Ventricular septal defect (VSD) is the most prevalent congenital heart disease (CHD), which is approximately 20
Although Achilles tendon thickening (ATT) is associated with adverse outcomes after percutaneous coronary intervention (PCI), whether its prognostic impact differs over time between acute (ACS) and chronic coronary syndromes (CCS) remains unclear. We retrospectively analyzed 1,362 patients who underwent successful PCI and assessment of ATT using soft X-ray radiography. ATT was defined as Achilles tendon thickness ≥8.0 in men and ≥7.5 mm in women. MACE, including death, myocardial infarction, stent thrombosis, stroke, and target vessel revascularization, were investigated for up to 3 years. To evaluate temporal differences, we conducted the Kaplan-Meier method with landmark analysis and time-segmented Cox proportional hazards analyses dividing follow-up into ≤ 1 year and 1–3 years after PCI. ATT was observed in 228 patients (16.7
Drug-coated balloons (DCBs) are attracting attention as a therapeutic alternative to drug-eluting stents (DES) in percutaneous coronary interventions. DCB technology allows direct delivery of antiproliferative drugs to the vessel wall without implantation of a permanent metallic prosthesis, thereby avoiding late stent-related complications. Compared with DES, DCB remain a developing technology, and a number of DCB devices are still undergoing development or clinical evaluation. There is currently no consensus supporting a ”class effect” among DCBs due to substantial differences in drug type, dosage, excipients, release kinetics, and tissue drug concentrations. Following consistent scientific evidence regarding the safety and efficacy of paclitaxel- or sirolimus-based DCBs in the treatment of in-stent restenosis, clinical interest has expanded over the past decade to include de novo coronary lesions. DCB angioplasty is now generally accepted in de novo small vessel disease, whereas its use in large vessel lesions remains an evolving topic compared with the current gold-standard DES. Optimal lesion preparation remains a fundamental prerequisite for successful and effective DCB angioplasty, irrespective of the specific DCB platform. In this context, intracoronary imaging and physiological assessments may offer important guidance in tailoring lesion preparation and optimizing treatment strategies. The Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) convened a task force to revise an expert consensus document outlining indications, lesion preparation strategies, and the role of intravascular imaging and physiological assessment in optimizing DCB-based treatment.
Cardiac amyloidosis (CA) is increasingly encountered by interventional cardiologists during the evaluation of chest pain, myocardial injury, coronary artery disease, atrial arrhythmias, and aortic stenosis. Its recognition can be challenging because amyloid cardiomyopathy often coexists with common coronary, valvular, and arrhythmic conditions. A key diagnostic clue is discordance: the apparent coronary, valvular, or hemodynamic abnormality does not fully explain the patient’s symptoms, myocardial phenotype, low-flow physiology, or persistent high-sensitivity cardiac troponin elevation. This review focuses on clinical situations in which interventional cardiologists should suspect CA. We discuss myocardial ischemia and coronary microvascular dysfunction caused by intramural vascular amyloid deposition, extravascular compression, and impaired vasodilator reserve; atrial arrhythmias and catheter ablation; the frequent coexistence of transthyretin cardiac amyloidosis (ATTR-CM) with aortic stenosis in patients undergoing transcatheter aortic valve implantation; and the complementary roles of echocardiography, cardiac computed tomography, cardiovascular magnetic resonance, bone-avid tracer scintigraphy, and invasive hemodynamic assessment. We also propose a practical cath-lab approach that integrates readily available clinical information, recognizes persistent or disproportionate myocardial injury as a diagnostic red flag, promptly distinguishes light-chain from ATTR amyloidosis, and preserves appropriate treatment of coexisting coronary or valvular disease. For the interventional cardiologist, the central principle is simple: when the lesion does not fully explain the patient, look beyond the lesion.
Dual antiplatelet therapy (DAPT) with low-dose prasugrel (3.75 mg daily) is widely implemented after percutaneous coronary intervention (PCI) in Japan. However, the efficacy compared with clopidogrel-based DAPT has not been fully examined in large-scale research. STOPDAPT-2 Total Cohort enrolled 5,997 patients who underwent PCI without major in-hospital complications. Among them, 2,547 patients received prasugrel-based DAPT and 3,402 patients received clopidogrel-based DAPT at discharge within 30 days after index PCI. After propensity score matching, 2,163 patients in each group were compared with respect to 30-day clinical outcomes. The primary outcome was a composite of cardiovascular events (cardiovascular death, myocardial infarction, stent thrombosis, or any stroke) and bleeding events (Thrombolysis in Myocardial Infarction [TIMI] major or minor). The two major secondary outcomes were these cardiovascular composite events and bleeding events. In the landmark analysis, there was no significant difference in the cumulative incidence of the primary outcome between the prasugrel group and the clopidogrel group at 30 days beyond hospital discharge (0.34
