Jacobsen MR, Graversen PL, Jabbari R
… +8 more, Grove EL, Glinge C, Holmvang L, Geisler T, Køber L, Torp-Pedersen C, Engstrøm T, Sørensen R
EuroIntervention
· 2025 Nov · PMID 41489712
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BACKGROUND: In 2020, the Danish national guidelines changed to recommend prasugrel over ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), prior to the 2023 upda...BACKGROUND: In 2020, the Danish national guidelines changed to recommend prasugrel over ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), prior to the 2023 update to the European guidelines. AIMS: We aimed to assess whether the shift from routine use of ticagrelor to prasugrel was implemented on a national level and whether prasugrel was associated with lower rates of major adverse cardiovascular events (MACE) and with similar bleeding rates compared to ticagrelor. METHODS: This register-based cohort study identified MI patients treated with PCI from 2019 to 2022 using Danish nationwide registries. Patients without contraindications were included if they were alive and redeemed a prasugrel or ticagrelor prescription within 7 days from discharge. RESULTS: In total, 10,984 patients redeemed prasugrel (38.0%) or ticagrelor (62.0%). In 2019, >99% of patients were treated with ticagrelor. By 2022, 89% of patients were treated with prasugrel. Prasugrel-treated patients were younger, more often male, had ST-segment elevation MI (STEMI) more frequently, and had fewer cardiovascular comorbidities than ticagrelor-treated patients. P2Y12 inhibitor adherence was high, and 4.3% of patients switched from prasugrel and 18.8% from ticagrelor. Prasugrel was associated with reduced 1-year rates of MACE (adjusted hazard ratio [adjHR] 0.67, 95% confidence interval [CI]: 0.47-0.95) and MI (adjHR 0.65, 95% CI: 0.44-0.96) compared with ticagrelor, without differences in bleeding after adjustment. These findings were replicated in a propensity score-matched population, in patients aged ≥75 years, and in non-STEMI patients. CONCLUSIONS: A shift from ticagrelor to prasugrel occurred between 2019 and 2022 among real-world MI patients post-PCI. Prasugrel was associated with reduced rates of MACE and MI and with similar bleeding rates compared with ticagrelor, supporting current guideline recommendations.
Zhao J, Zhao R, Chen Y
… +18 more, Cui L, Ma X, Chen J, Dong F, Lin T, Tan J, Wu T, Jin C, Xiu L, Wang W, Li L, Wang Y, Jiang S, Yu H, Hou J, Fang C, Dai J, Yu B
EuroIntervention
· 2026 Jan · PMID 41489103
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BACKGROUND: The role of non-culprit plaque rupture (a sign of pancoronary vulnerability) on long-term clinical outcomes remains unclear. AIMS: We aimed to investigate the association between non-culprit plaque rupture an...BACKGROUND: The role of non-culprit plaque rupture (a sign of pancoronary vulnerability) on long-term clinical outcomes remains unclear. AIMS: We aimed to investigate the association between non-culprit plaque rupture and long-term clinical outcomes. METHODS: ST-segment elevation myocardial infarction (STEMI) patients who had undergone 3-vessel optical coherence tomography before interventional therapy were studied. Patients and lesions were categorised into groups with and without non-culprit plaque rupture. Furthermore, non-ruptured thin-cap fibroatheroma (TCFA) was defined as a lesion with TCFA but not plaque rupture. All enrolled patients were followed for up to 5 years. The study endpoint was major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, and unplanned ischaemia-driven revascularisation. RESULTS: A total of 930 STEMI patients with 3,660 non-culprit lesions were included. Non-culprit plaque rupture was detected in 165 patients and 209 lesions. During a median 4.1-year follow-up, non-culprit lesion-related MACE occurred more frequently in patients with versus without plaque rupture (hazard ratio [HR] 2.25, 95% confidence interval [CI]: 1.13-4.49; p=0.021). However, non-culprit lesion-related MACE were similar for lesions with versus without plaque rupture (HR 0.05, 95% CI: 0.00-24.68; p=0.336). Furthermore, non-ruptured TCFA was identified in 214 patients and 281 lesions. Multivariable analysis demonstrated that non-ruptured TCFA was significantly associated with non-culprit lesion-related MACE, whereas plaque rupture was not, at both the patient and lesion levels. CONCLUSIONS: Patients with non-culprit plaque rupture had a poor long-term prognosis, which is predominantly due to the effect of non-ruptured TCFA. Non-ruptured TCFA, not plaque rupture, can identify lesions at increased risk of subsequent events.
