Abdul Jabbar AB, Ismayl M, Klisares M
… +6 more, Osborne J, Azouz M, Tak HJ, Aboeata A, Kabach A, Goldsweig AM
Cardiovasc Revasc Med
· 2026 Jun · PMID 40947324
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BACKGROUND: Acute myocardial infarction (AMI) is a leading cause of cardiovascular disease (CVD) mortality among young and middle-aged individuals in the United States (US). Though AMI mortality overall has been decreasi...BACKGROUND: Acute myocardial infarction (AMI) is a leading cause of cardiovascular disease (CVD) mortality among young and middle-aged individuals in the United States (US). Though AMI mortality overall has been decreasing in the US, contemporary trends in AMI-related mortality in the young and middle-aged population and the impact of the COVID-19 pandemic on these trends are unknown. METHODS: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to analyze death certificates from 1999 to 2023 for AMI-related deaths among the US population aged 25-64. Age-adjusted mortality rates (AAMRs) per 100,000 people and associated annual percent changes (APCs) were calculated using Joinpoint regression analysis. Mortality trends were stratified by sex, race/ethnicity, census region, and state for comparative analysis. RESULTS: From 1999 to 2023, there were 970,454 AMI-related deaths among U.S. adults aged 25-64 years. The annual number of AMI-related deaths decreased from 44,040 in 1999 to 31,522 in 2023. The overall AAMR per 100,000 decreased from 31.02 deaths (95 % confidence interval [CI] 30.73-31.31) in 1999 to 15.29 (95 % CI 15.11-15.46) in 2023 (average APC -2.92 %, 95 % CI -3.22 to -2.75). The AAMR per 100,000 declined at a faster rate from 31.02 in 1999 to 19.57 in 2010 (1999-2010, APC -4.26), followed by a slower rate from 19.57 in 2010 to 16.67 in 2019 (2010-2019, APC -1.41). The declining trend was disrupted by a transient increase during the COVID-19 pandemic, with a peak AAMR of 19.73 (95 % CI, 19.53 to 19.93) in 2021 (2019-2021, APC 8.52). The declining trend resumed from 2021 to 2023, with AAMR decreasing to its lowest levels of 15.29 in 2023 (2021-2023, APC -12.58). Heterogeneity across demographic and regional groups narrowed during these 25 years. However, disparities are still prevalent, with men, non-Hispanic (NH) Black or African American, American Indian or Alaska Native, and residents of the Southern United States having higher mortality rates. CONCLUSION: AMI-related mortality declined significantly from 1999 through 2023 in the young and middle-aged population of the US. AMI-related mortality rates increased transiently during the COVID-19 pandemic, but the declining trend resumed in 2022. Differences across demographic and regional subgroups narrowed; however, disparities remain prevalent and require comprehensive efforts to improve cardiovascular health, outcomes, and health equity among the young and middle-aged populations of the US.
BACKGROUND: Severe mitral regurgitation (MR) is associated with significant morbidity and mortality, particularly in patients with shock. While surgical repair remains the standard of care in acute primary MR, many criti...BACKGROUND: Severe mitral regurgitation (MR) is associated with significant morbidity and mortality, particularly in patients with shock. While surgical repair remains the standard of care in acute primary MR, many critically ill patients are ineligible due to advanced age or comorbidities. Transcatheter edge-to-edge mitral valve repair (TEER) with MitraClip has emerged as a promising alternative. Unlike prior registries, this study directly compares cardiogenic vs. mixed shock using invasive criteria, integrates SCAI staging, BOS-MA2 risk prediction, and valve phenotyping, and highlights the need for prospective studies to refine patient selection. OBJECTIVES: To evaluate the feasibility, safety, and clinical outcomes of MitraClip implantation in patients with severe MR and cardiogenic or mixed shock. METHODS: This retrospective cohort study analyzed 47 patients with severe MR and cardiogenic (n = 32) or mixed shock (n = 15) treated with MitraClip between January 2017 and December 2023. Procedural success, defined as successful clip deployment, reduction of MR to ≤2, and absence of major device-related complications, was assessed alongside short- and long-term outcomes. Baseline characteristics, hemodynamic parameters, and outcomes were compared between shock subtypes. RESULTS: Procedural success was achieved in 100 % of cases. MR severity improved significantly from grade 4 to grade ≤ 2 (p < 0.001). In-hospital mortality was 8.5 %, and 1-year mortality was 25.5 %. Patients with mixed shock had higher in-hospital mortality (20 % vs. 3.1 %, p = 0.53) and lower 1-year readmission rates (21.4 % vs. 58.6 %, p = 0.02). Predictors of 1-year mortality included advanced age, elevated left atrial volume index, and prolonged vasopressor use. CONCLUSIONS: MitraClip implantation is a feasible intervention for severe MR in patients with shock, demonstrating high procedural success and meaningful reductions in MR severity across both cardiogenic and mixed shock. These exploratory findings highlight the need for larger prospective studies to validate outcomes and refine patient selection.
