Cardiovascular Revascularization Medicine最新文献

{"title":"Early versus delayed percutaneous coronary revascularization in patients with concomitant sepsis and non-ST elevation myocardial infarction.","authors":"Hafez Golzarian, Daniel Tabares, Amar Kalidas, Mohammad Hamideh, Abhijay Shah, Amna Janjua, Suhas Tatapudi, Mehmet Elbey, Zahoor Khan, Negar Niknam, Dhavalkumar Patel, Mohamed Almahmoud, Okechukwu N Mgbemena","doi":"10.1016/j.carrev.2026.07.023","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.023","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of patients with concomitant sepsis and severe coronary artery disease (CAD) who develop acute myocardial infarction (AMI) is poor. While percutaneous coronary intervention (PCI) can improve survival in AMI during and post sepsis, the decision is complex due to high mortality rates and increased risk of complications. The optimal timing of intervention for these patients, once clinically indicated, remains controversial, with specific recommendations for revascularization lacking in current guidelines. This retrospective analysis investigates and compares clinical outcomes of early PCI strategy (<72 h from diagnosis of MI) versus delayed PCI strategy (≥72 h) in patients who were hospitalized with sepsis and concomitantly developed AMI.</p><p><strong>Methods: </strong>This multicenter retrospective study included 217 hospitalized patients with sepsis and AMI who underwent PCI after sepsis treatment, from January 2016 to May 2024. Patients with ST-elevation myocardial infarctions and non-obstructive CAD were excluded. Of these, 75 patients received early PCI, and 142 underwent delayed PCI. We analyzed in-hospital all-cause mortality, major cardiovascular events, progression to shock, length of stay, and readmission rates at 45 days and 1 year.</p><p><strong>Results: </strong>The mean peak serum troponin I level in the early revascularization cohort was higher (13.1 ng/mL vs. 7.8 ng/mL; P < 0.01). Baseline characteristics were otherwise similar. There was significantly higher all-cause mortality (16% vs. 3.5%; P < 0.01) associated with early PCI in patients with concomitant sepsis. However, a delayed invasive strategy was associated with a 28% longer length of stay (14.6 days vs. 11.4 days) and a greater likelihood of progression to shock (RR 1.41). There were no major differences in 45-day and 1-year readmission rates between the cohorts.</p><p><strong>Conclusions: </strong>In patients with non-ST elevation myocardial infarction in the context of sepsis, early PCI was associated with higher all-cause mortality compared to delayed PCI. The delayed PCI cohort had longer lengths of stay; however, these findings may be attributable to the lower mortality in this group. This study suggests that in select patients with concomitant MI and sepsis, it may not be unreasonable to prioritize treating the sepsis prior to attempting revascularization. However, major limitations exist in the study and a randomized controlled trial is warranted to further investigate these findings.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De-escalation of antiplatelet therapy to evaluate platelet reactivity and clinical outcomes after coronary stenting in patients at high bleeding risk and recent acute coronary syndrome: Rationale and design of the DESC-HBR trial.","authors":"Francesco Costa, Giampiero Vizzari, Simone Zecchino, Mattia Galli, Claudio Montalto, Gabriele Carciotto, Giorgio Quadri, Rocco Vergallo, Fausto Castriota, Emmanuele Soraci, Alberto Magliarditi, Stefania Lo Giudice, Giustina Iuvara, Andrea Munafò, Federico Giannino, Francesco Pallante, Marco Franzino, Lucio Teresi, Raffaele Piccolo, Ferdinando Varbella, Giuseppe Musumeci, Gianluca Di Bella, Luis Ortega-Paz, Dominick J Angiolillo, Antonio Micari","doi":"10.1016/j.carrev.2026.07.022","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.022","url":null,"abstract":"<p><strong>Background: </strong>Patients at high bleeding risk (HBR) presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI) have competing hazards of ischemic and bleeding events. In unselected ACS populations, trials of unguided de-escalation of P2Y₁₂ inhibition reduce bleeding without excess ischemia; however, HBR patients were largely underrepresented in these studies. Comparative evidence across multiple de-escalation regimens in this vulnerable cohort is currently lacking.