Deng D, Zhu P, Qu X
… +23 more, Li H, Xue X, Liu X, Gao Z, Zhang H, Qin H, Lu Y, Feng Y, Zeng M, Chen S, Li X, Zhou Y, Liu F, Gao H, Zheng W, Zhang C, Xu X, Chen W, Yi D, Papanastasiou G, Hau WK, Yang G, Zhang Z
EuroIntervention
· 2026 Jan · PMID 41489098
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BACKGROUND: Despite its high prevalence and major prognostic implications, coronary microvascular disease (CMD) is frequently underdiagnosed owing to the complexity and invasiveness of current diagnostic procedures. AIMS...BACKGROUND: Despite its high prevalence and major prognostic implications, coronary microvascular disease (CMD) is frequently underdiagnosed owing to the complexity and invasiveness of current diagnostic procedures. AIMS: This study aimed to introduce and validate the usefulness of a non-invasive index of microcirculatory resistance (IMR) derived from coronary computed tomography angiography (CCTA), called IMR, for accurate diagnosis of CMD. METHODS: This retrospective cohort study comprised consecutive patients referred for invasive coronary functional assessments who underwent CCTA within the 30 days preceding an invasive evaluation between January 2022 and March 2024. IMR was calculated by blinded evaluators and compared against invasively determined IMR, with IMR values ≥25 indicating CMD, to assess its diagnostic performance. RESULTS: A total of 176 patients (216 vessels) were included in the analysis. IMR showed good correlation with invasively measured IMR, both at the vessel level (r=0.71, 95% confidence interval [CI]: 0.62-0.76; p<0.001) and the patient level (r=0.72, 95% CI: 0.64-0.78; p<0.001). At the vessel level, diagnostic accuracy, sensitivity, specificity, and area under the curve were 81.9%, 80.8%, 82.5%, and 0.82, respectively; corresponding values at the patient level were 80.7%, 81.5%, 80.2%, and 0.81. In patients with non-obstructive coronary artery disease defined by CCTA stenosis <50%, coronary angiogram stenosis <50%, or fractional flow reserve>0.8, IMR reduced underdiagnosis rates from 38.8%, 35.3%, and 36.3% to 4.5%, 5.9%, and 5.6%, respectively. CONCLUSIONS: IMR serves as a valuable complement to current diagnostic approaches, addressing their limitations and offering a promising alternative for the diagnosis of CMD, with the potential to significantly reduce misdiagnosis rates.
