Journal: EuroIntervention

Sorted by: date / impact
Abstract

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma.

Fabris E, Berta B, Hommels T, Roleder T, ... Wojakowski W, Kedhi E
Background
The long-term prognostic implications of fractional flow reserve (FFR)-negative lesions hosting vulnerable plaques remain unsettled.
Aims
The aim of this study was to evaluate the association of non-ischaemic lesions hosting optical coherence tomography (OCT)-detected thin-cap fibroatheromas (TCFA) with first and recurrent cardiovascular events during follow-up up to 5 years in a diabetes mellitus (DM) patient population.
Methods
 COMBINE OCT-FFR is a prospective, international, double-blind, natural history study. Patients with DM and with ≥1 FFR-negative lesion were classified into 2 groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint (PE) is a composite of cardiac mortality, target vessel-related myocardial infarction (TV-MI), clinically driven target lesion revascularisation (TLR), or unstable angina (UA) requiring hospitalisation during follow-up up to 5 years.
Results
Among 390 DM patients (age 67.5±9 years; 37% female) with ≥1 FFR-negative lesion, 292 (74.9%) were TCFA-negative while 98 (25.1%) were TCFA-positive. The PE occurred more frequently in TCFA-positive than in TCFA-negative patients (21.4% vs 8.2%, hazard ratio [HR] 2.89, 95% confidence interval [CI]: 1.61-5.20; p<0.001; 6.42 vs 2.46 events per 100 patient-years, rate ratio [RR] 2.61, 95% CI: 1.38-4.90; p=0.002). Furthermore, when TV-MI, TLR, and UA were treated as recurrent components of the PE, TCFA-positive patients experienced a higher risk of recurrent events (HR 2.89, 95% CI; 1.74-4.80; p<0.001; 13.45 vs 2.87 events per 100 patient-years, RR 4.69, 95% CI: 2.86-7.83; p<0.001). A multivariable analysis identified the presence of TCFA as an independent predictor of the PE (HR 2.76, 95% CI: 1.53-4.97; p<0.001).
Conclusions
OCT-detected TCFA-positive lesions, although not ischaemia-generating, are associated with an increased risk of adverse events during long-term follow-up.
Clinicaltrials
gov: NCT02989740.



EuroIntervention: 28 Sep 2022; epub ahead of print
Fabris E, Berta B, Hommels T, Roleder T, ... Wojakowski W, Kedhi E
EuroIntervention: 28 Sep 2022; epub ahead of print | PMID: 36170036
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Impact:
Abstract

Diagnostic performance of exercise stress tests for detection of epicardial and microvascular coronary artery disease: the UZ Clear study.

Vandeloo B, Andreini D, Brouwers S, Mizukami T, ... Cosyns B, Collet C
Background
Cardiac stress tests remain the cornerstone for evaluating patients suspected of having obstructive coronary artery disease (CAD). Coronary microvascular dysfunction (CMD) can lead to abnormal non-invasive tests.
Aims
We sought to assess the diagnostic performance of exercise stress tests with indexes of epicardial and microvascular resistance as reference.
Methods
This was a prospective, single-arm, multicentre study of patients with an intermediate pretest probability of CAD and positive exercise stress tests who were referred for invasive angiography. Patients underwent an invasive diagnostic procedure (IDP) with measurement of fractional flow reserve (FFR) and index of microvascular resistance (IMR) in at least one coronary vessel. Obstructive CAD was defined as diameter stenosis (DS) >50% by quantitative coronary angiography (QCA). The objective was to determine the false discovery rate (FDR) of cardiac exercise stress tests with both FFR and IMR as references.
Results
One hundred and seven patients (137 vessels) were studied. The mean age was 62.1±8.7, and 27.1% were female. The mean diameter stenosis was 37.2±27.5%, FFR was 0.84±0.10, coronary flow reserve was 2.74±2.07, and IMR 20.3±11.9. Obstructive CAD was present in 39.3%, whereas CMD was detected in 20.6%. The FDR was 60.7% and 62.6% with QCA and FFR as references (p-value=0.803). The combination of FFR and IMR as clinical reference reduced the FDR by 25% compared to QCA (45.8% vs 60.7%; p-value=0.006).
Conclusions
In patients with evidence of ischaemia, an invasive functional assessment accounting for the epicardial and microvascular compartments led to an improvement in the diagnostic performance of exercise tests, driven by a significant FDR reduction.



EuroIntervention: 23 Sep 2022; epub ahead of print
Vandeloo B, Andreini D, Brouwers S, Mizukami T, ... Cosyns B, Collet C
EuroIntervention: 23 Sep 2022; epub ahead of print | PMID: 36147027
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Abstract

Permanent pacemaker implantation and left bundle branch block with self-expanding valves - a SCOPE 2 subanalysis.

