EuroIntervention
· 2026 Feb · PMID 41697662
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BACKGROUND: Calcified coronary lesions impede stent expansion and are associated with poor outcomes after percutaneous coronary interventions. Intravascular lithotripsy (IVL) has emerged as a safe and effective pretreatm...BACKGROUND: Calcified coronary lesions impede stent expansion and are associated with poor outcomes after percutaneous coronary interventions. Intravascular lithotripsy (IVL) has emerged as a safe and effective pretreatment to optimise stent implantation. AIMS: This study assesses the LithiX lithotripsy device, which uses the Hertz contact (HC) mechanism to fragment calcium while minimising injury to surrounding soft tissue, without requiring an external energy source. METHODS: The multicentre, prospective PINNACLE-I clinical trial enrolled patients with up to two moderately to severely calcified de novo lesions. The primary endpoints were <50% residual stenosis without in-hospital major adverse cardiovascular events (MACE) and the 30-day MACE rate. Clinical events were assessed up to 6 months. RESULTS: Sixty patients with 63 lesions were treated with successful delivery and use of the HC-IVL catheter and a median procedure time of 59.5 min (interquartile range: 40.5-76.0). The primary endpoint was achieved in 98.3%. All patients had residual stenosis <30% after stent placement. The 30-day MACE rate was 1.7%, due to 1 periprocedural target vessel non-Q-wave myocardial infarction. There were no cardiovascular deaths, no definite or probable stent thromboses, nor any device-related events up to 6 months of follow-up. The optical coherence tomography substudy in 32 subjects identified a wide range of calcium morphologies, including calcium arcs of 96-360° and calcified nodules. Following HC-IVL, calcium fractures were achieved in 90.6% of lesions, and the mean fracture depth was 0.81±0.33 mm. Stent expansion at the minimum stent area site was 96.7±25.5%. CONCLUSIONS: PINNACLE-I demonstrated the feasibility, safety, and efficacy of the novel HC-IVL to fracture calcified lesions and achieve optimal stent expansion in a broad range of calcium morphologies.
Oshima A, Serruys PW, Garg S
… +19 more, McEvoy JW, Wood DA, Doenst T, Taggart DP, Puskas JD, Shajahan A, Sharif F, Miyashita K, Tobe A, Tsai TY, Revaiah PC, Dunne F, Mehran R, Budoff MJ, Kastelein JJ, Stroes ESG, Khamis R, Koenig W, Onuma Y
EuroIntervention
· 2026 Feb · PMID 41697657
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Pharmacological treatment remains vital in the effective management of atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein (LDL) cholesterol-lowering therapies, such as statins, have consistently demo...Pharmacological treatment remains vital in the effective management of atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein (LDL) cholesterol-lowering therapies, such as statins, have consistently demonstrated robust efficacy in the primary and secondary prevention of cardiovascular events. The introduction of ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 inhibitors have further strengthened the effectiveness of LDL cholesterol management, particularly in patients who are statin intolerant or who remain at high risk despite maximal tolerated statin therapy. In addition to managing LDL cholesterol, addressing residual lipid risk by targeting elevated triglyceride and lipoprotein(a) levels and low high-density lipoprotein cholesterol levels has emerged as a potentially important therapeutic consideration, as these are increasingly recognised as independent cardiovascular risk factors. Concurrently, inflammation is increasingly acknowledged as a significant contributor to atherogenesis and subsequent cardiovascular events. Clinical trials examining anti-inflammatory therapies, such as colchicine and interleukin-1β inhibitors (e.g., canakinumab), have demonstrated beneficial effects in reducing cardiovascular events independent of lipid modification. This narrative review provides an updated overview targeted specifically at physicians performing coronary artery bypass grafting or percutaneous coronary intervention. It summarises current evidence regarding established lipid-lowering therapies, emerging therapeutic approaches to address residual lipid risk, and the evolving role of anti-inflammatory interventions in the comprehensive management of ASCVD.
