Piccolo R, Pio Vitale A, Laino A
… +6 more, Franzone A, Cirillo P, Di Serafino L, Bardi L, Spaccarotella CAM, Esposito G
EuroIntervention
· 2026 Apr · PMID 41943631
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BACKGROUND: Complex percutaneous coronary intervention (PCI) is increasingly performed among patients undergoing myocardial revascularisation. AIMS: We conducted a systematic review and meta-analysis to evaluate the asso...BACKGROUND: Complex percutaneous coronary intervention (PCI) is increasingly performed among patients undergoing myocardial revascularisation. AIMS: We conducted a systematic review and meta-analysis to evaluate the association between complex PCI and the risk of ischaemic and bleeding outcomes. METHODS: Hazard ratios (HRs) were pooled using a random-effects model within a Bayesian framework. The primary analysis was restricted to studies providing adjusted risk estimates, whereas the secondary analysis included unadjusted risk estimates. The primary outcomes were myocardial infarction and major bleeding. The secondary outcomes were all-cause death, stent thrombosis, cardiovascular death, target lesion or vessel revascularisation, and stroke. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for prognostic studies was used to determine the level of certainty in the association between complex PCI and the risk of events. RESULTS: We included 290,039 patients, of whom 94,633 (33%) underwent complex PCI. Compared with non-complex PCI, patients undergoing complex PCI had a higher risk of myocardial infarction (adjusted HR 1.71, 95% credible interval [CrI]: 1.49-1.96), major bleeding (adjusted HR 1.24, 95% CrI: 1.14-1.35), all-cause death (adjusted HR 1.21, 95% CrI: 1.12-1.32), cardiovascular death (adjusted HR 1.29, 95% CrI: 1.15-1.46), stent thrombosis (adjusted HR 1.76, 95% CrI: 1.49-2.14), target lesion or vessel revascularisation (adjusted HR 1.99, 95% CrI: 1.58-2.50), and stroke (adjusted HR 1.21, 95% CrI: 1.03-1.42). The posterior probability of a higher risk associated with complex versus non-complex PCI was >99% for all study outcomes. Except for stroke (which was low certainty), the certainty of evidence was moderate to high for all other outcomes. Secondary analysis, including unadjusted risk estimates, provided consistent results. CONCLUSIONS: Patients undergoing complex PCI have an increased risk of both ischaemic and bleeding events compared with patients undergoing non-complex PCI (PROSPERO: CRD420250656254).
EuroIntervention
· 2026 Apr · PMID 41943630
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The management of patients with coronary artery disease requiring percutaneous coronary revascularisation has undergone a significant transformation over the past several decades. With the increasing use of early invasiv...The management of patients with coronary artery disease requiring percutaneous coronary revascularisation has undergone a significant transformation over the past several decades. With the increasing use of early invasive strategies, the role of pretreatment with oral antiplatelet agents has evolved. Additionally, the introduction of novel agents such as cangrelor has had a significant impact on the management of thrombotic risk. In this review, we summarise the current evidence on the role of pretreatment with antiplatelet agents across the spectrum of coronary artery disease, from non-ST-segment elevation acute coronary syndromes and ST-segment elevation myocardial infarction to stable coronary artery disease. We also highlight data on novel parenteral agents, both available and in development.
Eerdekens R, Johnson NP, Adrichem R
… +13 more, van Mieghem NM, Eftekhari A, Kakouros N, Demandt JPA, Farissi ME, Vervaat FE, Houthuizen P, Felix SEA, Bouwmeester S, van 't Veer M, Johnson DT, Gould KL, Tonino PAL
EuroIntervention
· 2026 Mar · PMID 41834777
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BACKGROUND: Assessing aortic stenosis (AS) haemodynamics under stress may distinguish physiological responses beyond traditional severity metrics. AIMS: We aimed to evaluate symptomatic patients with moderate AS and pres...BACKGROUND: Assessing aortic stenosis (AS) haemodynamics under stress may distinguish physiological responses beyond traditional severity metrics. AIMS: We aimed to evaluate symptomatic patients with moderate AS and preserved left ventricular ejection fraction (LVEF) using invasive and non-invasive assessments at rest and during stress, hypothesising that the stress aortic valve index (SAVI) would show only modest agreement with echocardiographic parameters of AS severity but would be associated with clinical outcomes. METHODS: We prospectively enrolled 52 patients with moderate AS and preserved LVEF but who were symptomatic without an alternative explanation. The SAVI, quantifying the relative reduction in maximal flow, was measured but remained blinded. Comprehensive assessment included echocardiography (at rest, bicycle and dobutamine stress), calcium scoring, and clinical outcomes. Patients were managed according to current standards without knowledge of the SAVI and followed for ≥1 year. RESULTS: Invasive transvalvular gradient increased from 25±9 mmHg at rest to 42±14 mmHg during dobutamine. The aortic-to-left ventricular pressure ratio declined from 0.82 (interquartile range [IQR] 0.78-0.88) at rest to a SAVI of 0.70 (IQR 0.63-0.79) under stress. Resting aortic valve area (AVA) did not predict stress haemodynamics, underscoring physiological heterogeneity. Notably, 25/52 (48%) of patients demonstrated a SAVI ≤0.70, comparable with a severe AS cohort studied separately. Blinded SAVI scores independently predicted the need for clinical aortic valve (AV) intervention (hazard ratio 5.7; p=0.007), whereas AVA and sex-specific calcium thresholds did not. CONCLUSIONS: Stress haemodynamic assessment in moderate AS unmasks a subgroup, not identified by conventional metrics, who are at significantly higher risk for AV intervention. Patients with abnormal stress physiology despite only moderate AS at rest may benefit from AV intervention, supporting this pilot study as the basis for a future randomised trial.