Pellegrini C, Garot P, Morice MC, Tamburino C, ... Capodanno D, Joner M
Background
No detailed data on left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) exist from randomised clinical trials comparing the ACURATE neo and CoreValve Evolut devices.
Aims
Our aim was to assess the incidence and impact of new LBBB and PPI with self-expanding prostheses from a powered randomised comparison.
Methods
From the SCOPE 2 trial, 648 patients with no previous pacemaker were analysed for PPI at 30 days, and 426 patients without previous LBBB were adopted for analysis of LBBB at 30 days. 
Results:
At 30 days, 16.5% of patients required PPI; rates were higher in CoreValve Evolut compared to ACURATE neo recipients (21.0% vs 12.3%; p=0.004). Previous right bundle branch block (odds ratio [OR] 6.11, 95% confidence interval [CI]: 3.19-11.73; p<0.001) was associated with an increased risk of PPI at 30 days, whereas the use of the ACURATE neo (OR 0.50, 95% CI: 0.31-0.81; p=0.005) was associated with a decreased risk. One-year mortality was similar in patients with and without new PPI. A total of 9.4% of patients developed persistent LBBB at 30 days, with higher incidences in CoreValve Evolut recipients (13.4% vs 5.5%; p=0.007). New LBBB at 30 days was associated with lower ejection fraction at 1 year (65.7%±11.0 vs 69.1%±7.6; p=0.041).
Conclusions
New LBBB and PPI rates were lower in ACURATE neo compared to CoreValve Evolut recipients. The ACURATE neo valve was associated with a lower risk of PPI at 30 days. No effect on 1-year mortality was determined for PPI at 30 days, while LBBB at 30 days was associated with reduced ejection fraction at 1 year.



EuroIntervention: 21 Sep 2022; epub ahead of print
Pellegrini C, Garot P, Morice MC, Tamburino C, ... Capodanno D, Joner M
EuroIntervention: 21 Sep 2022; epub ahead of print | PMID: 36128956
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Abstract

Recanalisation of coronary chronic total occlusions.

Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.



EuroIntervention: 20 Sep 2022; 18:535-561
Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS
EuroIntervention: 20 Sep 2022; 18:535-561 | PMID: 36134683
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Abstract

Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses.

Zahid S, Ullah W, Hashem AM, Khan MZ, ... Vishnevsky A, Fischman DL
Background
Data on the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) compared with redo surgical mitral valve replacement (SMVR) in patients with a history of bioprosthetic mitral valve (MV) remain limited.
Aims
We aimed to evaluate the in-hospital, 30-day and 6-month readmission outcomes of ViV-TMVR compared with redo-SMVR in a real-world cohort.
Methods
The Nationwide Readmission Database was utilised, analysing data from 2015 to 2019. To determine the adjusted odds ratio (aOR), we used the propensity-matched analysis for major outcomes at index hospitalisation, 30 days, and 6 months during the episode of readmission.
Results
A total of 3,691 patients were included, of these, 24.2% underwent ViV-TMVR and 75.8% underwent redo-SMVR. Patients undergoing ViV-TMVR were older with higher rates of comorbidities. The mean length of stay (15 days vs 4 days) and cost of hospitalisation ($76,558 vs $46,743) were significantly higher for redo-SMVR. The rate of in-hospital all-cause mortality was also significantly lower in ViV-TMVR (2.6% vs 7.3%). By contrast, 30-day all-cause mortality during the episode of readmission (aOR 1.01, 95% confidence interval [CI]: 0.40-2.55) and all-cause readmission rates (aOR 0.82, 95% CI: 0.66-1.02) were similar between both groups. The incidence of all-cause readmissions at 6 months (aOR 0.83, 95% CI: 0.65-1.05) and all-cause mortality during the episode of readmission at 6 months (aOR 1.84, 95% CI: 0.54-6.36) were also comparable. The utilisation of the ViV-TMVR procedure increased significantly during our study duration, from 5.2% to 36.8%, (ptrend<0.01).
Conclusions
ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilisation. The all-cause readmissions and 30-day and 6-month mortality during the episode of readmissions were comparable between both groups.



EuroIntervention: 15 Sep 2022; epub ahead of print
Zahid S, Ullah W, Hashem AM, Khan MZ, ... Vishnevsky A, Fischman DL
EuroIntervention: 15 Sep 2022; epub ahead of print | PMID: 36106346
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Abstract

Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on pulmonary circulation and right ventricular function and the European Association of Percutaneous Cardiovascular Interventions.

Pruszczyk P, Klok FA, Kucher N, Roik M, ... Konstantinides S, Dudek D
There is a growing clinical and scientific interest in catheter-directed therapy (CDT) of acute pulmonary embolism (PE). Currently, CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed. Also, CDT is a treatment option for initially stable patients in whom anticoagulant treatment fails, i.e., those who experience haemodynamic deterioration despite adequately dosed anticoagulation. However, the definition of treatment failure (primary reperfusion therapy or anticoagulation alone) remains an important area of uncertainty. Moreover, several techniques for CDT are available without evidence supporting one over the other, and variation in practice with regard to periprocedural anticoagulation is considerable. The aim of this position paper is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT. We discuss several clinical scenarios of the clinical evaluation of the \"efficacy\" of thrombolysis and anticoagulation, including treatment failure with haemodynamic deterioration and treatment failure based on a lack of improvement. This clinical consensus statement serves as a practical guide for CDT, complementary to the formal guidelines.



