Early Aortic Valve Replacement in Symptomatic Normal-Flow, LowGradient Severe Aortic Stenosis:A Propensity Score–Matched Retrospective Cohort Study

Background and Objectives@#Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. @*Methods@#Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m 2 , mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm 2 ) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. @*Results@#During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings. @*Conclusions@#An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS.Future randomized studies are required to validate and confirm our findings.

Acute Myocardial Infarction with Simultaneous Occlusions of Left Anterior Descending Artery and Right Coronary Artery

Acute myocardial infarctions involving multiple coronary arteries simultaneously are infrequent and causative risk factors of the occlusions are unclear. However, severe complications arise, such as congestive heart failure or death. We report a case of two simultaneously occluded coronary arteries. A 39-year-old Korean man with simultaneous total occlusion of the left anterior descending artery and the right coronary artery presented with chest discomfort and cardiogenic shock. Immediate percutaneous coronary intervention was performed and a transvenous temporary pacemaker and intra-aortic balloon counterpulsation catheter were inserted. Through continuous effort he was discharged 8 days post intervention without any complaints.

A Case of Extremely Very Late Stent Thrombosis 8 Years after Implantation of Drug-Eluting Stent Observed by Intravascular Ultrasound

Drug-eluting stents (DES) are now widely used for patients with coronary artery disease undergoing percutaneous coronary interventions. The current major agenda for using DES is very late stent thrombosis (VLST) that occurs beyond 1 year after DES implantation. Although VLST is rare, it is a serious complication that can result in sudden death or myocardial infarction. Until now, there have been only a few case reports of VLST within 7 years. We report a case of a 78-year-old man who presented with an ST segment elevation myocardial infarction due to extremely very late stent thrombosis resulting from a mal-apposed stent and delayed neointimal coverage that occurred 8 years after stent implantation after the cessation of antiplatelet agents for 10 days.