Nicholson W, Alnahhal KI, Han J
… +5 more, Borenstein J, Ranjbar K, Talutis SD, Kumar S, Salehi P
Cardiovasc Revasc Med
· 2026 May · PMID 40925794
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BACKGROUND: protamine sulfate is used to reduce bleeding risk after Carotid Artery Stenting (CAS), but its efficacy in personalized patient settings remains underexplored. This study aims to identify factors associated w...BACKGROUND: protamine sulfate is used to reduce bleeding risk after Carotid Artery Stenting (CAS), but its efficacy in personalized patient settings remains underexplored. This study aims to identify factors associated with greater benefits from protamine sulfate following CAS. METHODS: A retrospective review of Vascular Quality Initiative (VQI) data (2016-2022) identified patients undergoing CAS, divided into Transfemoral CAS (TF-CAS) and Transcarotid artery revascularization (TCAR) groups. Multivariate analysis used to identify perioperative predictors of bleeding complications, and propensity score matching compared rates of death and thrombotic events (myocardial infarction (MI), stroke/transient ischemic attack (TIA)) between protamine and no protamine groups. RESULTS: Among 51,473 patients (36.9 % females), 56.4 % underwent TCAR (Protamine: 85.6 %; No protamine: 14.4 %), and 43.6 % underwent TF-CAS (Protamine: 18.9 %; No protamine: 81.1 %). Protamine significantly reduced bleeding complications in female patients and those on ACE inhibitors in both groups. In the TF-CAS group, protamine was associated with lower all-cause mortality (7.9 % vs. 11.5 %; P < .001) without an increase in MI (0.5 % vs. 0.9 %) or stroke/TIA (2.8 % vs. 2.9 %; P > .05). In the TCAR group, protamine had similar rates of all-cause mortality (7.7 % vs. 7.3 %), MI (0.4 % vs. 0.3 %), and stroke/TIA (2.4 % vs. 2.9 %; P > .05). CONCLUSIONS: Protamine sulfate appears to be effective in reducing the bleeding complications in TCAR patients without increasing death or thrombotic complications. Its benefits are especially notable in females and those on ACE inhibitors, regardless of the CAS approach. Although protamine use in the TF-CAS cohort was associated with reduced all-cause mortality, it did not show an overall benefit in bleeding reduction. However, in TF-CAS, females and patients on ACE inhibitors did appear to benefit, supporting a more selective approach to its use.
Ogami T, Staniloae CS, Habib H
… +3 more, Querijero M, Gaudio S, Williams MR
Cardiovasc Revasc Med
· 2026 Jun · PMID 40914701
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BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of aortic valve disease. However, delayed complications after hospital discharge and readmission remain in an issue fol...BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of aortic valve disease. However, delayed complications after hospital discharge and readmission remain in an issue following TAVR. We aimed to evaluate the impact of remote monitoring systems on clinical outcomes after TAVR. METHODS: All patients who underwent TAVR from September 2014 through January 2019 were included retrospectively. Additionally, all patients, clinically indicated for TAVR from 9/1/2018 through 8/30/2021, were screened, and patients who agreed were prospectively enrolled. Medtronic Care Management Service (MCMS) was used to monitor patients following TAVR after discharge (Medtronic, Minneapolis, MN). RESULTS: A total of 1078 patients were included. Among them, 843 (78.2 %) patients were discharged with MCMS (MCMS group) and 235 (21.8 %) patients were discharged without (non-MCMS group). Overall, the mean age was 81.5 years, and mean STS-PROM was 5.53 %. Baseline conduction defect was observed in 427 (39.6 %). Peripheral artery disease was more common in the MCMS group while a history of myocardial infarction was more likely seen in the non-MCMS group. After propensity-score matching, length of hospital stays was significantly shorter in the MCMS group (1.42 days vs. 1.82 days in the non-MCMS group, p < 0.001). Readmission rates and new permanent pacemaker insertion rates were similar between the two groups. All-cause mortality, 30-day and 90-day mortality were comparable between the groups. CONCLUSIONS: MCMS was easily applicable to a clinical practice and may reduce length of hospital stays in patients undergoing TAVR without increasing readmission or mortality.