EuroIntervention: 13 Sep 2022; epub ahead of print
Pruszczyk P, Klok FA, Kucher N, Roik M, ... Konstantinides S, Dudek D
EuroIntervention: 13 Sep 2022; epub ahead of print | PMID: 36112184
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Impact:
Abstract

Comparison of transcatheter aortic valve replacement with the ACURATE neo2 versus Evolut PRO/PRO+ devices.

Baggio S, Pagnesi M, Kim WK, Scotti A, ... Latib A, Mangieri A
Background
The ACURATE neo2 (NEO2) and Evolut PRO/PRO+ (PRO) bioprostheses are new-generation self-expanding valves developed for transcatheter aortic valve replacement (TAVR).
Aims
We sought to compare the performance of the ACURATE neo2 and Evolut PRO/PRO+ devices.
Methods
The NEOPRO-2 registry retrospectively included patients who underwent TAVR for severe aortic stenosis with either the NEO2 or PRO devices between August 2017 and December 2021 at 20 centres. In-hospital and 30-day Valve Academic Research Consortium (VARC)-3 defined outcomes were evaluated. Propensity score (PS) matching and binary logistic regression were performed to adjust the treatment effect for PS quintiles. A subgroup analysis assessed the impact of aortic valve calcification.
Results
A total of 2,175 patients (NEO2: n=763; PRO: n=1,412) were included. The mean age was 82±6.2 years and the mean Society of Thoracic Surgeons score was 4.2%. Periprocedural complications were low, and both groups achieved high rates of technical success (93.1% vs 94.1%; p=0.361) and predischarge intended valve performance (96.0% vs 94.1%; p=0.056), both in the unmatched and matched analysis (452 pairs). Device success at 30 days was comparable (84.3% vs 83.6%; p=0.688), regardless of aortic valve calcification severity (p>0.05 for interaction). A suggestion for higher VARC-3 early safety in the NEO2 group was mainly driven by reduced rates of new permanent pacemaker implantation (7.7% vs 15.6%; p<0.001).
Conclusions
This retrospective analysis reports a similar short-term performance of the ACURATE neo2 platform compared with the new-generation Evolut PRO/PRO+ devices. Randomised studies are needed to confirm our exploratory findings.



EuroIntervention: 12 Sep 2022; epub ahead of print
Baggio S, Pagnesi M, Kim WK, Scotti A, ... Latib A, Mangieri A
EuroIntervention: 12 Sep 2022; epub ahead of print | PMID: 36093795
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Abstract

Radial wall strain: a novel angiographic measure of plaque composition and vulnerability.

Hong H, Li C, Gutiérrez-Chico JL, Wang Z, ... Wijns W, Tu S
Background
The lipid-to-cap ratio (LCR) and thin-cap fibroatheroma (TCFA) derived from optical coherence tomography (OCT) are indicative of plaque vulnerability.
Aims
We aimed to explore the association of a novel method to estimate radial wall strain (RWS) from angiography with plaque composition and features of vulnerability assessed by OCT.
Methods
Anonymised data from patients with intermediate stenosis who underwent coronary angiography (CAG) and OCT were analysed in a core laboratory. Angiography-derived RWSmax was computed as the maximum deformation of lumen diameter throughout the cardiac cycle, expressed as a percentage of the largest lumen diameter. The LCR and TCFA were automatically determined on OCT images by a recently validated algorithm based on artificial intelligence.
Results
OCT and CAG images from 114 patients (124 vessels) were analysed. The average time for the analysis of RWSmax was 57 (39-82) seconds. The RWSmax in the interrogated plaques was 12% (10-15%) and correlated positively with the LCR (r=0.584; p<0.001) and lipidic plaque burden (r=0.411; p<0.001), and negatively with fibrous cap thickness (r= -0.439; p<0.001). An RWSmax >12% was an angiographic predictor for an LCR >0.33 (area under the curve [AUC]=0.86, 95% confidence interval [CI]: 0.78-0.91; p<0.001) and TCFA (AUC=0.72, 95% CI: 0.63-0.80; p<0.001). Lesions with RWSmax >12% had a higher prevalence of TCFA (22.0% versus 1.5%; p<0.001), thinner fibrous cap thickness (71 μm versus 101 μm; p<0.001), larger lipidic plaque burden (23.3% versus 15.4%; p<0.001), and higher maximum LCR (0.41 versus 0.18; p<0.001) compared to lesions with RWSmax ≤12%.
Conclusions
Angiography-derived RWS was significantly correlated with plaque composition and known OCT features of plaque vulnerability in patients with intermediate coronary stenosis.



EuroIntervention: 08 Sep 2022; epub ahead of print
Hong H, Li C, Gutiérrez-Chico JL, Wang Z, ... Wijns W, Tu S
EuroIntervention: 08 Sep 2022; epub ahead of print | PMID: 36073027
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Impact:
Abstract

A large, prospective, multicentre study of left main PCI using a latest-generation zotarolimus-eluting stent: the ROLEX study.