Siqueira DA, Abizaid AAC, Ramos AA
… +17 more, Issa M, Cervone AC, Bezerra CG, de Araripe Falcão BA, Cortes LA, de Freitas C Guimarães L, K São Thiago LE, Rezende M, Delamain TR, Togna DD, Assef JE, Vilela AA, Paladino AT, Pinto IM, Franchini K, Bhatt DL, Feres F
EuroIntervention
· 2026 Mar · PMID 41834775
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Bioprosthetic mitral valves are prone to structural valve deterioration (SVD) over time, which can lead to bioprosthetic valve dysfunction (BVD) requiring reintervention. Surgical redo-mitral valve replacement (rMVR) is...Bioprosthetic mitral valves are prone to structural valve deterioration (SVD) over time, which can lead to bioprosthetic valve dysfunction (BVD) requiring reintervention. Surgical redo-mitral valve replacement (rMVR) is currently the standard treatment, although it is associated with significant mortality in high-risk patients. Transcatheter mitral valve-in-valve (mViV) has emerged as an alternative to surgical rMVR in patients with failed bioprostheses, but randomised studies comparing the two treatments are lacking. The SURVIV trial is an investigator-initiated, prospective, multicentre, open-label, randomised controlled trial that will enrol 150 patients with mitral BVD suitable for surgical rMVR or transcatheter mViV. Participants will be randomised 1:1 to transseptal mViV with a balloon-expandable transcatheter heart valve or to conventional surgical rMVR. Procedures will be performed according to local best practices with contemporary medical devices. The primary endpoint is the composite of all-cause mortality or disabling stroke at 12 months. Key secondary endpoints are major complications (cardiovascular death, disabling stroke, life-threatening or major bleeding, acute kidney injury stage 2 or 3, and major vascular complications) at 30 days, according to Mitral Valve Academic Research Consortium criteria; rehospitalisation for cardiovascular causes at 12 months; echocardiographic and/or tomographic signs of prosthetic valve thrombosis and early SVD at 3 and 12 months; and health-related quality of life (EQ-5D-5L) at 3 and 12 months. Clinical follow-up will continue up to 10 years. SURVIV is the first randomised trial to compare a transcatheter mViV procedure with surgical rMVR for mitral BVD and may provide further clinical evidence to guide the management of patients with failed mitral bioprostheses. ClinicalTrials.gov: NCT04402931.
Jacobsen MR, Overduin DC, Sørensen R
… +11 more, Andreotti F, Schulte C, Huber K, Clemmensen P, Trenk D, De Backer O, Aradi D, Kristensen SD, Storey RF, Ten Berg JM, Geisler T
EuroIntervention
· 2026 Mar · PMID 41834772
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As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, it is important to understand the risk of valve thrombosis in TAVI prostheses and how this may contribute to biop...As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, it is important to understand the risk of valve thrombosis in TAVI prostheses and how this may contribute to bioprosthetic valve dysfunction and thromboembolic events. Subclassification of valve thrombosis by incidence or timing is challenged by differences in sensitivity and heterogeneity among the imaging modalities used for its detection. The long-term implications of valve thrombosis - particularly regarding stroke risk and prosthesis longevity - remain uncertain and debated. Current treatment options for valve thrombosis include temporary anticoagulation therapy, thrombolysis, and, in some cases, reintervention. To address these concerns, ongoing research is focused on improving the detection and treatment of valve thrombosis through standardised imaging protocols and the use of intensified antithrombotic regimens that balance the thrombotic and bleeding risks. Prevention of valve thrombosis remains a challenge requiring a better understanding of patient- and procedure-related risk factors. These insights will be essential to individualise antithrombotic therapy and improve prosthesis design. This review outlines current evidence on the mechanisms, prevalence, clinical relevance, and management of TAVI thrombosis and highlights ongoing clinical trials investigating this condition.
