JRSM Cardiovascular Disease最新文献

{"title":"Bleeding benefit, ischemic safety, and stent thrombosis risk of early aspirin discontinuation after percutaneous coronary intervention: A time-based meta-regression analysis.","authors":"Ismaila Ajayi Yusuf, Olurotimi J Badero, Ihesiulo Alozie, Micah Okwah, Jeremiah Adepoju, Abieyuwa Oshodin, Ihesiulo Uzoma, Oluwashina Oyeleye, Emmanuella Asikong","doi":"10.1177/20480040261489430","DOIUrl":"10.1177/20480040261489430","url":null,"abstract":"<p><strong>Background: </strong>Early aspirin discontinuation followed by P2Y12 inhibitor monotherapy is increasingly used after percutaneous coronary intervention (PCI), yet whether the timing of discontinuation within the early post-procedural period modifies clinical outcomes remains uncertain.</p><p><strong>Methods: </strong>We searched PubMed/MEDLINE, Scopus, Embase, CENTRAL, and ClinicalTrials.gov through March 5, 2026, for randomized controlled trials evaluating early aspirin discontinuation with P2Y12 inhibitor monotherapy versus continued dual antiplatelet therapy (DAPT) in adults undergoing PCI. Outcomes included major bleeding, stent thrombosis, myocardial infarction (MI), major adverse cardiovascular events (MACE), all-cause mortality, ischemic stroke, and net adverse clinical events (NACE).</p><p><strong>Results: </strong>Ten RCTs comprising 52,793 participants were included. Early aspirin discontinuation significantly reduced major bleeding (HR 0.59; 95% CI, 0.43-0.79; p = 0.0004), any bleeding (HR 0.52; 95% CI, 0.41-0.66; p < 0.0001), and NACE (HR 0.86; 95% CI, 0.76-0.97; p = 0.017), without significant increases in MI, MACE, or mortality. Stent thrombosis was significantly increased (HR 1.35; 95% CI, 1.03-1.78; p = 0.033; I² = 0%), with a directional gradient from HR 1.62 at 0 days to HR 0.81 at 90 days. Meta-regression found no significant association between discontinuation timing and any outcome (all p > 0.05). Hartung-Knapp sensitivity analysis did not materially alter pooled estimates.</p><p><strong>Conclusions: </strong>Early aspirin discontinuation after PCI reduces bleeding and improves net clinical outcomes without significant increases in MI, MACE, or mortality, but modestly increases stent thrombosis. Discontinuation timing within 0 to 90 days was not statistically associated with treatment effects; however, this finding is hypothesis-generating given limited power across only three discontinuation nodes.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261489430"},"PeriodicalIF":0.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-driven, patient-specific simulations in the right heart: Extracting valve geometry and kinematics from blood flow data.","authors":"Ibrahim Nasuh Yildiran, Francesco Capuano, Laura Olivieri, Yue-Hin Loke, Elias Balaras","doi":"10.1177/20480040261486544","DOIUrl":"10.1177/20480040261486544","url":null,"abstract":"<p><strong>Objectives: </strong>Although recent advancements in imaging technologies and computational power have significantly enhanced our ability to investigate intracardiac flow dynamics of the right heart (RH), inadequate imaging spatial and temporal resolution and reliance on experimentally derived constitutive relations pose challenges in creating patient-specific models capable of quantifying important flow parameters, particularly in pediatric cases. Image-driven computational models with prescribed kinematics offer a feasible and cost-efficient solution; however, accurate modeling of intricate structures including the tricuspid valve (TV) remains hindered by the resolution constraints of current imaging techniques.</p><p><strong>Methods: </strong>We present a novel, image-driven, patient-specific direct numerical simulation (DNS) framework that integrates TV kinematics with RH motion. The prescribed TV kinematics are informed by the 4D-flow MRI velocity field. This approach avoids reliance on fully resolved valve imaging while preserving essential valve dynamics. The results are validated through direct comparison with the 4D-MRI measurements for both healthy control and repaired tetralogy of fallot (rToF) cases.</p><p><strong>Results: </strong>The proposed framework successfully reproduced physiologically relevant RH flow features. Simulated velocity fields showed good qualitative agreement with 4D-MRI measurements, demonstrating the ability of the workflow to accurately capture RH hemodynamics. Volume-averaged total kinetic energy and vorticity magnitude also showed good quantitative agreement with the 4D-MRI data.