Tarantini G, Fovino LN, Varbella F, Trabattoni D, ... Tamburino C, Burzotta F
Background
Data on left main (LM) percutaneous coronary interventions (PCI) have mostly been obtained in studies using drug-eluting stent (DES) platforms without dedicated large-vessel devices and with limited expansion capability.
Aims
Our study aimed to investigate the safety and efficacy of LM PCI with the latest-generation Resolute Onyx DES.
Methods
ROLEX (Revascularization Of LEft main with resolute onyX) is a prospective, multicentre study (ClinicalTrials.gov: NCT03316833) enrolling patients with unprotected LM coronary artery disease and a SYNTAX score <33 undergoing PCI with the Resolute Onyx zotarolimus-eluting coronary stent, that includes dedicated extra-large vessel platforms. The primary endpoint (EP) was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR), at 1 year. All events were adjudicated by an independent clinical event committee. An independent core lab analysed all procedural angiograms.
Results
A total of 450 patients (mean age 71.8 years, SYNTAX score 24.5±7.2, acute coronary syndrome in 53%) were enrolled in 26 centres. Of these, 77% of subjects underwent PCI with a single-stent and 23% with a 2-stent technique (8% double kissing [DK] crush, 6% culotte, 9% T/T and small protrusion [TAP] stenting). Intravascular imaging guidance was used in 45% (42% intravascular ultrasound [IVUS], 3% optical coherence tomography [OCT]). At 1 year, the primary EP incidence was 5.1% (cardiac death 2.7%, TVMI 2.7%, ID-TLR 2.0%). The definite/probable stent thrombosis rate was 1.1%. In a prespecified adjusted subanalysis, the primary EP incidence was significantly lower in patients undergoing IVUS/OCT-guided versus angio-guided PCI (2.0 vs 7.6%; hazard ratio [HR] 0.28, 95% confidence interval [CI]: 0.13-0.58; p<0.001).
Conclusions
In this large, multicentre, prospective registry, LM PCI with the Resolute Onyx DES showed good safety and efficacy at 1 year, particularly when guided by intracoronary imaging.



EuroIntervention: 31 Aug 2022; epub ahead of print
Tarantini G, Fovino LN, Varbella F, Trabattoni D, ... Tamburino C, Burzotta F
EuroIntervention: 31 Aug 2022; epub ahead of print | PMID: 36043326
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Impact:
Abstract

Long-term risk of unplanned percutaneous coronary intervention after transcatheter aortic valve replacement.

Okuno T, Demirel C, Tomii D, Heg D, ... Windecker S, Pilgrim T
Background
Coronary access after transcatheter aortic valve replacement (TAVR) can be challenging and complicate percutaneous coronary intervention (PCI).
Aims
We aimed to investigate the incidence, characteristics, and predictors of unplanned PCI after TAVR.
Methods
In a single-centre registry, TAVR candidates were systematically screened for concomitant coronary artery disease (CAD) through the use of coronary angiography prior to TAVR. Rates of unplanned PCI were prospectively collected and independently adjudicated.
Results
Among 3,015 patients undergoing TAVR between August 2007 and December 2020, 67 patients (2.2%) underwent unplanned PCI after TAVR. The indication for unplanned PCI was acute coronary syndrome in more than half of the cases. Patients with unplanned PCI were younger (80.2±6.5 years vs 81.9±6.4 years; p=0.028) and more likely to be male (75% vs 50%; p<0.001) than those without unplanned PCI. In a multivariable analysis, the number of diseased vessels, male sex, and younger age were independently associated with an increased risk of unplanned PCI. The cumulative incidence rates of unplanned PCI at 1, 5, and 10 years were 0.1%, 0.4%, and 0.6% in patients with no CAD at the time of TAVR, 0.7%, 2.5%, and 3.4% in patients with single-vessel disease, and 1.5%, 5.4%, and 7.4% in patients with multivessel disease, respectively.
Conclusions
The lifetime risk of unplanned PCI after TAVR is low in patients with no CAD at the time of TAVR but accumulates over time in patients with known CAD, particularly multivessel disease.
Clinicaltrials
gov: NCT01368250.



EuroIntervention: 30 Aug 2022; epub ahead of print
Okuno T, Demirel C, Tomii D, Heg D, ... Windecker S, Pilgrim T
EuroIntervention: 30 Aug 2022; epub ahead of print | PMID: 36039573
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Abstract

Pretreatment with heparin in patients with ST-segment elevation myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

