EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-25-00331
Youngwoo Jang, Sang-Don Park, Joon Pyo Lee, Seong Huan Choi, Min Gyu Kong, Yoon Sun Won, Minsu Kim, Kyoung Hoon Lee, Seung Hwan Han, Sung Woo Kwon, Jon Suh, Woong Chol Kang
{"title":"One-month dual antiplatelet therapy followed by prasugrel monotherapy at a reduced dose: the 4D-ACS randomised trial.","authors":"Youngwoo Jang, Sang-Don Park, Joon Pyo Lee, Seong Huan Choi, Min Gyu Kong, Yoon Sun Won, Minsu Kim, Kyoung Hoon Lee, Seung Hwan Han, Sung Woo Kwon, Jon Suh, Woong Chol Kang","doi":"10.4244/EIJ-D-25-00331","DOIUrl":"10.4244/EIJ-D-25-00331","url":null,"abstract":"<p><strong>Background: </strong>The efficacy and safety of a 1-month prasugrel-based dual antiplatelet therapy (DAPT) strategy followed by reduced-dose prasugrel monotherapy in acute coronary syndrome (ACS) patients treated with drug-coated stents (DCS) have not been studied.</p><p><strong>Aims: </strong>We aimed to evaluate the safety and efficacy of a 1-month prasugrel-based DAPT regimen followed by reduced-dose monotherapy in ACS patients receiving a DCS.</p><p><strong>Methods: </strong>In the multicentre, randomised, open-label trial, 656 ACS patients (age: 60.9±9.7 years; 82.6% male) receiving DCS were randomised to either 1-month DAPT with aspirin 100 mg and prasugrel 10 mg (or 5 mg in patients aged ≥75 years or body weight <60 kg) followed by prasugrel 5 mg monotherapy (1M-DAPT) or 12-month DAPT with aspirin and prasugrel 5 mg (12M-DAPT). The primary endpoint was 12-month net adverse clinical events (NACE), a composite of death, non-fatal myocardial infarction, stroke, ischaemia-driven target vessel revascularisation, and Bleeding Academic Research Consortium Type 2-5 bleeding.</p><p><strong>Results: </strong>NACE occurred in 4.9% of the 1M-DAPT group and 8.8% of the 12M-DAPT group, meeting the criteria for both non-inferiority (non-inferiority margin: 2.0%; absolute difference: -3.9%; 95% confidence interval [CI] for absolute difference: -6.7% to -0.2%; p=0.014) and superiority (hazard ratio [HR] 0.51; 95% CI: 0.27-0.95; p=0.034). Any bleeding occurred in 1.2% vs 5.2% (HR 0.23; p=0.009), and major bleeding occurred in 0.6% vs 4.6% (HR 0.13; p=0.007) in the 1M-DAPT versus 12M-DAPT group, respectively. Ischaemic outcomes were similar.</p><p><strong>Conclusions: </strong>In ACS patients treated with DCS, a 1-month prasugrel-based DAPT strategy followed by prasugrel 5 mg monotherapy reduced NACE by 49%, mainly driven by a 77% reduction of bleeding events without compromising ischaemic safety.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":"e796-e809"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112767","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-24-00387
Hector M Garcia-Garcia, Jorge Sanz-Sanchez, Natalia Pinilla-Echeverri, Pablo J Blanco, Christos Bourantas, Fernando Alfonso
{"title":"Advances in coronary imaging of atherosclerotic plaques.","authors":"Hector M Garcia-Garcia, Jorge Sanz-Sanchez, Natalia Pinilla-Echeverri, Pablo J Blanco, Christos Bourantas, Fernando Alfonso","doi":"10.4244/EIJ-D-24-00387","DOIUrl":"10.4244/EIJ-D-24-00387","url":null,"abstract":"<p><p>Atherosclerosis is a complex disease with multiple factors associated with its progression and complications.Fibroatheroma is a pathological entity which contains abundant lipid, and often, a thin fibrous cap that is the most common underlying cause of acute myocardial infarction. Based on pathological descriptions, we propose a new imaging-based nomenclature indicating high-risk plaque characteristics that can be identified with imaging. Additionally, we review the literature indicating in vivo plaque characterisation as well as outlining the natural history of plaques and, more importantly, its responses to systemic and local therapies. Intravascular imaging has positively impacted how we evaluate atherosclerosis, and it can provide guidance on the use of tailored therapies and the evaluation of their long-term follow-up effects.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e778-e795"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709858","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-25-00025
