JACC. Cardiovascular interventions最新文献

{"title":"Occlusion-Focused Triage vs Very-High-Risk NSTEMI Criteria","authors":"Emre K. Aslanger MD,&nbsp;Burcu Aggül MD,&nbsp;Özlem Yıldırımtürk MD,&nbsp;Can Yücel Karabay MD,&nbsp;Harvey Pendell Meyers MD,&nbsp;Stephen W. Smith MD,&nbsp;Muzaffer Değertekin MD","doi":"10.1016/j.jcin.2026.06.040","DOIUrl":"10.1016/j.jcin.2026.06.040","url":null,"abstract":"<div><h3>Background</h3><div>The current ST-segment elevation myocardial infarction (STEMI)/NSTEMI framework may not fully identify patients with ACO who present without diagnostic STE. Although immediate invasive management is recommended for patients with very-high-risk NSTEMI features, these criteria are inconsistently applied in clinical practice. The OMI/NOMI framework has been proposed as an alternative strategy.</div></div><div><h3>Objectives</h3><div>This study sought to compare the occlusive and nonocclusive myocardial infarction (OMI/NOMI) classification with guideline-defined very-high-risk non–ST-segment elevation myocardial infarction (NSTEMI) criteria for the identification of acute coronary occlusion (ACO) in patients without diagnostic STE.</div></div><div><h3>Methods</h3><div>This was a substudy of the multicenter, cluster-randomized DIFOCCULT-3 (Time for a Diagnostic Paradigm Shift From ST-Elevation/Non–ST-Elevation to Occlusion/Non-Occlusion Myocardial Infarction-3) trial. Consecutive adult patients without diagnostic STE on the admission electrocardiogram were included and managed according to either the conventional STEMI/NSTEMI or the OMI/NOMI approach. Very-high-risk NSTEMI was defined according to current guidelines. Outcomes included immediate invasive management (within 2 hours) and adjudicated ACO.</div></div><div><h3>Results</h3><div>Among 4,398 patients, very-high-risk NSTEMI criteria identified a small proportion of patients and were inconsistently translated into early intervention. The OMI/NOMI approach selected more patients for early invasive management compared with the STEMI/NSTEMI framework (45.4% vs 13.6%; <em>P</em> &lt; 0.001). Adjudicated ACO was identified within 2 hours more frequently under the OMI/NOMI approach (35.1% vs 16.7%; <em>P</em> &lt; 0.001), without reduction in angiographic yield.</div></div><div><h3>Conclusions</h3><div>An occlusion-focused diagnostic approach was associated with substantially higher rates of immediate invasive management and earlier identification of patients with adjudicated ACO.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 19","pages":"Pages 2555-2566"},"PeriodicalIF":12.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167928","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":"Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention","authors":"Riyad Yazan Kherallah MD,&nbsp;Syed Zaid MD,&nbsp;Yazan Assaf MD,&nbsp;Angel Chen Marks MS,&nbsp;Glenn Levine MD,&nbsp;Neal S. Kleiman MD,&nbsp;Mirza Umair Khalid MD,&nbsp;Lorraine Mascarenhas MD,&nbsp;Jing Liu MD,&nbsp;Waleed Kayani MD,&nbsp;Yochai Birnbaum MD,&nbsp;Daniel Wojdyla PhD,&nbsp;Rajesh V. Swaminathan MD,&nbsp;Ali A. Denktas MD","doi":"10.1016/j.jcin.2026.07.032","DOIUrl":"10.1016/j.jcin.2026.07.032","url":null,"abstract":"<div><h3>Background</h3><div>Patients may present with acute coronary occlusions (ACOs) without manifesting electrocardiographic criteria for ST-segment elevation myocardial infarction (STEMI).</div></div><div><h3>Objectives</h3><div>The aim of this study was to examine the incidence, clinical characteristics, and in-hospital outcomes of non–ST-segment elevation myocardial infarction (NSTEMI) with ACO.</div></div><div><h3>Methods</h3><div>The study included patients with STEMI and NSTEMI in the CathPCI Registry who underwent percutaneous coronary intervention between April 1, 2018, and June 30, 2023. ACO was defined as 100% stenosis deemed acute. The cohort was stratified into STEMI (including STEMI equivalents), NSTEMI-ACO, and NSTEMI-no-ACO. The primary outcome was a composite of in-hospital stroke, myocardial infarction, or cardiovascular mortality. A sensitivity analysis with ACO defined as 100% acute occlusion or TIMI flow grade 0 or 1 in the culprit artery was performed.