascularizacion de la lesion evaluada. Resultados: Se incluyeron 277 pacientes con 433 lesiones evaluadas. La edad media fue de 65 ± 10 anos y el 74% eran varones. El 41% tenia antecedente de diabetes mellitus. La presentacion clinica fue angina estable en 160 pacientes (58%) y sindrome coronario agudo en 117 pacientes (42%). Se obtuvo un iFR > 0,89 en 266 lesiones (61,4%), en las cuales la intervencion coronaria percutanea fue diferida. Las lesiones restantes se revascularizaron. El software Syncvision/iFR se uso en 155 lesiones (36%) para guiar la toma de decisiones, principalmente lesiones largas, difusas o secuenciales (91 lesiones, 58,7%) y lesiones intermedias (52 lesiones, 33,5%). Tras un periodo de seguimiento de 18 meses, el objetivo primario se observo en 17 pacientes (6,1%), sin diferencias en funcion del iFR basal (≤ 0,89 o > 0,89) (4,2 frente a 3,8%; p = 0,9) ni de la presentacion clinica (angina estable o sindrome coronario agudo) (4,4 frente a 8,5%; p = 0,1). Conclusiones: La evaluacion fisiologica coronaria con iFR y el software Syncvision/iFR en la practica diaria y en todo tipo de pacientes parece ser segura, con un bajo porcentaje de eventos cardiacos adversos mayores a medio plazo. EnglishIntroduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.

OBJECTIVES To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI. BACKGROUND The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation. METHODS A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients. RESULTS Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p

Resumen Introduccion y objetivos El tipo de protesis utilizado en la cirugia de la endocarditis infecciosa sobre la valvula aortica nativa depende en gran medida de la edad del paciente y de las preferencias del cirujano. Existe poca informacion sobre el uso de homoinjertos en estos pacientes. Metodos Desde 1997 hasta 2017 se han intervenido en nuestro centro 20 casos de endocarditis infecciosa sobre valvula aortica nativa con implantacion de homoinjerto. Resultados La edad media de los pacientes fue 60 ± 12 anos, la tasa de hemocultivos negativos del 20% y los germenes responsables en mayor medida fueron enterococos (30%). Se intervino a los pacientes de forma urgente en el 70% de los casos, con un tiempo de isquemia de 112 ± 32 min; 9 pacientes (45%) fallecieron durante la fase activa. La tasa de reintervencion, hemorragia mayor o reinfeccion fue muy baja. En el seguimiento fallecieron 3 pacientes. Conclusiones Los pacientes con endocarditis infecciosa sobre la valvula nativa a los que se implanta un homoinjerto se intervienen con frecuencia de forma urgente, presentan tiempos de isquemia prolongados y su pronostico a corto y largo plazo es desfavorable.

Background: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus (T2D). We aimed to assess the risk for re-hospitalization in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge, as well as changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. Methods: We conducted a retrospective longitudinal study at a tertiary centre including 102 consecutive T2D patients discharged for acute HF without contraindication for SGLT2 inhibitors. We compared adverse clinical events (HF rehospitalization and cardiovascular death) and NT-ProBNP changes according to canagliflozin prescription at discharge. Results: Among the 102 patients included, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). After a median follow-up of 22 months, 45 patients (44.1%) were hospitalized for HF. Most of the rehospitalizations occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in the canagliflozin group and 29 patients (49.1%) in the control group (hazard ratio (HR): 0.45, 95% confidence interval (CI): 0.21–0.96, p &lt, 0.039). A composite outcome of hospitalization for HF or death from cardiovascular causes was lower in the canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51, 95% CI: 0.27–0.95, 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p = 0.002). Conclusions: Canagliflozin therapy at discharge was associated with a lower risk of readmission for HF and a reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF.

BACKGROUND: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus. We aimed to compare the incidence of readmission in patients who received canagliflozin at discharge after hospitalization of acute HF and changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. METHODS: We retrospectively included 102 consecutive patients with diabetes discharged for acute heart failure and without contraindications for SGLT2 inhibitors. We divided them in two groups: 45 patients with canagliflozin at discharge therapy and 57 without any SGLT2 inhibitors.RESULTS: Over a median follow-up of 22 months, 45 (44.1%) were hospitalized for HF. Most of the patients who were readmitted due to heart failure occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in canagliflozin group and 29 patients (49.1%) in control group (HR: 0.45; 95% CI: 0.21–0.96; p < 0.039) after multivariate adjustment. A composite outcome of hospitalization for HF or death for cardiovascular causes was lower in canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27–0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p=0.002).CONCLUSIONS: Canagliflozin therapy at discharge was associated with lower risk of readmission for HF and a reduction of NT-ProBNP concentration in patients with diabetes after hospitalization for HF.

During provisional stenting (PS) of a bifurcation lesion (BL), evaluation of the side branch (SB) result can be challenging [(1)][1]. To our knowledge, no studies have evaluated the feasibility of using a pressure wire (PW) as a jailed wire for the evaluation of SB results during PS. Thus, we

OBJECTIVES To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans-wrist access (TWA) approach versus a conventional approach based on trans-femoral access (TFA). BACKGROUND TFA is the preferred vascular access in CTO PCI, but it has been associated with a non-negligible risk of complications. METHODS This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success. RESULTS We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J-CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p

Percutaneous coronary intervention (PCI) of aorto-ostial coronary chronic total occlusion (CTO) can be a particularly challenging lesion subset due to, among other factors, the lack of antegrade support, proximal cap ambiguity, and unclear vessel course. The aim of this study was to analyze the

The aims of this study were to analyze the feasibility and efficacy of the jailed pressure wire technique for bifurcation lesions treated by provisional stenting and to assess the physiological side branch (SB) result using instantaneous wave-free ratio (iFR). Between June 2017 and December 2018