Circulation: Cardiovascular Interventions最新文献

{"title":"Timing of Intervention and Long-Term Outcomes in Mild Congenital Heart Disease: A 35-Year Study From the Pediatric Cardiac Care Consortium.","authors":"Gabriel L Perlow, Yanxu Yang, Jessica H Knight, Caroline Shi, Amanda S Thomas, Matthew Oster, Lazaros K Kochilas","doi":"10.1161/CIRCINTERVENTIONS.125.015719","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015719","url":null,"abstract":"<p><strong>Background: </strong>Mild congenital heart diseases such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, and pulmonary valve stenosis constitute a significant public health problem. Understanding long-term outcomes after interventions for mild congenital heart disease is essential to inform lifelong care.</p><p><strong>Methods: </strong>We queried the Pediatric Cardiac Care Consortium, a multicenter US-based registry of patients with congenital heart disease interventions, for patients undergoing surgical or transcatheter procedures for atrial septal defect, ventricular septal defect, patent ductus arteriosus, and pulmonary valve stenosis; 17 407 patients were included. Statistical methods included survival analysis using Kaplan-Meier plots, multivariable Cox proportional hazards models for risk factors for death and standardized mortality ratios.</p><p><strong>Results: </strong>There were 115 in-hospital deaths (0.7%), with the remaining patients included in the postdischarge. The 35-year post-discharge survival ranged from 95.5% for pulmonary valve stenosis to 92.1% for ventricular septal defect. Survival patterns differed by lesion and age at intervention, with intervention at 1≤5 years generally associated with more favorable outcomes. Lower weight-for-age at intervention was associated with an increased hazard of death across all shunt lesions but not for pulmonary valve stenosis. Compared with the general population, mortality risk remained elevated for up to 18 to 20 years after intervention.</p><p><strong>Conclusions: </strong>Long-term survival after intervention for mild congenital heart disease is excellent; yet lesion-specific risks persist for decades. Age and weight-for-age at intervention are associated with survival, together with excess mortality beyond childhood underscore the need for lifelong, lesion-tailored surveillance in this growing population.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015719"},"PeriodicalIF":7.4,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clopidogrel Versus Aspirin Monotherapy Beyond 1 Year After PCI: The Final 5-Year Results of the STOPDAPT-2 ACS and STOPDAPT-2 Total Cohort.","authors":"Hirotoshi Watanabe, Takeshi Morimoto, Masahiro Natsuaki, Ko Yamamoto, Yuki Obayashi, Ryusuke Nishikawa, Tomoya Kimura, Kazuaki Imada, Satoru Suwa, Tsuyoshi Isawa, Kenji Ando, Takanari Fujita, Kazushige Kadota, Hideo Tokuyama, Hiroki Sakamoto, Hiroshi Suzuki, Kohei Wakabayashi, Koh Ono, Fujio Hayashi, Kengo Tanabe, Masaharu Akao, Yuko Onishi, Ruka Yoshida, Takanori Kusuyama, Toshihiro Tamura, Yoshiro Onoue, Masahiro Yagi, Kazuaki Kaitani, Takeshi Kimura","doi":"10.1161/CIRCINTERVENTIONS.125.016280","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.016280","url":null,"abstract":"<p><strong>Background: </strong>Clopidogrel may have ischemic benefit over aspirin as long-term monotherapy in patients receiving percutaneous coronary intervention.</p><p><strong>Methods: </strong>Both the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy-2) and STOPDAPT-2 ACS (Short and Optimal Duration of Dual Antiplatelet Therapy-2 Study for the Patients With Acute Coronary Syndrome) were multicenter, open-label, adjudicator-blinded, randomized clinical trials in Japan, with the same protocol except that the STOPDAPT-2 ACS enrolled patients with acute coronary syndrome, exclusively. The patients after percutaneous coronary intervention with cobalt-chromium everolimus-eluting stents were randomized into 1-month dual antiplatelet therapy followed by clopidogrel monotherapy (clopidogrel group) or 12-month dual antiplatelet therapy followed by aspirin monotherapy (aspirin group). Follow-up duration was 5 years. The clinical effect between clopidogrel and aspirin monotherapy was compared by the 1-year landmark analysis in the STOPDAPT-2 ACS and STOPDAPT-2 total cohort, a pooled cohort of the 2 trials. The primary end point was the composite of cardiovascular end point (cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis) and bleeding end point (Thrombolysis in Myocardial Infarction major/minor). The major secondary end points were each of the cardiovascular composite end point and the bleeding end point.