Kristensen SK, Holm MB, Maillard L
… +14 more, Råmunddal T, Guiducci V, Stähli BE, Žiubrytė G, Westra J, Van Belle E, Erriquez A, Koltowski L, Mogensen LJH, Escaned J, Christiansen EH, Holm NR, Andersen BK, The Favor Iii Europe Study Team OB
EuroIntervention
· 2026 Jan · PMID 41489097
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BACKGROUND: Quantitative flow ratio (QFR) is a guideline-recommended angiography-based estimation of fractional flow reserve (FFR) for functional lesion evaluation. The FAVOR III Europe trial raised concerns regarding th...BACKGROUND: Quantitative flow ratio (QFR) is a guideline-recommended angiography-based estimation of fractional flow reserve (FFR) for functional lesion evaluation. The FAVOR III Europe trial raised concerns regarding the safety and efficacy of QFR compared with FFR. Whether the poor clinical outcomes in the trial were attributable to software limitations or suboptimal in-procedure QFR analysis is unknown. AIMS: We aimed to compare in-procedure and core laboratory QFR, and to evaluate the quality of in-procedure QFR analyses. METHODS: The 1,008 patients randomised to QFR in FAVOR III Europe were assessed for eligibility. Core laboratory QFR analyses were performed by two blinded observers. The quality of in-procedure QFR analyses were evaluated during patient enrolment. Quality scores from 1 (very poor) to 5 (very good) were assigned based on adherence to the standard operating procedure (SOP). RESULTS: Of 1,233 vessels with in-procedure QFR, 1,191 (96.6%) were analysable in the core laboratory and were included in the paired analysis. The median in-procedure QFR was 0.81 (interquartile range [IQR] 0.71-0.90) and core laboratory QFR was 0.84 (IQR 0.73-0.91). The mean difference was 0.02 (95% limits of agreement: -0.26 to 0.29). Spearman's rank correlation coefficient was 0.58, and diagnostic agreement was 72%. Most in-procedure QFR analyses demonstrated very good (19%), good (45%), or acceptable (28%) SOP adherence, while 8% were rated as poor or very poor. Suboptimal angiographic quality, poor in-procedure QFR analysis quality, high SYNTAX score, and diabetes were predictors of increased variability. CONCLUSIONS: In FAVOR III Europe, agreement between in-procedure and core laboratory QFR was modest. Measurement variability increased with reduced angiographic quality, poor in-procedure QFR analysis quality, and more advanced coronary artery disease.
Fabris E, Porcari A, Bussani R
… +6 more, Pinamonti M, Merlo M, Rakar S, Perkan A, Bartunek J, Sinagra G
EuroIntervention
· 2026 Jan · PMID 41489096
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Endomyocardial biopsy (EMB) has evolved from a single-indication test for the early diagnosis and monitoring of heart transplant rejection to the gold-standard technique to reach a definite and aetiological diagnosis in...Endomyocardial biopsy (EMB) has evolved from a single-indication test for the early diagnosis and monitoring of heart transplant rejection to the gold-standard technique to reach a definite and aetiological diagnosis in different cardiac disorders such as myocarditis and cardiomyopathies. It is currently considered a fundamental tool in the diagnostic workup of unexplained acute heart failure with haemodynamic compromise. For interventional cardiologists, EMB represents a unique opportunity to bridge invasive diagnostics with personalised care. By embracing technological advancements, integrating EMB with non-invasive modalities, the field advances towards more precise and effective management of complex cardiac conditions. However, safety remains a concern when performing EMB; indeed, although rare, major complications occur in about 1-5% of cases. Correct indication for the procedure and specific expertise to minimise the risk of complications are fundamental to obtain an acceptable risk/benefit profile. Therefore, this review examines the contemporary use of EMB from the perspective of interventional cardiologists to provide a practical resource for clinical practice and to better understand when and how to perform both right and left ventricular EMB in current practice.
Landi A, Mahfoud F, Frigoli E
… +19 more, Chalkou K, Heg D, Abhaichand RK, Abhyankar AD, Barbato E, Beygui F, Danse PW, Garachemani A, Del Blanco BG, Huber K, Koning R, Kukreja N, Piot C, Quang NN, Tirouvanziam A, Valla M, Smits PC, Valgimigli M, Master Dapt Investigators OBOT
EuroIntervention
· 2025 Dec · PMID 41342080
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BACKGROUND: Abbreviated antiplatelet therapy (APT) can reduce bleeding without increasing ischaemic harm in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI). The impact of chronic kid...BACKGROUND: Abbreviated antiplatelet therapy (APT) can reduce bleeding without increasing ischaemic harm in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI). The impact of chronic kidney disease (CKD) on the safety and effectiveness of abbreviated APT remains unknown. AIMS: We aimed to investigate the comparative effectiveness of abbreviated (1 month) versus standard (≥3 months) APT in HBR patients with and without CKD. METHODS: This was a prespecified analysis from the MASTER DAPT trial, which randomised 4,579 HBR patients (1,428 [31%] with CKD) to abbreviated or standard APT. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m. Co-primary outcomes were net adverse clinical events (NACE; a composite of all-cause death, myocardial infarction [MI], stroke, and major bleeding), major adverse cardiac or cerebral events (MACCE; all-cause death, MI and stroke), and Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding at 11 months. RESULTS: NACE did not significantly differ with abbreviated and standard APT among CKD patients (hazard ratio [HR] 0.91, 95% confidence interval [CI]: 0.66-1.24) and non-CKD patients (HR 0.96, 95% CI: 0.73-1.27; pinteraction=0.78). Similarly, MACCE did not differ in CKD patients (HR 0.91, 95% CI: 0.64-1.27) and non-CKD patients (HR 1.09, 95% CI: 0.78-1.51; pinteraction=0.45). Abbreviated APT was associated with consistently lower BARC 2, 3, or 5 bleeding in both patients with CKD (HR 0.74, 95% CI: 0.52-1.07) and without it (HR 0.66, 95% CI: 0.51-0.85; pinteraction=0.59). CONCLUSIONS: Abbreviated APT was associated with similar NACE and MACCE rates and reduced bleeding compared with standard APT in HBR patients undergoing PCI, regardless of the presence or absence of CKD. (ClinicalTrials.gov: NCT03023020).