</p><p><strong>Conclusion: </strong>This study introduces an image-driven, patient-specific modeling of TV driven by 4D-flow data. By integrating TV kinematics with RH, the proposed approach strengthens the link between medical imaging and high-fidelity simulation, enabling accurate characterization of RH flow dynamics without relying on structural property data.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261486544"},"PeriodicalIF":0.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature mortality from acute myocardial infarction and psychoactive substance use in the United States: An observational trend (1999-2023) and forecasting (2035) study.","authors":"Sachin Sapkota, Vijay Chennareddy, Suman Paudel, Suchita Acharya, Sakshi Nepal, Chioma Eliogu, Sandesh Murali, Mehran Abolbashari","doi":"10.1177/20480040261485004","DOIUrl":"10.1177/20480040261485004","url":null,"abstract":"<p><strong>Background: </strong>Acute myocardial infarction (AMI) remains a leading cause of premature death (<65 years) in the United States, with a significant association with psychoactive substance use (PSU). However, long-term trends and future projections of this combined burden remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death database to assess premature mortality (ages 25-65 years) related to AMI and PSU from 1999 to 2023. Age-adjusted mortality rates (AAMRs) were derived, and annual percentage changes (APCs) were calculated using joinpoint regression. An autoregressive integrated moving average (ARIMA) model was used to forecast mortality through 2035.</p><p><strong>Results: </strong>From 1999 to 2023, 176,641 premature deaths were attributed to AMI and PSU. The AAMR rose from 1.4 per 100,000 in 1999 to 4.16 in 2023. Mortality increased sharply from 1999 to 2005 (APC 19.04), continued rising through 2021 (APC 2.63), and declined between 2021 and 2023 (APC -9.13). Middle-aged adults (45-65 years) had substantially higher mortality than younger adults (25-45 years) (AAMR 9.63 vs 0.91, 2018-2023). Men had higher mortality than women (6.81 vs 2.53). American Indian/Alaska Native and White populations showed the higher racial burden. Nonmetropolitan areas had markedly higher mortality than metropolitan regions. South Dakota, Kentucky, and Arkansas had the highest state-level mortality. Forecasting predicts only a modest decline to 3.80 per 100,000 by 2035.</p><p><strong>Conclusion: </strong>Despite recent declines, premature mortality from AMI and PSU is projected to remain high through 2035, underscoring the need for targeted, evidence-based prevention strategies.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261485004"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter aortic valve implantation in 2026.","authors":"Satpal Singh Arri, Vitaliy Androshchuk, Simon Redwood","doi":"10.1177/20480040261477128","DOIUrl":"https://doi.org/10.1177/20480040261477128","url":null,"abstract":"<p><p>Since the first implant over two decades ago, transcatheter aortic valve implantation (TAVI) has become the standard treatment for patients with severe aortic stenosis at high and intermediate risk, with mounting evidence to support its use in the younger lower-risk patient. Increasing operator experience and ongoing technological advances have both refined the procedure and reduced overall risk. However, important challenges remain, including coronary access after TAVI, conduction disturbance following implantation, the long-term consequences of paravalvular leak, cost-effectiveness and broader implications on healthcare systems. This review is timely following publication of the latest European Society of Cardiology guidelines on the management of valvular heart disease and recent landmark trials. We aim to provide an update on key areas of development including patient selection, imaging, management of coronary disease, valve durability and lifetime management.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261477128"},"PeriodicalIF":0.