Toth GG, Amabile N, Barbato E
… +12 more, Borregaard B, Buszman P, Cuisset T, Gilard M, James S, Al-Lamee R, Mashayekhi K, Regazzoli D, Sarno G, Siller-Matula JM, Brugaletta S, Stefanini G
EuroIntervention
· 2026 Feb · PMID 41697656
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Percutaneous coronary procedures performed in a day-case setting are intended to facilitate an optimised resource allocation and increase patient satisfaction without compromising procedural and long-term safety or effic...Percutaneous coronary procedures performed in a day-case setting are intended to facilitate an optimised resource allocation and increase patient satisfaction without compromising procedural and long-term safety or efficacy. While an increasing number of centres have implemented a day-case approach, patient pathways and procedural aspects still lack standardisation, potentially leading to a large heterogeneity in practices. However, several centres and healthcare systems are still reluctant to adopt day-case diagnostic or therapeutic coronary procedures because of safety concerns, penalising reimbursement policies, or simple inertia. This clinical consensus statement summarises experience-based know-how and research-derived data on day-case coronary procedures with the objective of providing standardised practical guidance on patient selection, procedural considerations, and postprocedural management to facilitate wide-scale adoption of a day-case coronary programme. The document also provides clear advice on when such procedures must be converted into regular admissions to maximise patient safety.
Lee JH, Lee J, Kim SY
… +14 more, Jeon HS, Lee JW, Ahn SG, Lee YJ, Lee SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Hong SJ, Youn YJ
EuroIntervention
· 2026 Feb · PMID 41697655
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BACKGROUND: Ticagrelor monotherapy following abbreviated dual antiplatelet therapy (DAPT) is an emerging strategy for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Howev...BACKGROUND: Ticagrelor monotherapy following abbreviated dual antiplatelet therapy (DAPT) is an emerging strategy for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). However, the timing of aspirin discontinuation has not been directly compared in this setting. AIMS: We aimed to compare the clinical outcomes of aspirin discontinuation within 1 month versus at 3 months after PCI in patients with ACS. METHODS: This post hoc analysis used individual patient-level data from the TICO and T-PASS trials, which exclusively enrolled patients with ACS undergoing PCI. Of 2,953 patients who received ticagrelor monotherapy after abbreviated DAPT, 1,426 discontinued aspirin within 1 month and 1,527 at 3 months. After propensity score matching, 2,248 patients were included in the final analysis. The primary endpoint was a composite of all-cause death, myocardial infarction, stent thrombosis, ischaemia-driven target vessel revascularisation, stroke, and major bleeding at 1 year. RESULTS: The primary endpoint occurred less frequently in the <1-month group than in the 3-month group (3.2% vs 5.6%; hazard ratio [HR] 0.56, 95% confidence interval [CI]: 0.37-0.84; p=0.005). Ischaemic event rates were comparable (2.2% vs 2.3%; HR 0.86, 95% CI: 0.55-1.65; p=0.863), whereas major bleeding was significantly lower in the <1-month group (1.1% vs 3.3%; HR 0.32, 95% CI: 0.17-0.61; p<0.001). Landmark analysis showed that event rates diverged primarily within the first 90 days, with no significant heterogeneity between the early and late periods. CONCLUSIONS: Aspirin discontinuation within 1 month followed by ticagrelor monotherapy improved net clinical outcomes compared with 3-month discontinuation, primarily by reducing major bleeding without increasing ischaemic risk. CLINICALTRIALS: gov: NCT02494895 (TICO), NCT03797651 (T-PASS).