</p><p><strong>Results: </strong>Of 2986 patients (clopidogrel group: 1492, aspirin group: 1494) in the 5-year analysis of the STOPDAPT-2 ACS, 2875 (96.3%) completed follow-up. By the 1-year landmark analysis, clopidogrel group was superior to aspirin group for both the primary end point (6.18% and 8.27%; hazard ratio, 0.75 [95% CI, 0.57-0.997]; <i>P</i>=0.048) and the major secondary cardiovascular end point (4.73% and 6.77%; hazard ratio, 0.70 [95% CI, 0.51-0.96]; <i>P</i>=0.03). In the STOPDAPT-2 total cohort, including 5991 patients, the superiority of clopidogrel over aspirin for the cardiovascular end point was highly significant (hazard ratio, 0.74 [95% CI, 0.60-0.91]; <i>P</i>=0.004), although the superiority on the primary end point was insignificant (hazard ratio, 0.86 [95% CI, 0.72-1.03]; <i>P</i>=0.11). There was no between-groups difference in the major secondary bleeding end point, both in the STOPDAPT-2 ACS and STOPDAPT-2 total cohort.</p><p><strong>Conclusions: </strong>Clopidogrel monotherapy was superior to aspirin monotherapy for cardiovascular outcomes beyond 1 year after percutaneous coronary intervention, without increased bleeding risk.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02619760 and NCT03462498.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016280"},"PeriodicalIF":7.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiography-Derived Fractional Flow Reserve During Percutaneous Coronary Intervention.","authors":"Chieh Yang Christopher Koo, Siling Li, Rasha Al-Lamee, David J Cohen, William F Fearon, Ajay J Kirtane, Martin B Leon, Guy Witberg, Robert W Yeh, Eric A Secemsky","doi":"10.1161/CIRCINTERVENTIONS.125.016213","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.016213","url":null,"abstract":"<p><p><b>Background:</b> Angiography-derived fractional flow reserve (Angio-FFR) is an emerging tool for guiding percutaneous coronary intervention (PCI). Its uptake and outcomes compared to pressure wire (PW)-based assessment in the US are unknown. <b>Methods:</b> We conducted a cohort study of US Medicare beneficiary data from 1 January 2019 to 31 December 2024. Propensity score matching (1:3) of Angio-FFR to PW was performed in patients who underwent PCI during the same procedure, and separately among those who did not undergo PCI during the same procedure. The primary outcome was the cumulative incidence of major adverse cardiovascular events (MACE) through 2 years, including all-cause death, myocardial infarction (MI) and repeat revascularization. Secondary outcomes included individual MACE components, 30-day acute kidney injury and 30-day major bleeding. Falsification endpoints (hospitalization for pneumonia and hip fracture) were used to assess unmeasured confounding. <b>Results:</b> Of 466,535 angiograms that included intra-procedural physiologic assessment, 1.00% (N=4,672) used Angio-FFR. Annual use increased from 0.47% in 2019 to 3.85% in 2024. Among PCI patients, 1,591 Angio-FFR and 4,773 PW matched PCI patients had similar MACE rates through 2 years (24.8% vs 23.5%; HR 1.01, 95% CI 0.85 - 1.20). Secondary outcomes and falsification endpoints were not significantly different. In non-PCI patients, 2,532 Angio-FFR and 7,596 PW matched patients also had similar MACE through 2 years (24.1% vs 23.9%; HR 0.97, 95% CI 0.84 - 1.11). <b>Conclusions:</b> Angio-FFR usage in the US is modest but increasing. Angio-FFR guidance during angiography versus PW was associated with comparable outcomes through 2 years.