Emilsson OL, Bergman S, Mohammad MA, Olivecrona GK, ... Erlinge D, Koul S
Background
Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Aims
The aim of the study was to investigate if pretreatment with UFH prior to arrival at the catheterisation laboratory affects coronary artery occlusion, mortality, and in-hospital major bleeding in patients with STEMI undergoing PCI.
Methods
Patients with a first STEMI event undergoing PCI between 2008 and 2016 were extracted from the Swedish Coronary Angiography and Angioplasty Registry. Risk ratios for UFH pretreatment versus no pretreatment regarding coronary artery occlusion at presentation in the catheterisation laboratory, 30-day mortality, and bleeding were obtained using adjusted Poisson regression models with robust standard errors. Analyses of propensity score (PS)-matched groups were performed to obtain absolute risk differences.
Results
In all, 41,631 patients were included, 16,026 (38%) with and 25,605 (62%) without UFH pretreatment. Adjusted risk ratios were 0.89 (95% confidence interval [CI]: 0.87 to 0.90) for coronary artery occlusion, 0.87 (0.77 to 0.99) for mortality, and 1.01 (0.86 to 1.18) for bleeding. In the PS-matched analyses, the absolute risk differences were -0.087 (-0.074 to -0.099) for coronary artery occlusion, -0.011 (-0.017 to -0.0041) for mortality, and 0 (-0.0052 to 0.0052) for bleeding.
Conclusions
Pretreatment with UFH was associated with a reduction in coronary artery occlusion among patients with STEMI, with a number needed to treat (NNT) of 12, without increasing the risk of major in-hospital bleeding. Regarding mortality, a reduction was found with UFH pretreatment, with an NNT of 94, but this effect was not robust over all sensitivity analyses and residual confounding cannot be excluded.



EuroIntervention: 29 Aug 2022; epub ahead of print
Emilsson OL, Bergman S, Mohammad MA, Olivecrona GK, ... Erlinge D, Koul S
EuroIntervention: 29 Aug 2022; epub ahead of print | PMID: 36036797
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Abstract

Durable polymer versus biodegradable polymer drug-eluting stents in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention: a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS trial.

Hwang D, Lim HS, Park KW, Shin WY, ... Kim DB, Kim HS
Background
Comparative data of durable polymer (DP) versus biodegradable polymer (BP) drug-eluting stents (DES) are limited in patients presenting with acute coronary syndrome (ACS) undergoing complex percutaneous coronary intervention (PCI).
Aims
We sought to evaluate the efficacy and safety of DP-DES and BP-DES in ACS patients receiving complex PCI.
Methods
This study was a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomly assigned 1:1 to DP-DES or BP-DES in the HOST-REDUCE-POLYTECH-ACS trial. Complex PCI was defined as having at least 1 of the following features: ≥3 stents implanted, ≥3 lesions treated, total stent length ≥60 mm, bifurcation PCI with 2 stents, left main PCI, or heavy calcification. Patient-oriented (POCO, a composite of all-cause death, non-fatal myocardial infarction, and any repeat revascularisation) and device-oriented composite outcomes (DOCO, a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularisation) were evaluated at 12 months.
Results
Among 3,301 patients for whom full procedural data were available, 1,140 patients received complex PCI. Complex PCI was associated with higher risks of POCO and DOCO. The risks of POCO were comparable between DP-DES and BP-DES in both the complex (HR 0.87, 95% confidence interval [CI]: 0.57-1.33; p=0.522) and non-complex (HR 0.83, 95% CI: 0.56-1.24; p=0.368; p for interaction=0.884) PCI groups. DOCO was also not significantly different between DP-DES and BP-DES in both the complex (HR 0.74, 95% CI: 0.43-1.27; p=0.278) and non-complex (HR 0.67, 95% CI: 0.38-1.19; p=0.175; p for interaction=0.814) PCI groups.
Conclusions
In ACS patients, DP-DES and BP-DES showed similar clinical outcomes irrespective of PCI complexity. The registration information for the HOST-REDUCE-POLYTECH-ACS trial is available at ClinicalTrials.gov: NCT02193971.



EuroIntervention: 24 Aug 2022; epub ahead of print
Hwang D, Lim HS, Park KW, Shin WY, ... Kim DB, Kim HS
EuroIntervention: 24 Aug 2022; epub ahead of print | PMID: 36000257
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Abstract

Pre-procedural Planning of Coronary Revascularization by Cardiac Computed Tomography : An Expert Consensus Document of the Society of Cardiovascular Computed Tomography.

Andreini D, Collet C, Leipsic J, Nieman K, ... Ghoshhajra B, Serruys PW
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; 3) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; 4) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.



EuroIntervention: 22 Aug 2022; epub ahead of print
Andreini D, Collet C, Leipsic J, Nieman K, ... Ghoshhajra B, Serruys PW
EuroIntervention: 22 Aug 2022; epub ahead of print | PMID: 35994043
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Abstract

Ticagrelor with and without aspirin in patients with a prior coronary artery bypass graft undergoing percutaneous coronary intervention: the TWILIGHT-CABG study.