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioresorbable-polymer sirolimus-eluting stents versus durable-polymer everolimus-eluting stents in percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials with GRADE assessment.","authors":"Deepanshu Agrawat, Aarushi Gupta, Munir Rajpura, Sanaa Sadikhussain Diwan, Mokshit Mehul Shah, Asma Mukhtar, Umais Naveed Warraich, Areesha Talib Lashari, Muhammad Usama Tariq, Dania Khan, Mirza Muhammad Hadeed Khawar, Muneeb Khawar","doi":"10.1177/20480040261478165","DOIUrl":"10.1177/20480040261478165","url":null,"abstract":"<p><strong>Background: </strong>Ultrathin bioresorbable-polymer sirolimus-eluting stents (BP-SES), including bioresorbable scaffolds (BRS), were developed to mitigate adverse events associated with durable-polymer everolimus-eluting stents (DP-EES). This study aims to compare the efficacy and safety of BP-SES versus DP-EES in patients undergoing percutaneous coronary intervention for de novo coronary artery lesions.</p><p><strong>Methods: </strong>We searched PubMed, Embase, ScienceDirect and ClinicalTrials.gov from inception to May 2026 for randomised controlled trials (RCTs) comparing BP-SES or BRS with DP-EES. Random-effects models were used to pool risk ratios (RRs) or mean differences with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Nineteen RCTs involving 18,501 patients were included. No significant differences were observed between BP-SES and DP-EES for target lesion failure (RR 1.15, 95% CI 0.74-1.79; I² = 94%), target vessel failure (RR 0.93, 95% CI 0.84-1.03; I² = 10%), cardiac death (RR 0.96, 95% CI 0.78-1.18), target vessel myocardial infarction (RR 0.89, 95% CI 0.77-1.03), clinically indicated target lesion revascularisation (RR 0.99, 95% CI 0.80-1.22). Binary restenosis was significantly higher in the BP-SES arm overall (RR 2.46, 95% CI 1.41-4.29; <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>Metallic BP-SES and DP-EES showed similar rates for most clinical endpoints. However, extreme heterogeneity and accrual of only 5.7% of the required information size render the evidence for target lesion failure inconclusive. Higher binary restenosis increased target lesion revascularisation with fully BRS indicate that these platforms are not interchangeable with contemporary metallic stents. Further large, long-term trials are required.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261478165"},"PeriodicalIF":0.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of the art: Transcatheter tricuspid valve intervention.","authors":"Joshua Wilcox, Benedict Mcdonaugh, Rea Ganatra, Alexander Birkinshaw, Vitaliy Androshchuk, Omar Chehab, Ioannis Lianos, Edouard Long, Satpal Arri, Karine Grigoryan, Giulia Benedetti, Rebecca Preston, Bushra Rana, Christopher Aldo Rinaldi, Ronak Rajani, Pier Giorgio Masci, Simon Redwood, Bernard Prendergast","doi":"10.1177/20480040261467513","DOIUrl":"10.1177/20480040261467513","url":null,"abstract":"<p><p>Tricuspid regurgitation (TR) has a community prevalence of 3%, which increases with age and affects up to 7% of elderly patients. TR is secondary (functional) in 90% of cases (usually resulting from left heart disease and/or pulmonary hypertension), although atrial dilatation is an increasingly recognised cause. Awareness of the poor prognosis associated with increasing TR severity has refocused the quest for effective treatments. Surgical intervention has been hindered by high in-hospital mortality (up to 10%), even in carefully selected cases, and transcatheter tricuspid valve interventions (TTVIs) have emerged as a low-risk alternative for this high-risk cohort. Increasing data demonstrate the clinical safety and efficacy of TTVIs, but uncertainties remain concerning optimal case selection and procedural timing. Herein, we review newly established techniques alongside emerging clinical and procedural outcome data.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261467513"},"PeriodicalIF":0.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring cardioplegia delivery circuits with modular heart-lung machines: A narrative review.","authors":"Youssef El Dsouki, Sibel Aydın, Hanan Abdullah Mohammed Alanazi, Zakaria El Koraychi, Gopikrishnan Thalapathy, Ignazio Condello","doi":"10.1177/20480040261472353","DOIUrl":"10.1177/20480040261472353","url":null,"abstract":"<p><strong>Background: </strong>Cardioplegia remains a cornerstone of myocardial protection during cardiac surgery; however, the configuration of its delivery circuit, particularly priming volume and blood-synthetic surface area, can exert a measurable influence on patient outcomes. Oversized or non-tailored circuits inherently increase hemodilution, inflammatory activation, and coagulation disturbances, effects that are especially pronounced in neonates and small children, whose circulating blood volume is limited. Advances in modular heart-lung machine (HLM) technology have introduced the possibility of tailoring cardioplegia circuits to patient size and procedural requirements, aligning mechanical design with physiological principles.