Haberman D, Reardon MJ, Stone GW
… +8 more, Rihal C, Aranzulla TC, Madan N, Wojakowski W, Reisman MJ, Lupu L, Chaturvedi A, Waksman R
Cardiovasc Revasc Med
· 2025 Oct · PMID 40914700
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Secondary mitral regurgitation (SMR) remains a prevalent and challenging complication in patients with heart failure (HF), associated with poor prognosis despite optimal guideline-directed medical therapy (GDMT) and card...Secondary mitral regurgitation (SMR) remains a prevalent and challenging complication in patients with heart failure (HF), associated with poor prognosis despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy. Current American and European guidelines recommend GDMT as first-line therapy, with transcatheter edge-to-edge repair (TEER) reserved for severe symptomatic SMR patients who remain refractory. However, both guidelines preceded the reporting of pivotal randomized controlled trials (RESHAPE-HF2, MATTERHORN, and EFFORT) and emerging evidence in new clinical scenarios. At the 2025 Cardiovascular Research Technologies (CRT) conference, the session "Beyond the Guidelines" convened an expert panel to address existing gaps and evolving indications. Discussions highlighted unresolved questions regarding TEER in moderate SMR, asymptomatic patients, atrial functional MR, cardiogenic shock, and as a bridge in end-stage HF. Panel consensus emphasized the need for dedicated randomized trials in these subgroups and consideration of broader TEER use based on registry and observational data demonstrating procedural safety and clinical benefit. This review summarizes current evidence, knowledge gaps, and expert perspectives to inform future guideline development and optimize management of SMR across the spectrum of HF.
OBJECTIVE: Data remain limited on factors influencing the selection of redo-transcatheter aortic valve replacement (TAVR) versus surgical explant in patients with failing transcatheter heart valves. This study aimed to i...OBJECTIVE: Data remain limited on factors influencing the selection of redo-transcatheter aortic valve replacement (TAVR) versus surgical explant in patients with failing transcatheter heart valves. This study aimed to identify clinical and procedural factors guiding treatment decisions. METHODS: This single-center, retrospective study included all patients who underwent aortic valve reintervention following prior TAVR at a U.S. tertiary referral center between January 2015 and June 2024. Clinical records, imaging, and Heart Team notes were reviewed to determine rationale for treatment selection. Procedural details and major adverse cardiac events (MACE: death, rehospitalization, or stroke) were collected. RESULTS: Among 47 patients, 24 (51 %) underwent surgical explant and 23 (49 %) redo-TAVR. The explant group was significantly younger (75 vs. 79 years; p = 0.018), with similar gender distribution (31.9 % female). Time to reintervention was comparable (27.8 vs. 34.2 months; p = 0.75). Common indications for explant included endocarditis (33.3 %), patient-prosthesis mismatch (16.7 %), prior valve-in-valve (16.7 %), annular rupture risk (12.5 %), need for concomitant surgery (8.3 %), and coronary obstruction risk (8.3 %). Thirty-day and one-year MACE rates were significantly higher with explant (30.4 % vs. 0 %, p = 0.029; 59.1 % vs. 21.4 %, p = 0.041). Mortality was numerically higher but not statistically significant. Patients undergoing explant often had more comorbidities and required complex procedures. CONCLUSION: Among patients undergoing reintervention after TAVR, treatment was evenly split between redo-TAVR and explant, underscoring the importance of lifetime planning at initial TAVR. This analysis shows the two groups represent inherently different patient populations and highlights the need for randomized trials to define optimal treatment pathways.