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-level Variability in NSTEMI Management: Findings from the NCDR Chest Pain-MI Registry.","authors":"Yasser M Sammour, John A Spertus, Nathaniel R Smilowitz, Huaying Dong, Pratik B Sandesara, Sachin S Goel, Safi U Khan, Alpesh Shah, Philip Jones, Natalie Wheeler, Yang Song, Tanveer Rab, William J Nicholson, Wissam A Jaber, Rishi K Wadhera, Neal S Kleiman","doi":"10.1161/CIRCINTERVENTIONS.126.016534","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016534","url":null,"abstract":"<p><p><b>Background:</b> Although guidelines recommend invasive management for non-ST-elevation myocardial infarction (NSTEMI), there is considerable variability in the application of these recommendations across different hospitals, reflecting a lack of standardized clinical pathways and highlighting ongoing uncertainty in real-world practice. We sought to describe site-level variability in the use and timing of invasive angiography for NSTEMI and their association with in-hospital outcomes. <b>Methods:</b> Using NCDR Chest Pain-MI registry data (2019-2024), the rates and timing of invasive coronary angiography, if any, were characterized among patients with NSTEMI. Hierarchical logistic regression models were created to describe hospital-level variability in management using median odds ratios (MORs), adjusted for patient and site characteristics. Inverse probability weighting was used to estimate the association between treatment strategy and in-hospital outcomes. <b>Results:</b> We included 287,275 patients with Type-1 NSTEMI from 541 hospitals (age 67.6±13.3 years, 36.4% women). Invasive coronary angiography was performed in 87.1%, of whom 56.9% within 24 hours. Among those treated invasively, 66.1% received percutaneous coronary intervention. Older patients with more comorbidities were paradoxically more likely to receive conservative management or delayed intervention (>24 hours). Site-level variability for invasive strategy (vs. conservative) was large [MOR 2.85 (2.64-3.10)], as was early invasive treatment [MOR 1.67 (1.62-1.74)], particularly on weekends/holidays [MOR 1.89 (1.81-1.98)]. The use of any invasive strategy was associated with lower in-hospital mortality versus conservative management [weighted OR 0.36 (0.31-0.42)]. This finding was consistent across all baseline risk categories (P-interaction <0.001). <b>Conclusions:</b> Patients with Type-1 NSTEMI and higher-risk clinical profiles were not consistently prioritized to undergo early invasive management with substantial variability across hospitals. Invasive management was associated with lower in-hospital mortality compared with conservative treatment. Future randomized studies in the modern PCI era are needed to confirm our findings, and identify which patients benefit most and when intervention should occur.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress Perfusion CMR Imaging-Guided Management and Prognosis in Patients With Suspected Coronary Heart Disease.","authors":"Antonin Trimaille, Philippe Garot, Solenn Toupin, Francesca Sanguineti, Thomas Hovasse, Suzanne Duhamel, Stéphane Champagne, Thierry Unterseeh, Mariama Akodad, Antoinette Neylon, Lounis Hamzi, Trecy Gonçalves, Andreea Sorina Afana, Alexandre Unger, Jeremy Florence, Emmanuel Gall, Paul-Jun Martial, Alexandre Pfeffer, Elena Sofia Canuti, Aicha Kante, Manveer Singh, Jean Guillaume Dillinger, Patrick Henry, Olivier Morel, Valérie Bousson, Jérôme Garot, Théo Pezel","doi":"10.1161/CIRCINTERVENTIONS.125.015765","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015765","url":null,"abstract":"<p><strong>Background: </strong>Identifying patients with chronic coronary syndrome who will benefit most from a coronary revascularization strategy is essential. Data on the performance of stress cardiac magnetic resonance (CMR) to guide revascularization are limited. To assess the long-term prognostic impact of stress CMR-guided revascularization strategy to predict all-cause death.