Sardella G, Beerkens FJ, Dangas G, Cao D, ... Gibson CM, Mehran R
Background
Prior coronary artery bypass graft surgery (CABG) patients undergoing percutaneous coronary intervention (PCI) are often older and present with multiple comorbidities. Ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) has emerged as an effective bleeding-avoidance strategy among high-risk patients.
Aims
We aimed to examine the effects of ticagrelor with or without aspirin in prior CABG patients undergoing PCI within the TWILIGHT trial.
Methods
After 3 months of ticagrelor plus aspirin, patients were randomised to either aspirin or placebo, in addition to ticagrelor, for 12 months and compared by prior CABG status. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was all-cause death, myocardial infarction (MI), or stroke.
Results
Out of 7,119 patients, a total of 703 (10.8%) patients had prior CABG within the randomised cohort. Prior CABG patients had more comorbidities and a higher incidence of BARC type 2, 3, or 5 bleeding and death, MI or stroke at 1 year after randomisation, compared with patients without prior CABG. Ticagrelor monotherapy was associated with significantly less BARC 2, 3, or 5 bleeding among prior CABG patients compared with DAPT (4.9% vs 9.6%, hazard ratio [HR] 0.50, 95% confidence interval [CI]: 0.28 to 0.90; pinteraction=0.676) and similar rates of death, MI or stroke (10.0% vs 8.7%, HR 1.14, 95% CI: 0.70 to 1.87; pinteraction=0.484). When comparing target vessel type, treatment effects were consistent among graft- and native-vessel interventions.
Conclusions
In high-risk patients with prior CABG, ticagrelor monotherapy reduced bleeding without compromising ischaemic outcomes compared with ticagrelor plus aspirin.



EuroIntervention: 18 Aug 2022; epub ahead of print
Sardella G, Beerkens FJ, Dangas G, Cao D, ... Gibson CM, Mehran R
EuroIntervention: 18 Aug 2022; epub ahead of print | PMID: 35979636
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Impact:
Abstract

Impact of moderate or severe left ventricular outflow tract calcification on clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation with self- and balloon-expandable valves: a post hoc analysis from the SOLVE-TAVI trial.

Farhan S, Stachel G, Desch S, Kurz T, ... de Waha-Thiele S, Thiele H
Background
Left ventricular outflow tract (LVOT) calcification has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence the selection of prosthetic valve type.
Aims
We aimed to evaluate the impact of LVOT calcification on outcomes after TAVI with a self-expanding valve (SEV) versus a balloon-expandable valve (BEV).
Methods
Patients of the SOLVE-TAVI trial, randomised to Edwards SAPIEN 3 or Medtronic Evolut R, were divided according to LVOT calcification into no/mild (≤1 calcium nodule extending <5 mm and covering <10% of the LVOT perimeter) and moderate/severe LVOT calcification groups. The primary endpoint was a composite of death, stroke, moderate/severe paravalvular regurgitation, permanent pacemaker implantation and annulus rupture at 30 days. Additional endpoints included all-cause and cardiovascular mortality at 1 year.
Results
Out of 416 eligible patients, moderate/severe LVOT calcification was present in 143 (34.4%). Moderate/severe LVOT calcification was associated with significantly longer fluoroscopy time and higher rates of pre- and post-dilation. Regardless of the LVOT calcification group, there was no significant difference in the primary endpoint associated with the valve type (no/mild LVOT calcification group: SEV 25.0% vs BEV 27.0%; hazard ratio [HR] 1.10, 95% confidence interval [95% CI]: 0.68-1.73; p=0.73 and moderate/severe LVOT calcification group: SEV 25.0% vs BEV 19.4%; HR 0.76, 95% CI: 0.38-1.61; p=0.49), no significant interaction between LVOT calcification and valve type (pint=0.29) and no differences between SEV vs BEV within LVOT calcification groups regarding 1-year all-cause and cardiovascular mortality.
Conclusions
Moderate/severe LVOT calcification was associated with longer fluoroscopy time and an increased need for pre- and post-dilation, but not with a higher incidence of early and mid-term adverse clinical outcomes, regardless of valve type. (ClinicalTrials.gov: NCT02737150).



EuroIntervention: 09 Aug 2022; epub ahead of print
Farhan S, Stachel G, Desch S, Kurz T, ... de Waha-Thiele S, Thiele H
EuroIntervention: 09 Aug 2022; epub ahead of print | PMID: 35942626
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Abstract

Durability of blood pressure reduction after ultrasound renal denervation: three-year follow-up of the treatment arm of the randomised RADIANCE-HTN SOLO trial.

Rader F, Kirtane AJ, Wang Y, Daemen J, ... Azizi M, Weber MA
Background
While the blood pressure (BP)-lowering effect of renal denervation (RDN) has been established, long-term durability is a key prerequisite for a broader clinical implementation.
Aims
Our aims were to assess the long-term durability of the office BP (OBP)-lowering efficacy, antihypertensive medication (AHM) use, and safety of ultrasound RDN (uRDN).
Methods
Four weeks after withdrawal of AHM, patients with untreated daytime ambulatory BP ≥135/85 mmHg and <170/105 mmHg were randomised to uRDN (n=74) or sham (n=72) in the RADIANCE-HTN SOLO trial. Initiation of AHM was encouraged for home BP >135/85 mmHg following primary endpoint ascertainment at 2 months. Patients and physicians were unblinded at 6 months.
Results
Fifty-one of 74 patients (age: 53.9±11 years; 67% men) originally randomised to uRDN completed the 36-month follow-up. Initial screening OBP upon study entry was 145/92±14/10 mmHg on a mean of 1.2 AHM (range: 0-2.0). Baseline OBP after AHM washout was 154/99±13/8 mmHg. At 36 months, patients were on an average of 1.3 AHM (range: 0-3.0) with 8 patients on no AHM. OBP decreased by 18/11±15/9 mmHg from baseline to 36 months (p<0.001 for both). Overall, OBP control (<140/90 mmHg) improved from 29.4% at screening to 45.1% at 36 months (p=0.059). For patients uncontrolled at screening (n=36), systolic OBP decreased by 10.8 mmHg (p<0.001) at 36 months on similar AHM (p=0.158).
Conclusions
The safety and effectiveness of uRDN was durable to 36 months, with reduced OBP and improved OBP control despite a similar starting medication burden. No new uRDN-related long-term safety concerns were identified.