</p><p><strong>Study design: </strong>DESC-HBR is a prospective, multicenter, randomized, open-label trial with blinded endpoint adjudication enrolling 200 HBR patients (PRECISE-DAPT ≥25 or ARC-HBR criteria) at 30 ± 7 days after ACS-PCI. Following one month of dual antiplatelet therapy (DAPT) with prasugrel 10 mg once daily or ticagrelor 90 mg twice daily, on a background of aspirin 100 mg, patients are randomized (1: 1:1:1) to clopidogrel 75 mg once daily, prasugrel 5 mg once daily, ticagrelor 60 mg twice daily, or continuation of full-dose potent therapy. The primary endpoint is the proportion of patients achieving optimal platelet reactivity (VerifyNow PRU 85-208) at 14 ± 2 days post-randomization, 2-h after maintenance dose. Key secondary outcomes include BARC bleeding, net adverse clinical events, quality of life and adherence. Pharmacodynamic profiling incorporates VerifyNow and Total Thrombus Formation Analysis (T-TAS). A total sample of 200 patients allows >80% power to detect superiority of each de-escalation arm versus control (α = 0.017).</p><p><strong>Conclusions: </strong>DESC-HBR is the first randomized trial directly comparing multiple P2Y₁₂ inhibitor de-escalation strategies in HBR patients post-ACS. By integrating pharmacodynamic, clinical, and patient-reported outcomes, it will provide information to guide individualized antiplatelet strategies balancing ischemic protection and bleeding mitigation in HBR patients.</p><p><strong>Clinical trial registration unique identifier: </strong>NCT05903976, EudraCT 2023-000029-10.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine echocardiography after left atrial appendage closure: The impact of patient selection and clinical triage on outcomes.","authors":"Gazi Capar","doi":"10.1016/j.carrev.2026.07.021","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.021","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary sinus reduction therapy for refractory angina: Current evidence and future directions.","authors":"Debabrata Dash, Umanshi Dash, Sreenivas Reddy, Naeem Hasanfatta","doi":"10.1016/j.carrev.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.07.015","url":null,"abstract":"<p><p>Refractory angina is a chronic, debilitating condition characterized by persistent anginal symptoms despite optimal medical therapy and when further revascularization is not feasible. This condition is a major global cardiovascular healthcare challenge. The coronary sinus reducer represents an emerging therapeutic option intended to relieve symptoms by increasing coronary venous pressure and redistributing myocardial blood flow to ischemic subendocardial regions. Growing evidence has demonstrated improvements in angina class and quality of life, although results vary across studies and benefit magnitude is modest in blinded studies. This device appears to be safe and effective in reducing angina burden and improving quality of life in appropriately selected patients. Mechanistic understanding continues to evolve, and large ongoing randomized trials and meta-analyses aim to refine the indication, patient selection (including patients with microvascular angina), and long-term outcomes. Health-technology appraisals recognize potential clinical utility but call for more robust long-term data. This review provides an up-to-date description of the device, physiological rationale, clinical evidence, procedural technique, complications, and future directions. It also highlights knowledge gaps and discusses areas of on-going research.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of manual with mechanical aspiration thrombectomy in patients presenting with acute coronary syndrome","authors":"Matthew Nardi,&nbsp;Mohamed Rezk,&nbsp;Jorge Escobar,&nbsp;Alexander Postalian,&nbsp;Kathy Dougherty,&nbsp;Allison Weiderhold,&nbsp;Priyanka Sen,&nbsp;Mahboob Alam,&nbsp;George Younis,&nbsp;Mehran Massumi,&nbsp;Emerson Perin,&nbsp;Nikolaos Diakos","doi":"10.1016/j.carrev.2025.12.020","DOIUrl":"10.1016/j.carrev.2025.12.020","url":null,"abstract":"<div><h3>Background</h3><div>Routine manual aspiration thrombectomy has shown limited benefit in patients with acute coronary syndrome (ACS). Selective application of mechanical thrombectomy in patients with ACS and high thrombus burden may improve coronary flow and myocardial perfusion. We aimed to compare safety and efficacy between manual (MaT) and mechanical aspiration thrombectomy (MeT) in this population.</div></div><div><h3>Methods</h3><div>Retrospective review of 70 patients presenting with ACS between May 2019 and February 2024, with 27 receiving MaT and 43 MeT. Our comparative analysis included Thrombolysis in Myocardial Infarction (TIMI) thrombus grade, TIMI flow grade, Myocardial Blush grade, survival to discharge and stroke.