</div></div><div><h3>Results</h3><div>Of 1,198,544 patients, 26.1% had STEMI, 11.0% had NSTEMI-ACO (15% of whom had NSTEMI), and 62.9% had NSTEMI-no-ACO. Compared with those with NSTEMI-no-ACO, NSTEMI-ACO patients had more cardiogenic shock (9.0% STEMI vs 3.8% NSTEMI-ACO vs 1.9% NSTEMI-no-ACO; <em>P</em> &lt; 0.001), ventricular arrhythmias (4.9% vs 2.0% vs 1.3%; <em>P</em> &lt; 0.001), and in-hospital cardiac arrest (6.1% vs 2.7% vs 1.6%; <em>P</em> &lt; 0.001). Patients with NSTEMI-ACO had a higher risk for the primary composite compared with those with NSTEMI-no-ACO (adjusted OR: 2.26; 95% CI: 2.18-2.34; <em>P</em> &lt; 0.001) but a lower risk compared with those with STEMI (adjusted OR: 0.54; 95% CI: 0.52-0.56; <em>P</em> &lt; 0.001). Using a definition of ACO including TIMI flow grade 0 or 1, NSTEMI-ACO accounted for 216,054 presentations (24.4% of NSTEMI). In-hospital outcomes were similarly worse compared with NSTEMI-no-ACO and better compared with STEMI.</div></div><div><h3>Conclusions</h3><div>ACO occurs in a substantial proportion of patients with NSTEMI and is associated with worse in-hospital outcomes relative to those with NSTEMI-no-ACO. Further studies of early identification and reperfusion practices for NSTEMI-ACO are warranted.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 19","pages":"Pages 2539-2551"},"PeriodicalIF":12.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169447","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":"Frequency and Prognosis of Alternative Definitions of Occlusion Myocardial Infarction Across the Whole Spectrum of Acute Coronary Syndromes","authors":"Andrea Milzi MD,&nbsp;Andrea Zito MD,&nbsp;Antonio Landi MD PhD,&nbsp;Enrico Frigoli MD,&nbsp;Giuseppe Andò MD,&nbsp;Giacomo Boccuzzi MD,&nbsp;Paolo Calabrò MD,&nbsp;Gianluca Campo MD,&nbsp;Marco Frazzetto MD,&nbsp;Marco Covani MD,&nbsp;Jose Maria De La Torre Hernandez MD,&nbsp;Dik Heg PhD,&nbsp;Sergio Leonardi MD,&nbsp;Filippo Russo MD,&nbsp;Gennaro Sardella MD,&nbsp;Arnoud WJ. Vant’Hof MD,&nbsp;Ferdinando Varbella MD,&nbsp;Pascal Vranckx MD,&nbsp;Marco Valgimigli MD","doi":"10.1016/j.jcin.2026.08.007","DOIUrl":"10.1016/j.jcin.2026.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Occlusion myocardial infarction (OMI) refers to a myocardial infarction caused by a persistent or transient, complete or near-complete coronary artery occlusion. Multiple definitions have been proposed, yet their frequency and comparative prognostic relevance remain unclear.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate the frequency and prognosis of previously proposed OMI definitions across the whole spectrum of acute coronary syndromes (ACS) from the MATRIX trial.</div></div><div><h3>Methods</h3><div>Five alternative OMI definitions were assessed: 1) culprit artery (CA) TIMI flow grade 0; 2) CA-TIMI flow grade 0-1; 3) CA-TIMI flow grade 0-2; 4) CA-TIMI flow grade 0-2 or TIMI flow grade 3 with cardiac troponin &gt;30× upper reference limit; and 5) CA-TIMI flow grade 0-2 or CA-TIMI flow grade 3 with cardiac troponin &gt;100× upper reference limit. The endpoint of interest was 1-year all-cause mortality.</div></div><div><h3>Results</h3><div>Among 6,558 patients with ACS, OMI frequency ranged from 37.8% for definition 1 to 76.1% for definition 4. OMI was independently associated with higher 1-year mortality according to definitions 1-4 (adjusted HR: 2.08 [95% CI: 1.56-2.78], 1.97[1.47-2.63], 1.70 [1.25-2.32], 1.47 [1.01-2.12], respectively) but not according to definition 5 (adjusted HR: 1.26 [0.90-1.75]). OMI definitions exclusively based on impaired CA flow (ie, definitions 1-3) improved discrimination, reclassification, and model fit when added to the conventional STE/NSTE-ACS classification. One-year mortality did not differ among patients with NSTE-ACS with OMI definition 1 or 2 compared with ST-segment elevation MI (STEMI) patients.</div></div><div><h3>Conclusions</h3><div>OMI defined by impaired CA flow confers prognostic implications beyond the presence or absence of ST-segment elevation in a broad ACS population and identifies patients without ST-segment elevation with 1-year mortality similar to that of STEMI.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 19","pages":"Pages 2571-2585"},"PeriodicalIF":12.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165508","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":"Conduction System Pacing After TAVR","authors":"Patrick Badertscher MD","doi":"10.1016/j.jcin.2026.08.010","DOIUrl":"10.1016/j.jcin.2026.08.010","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 19","pages":"Pages 2648-2650"},"PeriodicalIF":12.