Marin F, Fawaz S, Kotronias RA
… +14 more, Chai J, Walsh J, Mahendiran T, Karamasis GV, Cook CM, Khan S, Davies JR, Collet C, Bruyne B, Channon K, Banning AP, Keeble TR, De Maria GL, Of The Oxford Acute Myocardial Infarction OxAMI Study Investigator OB
EuroIntervention
· 2026 Mar · PMID 41770275
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BACKGROUND: Treating a coronary stenosis by percutaneous coronary intervention (PCI) aims to relieve myocardial ischaemia by improving coronary blood flow. The evolution of coronary flow and resistance post-PCI is not fu...BACKGROUND: Treating a coronary stenosis by percutaneous coronary intervention (PCI) aims to relieve myocardial ischaemia by improving coronary blood flow. The evolution of coronary flow and resistance post-PCI is not fully understood. AIMS: This study aimed to investigate the immediate impact of PCI on absolute coronary flow (Q), and epicardial and microvascular resistance (R and R). METHODS: In a two-centre cohort including 52 patients, pre- and post-PCI physiological assessments were performed using continuous thermodilution, via a combination of a pressure-temperature sensor wire and a dedicated infusion microcatheter. RESULTS: Resting Q remained similar before and after PCI (Δ +2 [interquartile range [IQR] -9 to 21] mL/min; p=0.21), as a 193 Wood unit (WU) reduction in resting R (Δ -193 [IQR -400 to -59] WU; p<0.001) was offset by a 267 WU increase in resting R (Δ +267 [IQR -20 to 474] WU; p=0.002). Conversely, hyperaemic Q rose significantly (Δ +44 [IQR 16 to 92] mL/min; p<0.001), reflecting a 195 WU reduction in hyperaemic R (Δ -195 [IQR -379 to -82] WU; p<0.001), while hyperaemic R remained stable (Δ +3 [IQR -96 to 75] WU; p=0.87). The median microvascular resistance reserve (MRR) did not change significantly after PCI (Δ -0.2 [IQR -0.7 to 0.6]; p=0.301). Pre- and post-PCI fractional flow reserve (FFR) were strongly and inversely associated with R and predicted the improvement of hyperaemic Q. CONCLUSIONS: PCI significantly reduces epicardial resistance, leading to a pronounced increase in hyperaemic flow, which can be predicted by FFR. Resting Q remained unchanged because of compensatory increases in microvascular resistance, providing direct evidence of coronary flow autoregulation in humans. The MRR was unaffected by PCI, confirming its specificity as an index of microvascular function.
Takegawa K, Kanaoka K, Iwanaga Y
… +6 more, Sasano T, Nishioka Y, Myojin T, Noda T, Imamura T, Miyamoto Y
EuroIntervention
· 2026 Mar · PMID 41770274
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BACKGROUND: The recurrences of acute coronary syndrome (ACS) and target vessel failure after percutaneous coronary intervention (PCI) remain clinical concerns. Intravascular imaging, such as optical coherence tomography...BACKGROUND: The recurrences of acute coronary syndrome (ACS) and target vessel failure after percutaneous coronary intervention (PCI) remain clinical concerns. Intravascular imaging, such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS), has demonstrated clinical benefits in patients with stable coronary disease; however, the benefits of its use remains unclear in patients with ACS. AIMS: This study aimed to investigate the benefit of imaging-guided PCI in patients with ACS on the recurrence of ACS using a nationwide database in Japan. METHODS: This retrospective observational study used records from the National Database between April 2014 and March 2021. We included patients hospitalised with ACS aged ≥20 years who had undergone first-time PCI and divided them into imaging-guided PCI (OCT or IVUS) and angiography-guided PCI groups. The primary outcome was ACS recurrence during a 3-year follow-up period. We analysed the association between intravascular imaging and the outcome using inverse probability of treatment weighting. RESULTS: Among the patients with ACS, angiography-guided PCI, OCT-guided PCI, and IVUS-guided PCI were performed in 32,044, 22,748, and 297,944 patients, respectively. During the study period, both OCT- and IVUS-guided PCI rates increased, from 4.7% to 6.9% and from 77.0% to 87.9%, respectively. OCT-guided PCI was associated with a lower risk of ACS recurrence (hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.71-0.91; p<0.001); IVUS-guided PCI was also associated with a lower risk of ACS recurrence (HR 0.76, 95% CI: 0.71-0.82; p<0.001). CONCLUSIONS: In real-world clinical practice, the rates of both OCT- and IVUS-guided PCI have increased and have been associated with a lower risk of ACS recurrence compared with angiography-guided PCI in patients with ACS.