</div></div><div><h3>Results</h3><div>There was no difference in the clinical characteristics of the two groups except higher prevalence of hypertension in the MaT group (93 % vs 70 % in MeT, <em>p</em> = 0.02). Baseline thrombus burden did not differ between groups. Both MaT and MeT resulted in a significant reduction in thrombus burden and improvement in coronary flow and myocardial blush. MaT and MeT had similar post-thrombectomy rates of TIMI thrombus grade 0 (63 % vs 77 %, <em>p</em> = 0.3), TIMI flow grade 3 (70 % vs 67 %, <em>p</em> = 1) and Myocardial Blush grade 3 (44 % vs 51 %, <em>p</em> = 0.6). One stroke was reported in the MeT group. Finally, Survival to discharge was similar (MaT 88 % vs MeT 84 %, <em>p</em> = 0.7).</div></div><div><h3>Conclusions</h3><div>Selective thrombectomy in ACS patients with high thrombus burden is safe and effectively reduces thrombus burden while improving coronary flow and myocardial perfusion. Manual and mechanical thrombectomy show similar efficacy and safety profiles.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 37-41"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145945620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular lithotripsy with or without rotational atherectomy for coronary calcific nodule treatment","authors":"Marco Zuin,&nbsp;Giuseppe Marchese,&nbsp;Ervis Hiso,&nbsp;Andrea Bertolini,&nbsp;Alberto Zamboni,&nbsp;Gianluca Rigatelli","doi":"10.1016/j.carrev.2025.12.005","DOIUrl":"10.1016/j.carrev.2025.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Calcific coronary nodules (CNs) are a challenging form of coronary artery disease, often linked to acute coronary syndromes (ACS) and resistant to standard lesion preparation. While intravascular lithotripsy (IVL) and rotational atherectomy (RA) are used for plaque modification, the optimal strategy remains unclear. This study compares procedural characteristics and mid-term outcomes of IVL alone versus IVL combined with RA (IVL + RA) in patients with CNs.</div></div><div><h3>Methods</h3><div>In this prospective, single-center study, 120 patients with angiographically confirmed CNs undergoing PCI were analyzed after 1:1 propensity score matching (PSM) to compare IVL (<em>n</em> = 60) versus IVL + RA (n = 60). Clinical, angiographic, and procedural data were collected. The primary endpoint was major adverse cardiovascular events (MACE) at 6 months, including cardiovascular death, ACS, or target vessel revascularization. Secondary endpoints included intraprocedural complications and 30-day outcomes.</div></div><div><h3>Results</h3><div>Baseline characteristics and lesion complexity were well matched between groups. Procedural success and stent deployment metrics were similar. Rates of intraprocedural complications were low and not significantly different (6.7 % IVL vs. 8.3 % IVL + RA; <em>p</em> = 0.68). At 6 months, MACE rates were comparable (8.3 % vs. 10.3 %; <em>p</em> = 0.68), with no differences in cardiovascular death (5.0 % vs. 6.9 %) or ACS (6.7 % vs. 8.6 %).</div></div><div><h3>Conclusions</h3><div>In patients with calcific nodules, both IVL alone and the IVL + RA combination showed similar safety and efficacy, with low complication rates and comparable mid-term outcomes. Further randomized studies are needed to determine the optimal treatment approach for this high-risk group.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 61-65"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prasugrel monotherapy versus 12-month dual antiplatelet therapy in STEMI patients undergoing intravascular imaging-guided PCI: Study design and rationale of the randomized PREMIUM trial","authors":"Kuniaki Takahashi,&nbsp;Ken Kozuma,&nbsp;Yoshihiro Morino,&nbsp;Kosuke Kashiwabara,&nbsp;Hiromasa Otake,&nbsp;Satoru Suwa,&nbsp;Mamoru Nanasato,&nbsp;Takashi Muramatsu,&nbsp;Hitoshi Anzai,&nbsp;Akihiro Shirakabe,&nbsp;Masashi Yamamoto,&nbsp;Yasuhide Asaumi,&nbsp;Masashi Sakuma,&nbsp;Hideki Okayama,&nbsp;Yuji Ikari,&nbsp;Gaku Nakazawa","doi":"10.1016/j.carrev.2025.12.007","DOIUrl":"10.1016/j.carrev.2025.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Previous randomized trials have demonstrated the safety of P2Y₁₂ inhibitor monotherapy after 1–3 months of dual antiplatelet therapy (DAPT) compared with 12-month DAPT following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes. However, the safety of initiating prasugrel monotherapy at the time of primary PCI in patients presenting with ST-segment elevation myocardial infarction (STEMI) remains unknown.