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166586","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":"Drug-Coated Balloon PCI for Bypass Graft Lesions","authors":"Fernando Macaya-Ten MD, PhD,&nbsp;Nieves Gonzalo MD, PhD","doi":"10.1016/j.jcin.2026.06.035","DOIUrl":"10.1016/j.jcin.2026.06.035","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2441-2443"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067854","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":"Transcatheter Patent Ductus Arteriosus Closure in Extremely Premature Infants","authors":"Shyam Sathanandam MD,&nbsp;Ashley Molloy MD,&nbsp;Ranjit Philip MD,&nbsp;Janet Sessums CRNA,&nbsp;Neil Tailor MD,&nbsp;Leah Apalodimas DNP, CPNP-AC/PC,&nbsp;Sharvari Shyam MD,&nbsp;Ashley Giannini RCIS,&nbsp;Katherine Hunter MSN, CPNP,&nbsp;Jason N. Johnson MD","doi":"10.1016/j.jcin.2026.05.040","DOIUrl":"10.1016/j.jcin.2026.05.040","url":null,"abstract":"<div><h3>Background</h3><div>Extremely premature infants (&lt;28 weeks’ gestation) with hemodynamically significant patent ductus arteriosus (PDA) may require transcatheter PDA closure (TCPC) when medical therapy fails. Although TCPC is associated with improved respiratory outcomes over surgical ligation, its availability is limited because of the need to transport these critically ill infants to cardiac catheterization laboratories, delaying care and increasing risk.</div></div><div><h3>Objectives</h3><div>The authors describe the successful transition of TCPC from the catheterization laboratory to the neonatal intensive care unit (NICU) bedside, emphasizing feasibility, safety, and early outcomes.</div></div><div><h3>Methods</h3><div>The authors conducted a retrospective review of infants at &lt;28 weeks’ gestation weighing &lt;2 kg who underwent TCPC between July 2012 and December 2024. The program evolved in 3 phases: traditional laboratory-based TCPC (2012-2021), laboratory-based TCPC using transthoracic echocardiographic guidance only (July to December 2021), and bedside TCPC in the NICU (2022-2024).</div></div><div><h3>Results</h3><div>Of 500 infants, 176 underwent bedside TCPC. These infants were younger (median 20 days vs 29 days) and smaller (820 g vs 1,010 g) than laboratory-treated infants. Bedside procedures were shorter (18 minutes vs 32 minutes) and had reduced radiation exposure (0.019 Gy × cm² vs 0.068 Gy × cm²; <em>P</em> &lt; 0.001). Procedural success was 100% across all settings. Major complication rates were low (1.7%) and similar across settings. Follow-up (median 6.8 years) showed an 89% survival rate, no residual PDAs, and minimal late complications.</div></div><div><h3>Conclusions</h3><div>Bedside TCPC is a feasible, safe, and effective approach for managing PDA in extremely premature infants. It eliminates the need for interhospital transport, supports earlier intervention, and may improve outcomes. With appropriate training and experience, bedside TCPC has the potential to become the standard of care across NICUs.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2490-2500"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067860","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":"Transfemoral TAVR With a 35-mm Myval Valve in an Extremely Large Aortic Annulus Using Intentional Undersizing","authors":"Balázs Magyari MD,&nbsp;Bálint Kittka MD,&nbsp;Ilona Goják MD,&nbsp;Iván Horváth MD, PhD","doi":"10.1016/j.jcin.2026.06.036","DOIUrl":"10.1016/j.jcin.2026.06.036","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2525-2528"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067701","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":"Full Issue PDF","authors":"","doi":"10.1016/S1936-8798(26)02339-3","DOIUrl":"10.1016/S1936-8798(26)02339-3","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages I-CXIII"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067837","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":"Revascularization of Cabrol Graft Thrombosis Presenting as STEMI in Young Adult After Redo Bentall Procedure","authors":"Joseph Crowder MD,&nbsp;Austin Harris MD,&nbsp;Orly Leiva MD,&nbsp;Andrew Leventhal MD","doi":"10.1016/j.jcin.2026.05.034","DOIUrl":"10.1016/j.jcin.2026.05.034","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2529-2531"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067702","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":"Intraprocedural Left Atrial Pressure Monitoring and Clinical Outcomes in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair","authors":"Ryo Shigeno MD,&nbsp;Masaki Miyasaka MD, PhD,&nbsp;Takao Morikawa MD,&nbsp;Tomofumi Nakatsukasa MD, PhD,&nbsp;Arudo Hiraoka MD, PhD,&nbsp;Ayumi Nojiri MD, PhD,&nbsp;Sae Ochi MD, PhD,&nbsp;Atsushi Hirohata MD, PhD","doi":"10.1016/j.jcin.2026.07.028","DOIUrl":"10.1016/j.jcin.2026.07.028","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 18","pages":"Pages 2515-2517"},"PeriodicalIF":12.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067862","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}