</p><p><strong>Methods: </strong>We conducted an observational study including all consecutive patients who underwent stress CMR for suspected or known chronic coronary syndrome in 3 centers in France. CMR-guided coronary revascularization was defined as any revascularization performed within 90 days following stress CMR. The primary outcome was all-cause death.</p><p><strong>Results: </strong>A total of 50 701 patients were included (mean age, 64±12 years; 68.5% men). After a median follow-up of 7.2 years (interquartile range, 3.0-11.0), 3665 (7.2%) patients died. Among the 7396 patients with ischemia, 6523 (88%) underwent revascularization. Ischemia and late gadolinium enhancement (LGE) without viability were independent predictors of death (adjusted hazard ratio, 3.67 [99.5% CI, 3.15-4.27] and adjusted hazard ratio, 1.26 [99.5% CI, 1.10-1.44], respectively; <i>P</i><0.001 for both). CMR-guided revascularization was an independent predictor of improved survival in the overall population (adjusted hazard ratio, 0.30 [99.5% CI, 0.25-0.36]). In a 1:1 propensity-matched cohort of 1700 patients, CMR-guided revascularization remained independently associated with a lower incidence of death (adjusted hazard ratio, 0.37 [99.5% CI, 0.28-0.50]; <i>P</i><0.001). This beneficial effect was observed in patients without LGE or with LGE and viability (<i>P</i><0.001 for both), but not in those with LGE without viability (<i>P</i>=0.23).</p><p><strong>Conclusions: </strong>In this registry of consecutive patients with chronic coronary syndrome from 3 centers, stress CMR-guided revascularization was associated with a lower rate of death. The combined assessment of inducible myocardial ischemia and LGE may help to select patients most suitable for revascularization.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"19 3","pages":"e015765"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Pullback Pressure Gradient on Residual Angina at One Year.","authors":"Takuya Mizukami, Kazumasa Ikeda, Daniel Munhoz, Koshiro Sakai, Jeroen Sonck, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Antonio Maria Leone, Lokien X van Nunen, William F Fearon, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien Adjedj, Javier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Frederik M Zimmermann, Tatyana Storozhenko, Frédéric Bouisset, Domenico Galante, Bruno R da Costa, Gianluca Campo, Colin Berry, Damien Collison, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A Ali, Ethan Korngold, Eric Wyffels, Adriaan Wilgenhof, Nico Pijls, Bernard De Bruyne, Nils P Johnson, Carlos Collet","doi":"10.1161/CIRCINTERVENTIONS.125.015851","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015851","url":null,"abstract":"<p><strong>Background: </strong>The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year.</p><p><strong>Methods: </strong>PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up.</p><p><strong>Results: </strong>The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; <i>P</i>=0.006). PPG was independently associated with improvement in angina (<i>P</i>=0.017).</p><p><strong>Conclusions: </strong>In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015851"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves.","authors":"Amr E Abbas, Tsuyoshi Kaneko, Houman Khalili, Samir R Kapadia, Vasilis C Babaliaros, Adam B Greenbaum, Thomas A Schwann, Pradeep Yadav, Issam D Moussa, Grant W Reed, Roger J Laham, Michael A Morse, Pedro Villablanca, Evelio Rodriguez, Jeremiah P Depta, James M McCabe, Vinayak N Bapat, Vinod H Thourani, Amar Krishnaswamy","doi":"10.1161/CIRCINTERVENTIONS.125.015945","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015945","url":null,"abstract":"<p><strong>Background: </strong>Lower (<10 mm Hg) discharge echocardiographic mean gradients (MGs) following transcatheter aortic valve replacement with balloon-expandable valves are associated with lower ejection fraction and higher 5-year mortality compared with higher gradients. Using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, we studied the relationship between echocardiographic MG and patient prosthesis mismatch (PPM) following transcatheter aortic valve-in-valve replacement and clinical outcomes.