Kharsa C, Sella G, Kritya M
… +7 more, Sammour YM, Bou Chaaya RG, Philip J, Maqsood MH, Zoghbi WA, Kleiman NS, Shah AR
Cardiovasc Revasc Med
· 2026 May · PMID 40897612
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BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world dat...BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world data from the Houston Methodist CTO PCI Registry to characterize procedural success, safety, and mid- to long-term outcomes. METHODS: We retrospectively analyzed 507 patients undergoing CTO PCI between 2018 and 2023. Baseline clinical characteristics, procedural details, and outcomes including procedural success, in-hospital complications, and follow-up events were evaluated. Multivariable logistic regression identified predictors of procedural success. RESULTS: The cohort had a mean age of 65.3 ± 10.0 years, 20.9 % women, and a high prevalence of comorbidities (hypertension 96.1 %, diabetes 49.7 %). The mean J-CTO score was 1.8 ± 1.1. Procedural success was achieved in 81.2 % of cases, with low in-hospital mortality (0.4 %) and complication rates. Annual success rates improved from 72.7 % in 2018 to a peak of 86.7 % in 2020, reflecting growing operator experience and evolving techniques. Multivariable analysis showed that age (OR 0.97, 95 % CI [0.95-1.00]; p = 0.03), cumulative air kerma (OR 1.00, 95 % CI [1.00-1.00]; p = 0.003) and lesion length (OR 1.05, 95 % CI [1.03-1.07], p < 0.001) were independent predictors of success. KM analysis revealed a 2-year overall survival of 91.4 %, freedom from clinically driven target lesion revascularization (TLR) of 93.6 % at 2 years, and event-free survival from target lesion failure (TLF) of approximately 85 % at 2 years. At a median follow-up of 745 days, all-cause mortality was 9.2 %, and TLR occurred in 2.4 % of patients. CONCLUSION: CTO PCI can be performed safely with high success rates and favorable mid- to long-term outcomes in a complex population. Procedural success is primarily driven by lesion-specific factors rather than clinical comorbidities. These findings support the continued evolution and application of CTO PCI in appropriately selected patients.
Sawalha K, Alakchar M, Mamas MA
… +3 more, Johnson D, Bhan A, Goldsweig AM
Cardiovasc Revasc Med
· 2026 Mar · PMID 40877076
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BACKGROUND: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to ora...BACKGROUND: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain. OBJECTIVE: To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I statistic. RESULTS: Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I = 0 %). Pre-DCCV imaging protocols varied widely among studies. CONCLUSIONS: In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials.
Rao A, Rahman H, Bhatia H
… +5 more, Agrawal A, Aafreen A, Sharma S, Lopez CY, Kaluski E
Cardiovasc Revasc Med
· 2026 Feb · PMID 40866176
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Embolic stroke of undetermined source (ESUS) is a clinical event with an undelineated embolic etiology after the initial stroke workup. Once stroke specialists confirm ESUS, evaluation of rhythm disorders such as atrial...Embolic stroke of undetermined source (ESUS) is a clinical event with an undelineated embolic etiology after the initial stroke workup. Once stroke specialists confirm ESUS, evaluation of rhythm disorders such as atrial fibrillation, specific cardiac pathologies (cardiomyopathy, left atrial cardiopathy, left-atrial septal pouch, aortic or mitral valve disease, cardiac neoplasm, right-to-left shunts, or device-related thrombus), and acquired hypercoagulable states, which may occasionally be related to malignancy, should be performed. While most ESUS patients require appropriate antiplatelet therapy, certain subsets may require oral anticoagulation. However, routine prescription of oral anticoagulants in the absence of documented atrial fibrillation, cancer-related thrombosis, or cardiac thrombosis is discouraged. Shared decision-making between the patient and the physician about additional diagnostic and therapeutic decisions is particularly encouraged in this condition, given the limited availability of high-quality clinical data and considerable uncertainty about the safety and efficacy of therapeutic options and clinical outcomes.