</p><p><strong>Materials and methods: </strong>A narrative review was conducted using PubMed, Scopus, and Google Scholar for studies published between January 1976 and July 2025. Search terms included \"cardioplegia,\" \"myocardial protection,\" \"cardioplegia circuit,\" \"priming volume,\" \"modular heart-lung machine,\" \"microplegia,\" \"del Nido cardioplegia,\" and related keywords. The search identified 286 records; after duplicate removal and eligibility screening, 22 studies were included in the final qualitative synthesis. Evidence was analyzed according to four domains: priming volume and blood conservation, contact surface area and inflammation, modularity and circuit customization, and physiological implications of delivery strategy.</p><p><strong>Results: </strong>Cardioplegia delivery circuit design appears to be a clinically relevant but underrecognized component of myocardial protection. Modular HLM platforms provide a practical approach to reduce circuit complexity and adapt extracorporeal circulation to individual patient requirements. Further prospective multicenter studies are needed to define the impact of modular cardioplegia circuits on clinical outcomes.</p><p><strong>Conclusions: </strong>Modular HLM technology provides a flexible and physiologically grounded platform for tailoring cardioplegia delivery to individual patient profiles. Standardizing weight-banded modular configurations and implementing routine monitoring of priming volume-to-weight ratios could improve consistency in practice and serve as a foundation for prospective studies. The cumulative evidence suggests that extending modular principles to the cardioplegia circuit represents an underutilized but promising opportunity to enhance both pediatric and adult cardiac surgical outcomes.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261472353"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chagas disease and health-related quality of life in pacemaker patients: A cross-sectional analysis using the AQUAREL questionnaire.","authors":"Victor Cordeiro Simão, Laura Porto Augusto, Pedro Teixeira Guará, Luiz Antônio Batista De Sá, Fabrício Alves Araújo","doi":"10.1177/20480040261469407","DOIUrl":"10.1177/20480040261469407","url":null,"abstract":"<p><strong>Background: </strong>Pacemakers (PMs) are crucial for treating symptomatic bradyarrhythmias and improving patient health-related quality of life (HRQoL). While Chagas disease (ChD) is known to impair HRQoL, its specific impact on PM recipients, as measured by the AQUAREL questionnaire, is not well understood. This study aimed to compare HRQoL between pacemaker patients with and without ChD.</p><p><strong>Methods: </strong>This cross-sectional study included 57 adult patients with PM (29 with ChD and 28 without). HRQoL was evaluated using the AQUAREL questionnaire, which assesses three domains: Chest Discomfort, Arrhythmia, and Dyspnea. We used multivariate inflated beta regression models, adjusting for clinical and demographic covariates, to analyze the data.</p><p><strong>Results: </strong>Participants with ChD (median age 64 years, interquartile range [IQR], 56-72 years) reported significantly worse HRQoL than those without ChD (median age 57 years, IQR, 53-69 years). After multivariate adjustment, ChD remained significantly associated with poorer HRQoL scores in all domains: Chest discomfort (adjusted odds ratio [OR] 0.59; <i>p = .</i>044), Arrhythmia (adj. OR 0.38; <i>p = .</i>004), and Dyspnea (adj. OR 0.61; <i>p = .</i>049). An OR < 1 indicates worse outcomes for the ChD group.</p><p><strong>Conclusions: </strong>ChD is independently associated with a significantly poorer perception of HRQoL in pacemaker patients compared to those without ChD. This impairment spans the critical domains of chest discomfort, arrhythmia, and dyspnea, highlighting the distinct health burden imposed by ChD in this patient population.