EuroIntervention: 01 Aug 2022; epub ahead of print
Rader F, Kirtane AJ, Wang Y, Daemen J, ... Azizi M, Weber MA
EuroIntervention: 01 Aug 2022; epub ahead of print | PMID: 35913759
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Abstract

Dual ProGlide versus ProGlide and FemoSeal for vascular access haemostasis after transcatheter aortic valve implantation.

Gmeiner JMD, Linnemann M, Steffen J, Scherer C, ... Deseive S, Braun D
Background
Large-bore arteriotomy for transcatheter aortic valve implantation (TAVI) requires percutaneous vascular closure devices, but real-world data comparing different closure strategies are limited.
Aims
We sought to compare a dual ProGlide strategy vs a combination of one ProGlide and one FemoSeal for vascular closure after TAVI.
Methods
We retrospectively analysed 874 propensity score-matched patients undergoing TAVI at the Munich University Hospital from August 2018 to October 2020. From August 2018 to August 2019, a dual ProGlide strategy was used for vascular closure. From October 2019 to October 2020, a combination of one ProGlide and one FemoSeal was used. The primary endpoint was defined as access-related major vascular complications or bleeding ≥Type 2 according to Valve Academic Research Consortium 3 criteria.
Results
Patients in the dual ProGlide group (n=437) had a higher incidence of the primary endpoint than patients treated with one ProGlide and one FemoSeal (n=437; 11.4% vs 3.0%; p<0.001). Furthermore, they had a higher rate of closure device failure (2.7% vs 0.9%; p=0.044) and more often required unplanned surgery or endovascular treatment (3.9% vs 0.9%; p=0.004). The incidence of death did not differ significantly between groups (3.4% vs 1.6%; p=0.08).
Conclusions
A combined ProGlide and FemoSeal strategy might have the potential to reduce access-related vascular complications following TAVI.



EuroIntervention: 29 Jul 2022; epub ahead of print
Gmeiner JMD, Linnemann M, Steffen J, Scherer C, ... Deseive S, Braun D
EuroIntervention: 29 Jul 2022; epub ahead of print | PMID: 35903846
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Abstract

Timing and predictors of definite stent thrombosis in comatose survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention and therapeutic hypothermia (ST-OHCA study).

Rauber M, Nicol P, Sabic E, Joner M, Noc M
Background
Incidence of stent thrombosis (ST) in comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing immediate percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) varies considerably, from 2.7% to 31.2%, in retrospective studies.
Aims
We aimed to investigate occurrence, timing and predictors of definite ST.
Methods
We prospectively investigated consecutive comatose survivors of OHCA with presumed cardiac aetiology undergoing immediate PCI with drug-eluting stents (DES) and TH targeted at 32-34°C admitted between August 2016 and July 2021. Repeat coronary angiography (CAG) was performed if ST was suspected and systematically between day 8-12 in the absence of clinical signs. All deceased patients underwent autopsy and histopathological analysis. 
Results:
Among 362 comatose survivors of OHCA, immediate PCI with stenting was performed in 169 patients (47%). Since 18 patients did not complete follow-up, 151 patients were ultimately enrolled in ST analysis. Definite ST was confirmed in 29 patients (19.2%; 95% confidence interval [CI]: 12.9%-25.6%) either by CAG (n=18) or autopsy (n=11). ST occurred within 3 days in 62% and presented with at least one clinical sign in 79%. Survival with good neurological recovery was observed in 17% of patients with ST and in 60% of patients without ST (p<0.001). Independent predictors of ST were longer prehospital resuscitation, lower arterial pH and increased creatinine on admission.
Conclusions
The incidence of definite ST in comatose survivors of OHCA undergoing immediate PCI and TH targeted at 32-34°C is substantial (19.2%) and significantly higher than in other PCI subsets despite systematic use of contemporary DES and anticoagulation/antiplatelet treatment.



EuroIntervention: 25 Jul 2022; epub ahead of print
Rauber M, Nicol P, Sabic E, Joner M, Noc M
EuroIntervention: 25 Jul 2022; epub ahead of print | PMID: 35876187
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Abstract

Percutaneous coronary intervention of bifurcation lesions.

Hildick-Smith D, Arunothayaraj S, Stankovic G, Chen SL
Bifurcation coronary artery disease is common as the development of atherosclerosis is facilitated by altered endothelial shear stress. Multiple anatomical and physiological factors need to be considered when treating bifurcation lesions. To achieve optimal results, various stenting techniques have been developed, each with benefits and limitations. In this state-of-the-art review we describe technically important characteristics of bifurcation lesions and summarise the evidence supporting contemporary bifurcation techniques.