Dubosq-Lebaz M, Li S, Gouëffic Y
… +6 more, Lee HH, Kim JM, Sobocinski J, Behrendt CA, Iida O, Secemsky EA
EuroIntervention
· 2026 Mar · PMID 41770273
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BACKGROUND: Endovascular therapy is a cornerstone for chronic limb-threatening ischaemia (CLTI), yet the optimal device strategy remains uncertain. AIMS: Our objective was to compare the clinical and economic outcomes be...BACKGROUND: Endovascular therapy is a cornerstone for chronic limb-threatening ischaemia (CLTI), yet the optimal device strategy remains uncertain. AIMS: Our objective was to compare the clinical and economic outcomes between plain balloon angioplasty±bare metal stents (PBA±BMS), drug-coated balloons (DCBs)±BMS, and drug-eluting stents (DES) in a national real-world CLTI cohort. METHODS: Medicare beneficiaries aged ≥66 years who underwent femoropopliteal revascularisation for CLTI between 2016 and 2023 were included. Patients were grouped by index device. Outcomes included a composite of all-cause mortality or major amputation, as well as major adverse limb events (MALE) and reintervention. Patients were followed from the index procedure until death, loss to follow-up, or the end of the study period. Time-to-event and cost outcomes were analysed using multivariable Cox and gamma regression models, respectively. RESULTS: Among 108,304 CLTI patients, 52.5% received PBA±BMS, 30.7% DCBs, and 16.8% DES. At 2 years, the composite outcome occurred in 50.54% (PBA±BMS), 43.08% (DCB±BMS), and 43.71% (DES); at 5 years, it occurred in 75.69%, 71.19%, and 71.71%, respectively. Compared with PBA±BMS, DCB±BMS (hazard ratio [HR] 0.92, 95% confidence interval [CI]: 0.90-0.93) and DES (HR 0.93, 95% CI: 0.92-0.95) were associated with a lower risk of the composite outcome. DCBs were associated with reduced major amputation (HR 0.87, 95% CI: 0.84-0.91), mortality (HR 0.93, 95% CI: 0.91-0.94), MALE (HR 0.96, 95% CI: 0.94-0.98), and reintervention (HR 0.97, 95% CI: 0.96-0.99) compared with PBA±BMS. The proportion of BMS use was 10.1% in the PBA±BMS group and 3.1% in the DCB±BMS group. CONCLUSIONS: In this national CLTI cohort, drug-coated devices were associated with reduced amputation and mortality. Data from this study suggest that DCBs may offer consistent benefit without increased costs.
Bijloo I, Woudstra J, Aribas E
… +7 more, Elias-Smale SE, Vink C, Piek JJ, Duncker DJ, Roeters van Lennep JE, Kavousi M, Appelman Y
EuroIntervention
· 2026 Mar · PMID 41770271
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In patients who have angina with non-obstructive coronary artery disease (ANOCA), invasive coronary function testing (ICFT) is the gold standard to comprehensively diagnose coronary dysfunction. Coronary dysfunction is d...In patients who have angina with non-obstructive coronary artery disease (ANOCA), invasive coronary function testing (ICFT) is the gold standard to comprehensively diagnose coronary dysfunction. Coronary dysfunction is divided into the endotypes coronary vasospasm, coronary endothelial dysfunction, and coronary microvascular dysfunction (i.e., an abnormal reduced coronary flow reserve [CFR] and/or enhanced microvascular resistance [MR]). However, because of the inherently invasive nature of ICFT, it is important to investigate non-invasive approaches for the diagnosis of coronary dysfunction. Several non-invasive modalities have been proposed as alternative techniques to measure different endotypes of coronary dysfunction. This is promising, given their higher availability and easier applicability. As such, an important clinical question is whether these non-invasive methods are equivalent to invasive tests. In this review, we provide an overview of the invasive and non-invasive diagnostic modalities available to assess coronary dysfunction. Our findings indicate that only CFR can be reliably measured non-invasively, using positron emission tomography (PET), transthoracic Doppler echocardiography (TTDE), and possibly stress cardiac magnetic resonance (CMR) imaging, although the latter has shown conflicting results. Reliable non-invasive techniques to measure coronary vasospasm, coronary endothelial dysfunction, or MR are scarce. Since most patients suffer from more than one coronary dysfunction entity, the added value of non-invasive techniques is still limited. To date, ICFT is the only method capable of investigating all endotypes of coronary dysfunction. Studies investigating the performance of non-invasive modalities for the diagnosis of all components of coronary dysfunction in ANOCA patients are warranted.