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261469407"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MeshGrow: Integrated framework for simulation-ready cardiac and vascular mesh construction from medical imaging.","authors":"Numi Sveinsson Cepero, Arjun Narayanan, Fanwei Kong, Shawn C Shadden","doi":"10.1177/20480040261455944","DOIUrl":"10.1177/20480040261455944","url":null,"abstract":"<p><p>Patient-specific cardiovascular simulations are an integral part of cardiovascular research and are increasingly finding use in clinical practice. A primary factor hindering large cohort studies and clinical utilization of cardiovascular simulations is the time-consuming process of constructing simulation-suitable computer models from medical image data. Methods have been proposed to automate the model construction process, but are tailored to either vascular or cardiac models. We herein propose a framework, MeshGrow, that is capable of combining automated modeling of cardiac and extended vascular territories. Namely, we demonstrate that this method can be used to reconstruct the main cardiac chambers along with the aorta and its main sub-branches, and returns a simulation-suitable mesh with a defined aortic valve surface and other surfaces needed for boundary condition specification. MeshGrow combines two different machine learning based techniques to address the specific challenges involved with cardiac and vascular model construction. This results in a two-stage approach; (a) meshing the cardiac structures and (b) growing the vasculature out from it. We present results of our method on five CT test datasets and compare predictions against state-of-the-art benchmark methods, as well as ground truth manually constructed models. Results show that MeshGrow achieves higher metric scores than benchmark methods on the test data. Additionally, we showcase the applicability of the method by running three-dimensional computational fluid dynamics simulations with two of the test cases. With this work, we demonstrate a method that can automate the construction of combined cardiac and vascular models for patient-specific cardiovascular hemodynamic simulation.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261455944"},"PeriodicalIF":0.6,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiography-derived physiology versus pressure wire-based fractional flow reserve for coronary revascularization guidance: A systematic review and meta-analysis.","authors":"Mokshit Mehul Shah, Sarosh Fatima, Mariam Khachatryan, Igwilo Chukwudumebi Angela, Umair Arshad, Jahnoy St Jacques, Naima Agha, Hamza Hashmi, Bigenimana Adimirabilis Malombe, Zeeshan Ayaz, Mirza Muhammad Hadeed Khawar, Muneeb Khawar","doi":"10.1177/20480040261469414","DOIUrl":"10.1177/20480040261469414","url":null,"abstract":"<p><strong>Background: </strong>Pressure-wire-based fractional flow reserve (FFR) is the gold standard for physiological assessment of intermediate coronary stenoses but remains underutilized owing to procedural complexity, cost, and the need for hyperemic agents. Angiography-derived physiology (ADP) platforms offer a wire-free, adenosine-free alternative. This systematic review and meta-analysis compared the clinical outcomes of ADP-guided versus FFR-guided revascularization in patients with coronary artery disease.</p><p><strong>Methods: </strong>Comprehensive searches were performed in PubMed, Embase, ScienceDirect, and Cochrane CENTRAL from inception to April 2026. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals using random-effects models and robustness was checked with trial sequential analysis (TSA).</p><p><strong>Results: </strong>Three multicenter randomized controlled trials involving 6165 patients were included. There was no significant difference in the primary composite endpoint (RR: 1.14, 95% CI: 0.85-1.54; <i>p</i> = 0.37; <i>I</i> ² = 57%), all-cause mortality (RR: 1.08, 95% CI: 0.75-1.56; <i>p</i> = .68), cardiac death (RR: 0.89, 95% CI: 0.53-1.49; <i>p</i> = .66), and any myocardial infarction (RR: 1.14, 95% CI: 0.66-1.98; <i>p</i> = .64) between ADP-guided and pressure-wire-based FFR-guided strategies. Clinically indicated revascularization was significantly higher with ADP (RR: 1.12, 95% CI: 1.05-1.20; <i>p</i> = .005; <i>I</i> ² = 0%). Trial sequential analysis confirmed that the accumulated evidence was sufficient to conclude no clinically meaningful difference in composite outcome.</p><p><strong>Conclusion: </strong>ADP-guided revascularization achieves broadly comparable clinical outcomes to pressure-wire-based FFR. Although ADP offers procedural advantages, certain platforms were associated with modestly higher revascularization rates. These findings support ADP as a practical alternative to conventional FFR in selected patients.</p>","PeriodicalId":30457,"journal":{"name":"JRSM Cardiovascular Disease","volume":"15 ","pages":"20480040261469414"},"PeriodicalIF":0.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}