Smits PC, Włodarczak A, Chevalier B
… +17 more, West NEJ, Gori T, Abdel-Wahab M, Barbato E, Esposito G, Tarantini G, Kocka V, Achenbach S, Dudek D, Escaned J, Tijssen JGP, Rademaker-Havinga TAM, Serruys P, Morice MC, Onuma Y, Geuns RV, Behalf Of The Compare-Absorb Trial Investigators O
EuroIntervention
· 2026 Feb · PMID 41697654
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BACKGROUND: The clinical outcomes of bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents (EES) beyond 5-year follow-up are unknown. AIMS: This study aims to investigate clinical outcomes of BVS...BACKGROUND: The clinical outcomes of bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents (EES) beyond 5-year follow-up are unknown. AIMS: This study aims to investigate clinical outcomes of BVS 7 years after implantation. METHODS: The COMPARE-ABSORB trial is an investigator-initiated, prospective randomised study. Patients at high risk of restenosis were randomly assigned to receive either a BVS or an EES. A dedicated implantation technique was recommended for BVS. The primary endpoint was target lesion failure (TLF), defined as the composite of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularisation (CI-TLR). The primary and co-primary objectives were non-inferiority at 1 year and superiority of BVS at 7 years after a 3-year landmark analysis. RESULTS: Although enrolment was stopped at 1,670 patients (80% of the intended 2,100 patients; 848 patients receiving BVS and 822 EES) because of high thrombosis and TVMI rates in the BVS arm, non-inferiority for TLF at 1 year was met. At 7-year follow-up subsequent to a 3-year landmark analysis, the TLF rate of BVS was 6.7% versus 5.9% for EES (hazard ratio [HR] 1.14, 95% confidence interval [CI]: 0.76-1.77; p=0.53); therefore, superiority was not met. Cardiac death, TVMI, and device thrombosis rates did not differ between both groups; however, CI-TLR was significantly higher in the BVS arm (4.4% vs 2.2%; HR 1.97, 95% CI: 1.08-3.60; p=0.023). CONCLUSIONS: After complete resorption, no benefit was observed with BVS compared with EES at 7-year follow-up, despite the use of a dedicated implantation protocol for BVS. In fact, after 3 years, more target lesion revascularisations occurred with BVS than with EES.
Cannata S, Sultan I, Van Mieghem NM
… +36 more, Giordano A, Backer O, Byrne J, Tchétché D, Buccheri S, Nombela-Franco L, Campante Teles R, Barbanti M, Barbato E, Amat Santos I, Blackman DJ, Maisano F, Lorusso R, La Spina K, Millin A, Kliner DE, van den Dorpel M, Acerbi E, Lulic D, Fayed H, De Biase C, Chavez Solsol JF, Brito J, Costa G, Casenghi M, Cordon CF, Sherwen A, Buzzatti N, Pasta S, Turrisi M, Manca P, Nuzzi V, Tamburino C, Bedogni F, Gandolfo C, Latib A
EuroIntervention
· 2026 Feb · PMID 41627781
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BACKGROUND: Comparative data between self-expanding Navitor (NAV) and balloon-expandable SAPIEN 3 Ultra (ULTRA) transcatheter heart valves (THVs) in patients with small aortic annuli are lacking. AIMS: This study sought...BACKGROUND: Comparative data between self-expanding Navitor (NAV) and balloon-expandable SAPIEN 3 Ultra (ULTRA) transcatheter heart valves (THVs) in patients with small aortic annuli are lacking. AIMS: This study sought to evaluate outcomes of transcatheter aortic valve implantation (TAVI) using the intra-annular NAV and the ULTRA THVs in severe aortic stenosis patients with small annuli. METHODS: Patients with an aortic annulus area ≤430 mm undergoing TAVI with either NAV or ULTRA from the NAVULTRA registry were included. Propensity-matched analysis was performed for adjustment. Primary endpoints included 1-year mortality, a composite endpoint (all-cause mortality, disabling stroke, or heart failure hospitalisation), and 30-day device-oriented outcomes (severe prosthesis-patient mismatch, moderate or greater paravalvular leak [PVL], mean gradient ≥20 mmHg). RESULTS: Among 1,617 patients, 524 propensity score-matched pairs were analysed. At 1 year, all-cause mortality was 8.8% with NAV versus 9.0% with ULTRA (adjusted p=0.585), and the composite endpoint occurred in 11.3% versus 11.8%, respectively (adjusted p=0.149). The device-oriented endpoint favoured NAV compared to ULTRA (6.0% vs 29.3%; adjusted p<0.01), with a lower residual transvalvular gradient (7.3 mmHg vs 12.7 mmHg; adjusted p<0.01), and reduced incidence of any prosthesis-patient mismatch (odds ratio 0.27, 95% confidence interval: 0.18-0.43; adjusted p<0.01). However, NAV was associated with higher rates of mild paravalvular leak (NAV 33.5% vs ULTRA 23.2%; adjusted p<0.05) and permanent pacemaker implantation (PPI; NAV 20.1% vs 11.9% ULTRA; adjusted p<0.01). CONCLUSIONS: In patients with small aortic annuli, TAVI with both NAV and ULTRA provided comparable 1-year clinical outcomes, but NAV showed better haemodynamic performance at the cost of higher rates of mild PVL and PPI.