Ali ZA, Spratt JC, Finn AV
… +2 more, Maehara A, Shin D
EuroIntervention
· 2025 Dec · PMID 41342079
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Calcified nodules (CNs) represent significant challenges in percutaneous coronary intervention (PCI) due to their complex morphology, variable treatment responses, and association with stent failure due to reprotrusion o...Calcified nodules (CNs) represent significant challenges in percutaneous coronary intervention (PCI) due to their complex morphology, variable treatment responses, and association with stent failure due to reprotrusion or stent underexpansion. CNs are classified into eruptive and non-eruptive subtypes, each with distinct histological features and prognostic implications. Eruptive CNs are biologically active, being associated with a disrupted fibrous cap, overlying thrombus, and intraplaque haemorrhage, and they are thus more readily deformable by balloon dilation during PCI. Non-eruptive CNs, or nodular calcifications, tend to be stable, with an intact fibrous cap, and their deformability varies depending on the composition and base of the nodules. Enhanced angiography and intravascular imaging have greatly improved our understanding of CNs and may help to accurately identify nodule subtypes and guide treatment. Furthermore, understanding the deformability of CNs is crucial for optimising treatment outcomes. In this review, we discuss the identification and management of CNs in the context of PCI.
Kovacevic M, Jones DA, Thiele H
… +2 more, Steg PG, Kunadian V
EuroIntervention
· 2025 Dec · PMID 41342077
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Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represents a unique clinical syndrome, comprising non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. NSTEMI, as the more common and se...Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represents a unique clinical syndrome, comprising non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. NSTEMI, as the more common and serious form of NSTE-ACS, is particularly noteworthy because of its diverse clinical presentation, electrocardiogram changes, and angiography findings, which may pose challenges in diagnosis and treatment and may subsequently influence prognosis. This review offers a comprehensive overview of current evidence-based approaches to NSTE-ACS management, focusing on diagnosis, risk stratification, and treatment strategies while highlighting emerging trends and ongoing challenges in optimising patient outcomes.
