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Galli, Mattia; ten Berg, Jurrien; Valgimigli, Marco; Capodanno, Davide; Gragnano, Felice; Kimura, Takeshi; Bhatt, Deepak L; Gibson, C Michael; Mehran, Roxana; Angiolillo, Dominick J
doi: 10.1093/eurheartj/ehaf718pmid: 41211721
Serruys, Patrick W; Oshima, Asahi; Ferraz-Costa, Gonçalo; Garg, Scot; Tsai, Tsung-Ying; Sharif, Faisal; Onuma, Yoshinobu
doi: 10.1093/eurheartj/ehaf883pmid: 41271218
Graphical AbstractGraphical AbstractOverview of anticipated advances in coronary revascularization by the year 2040.
Miner, Steve; Mejia-Renteria, Hernan; Leone, Antonio Maria; Velollari, Ornela; Sykes, Robert; Biscaglia, Simone; Esposito, Giuseppe; Galante, Domenico; Oreglia, Jacopo; Ang, Daniel; Weferling, Maren; Di Serafino, Luigi; Berry, Colin; Campo, Gianluca; Escaned, Javier; Crea, Filippo; Gori, Tommaso
Heusch, Gerd; Kleinbongard, Petra
doi: 10.1093/eurheartj/ehaf833pmid: 41214897
Graphical AbstractGraphical AbstractThere are four steps from: (1) diagnosis of ANOCA (by pain, ECG signs of ischaemia and angiographic exclusion of obstruction worthy of intervention) over (2) haemodynamic phenotyping (by adenosine and acetylcholine responsiveness in epicardial arteries and microvessels) and (3) mechanistic pathophysiology (by identification of causal mediators and mechanisms) to finally, (4) a causal pharmacotherapy (addressing the symptoms through effects on the pathophysiological mechanism).
Lee, Seung-Jun; Lee, Seung-Jae; Hong, Sung-Jin; Cho, Deok-Kyu; Kim, Jin Won; Kim, Sang Min; Hur, Seung-Ho; Heo, Jung Ho; Jang, Ji-Yong; Koh, Jin Sin; Won, Hoyoun; Lee, Jun-Won; Hong, Soon Jun; Kim, Dong-Kie; Choe, Jeong Cheon; Lee, Jin Bae;
Alfonso, Fernando; Prati, Francesco
doi: 10.1093/eurheartj/ehaf711pmid: 41662442
Graphical AbstractGraphical Abstract
Fazel, Reza; Rao, Sunil V; Cohen, David J; Secemsky, Eric A; Swaminathan, Rajesh V; Manandhar, Pratik; Rymer, Jennifer A; Wojdyla, Daniel M; Yeh, Robert W
doi: 10.1093/eurheartj/ehaf426pmid: 40614078
Background and AimsRadial access site for percutaneous coronary intervention (PCI) is recommended by clinical practice guidelines because of superior outcomes compared with femoral access site. Historically, the adoption of radial access site in the USA has lagged behind much of the rest of the world, but contemporary data on access site selection across the spectrum of clinical presentations and its association with outcomes are lacking.MethodsA retrospective cohort study from the National Cardiovascular Data Registry's CathPCI Registry was conducted including PCIs performed between 1 January 2013 and 30 June 2022. The comparative safety of radial vs femoral access site for PCI was evaluated with instrumental variable analysis, a technique that can be used to support causal inference, exploiting operator variation in access site preferences as the instrumental variable.ResultsOverall, 6 658 479 PCI procedures were performed during the study period, of which 40.4% (n = 2 690 355) were performed via radial access site, increasing from 20.3% in 2013 to 57.5% in 2022. This increase was seen in all geographic regions and across the full spectrum of presentations, with the largest relative increase seen in patients with ST-elevation myocardial infarction. Overall, 2 420 805 PCIs met inclusion criteria for the comparative safety analysis. In instrumental variable analyses, radial access site was associated with lower in-hospital mortality [absolute risk difference (ARD) −.15%, 95% confidence interval (CI) −.20 to −.10], major access site bleeding (ARD −.64%, 95% CI −.68 to −.60), and other major vascular complications (ARD −.21%, 95% CI −.23 to −.18) but a higher risk of ischaemic stroke (ARD .05%, 95% CI .03–.08). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (ARD .00%, 95% CI −.03–.03).ConclusionsOver the past decade, use of radial access site for PCI has increased 2.8-fold in the USA and now represents the dominant form of access site across all procedural indications. Based on instrumental variable analyses, PCI with radial access site had lower rates of in-hospital mortality, major access site bleeding, and other major vascular complications compared with femoral access site but a slightly higher risk of ischaemic stroke in contemporary practice.