Berti S, D'Agostino A, Backer O
… +7 more, Ho E, Kreidel F, Latib A, Mariani M, Praz F, Wunderlich NC, von Bardeleben RS
EuroIntervention
· 2026 Feb · PMID 41627777
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Transcatheter heart interventions are expanding, and structural procedures are becoming more complex. This makes detailed visualisation and characterisation of cardiac anatomy and pathology increasingly important. As a r...Transcatheter heart interventions are expanding, and structural procedures are becoming more complex. This makes detailed visualisation and characterisation of cardiac anatomy and pathology increasingly important. As a result, there is a growing interest in interventional imaging for procedural guidance. Specifically, there is an increasing interest in using intracardiac echocardiography (ICE) as a complementary or alternative tool to transoesophageal echocardiography. Furthermore, new-generation three-dimensional matrix array ICE probes provide the possibility of obtaining multiplanar reconstruction imaging, playing a crucial role in structural heart interventions. To date, we still need guidelines that summarise the technical details of the most used ICE probes and that standardise procedure protocols. The purpose of this expert review is to provide an overview of ICE technology, describe the technical characteristics of the available probes, and present a review by a group of experts on their use in guiding structural heart interventions based on global clinical experience.
Ammirabile N, Giacoppo D, Mazzone PM
… +3 more, Landolina D, Spagnolo M, Capodanno D
EuroIntervention
· 2026 Jan · PMID 41549691
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BACKGROUND: Transcatheter edge-to-edge repair (TEER) is among the treatments for functional mitral regurgitation (FMR), but its benefits over guideline-directed medical therapy (GDMT) alone are discordant. We conducted a...BACKGROUND: Transcatheter edge-to-edge repair (TEER) is among the treatments for functional mitral regurgitation (FMR), but its benefits over guideline-directed medical therapy (GDMT) alone are discordant. We conducted a meta-analysis of randomised trials comparing long-term outcomes between these treatment strategies. AIMS: We aimed to compare long-term clinical outcomes between TEER plus GDMT and GDMT alone in symptomatic moderate-to-severe FMR. METHODS: Major electronic databases were searched for randomised trials comparing TEER plus GDMT with GDMT alone in FMR. The primary outcome was death or first hospitalisation due to heart failure at 24 months. The key secondary outcome was first hospitalisation due to heart failure at 24 months. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by mixed-effects Cox models based on reconstructed time-to-first event individual patient data and random-effects models based on study-level data. RESULTS: Three randomised trials (MITRA-FR, COAPT, and RESHAPE-HF2) were included, for a total of 1,422 patients assigned to TEER plus GDMT (n=703) or GDMT alone (n=719). The primary outcome was significantly lower in the TEER plus GDMT group compared with the GDMT-alone group by one-stage analysis (HR 0.72, 95% CI: 0.56-0.92; p=0.010). However, the two-stage analysis marginally failed to confirm this result (HR 0.72, 95% CI: 0.51-1.00; p=0.052) and showed substantial heterogeneity (I²=80.3%; p=0.006). Hospitalisation due to heart failure was significantly lower in the TEER plus GDMT group, regardless of the statistical method used (one-stage: HR 0.65, 95% CI: 0.48-0.88; p=0.006; two-stage: HR 0.66, 95% CI: 0.45-0.96; p=0.031). However, heterogeneity was substantial (I²=81.2%; p=0.005). All-cause death and cardiovascular death at 24 months were not significantly different between treatment groups but became significant after excluding MITRA-FR in the leave-one-out analysis. CONCLUSIONS: In symptomatic moderate-to-severe FMR, TEER plus GDMT significantly reduces death or hospitalisation due to heart failure and hospitalisation due to heart failure at 24 months.