Koshiro Sakai, Jeroen Sonck, Takuya Mizukami, Hitoshi Matsuo, Brian Ko, Divaka Perera, Hirohiko Ando, Simone Biscaglia, Fernando Rivero, Antonio Maria Leone, Liyew Desta, Javier Escaned, Masafumi Nakayama, Daniel Munhoz, Tatyana Storozhenko, Hirofumi Ohashi, Gianluca Campo, Tetsuya Amano, Toshiro Shinke, Ziad Ali, Bernard De Bruyne, Nils P Johnson, Carlos Collet, Allen Jeremias
{"title":"Validation of the pullback pressure gradient in resting conditions.","authors":"Koshiro Sakai, Jeroen Sonck, Takuya Mizukami, Hitoshi Matsuo, Brian Ko, Divaka Perera, Hirohiko Ando, Simone Biscaglia, Fernando Rivero, Antonio Maria Leone, Liyew Desta, Javier Escaned, Masafumi Nakayama, Daniel Munhoz, Tatyana Storozhenko, Hirofumi Ohashi, Gianluca Campo, Tetsuya Amano, Toshiro Shinke, Ziad Ali, Bernard De Bruyne, Nils P Johnson, Carlos Collet, Allen Jeremias","doi":"10.4244/EIJ-D-25-00025","DOIUrl":"10.4244/EIJ-D-25-00025","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e820-e823"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709864","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-E-25-00031
Gregg W Stone, Oludamilola Akinmolayemi
{"title":"Supersaturated oxygen therapy to reduce myocardial infarct size: time to pay attention!","authors":"Gregg W Stone, Oludamilola Akinmolayemi","doi":"10.4244/EIJ-E-25-00031","DOIUrl":"10.4244/EIJ-E-25-00031","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e774-e775"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709862","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-24-00461
Ali Husain, Julius Jelisejevas, John King Khoo, Jasem Althekrallah, Noah Tregobov, Sophie Offen, Kevin Millar, Jonathon A Leipsic, David Meier, Stephanie L Sellers, John G Webb
{"title":"The heterogeneity of response to direct oral anticoagulants in patients with hypoattenuating leaflet thickening.","authors":"Ali Husain, Julius Jelisejevas, John King Khoo, Jasem Althekrallah, Noah Tregobov, Sophie Offen, Kevin Millar, Jonathon A Leipsic, David Meier, Stephanie L Sellers, John G Webb","doi":"10.4244/EIJ-D-24-00461","DOIUrl":"10.4244/EIJ-D-24-00461","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e827-e828"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709863","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-E-25-00023
Thomas Cuisset, Guillaume Cayla
{"title":"DAPT de-escalation post-ACS: a new rule or just a new option? Lessons from the 4D-ACS trial.","authors":"Thomas Cuisset, Guillaume Cayla","doi":"10.4244/EIJ-E-25-00023","DOIUrl":"10.4244/EIJ-E-25-00023","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":"e772-e773"},"PeriodicalIF":7.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112765","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-25-00034
Tobias König, Dominik Berliner, Johanna Diekmann, Muharrem Akin, Tobias Pfeffer, Carolina Sanchez Martinez, Vera Garcheva, Frank M Bengel, Johann Bauersachs, Andreas Schäfer
{"title":"Impact of intracoronary supersaturated oxygen therapy on microvascular obstruction and infarct size in patients with acute anterior myocardial infarction.","authors":"Tobias König, Dominik Berliner, Johanna Diekmann, Muharrem Akin, Tobias Pfeffer, Carolina Sanchez Martinez, Vera Garcheva, Frank M Bengel, Johann Bauersachs, Andreas Schäfer","doi":"10.4244/EIJ-D-25-00034","DOIUrl":"10.4244/EIJ-D-25-00034","url":null,"abstract":"<p><strong>Background: </strong>Final infarct size (FIS) and microvascular obstruction (MVO) are associated with heart failure hospitalisations and mortality in patients with acute myocardial infarction (AMI). Interventions beyond primary percutaneous coronary intervention (PCI) to reduce FIS are needed. Supersaturated oxygen (SSO<sub>2</sub>) therapy demonstrated reduced FIS in clinical trials.</p><p><strong>Aims: </strong>We aimed to investigate whether routine use of SSO<sub>2</sub> reduces FIS and MVO in clinical practice.</p><p><strong>Methods: </strong>Intracoronary SSO<sub>2</sub> was delivered for 60 minutes after successful primary PCI in patients with anterior AMI. Results from 20 SSO<sub>2</sub> patients were compared with those from 20 similar non-SSO<sub>2</sub> AMI patients. Multimodal imaging including single-photon emission computed tomography (SPECT), fibroblast activation protein inhibitor positron emission tomography (FAPI-PET), and cardiac magnetic resonance imaging (CMR) was performed to assess left ventricular function, FIS, area at risk, extent of myocardial fibroblast activation, myocardial salvage, and MVO.