</p><p><strong>Methods: </strong>Patients who underwent aortic valve-in-valve replacement with a balloon-expandable valve from July 2015 to December 2023 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were included. Adjusted Cox models with regression splines explored the relationship between MG and 5-year mortality. Kaplan-Meier estimates and adjusted hazard ratios compared the occurrence of 5-year mortality between gradient cutoffs and PPM presence.</p><p><strong>Results: </strong>A total of 13 054 patients were included; spline curves demonstrated a nonlinear relationship between discharge MG and 5-year mortality. Kaplan-Meier curves suggested higher 5-year mortality with MG <10 mm Hg compared with MG ≥10 mm Hg (hazard ratio, 1.15 [95% CI, 1.02-1.29]; <i>P</i>=0.024). MG <10 mm Hg was associated with lower ejection fraction compared with higher MG (50.4±13.9 versus 53.2±12.8; <i>P</i><0.0001). Severe PPM and MG ≥20 mm Hg were not associated with worse 5-year outcomes compared with none/moderate PPM or MG ≤20 mm Hg, respectively.</p><p><strong>Conclusions: </strong>Discharge MG <10 mm Hg is associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Severe PPM and MG > 20 mm Hg were not associated with worse 5-year clinical outcomes. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015945"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon- Versus Self-Expanding Transcatheter Valves for Failed Small Surgical Aortic Bioprostheses: 3-Year Results of the LYTEN Trial.","authors":"Pedro Cepas-Guillén, Amr E Abbas, Vicenç Serra, Victoria Vilalta, Luis Nombela-Franco, Ander Regueiro, Karim M Al-Azizi, Ayman Iskander, Lenard Conradi, Jessica Forcillo, Scott Lilly, Álvaro Calabuig, Eduard Fernandez-Nofrerias, Siamak Mohammadi, Carlos Giuliani, Emilie Pelletier-Beaumont, Philippe Pibarot, Josep Rodés-Cabau","doi":"10.1161/CIRCINTERVENTIONS.125.016255","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.016255","url":null,"abstract":"<p><strong>Background: </strong>Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (TAVR) field have been obtained from retrospective studies. This prespecified secondary analysis of the LYTEN randomized trial (Comparison of the Balloon-Expandable Edwards Valve and Self-Expandable CoreValve Evolut R or Evolut PRO System for the Treatment of Small, Severely Dysfunctional Surgical Aortic Bioprostheses) aims to compare the 3-year hemodynamic performance and clinical outcomes between balloon-expandable valves (BEV) SAPIEN 3/ULTRA (Edwards Lifesciences) and self-expanding valves (SEV) Evolut R/PRO/PRO+ (Medtronic) in valve-in-valve TAVR.</p><p><strong>Methods: </strong>Patients with a failed small (≤23 mm) surgical valve undergoing valve-in-valve TAVR were randomized to receive a SEV or a BEV. Patients had a clinical and valve hemodynamic (Doppler echocardiography) evaluation at 3-year follow-up. Study outcomes were defined according to VARC (Valve Academic Research Consortium)-2/VARC-3 criteria. Intended performance of the valve was defined as mean gradient <20 mm Hg, peak velocity <3 m/s, Doppler velocity index ≥0.25, and less than moderate aortic regurgitation.</p><p><strong>Results: </strong>Ninety-eight patients underwent TAVR (46 BEV [SAPIEN 3/ULTRA], 52 SEV [Evolut R-PRO-PRO+]). At 3 years, patients receiving a SEV had a higher rate of intended valve performance (BEV: 27.6% versus SEV: 82.4%; <i>P</i><0.001), with lower mean gradients (BEV: 20±9 versus SEV: 13±9 mm Hg; <i>P</i>=0.002), and larger indexed effective orifice area (BEV: 0.69±0.27 versus SEV: 0.93±0.32 cm²/m²; <i>P</i>=0.002). The rate of moderate aortic regurgitation was 0% in the BEV group versus 2.9% in the SEV group (<i>P</i>=0.582). Functional status and quality of life improved similarly in both groups. No differences were observed in the composite end point of death, stroke, or heart failure-related hospitalization (BEV: 32.6% versus SEV: 25.5%; <i>P</i>=0.489). Mortality was also not statistically different between groups (BEV: 23.3% versus SEV: 15.7%; <i>P</i>=0.375). No significant differences were observed in other adverse events.