</div></div><div><h3>Methods/design</h3><div>The PREMIUM (Prasugrel monotherapy following primary percutaneous coronary intervention for ST-elevation myocardial infarction) trial is an investigator-initiated, open-label, multicenter randomized controlled trial. A total of 2268 STEMI patients indicated for primary PCI with current generation platinum‑chromium everolimus-eluting stents were randomized 1:1 to either prasugrel monotherapy (20 mg loading, 3.75 mg daily) initiated before PCI or standard 12-month DAPT with aspirin plus prasugrel. The primary endpoint is a composite of all-cause death, myocardial infarction, or stroke at 12 months tested for noninferiority. The major secondary endpoint is Bleeding Academic Research Consortium type 3 or 5 bleeding at 12 months tested for superiority.</div></div><div><h3>Summary</h3><div>The PREMIUM trial is the first large-scale randomized study to evaluate an upfront aspirin-free strategy with prasugrel monotherapy compared with standard 12-month DAPT in STEMI undergoing contemporary imaging-guided PCI. The trial is designed to determine noninferiority for ischemic outcomes and to assess superiority in reducing major bleeding at 12 months in East Asian patients.</div></div><div><h3>Trial registration</h3><div><span><span>NCT05709626</span><svg><path></path></svg></span>; jRCTs052220145.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 30-36"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous micro-axial flow pump use during non-emergent high-risk PCI: The authors reply","authors":"Hossam Elbenawi,&nbsp;Mahmoud Shaaban Abdelgalil,&nbsp;Morad Zaaya,&nbsp;Mohamed Doma,&nbsp;Busra Cangut,&nbsp;Omar Almaadawy,&nbsp;Islam Abdelkarim,&nbsp;Ramzi Ibrahim,&nbsp;Yasser Ahmed Sadek,&nbsp;Karim M. Al-Azizi,&nbsp;Andrew M. Goldsweig,&nbsp;Ayman Elbadawi,&nbsp;Gregg W. Stone,&nbsp;Islam Y. Elgendy","doi":"10.1016/j.carrev.2026.04.011","DOIUrl":"10.1016/j.carrev.2026.04.011","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 101-102"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: All the roads lead to the heart: Which one are you taking?","authors":"Georges Ephrem","doi":"10.1016/j.carrev.2026.06.003","DOIUrl":"10.1016/j.carrev.2026.06.003","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 21-22"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiographic phenotypes predict FFR/iFR discordance in severe aortic stenosis: A cluster analysis","authors":"Artur Dziewierz,&nbsp;Barbara Zdzierak,&nbsp;Łukasz Rzeszutko,&nbsp;Łukasz Niewiara,&nbsp;Jacek Legutko,&nbsp;Paweł Kleczyński","doi":"10.1016/j.carrev.2025.12.004","DOIUrl":"10.1016/j.carrev.2025.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Assessing coronary artery disease in severe aortic stenosis (AS) is challenging due to altered hemodynamics, causing discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). The role of angiographic lesion characteristics in predicting this discordance remains unclear.</div></div><div><h3>Objectives</h3><div>To identify angiographic predictors of FFR/iFR discordance and define distinct angiographic phenotypes using unsupervised machine learning.</div></div><div><h3>Methods</h3><div>This prospective, single-center registry evaluated 401 intermediate coronary lesions from 221 patients with severe AS (aortic valve area &lt; 1.0 cm², mean gradient &gt;40 mmHg) using FFR and iFR. Quantitative coronary angiography measured percent diameter stenosis (%DS), lesion length (LL), and other parameters. The primary outcome was FFR/iFR discordance. Receiver operating characteristic and decision curve analyses evaluated %DS predictive utility. K-means clustering was applied to %DS and LL to identify lesion phenotypes.</div></div><div><h3>Results</h3><div>FFR/iFR discordance occurred in 30 lesions (7.5 %), exclusively as FFR-negative/iFR-positive pattern. Higher %DS was the only independent angiographic predictor of discordance (adjusted OR 1.35 per 10 % increase; 95 % CI 1.12–1.64; <em>p</em> = 0.002), with modest discriminative ability (AUC = 0.69). Cluster analysis identified three phenotypes: Cluster 0 (High %DS [median 75.0 %]/Intermediate LL [median 15.0 mm], <em>n</em> = 103); Cluster 1 (Low %DS [median 49.0 %]/Short-Intermediate LL [median 13.6 mm], <em>n</em> = 220); and Cluster 2 (Intermediate %DS [median 63.5 %]/Long LL [median 32.4 mm], <em>n</em> = 78). Discordance incidence was highest in Cluster 0 (16.5 %) versus Clusters 1 (2.7 %) and 2 (9.0 %) (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In severe AS, FFR/iFR discordance manifests solely as FFR-negative/iFR-positive pattern. While %DS modestly predicts this mismatch, unsupervised clustering reveals that “High %DS / Intermediate Length” lesions primarily drive physiological discordance, identifying cases where iFR may overestimate severity due to AS-related hemodynamics.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"89 ","pages":"Pages 52-58"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}