Carvalho PEP, Mutlu D, Strepkos D
… +7 more, Alexandrou M, Kladou E, Jalli S, Ser OS, Rangan BV, Brilakis ES, Sandoval Y
Cardiovasc Revasc Med
· 2026 May · PMID 40846601
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Fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPR) are established physiologic indices that can help inform the need for percutaneous coronary intervention (PCI), however, their use in patients underg...Fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPR) are established physiologic indices that can help inform the need for percutaneous coronary intervention (PCI), however, their use in patients undergoing bifurcation PCI is uncertain. The PROGRESS-BIFURCATION study is an ongoing multi-center, international registry conducted across six centers. Among 2494 bifurcation lesions treated (2271 patients), only 158 (6.3 %) had pressure-wire based physiology assessment. Pre-PCI, 127 (5.1 %) lesions had assessments of the main vessel (MV), 32 (1.3 %) of the side branches (SB), and 18 (0.7 %) had assessments of both MV and SB. Post-PCI, 23 (0.9 %) had assessments of the MV, and 9 (0.4 %) of the SB. NHPR were used in 55 % and FFR in 45 % of cases. Technical and procedural success rates, as well as complication rates, were comparable between bifurcation PCIs performed with and without physiology assessments. However, the use of physiology assessment was associated with a lower incidence of in-hospital major adverse cardiac events (MACE) (0.0 % vs. 3.8 %; p = 0.02). Despite randomized controlled trials showing benefits of coronary physiology to inform the need for PCI and improve clinical outcomes, real-world adoption of physiology-based assessment in bifurcation PCI remains low.
Cardiovasc Revasc Med
· 2026 Feb · PMID 40819999
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Mitral regurgitation (MR) remains a prevalent and undertreated condition, particularly in patients at high surgical risk or unsuitable for mitral transcatheter edge-to-edge repair (M-TEER). The HighLife (HighLife SAS, Pa...Mitral regurgitation (MR) remains a prevalent and undertreated condition, particularly in patients at high surgical risk or unsuitable for mitral transcatheter edge-to-edge repair (M-TEER). The HighLife (HighLife SAS, Paris, France) transcatheter mitral valve replacement (TMVR) system offers a novel solution with its unique two-component design comprising a subannular ring and a self-expanding bioprosthetic valve. Delivered via a transfemoral arterial and transseptal venous approach, this "valve-in-ring" system enables circumferential anchoring without the need for annular calcification or transapical access. Early clinical experience, including first-in-human and feasibility studies, has demonstrated high technical success, significant MR reduction, and favorable short- and mid-term outcomes. Recent device iterations, such as the large annulus valve and Clarity prosthesis, address prior limitations related to annular size and left ventricular outflow tract (LVOT) obstruction risk, broadening the range of suitable anatomies. Despite its promise, the HighLife system presents challenges including procedural complexity, bleeding risk, and the need for precise imaging and experienced operators. Ongoing clinical trials will be critical to further define its safety, durability, and long-term efficacy. With further evidence, the HighLife system may offer a viable TMVR option for patients previously deemed untreatable by conventional transcatheter or surgical approaches.
Franchin L, Angriman F, Pezzato A
… +5 more, Vignut LS, Fabris E, Sinagra G, van 't Hof AWJ, Imazio M
Cardiovasc Revasc Med
· 2026 Jan · PMID 40818917
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OBJECTIVES: To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction. BACKGROUND: There is a paucity of data regarding the...OBJECTIVES: To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction. BACKGROUND: There is a paucity of data regarding the best timing for heparin administration in STEMI. METHODS: We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. RESULTS: 11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56-0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48-0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR = 1.54; 95 % CI 1.37-1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74-1.24). CONCLUSION: A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.
Caron E, Ciftcikal Y, Cannata M
… +12 more, Shin D, Sami Z, Gujja M, Hoque R, Sakai K, Sosa F, Ughi G, Moses JW, Shlofmitz RA, Jeremias A, Ali ZA, Shlofmitz E
Cardiovasc Revasc Med
· 2026 Mar · PMID 40817012
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