EuroIntervention: 22 Jul 2022; 18:e273-e291
Hildick-Smith D, Arunothayaraj S, Stankovic G, Chen SL
EuroIntervention: 22 Jul 2022; 18:e273-e291 | PMID: 35866256
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Abstract

Evolocumab for prevention of microvascular dysfunction in patients undergoing percutaneous coronary intervention: the randomised, open-label EVOCATION trial.

Ishihara M, Asakura M, Hibi K, Okada K, ... Okamoto R, Suna S
Background
Statins have been shown to prevent microvascular dysfunction that may cause periprocedural myocardial infarction after percutaneous coronary intervention (PCI). Evolocumab has more potent lipid-lowering properties than statins.
Aims
The aims of this study were to investigate whether evolocumab pretreatment on top of statin therapy could prevent periprocedural microvascular dysfunction.
Methods
This study included 100 patients with stable coronary artery disease who were scheduled to undergo PCI and had high low-density lipoprotein cholesterol (LDL-C) under statin therapy. Patients were randomised to receive evolocumab 140 mg every 2 weeks for 2 to 6 weeks before PCI (evolocumab group: N=54) or not (control group: N=46). The primary endpoint was the index of microvascular resistance (IMR) after PCI. Troponin T was measured before and 24 hours after PCI.
Results
Geometric mean LDL-C was 94.1 (95% confidence interval [CI]: 86.8-102.1) mg/dl and 89.4 (95% CI: 83.5-95.7) mg/dl at baseline, and 25.6 (95% CI: 21.9-30.0) mg/dl and 79.8 (95% CI: 73.9-86.3) mg/dl before PCI, in the evolocumab group and in the control group, respectively. PCI was performed 22.1±8.5 days after allocation. Geometric mean IMR was 20.6 (95% CI: 17.2-24.6) in the evolocumab group and 20.6 (95% CI: 17.0-25.0) in the control group (p=0.98). There was no significant difference in the geometric mean of post-PCI troponin T (0.054, 95% CI: 0.041-0.071 ng/ml vs 0.054, 95% CI: 0.038-0.077 ng/ml; p=0.99) and in the incidence of major periprocedural myocardial infarction between the 2 groups (44.4% vs 44.2%; p=1.00).
Conclusions
Evolocumab pretreatment did not prevent periprocedural microvascular dysfunction in patients on modern medical management with statins.



EuroIntervention: 15 Jul 2022; epub ahead of print
Ishihara M, Asakura M, Hibi K, Okada K, ... Okamoto R, Suna S
EuroIntervention: 15 Jul 2022; epub ahead of print | PMID: 35837711
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Abstract

Changes in coronary collateral function after successful chronic total occlusion percutaneous coronary intervention.

Keulards DCJ, Alsanjari O, Keeble TR, Vlaar PJ, ... Davies J, Karamasis GV
Background
Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) incorporates wire escalation and dissection/re-entry recanalisation strategies.
Aims
The purpose of the study was to investigate changes in collateral function after CTO PCI and to identify whether the mode of successful recanalisation influences collateral function regression.
Methods
Patients scheduled for elective CTO PCI with evidence of viability in the CTO territory by noninvasive imaging were included in this study. After successful CTO PCI, the aortic pressure (Pa) and distal coronary artery wedge pressure (Pw) during balloon occlusion were measured, both in a resting state and during infusion of intravenous adenosine, allowing the calculation of the pressure-derived collateral pressure index at rest and hyperaemia (CPIrest and the collateral fractional flow reserve [FFRcoll], respectively). Measurements were repeated 3 months later during angiographic follow-up.
Results
Eighty-one patients had physiological measurements at baseline and follow-up. In the final cohort the mean age was 64 years and 82% were male. The mean maximal stent diameter and total stent length were 3.2±0.5 mm and 68±31 mm, respectively. Successful strategies were antegrade wiring (64.2%), antegrade dissection re-entry (8.6%), and retrograde dissection re-entry (27.1%). Between the index procedure and follow-up, wedge pressure decreased from 34±11 mmHg to 21±8.5 mmHg (p<0.01), respectively. FFRcoll changed from 0.34±0.11 to 0.19±0.09 (p<0.01) at follow-up and CPIrest from 0.40±0.14 to 0.17±0.09 (p<0.01). Absolute maximum collateral flow decreased from 55±32 ml/min directly after PCI to 38±24 ml/min (p<0.01). There was no relation between the recanalisation technique and changes in FFRcoll.
Conclusions
There was significant reduction in collateral flow over time, independent of the recanalisation technique.



EuroIntervention: 08 Jul 2022; epub ahead of print
Keulards DCJ, Alsanjari O, Keeble TR, Vlaar PJ, ... Davies J, Karamasis GV
EuroIntervention: 08 Jul 2022; epub ahead of print | PMID: 35994015
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Impact:

This program is still in alpha version.