Backer O, Khokhar AA, Bieliauskas G
… +23 more, Latib A, Puri R, Shaburishvili T, Zhividze M, Zirakashvili T, Asgar A, Krishnaswamy A, Garcia SA, Hahn RT, Mahoney PD, Waggoner T, Ailawadi G, Chetcuti S, Kim WK, Cavalcante J, Feldt K, Popma JJ, Coisne A, Meier D, Meduri CU, Windecker S, Reardon MJ, Bapat VN
EuroIntervention
· 2026 Feb · PMID 41251720
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BACKGROUND: Transcatheter aortic valve implantation (TAVI) in patients with small aortic annuli (SAA) is associated with an increased risk of prosthesis-patient mismatch (PPM). AIMS: This study assesses the 30-day perfor...BACKGROUND: Transcatheter aortic valve implantation (TAVI) in patients with small aortic annuli (SAA) is associated with an increased risk of prosthesis-patient mismatch (PPM). AIMS: This study assesses the 30-day performance of the novel balloon-expandable DurAVR transcatheter heart valve (THV), which features a unique single-piece biomimetic leaflet design, in patients with SAA. METHODS: This pooled analysis derived from first-in-human and early feasibility studies includes all patients with SAA (defined as an aortic annular area from 346 mm2 to 452 mm) treated with the small-sized DurAVR THV. The mean computed tomography (CT)-derived aortic annulus area was 404±37 mm, with a mean diameter of 22.7±1.0 mm. Outcomes at 30 days, including PPM, were evaluated per Valve Academic Research Consortium 3 criteria, with independent adjudication of clinical events and core laboratory analysis of post-implant transthoracic echocardiograms. RESULTS: Amongst 100 patients (mean age 77.0±7.3 years; 78% female; mean Society of Thoracic Surgeons score 4.7±4.0%) treated with the DurAVR THV, the overall technical success rate was 93%. At 30 days, device success was achieved in 91% of patients, with no reported deaths and a stroke rate of 2%. Echocardiographic haemodynamic assessment showed a mean transprosthetic gradient of 8.2±3.1 mmHg, a mean effective orifice area of 2.2±0.3 cm, and a Doppler velocity index of 0.60±0.10. The incidence of moderate or greater PPM was 3%, and no patients experienced more than mild paravalvular leak. The rate of new permanent pacemaker implantation was 6%. CONCLUSIONS: In patients with SAA, the DurAVR THV demonstrated promising clinical and echocardiographic outcomes at 30 days. Longer-term follow-up in larger cohorts is needed to confirm these encouraging early results.
Tang GHL, Rajagopal V, Sorajja P
… +24 more, Bajwa T, Gooley R, Walton A, Modine T, Ng MK, Williams MR, Zajarias A, Hildick-Smith D, Tchétché D, Spargias K, Rajani R, Bapat VN, De Backer O, Blackman D, McCarthy P, Laine M, Jain R, Martin R, Thaden JJ, Marka NA, Mack M, Adams DH, Leon MB, Reardon MJ
EuroIntervention
· 2026 Feb · PMID 41251714
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BACKGROUND: Transcatheter mitral valve replacement (TMVR) offers a potential treatment option for select patients with mitral regurgitation (MR) deemed unsuitable for surgery or transcatheter repair, but data are limited...BACKGROUND: Transcatheter mitral valve replacement (TMVR) offers a potential treatment option for select patients with mitral regurgitation (MR) deemed unsuitable for surgery or transcatheter repair, but data are limited on its long-term durability and performance. AIMS: We evaluated 5-year outcomes from the global Pilot Study with the Intrepid transapical (TA) TMVR system. METHODS: This multicentre, single-arm study evaluated the early-generation Intrepid TA system in patients with symptomatic ≥moderate-severe MR at high risk for mitral valve (MV) surgery. Echocardiograms and clinical events were independently adjudicated, and patients were followed for up to 5 years. RESULTS: Ninety-five patients were enrolled at 21 sites between 2015 and 2019. The mean age was 74.0±9.2 years, 43.2% of patients were female, the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 6.5±4.8%, 57.9% had prior heart failure hospitalisation (HFH), and 88.4% were in New York Heart Association (NYHA) Functional Class III/IV. Secondary MR was present in 78.7%, and 76.6% had a left ventricular ejection fraction ≤50%. Up to 5 years, all-cause mortality was 66.7% and HFH was 55.4%, with one 30-day MV reintervention (1.1%). Haemodynamic valve deterioration occurred in 1.4%, the median MV mean gradient remained stable at 3.6 mmHg (first and third quartiles: 3.0, 4.8 mmHg), ≤mild MR was present in 100% of patients, and no patient experienced paravalvular leak. NYHA Functional Class I/II was maintained in 84.6%. CONCLUSIONS: In this 5-year follow-up of the early-generation Intrepid TA TMVR system, we observed sustained MR reduction, durable haemodynamic valve performance, and improved functional status among survivors. The APOLLO (ClinicalTrials.gov: NCT03242642) and APOLLO-EU (NCT05496998) trials using the transfemoral Intrepid system will further determine the role of TMVR in managing this high-risk patient population. CLINICALTRIALS: gov: NCT02322840.