</p><p><strong>Results: </strong>The two groups did not significantly differ regarding sex, age, weight, hypertension, dyslipidaemia, smoking and diabetes status, prehospital cardiac arrest, door-to-balloon time, Thrombolysis in Myocardial Infarction flow before and after PCI, or renal function (p>0.1 for each) and had comparable area at risk by CMR and FAPI-PET. SSO<sub>2</sub> patients showed lower FIS determined by CMR (SSO<sub>2</sub>: 20% vs non-SSO<sub>2</sub>: 32%; p<0.001) and SPECT (SSO<sub>2</sub>: 16% vs non-SSO<sub>2</sub>: 29%; p=0.014). Myocardial salvage was higher in SSO<sub>2</sub> patients (50% vs 28%; p=0.002). MVO occurred less often and was less extreme under SSO<sub>2</sub> therapy.</p><p><strong>Conclusions: </strong>SSO<sub>2</sub> therapy was associated with significantly reduced microvascular obstruction and FIS in patients with anterior AMI in clinical routine practice.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e810-e819"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709860","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}
EurointerventionPub Date : 2025-07-21DOI: 10.4244/EIJ-D-24-00943
Renato D Lopes, Alexander C Fanaroff
{"title":"Factor XI inhibition for ACS patients: premises and prospects.","authors":"Renato D Lopes, Alexander C Fanaroff","doi":"10.4244/EIJ-D-24-00943","DOIUrl":"10.4244/EIJ-D-24-00943","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 14","pages":"e776-e777"},"PeriodicalIF":9.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709859","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":"Intra- versus supra-annular self-expanding transcatheter heart valves in small aortic annuli.","authors":"Masanori Yamamoto, Toshinobu Ryuzaki, Hirofumi Hioki, Ai Kagase, Shinichi Shirai, Yohei Ohno, Fumiaki Yashima, Toru Naganuma, Masahiro Yamawaki, Yusuke Watanabe, Futoshi Yamanaka, Kazuki Mizutani, Masahiko Noguchi, Masaki Izumo, Kensuke Takagi, Masahiko Asami, Hiroshi Ueno, Hidetaka Nishina, Hiroto Suzuyama, Kazumasa Yamasaki, Kenji Nishioka, Daisuke Hachinohe, Yasushi Fuku, Toshiaki Otsuka, Kentaro Hayashida, On Behalf Of The Ocean-Tavi Investigators","doi":"10.4244/EIJ-D-24-00966","DOIUrl":"10.4244/EIJ-D-24-00966","url":null,"abstract":"<p><strong>Background: </strong>Clinical data are scarce comparing supra-annular self-expanding valves (SA-SEVs) and intra-annular (IA)-SEVs after transcatheter aortic valve implantation (TAVI), particularly in patients with a small aortic annulus (SAA).</p><p><strong>Aims: </strong>We aimed to compare early clinical outcomes, including echocardiographic parameters, between the latest generation of IA-SEV and SA-SEV after TAVI in patients with SAA.</p><p><strong>Methods: </strong>Focused on patients with SAA, defined as an annulus area ≤430 mm<sup>2</sup>, the data of 919 patients who underwent TAVI with an IA-SEV (n=518, Navitor) or an SA-SEV (n=401, Evolut FX) were retrospectively extracted. Differences in valve design on postprocedural results were investigated between the two groups and in the propensity score-matched (PSM) cohort.</p><p><strong>Results: </strong>The postprocedural effective orifice area (EOA), indexed EOA, and mean pressure gradient (mPG) were similar in the overall cohort between the two groups (allp>0.05), whereas the mPG was higher with IA-SEVs than with SA-SEVs (8.74±5.01 mmHg vs 7.84±4.43 mmHg; p=0.049) after PSM (n=219 patients/group). There were no significant differences in the incidence of severe prosthesis-patient mismatch (1.9% vs 0.9%; p=0.405) or paravalvular leakage ≥mild (34.1% vs 42.2%; p=0.084) between the 2 groups in the PSM cohort. The rates of technical success (95.9% vs 95.8%), device success at discharge (91.3% vs 87.8%), and in-hospital death (1.4% vs 0.5%) were comparable in the overall cohort (allp>0.05). These results were not changed in the PSM cohort (allp>0.05).</p><p><strong>Conclusions: </strong>The latest-generation IA-SEV and SA-SEV demonstrated similar clinical results except for a few echocardiographic findings after TAVI in patients with SAA.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 13","pages":"e749-e757"},"PeriodicalIF":7.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585670","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}