Showing 1 to 10 of 17 Articles
Graphical AbstractGraphical AbstractUpper section: factors favouring aspirin vs P2Y12 inhibitor monotherapy in patients with atherosclerotic cardiovascular disease. Lower section: time course of pivotal studies on aspirin vs P2Y12 inhibitor monotherapy in patients with atherosclerotic disease.
doi: 10.1093/eurheartj/ehaf839pmid: 41214896
Background and AimsAngina with non-obstructive coronary arteries (ANOCA) is a prevalent myocardial ischaemic syndrome, and women are disproportionately affected. Mechanisms of ischaemia are challenging to diagnose and treatment is empirical.MethodsConsecutive patients with angina (or equivalent symptoms), no angiographically severe stenosis and fractional flow reserve > 0.80 undergoing coronary functional testing were prospectively enrolled in nine centres in Europe and North America. Haemodynamic endotypes were assessed measuring coronary flow reserve and resistance using an intracoronary pressure- and temperature-sensitive sensor and bolus thermodilution. Measurements were obtained during resting conditions and following adenosine and acetylcholine. Chest pain and electrocardiographic ischaemic changes were recorded. The participant characteristics of each haemodynamic endotype were investigated using regression analysis. A three-step Delphi consensus method was applied to identify endotype-specific therapies.ResultsOverall, 1001 participants (mean age 62 ± 11years, 56% female) were enrolled and eight distinct endotypes were defined by adenosine testing (n = 3) and acetylcholine testing (n = 5), respectively: high resting coronary blood flow (n = 195, 19%); high resistance (n = 125, 13%); compensated high resistance (n = 112, 11%); epicardial coronary spasm (n = 162, 17%); microvascular spasm (n = 75, 8%); endothelial dysfunction (n = 96, 10%); ischaemia w/o haemodynamic changes (n = 68, 7%); and enhanced cardiac nociception (n = 79, 8%). More than one endotype occurred in 119 (12%) individuals and normal responses occurred in 234 (23%) individuals. Each endotype was associated with distinct clinical correlates. The Delphi consensus (100% ‘agree’ or ‘strongly agree’) identified endotype-specific medical therapy with a Likert scale score ≥ 6 for all endotypes.ConclusionsIn patients with suspected ANOCA, assessment of the symptomatic, electrocardiographic, and haemodynamic responses to adenosine and acetylcholine identifies distinct endotypes and enables mechanism-guided stratified medicine.
doi: 10.1093/eurheartj/ehaf884pmid: 41259082
Background and AimsThis study evaluated the incidence, determinants, and clinical impact of stent optimization after optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) for complex lesions.MethodsFrom the OCCUPI randomized trial investigating the impact of OCT guidance compared to angiography guidance in complex lesions, patients who underwent OCT-guided PCI with post-stenting OCT evaluations were enrolled and classified into two groups based on whether they met the OCCUPI-OCT criteria: OCT Optimization vs OCT Sub-Optimization. The primary endpoint was the cumulative incidence of cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven target vessel revascularization during one year in the as-treated population.ResultsAmong the 773 patients who underwent OCT-guided PCI, 549 (71.0%) met the optimization criteria (OCT Optimization), whereas 224 did not (OCT Sub-Optimization). On multivariable analysis, long lesions and small-vessel disease were significant independent predictors of OCT Sub-Optimization. The occurrence of the primary endpoint was significantly lower in the OCT Optimization (2.9%) than in the OCT Sub-Optimization [9.4%, hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.16–0.58, P < .001] or angiography guidance [7.5%, HR: 0.38, 95% CI: 0.22–0.66, P < .001]. Each acceptable component of OCCUPI-OCT criteria assessing stent expansion (minimal stent area, ≥80% mean reference lumen or ≥100% distal reference lumen areas; > 4.5 mm2), apposition (malapposed distance, <400 μm), and absence of major edge dissection, was significantly associated with favourable outcomes (all P < .001).ConclusionsThe current study identifies long lesions or small-vessel disease as the determinants of stent optimization following OCT guidance, with the achievement of stent optimization significantly associated with improved clinical outcomes. Stent expansion, apposition, and edge dissection, the three key components of the OCCUPI-OCT criteria, were highly predictive of favourable clinical outcomes.