</p><p><strong>Conclusions: </strong>In patients undergoing valve-in-valve TAVR for failed small aortic bioprostheses, SEV demonstrated a superior valve hemodynamic performance at 3-year follow-up, with similar clinical outcomes and functional improvement compared with BEV.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03520101.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016255"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delay From First Symptoms in Patients Presenting With STEMI and Cardiogenic Shock: Insights From the DanGer Shock Trial.","authors":"Lisette Okkels Jensen, Rasmus Paulin Beske, Hans Eiskjær, Norman Mangner, Amin Polzin, P Christian Schulze, Carsten Skurk, Peter Nordbeck, Peter Clemmensen, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Nikos Werner, Lene Holmvang, Kristian Wachtell, Thomas Engstøm, Nanna Louise Junker Udesen, Henrik Schmidt, Anders Junker, Christian Juhl Terkelsen, Steffen Christensen, Axel Linke, Jacob Eifer Møller, Christian Hassager","doi":"10.1161/CIRCINTERVENTIONS.125.015718","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.015718","url":null,"abstract":"<p><strong>Background: </strong>Microaxial flow pump (mAFP) use in selected patients with ST-segment-elevation myocardial infarction complicated by cardiogenic shock improves survival. The present study aimed to assess the influence of delay from first symptoms to randomization on the benefit of an mAFP in patients with ST-segment-elevation myocardial infarction complicated by cardiogenic shock.</p><p><strong>Methods: </strong>This was a secondary analysis of the international, multicenter, randomized, open-labeled DanGer Shock trial (Danish-German Cardiogenic Shock). A total of 345 of 355 patients with ST-segment-elevation myocardial infarction and cardiogenic shock were enrolled in this substudy. Patients were stratified into quartiles according to delay from first symptoms to randomization to either an mAFP or standard care alone. The end point was death from any cause at 180 days for treatment with an mAFP versus standard of care, according to time from onset of symptoms to randomization obtained by logistic regression analysis.</p><p><strong>Results: </strong>Mortality at 180 days increased across quartiles of time from onset of symptoms to randomization: Q1 (0-140 minutes), 36%; Q2 (141-248 minutes), 53%; Q3 (249-650 minutes), 59%; and Q4 (> 651 minutes), 62%, respectively (log-rank <i>P</i>=0.002). However, those with longer delays were also older and more often women. Median age rose from 66 years (interquartile range, 57-73) in the earliest quartile to 71 years (interquartile range, 62-79) in the latest quartile (<i>P</i>=0.005), and the proportion of women increased from 15% to 34%, respectively. Combining the 3 lowest quartiles for the time from onset of symptoms to randomization, the mAFP treatment was associated with an odds ratio of 0.51 (95% CI, 0.31-0.84), whereas the odds ratio for the highest quartile was 0.92 (95% CI, 0.38-2.22; <i>P</i> for interaction = 0.26).</p><p><strong>Conclusions: </strong>In patients with ST-segment-elevation myocardial infarction complicated with cardiogenic shock, treatment with an mAFP was associated with reduced all-cause mortality, but the treatment benefit appeared to weaken with prolonged time from the onset of symptoms to randomization.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01633502.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015718"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Paradox of Elevated Gradients After Valve-in-Valve Transcatheter Aortic Valve Implantation.","authors":"Riyad Yazan Kherallah, Syed Zaid","doi":"10.1161/CIRCINTERVENTIONS.126.016577","DOIUrl":"10.1161/CIRCINTERVENTIONS.126.016577","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016577"},"PeriodicalIF":7.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}