Eurointervention最新文献

{"title":"Changes in blood pressure after crossover to ultrasound renal denervation.","authors":"Michael J Bloch, Michel Azizi, Ajay J Kirtane, Felix Mahfoud, Andrew S P Sharp, Maureen McGuire, Candace K McClure, Michael Weber, On Behalf Of The Radiance Investigators","doi":"10.4244/EIJ-D-24-00321","DOIUrl":"https://doi.org/10.4244/EIJ-D-24-00321","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"93-95"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958896","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":"A systematic review of enrolment criteria and treatment efficacy for microvascular angina.","authors":"Matthew Hammond-Haley, Kayla Chiew, Fiyyaz Ahmed-Jushuf, Christopher A Rajkumar, Michael J Foley, Florentina A Simader, Shayna Chotai, Matthew J Shun-Shin, Rasha Al-Lamee","doi":"10.4244/EIJ-D-24-00404","DOIUrl":"https://doi.org/10.4244/EIJ-D-24-00404","url":null,"abstract":"<p><strong>Background: </strong>Microvascular angina (MVA) is an important contributor to morbidity and mortality in patients with non-obstructive coronary artery disease. Despite improvements in its recognition and diagnosis, uncertainty remains around the most effective treatment strategy, and more data are needed.</p><p><strong>Aims: </strong>We aimed to evaluate the quality of patient selection in treatment studies of MVA and provide a contemporary overview of the evidence base for the treatment of MVA.</p><p><strong>Methods: </strong>PubMed, the Cochrane Library and Google Scholar were searched from inception to 4 November 2023 for all treatment studies in patients with angina and non-obstructive coronary artery disease or coronary microvascular dysfunction. Populations with acute coronary syndrome were excluded (PROSPERO: CRD42023383075).</p><p><strong>Results: </strong>Forty-three studies were included. By contemporary definitions of MVA according to the Coronary Vasomotor Disorders International Study Group criteria, 11 (26%) studies enrolled patients with \"definitive\" MVA, 24 (56%) with \"suspected\" MVA, and 8 (19%) did not enrol patients who met the diagnostic criteria. A total of 24 unique treatment interventions were investigated. Most studies were observational and single armed (12/24, 50%) or had a single randomised study (9/24, 38%). Ranolazine is the most well-studied intervention drug. Double-blind randomised controlled trials of ranolazine (n=6) have shown inconsistent improvements in Seattle Angina Questionnaire scores and coronary flow reserve with short-term follow-up.</p><p><strong>Conclusions: </strong>Treatment studies of MVA enrolled a heterogeneous population, with only a quarter meeting contemporary diagnostic criteria for definitive MVA. There is a paucity of high quality, randomised data to support any specific treatment intervention. Larger studies with robust selection criteria, blinded patient-reported outcomes, and long-term follow-up are needed.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"46-57"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958781","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":"Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials.","authors":"Yaser Jenab, Parham Sadeghipour, Reza Mohseni-Badalabadi, Raheleh Kaviani, Kaveh Hosseini, Yeganeh Pasebani, Hamid Khederlou, Ali Rafati, Zohre Mohammadi, Sepehr Jamalkhani, Azita Haj Hossein Talasaz, Ata Firouzi, Hamid Ariannejad, Mohammad Javad Alemzadeh-Ansari, Sajjad Ahmadi-Renani, Mohsen Maadani, Melody Farrashi, Hooman Bakhshandeh, Gregory Piazza, Harlan M Krumholz, Roxana Mehran, Gregory Y H Lip, Behnood Bikdeli","doi":"10.4244/EIJ-D-24-00527","DOIUrl":"10.4244/EIJ-D-24-00527","url":null,"abstract":"<p><strong>Background: </strong>The role of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT) after ST-elevation myocardial infarction (STEMI) remains uncertain.</p><p><strong>Aims: </strong>We aimed to compare the effect of rivaroxaban versus warfarin in patients with STEMI complicated by LVT.</p><p><strong>Methods: </strong>Adult patients with STEMI and two-dimensional transthoracic echocardiography showing LVT were assigned to rivaroxaban (15 mg once daily) or warfarin (international normalised ratio goal of 2.0-2.5) in an open-label, randomised clinical trial (RCT). A prospective pooled analysis was planned comparing DOAC- versus warfarin-based anticoagulation for the same indication. The main outcome of the RCT was complete LVT resolution at 3 months, determined by a blinded imaging core laboratory. Complete LVT resolution and bleeding were investigated in the pooled analysis.</p><p><strong>Results: </strong>A total of 50 patients (median age: 55 years, 18% females) were enrolled from June 2020 to November 2022. Three-month complete LVT resolution occurred in 19/25 (76.0%) patients assigned to rivaroxaban and 13/24 (54.2%) assigned to warfarin (relative risk [RR] 1.40, 95% confidence interval [CI]: 0.91-2.15; p=0.12) with no thrombotic or major bleeding events. Pooled analysis showed numerically better complete LVT resolution with DOACs (rivaroxaban and apixaban; 93/115 [80.8%] vs 79/112 [70.5%], RR 1.14, 95% CI: 0.98-1.32; p=0.08) and less major bleeding (2/116 [1.7%] and 9/112 [8.0%], risk difference -0.06, 95% CI: -0.12 to 0.00; p=0.05) than with warfarin.</p><p><strong>Conclusions: </strong>Although the findings are limited by a small sample size, the results suggest that DOACs are safe with at least similar outcomes concerning LVT resolution and major bleeding compared with warfarin. (ClinicalTrials.gov: NCT05705089).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"82-92"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958899","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":"Usefulness of FFR-CT to exclude haemodynamically significant lesions in high-risk NSTE-ACS.","authors":"David Meier, Daniele Andreini, Bernard Cosyns, Ioannis Skalidis, Tatyana Storozhenko, Thabo Mahendiran, Emilio Assanelli, Jeroen Sonck, Bram Roosens, David C Rotzinger, Salah Dine Qanadli, Georgios Tzimas, Olivier Muller, Bernard De Bruyne, Carlos Collet, Stephane Fournier","doi":"10.4244/EIJ-D-24-00779","DOIUrl":"10.4244/EIJ-D-24-00779","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) derived from CCTA (FFR-CT) may provide a means of reducing unnecessary invasive coronary angiography (ICA) in patients with suspected non-ST-elevation acute coronary syndromes (NSTE-ACS).</p><p><strong>Aims: </strong>The aim of this study was to evaluate the capacity of FFR-CT and CCTA to rule out significant lesions in high-risk NSTE-ACS patients, using ICA with invasive FFR as the gold standard.</p><p><strong>Methods: </strong>High-risk NSTE-ACS patients admitted to 4 European centres were enrolled in this single-arm, prospective core lab-adjudicated study. Patients underwent CCTA with FFR-CT analysis, followed by ICA with invasive FFR.</p><p><strong>Results: </strong>Out of the 250 initially planned NSTE-ACS patients, 168 were included, of whom 151 (92%) had sufficient CCTA image quality to undergo CCTA and FFR-CT analysis. The median high-sensitivity troponin T level at 1 hour post-hospitalisation was 5.3 (interquartile range: 1.8-18.6) times the upper reference limit. At the patient level, the diagnostic performance of FFR-CT was numerically higher as compared to CCTA though not statistically significant (sensitivity: 94% vs 93%, specificity: 63% vs 54%, positive predictive value: 83% vs 79%, negative predictive value: 85% vs 80% and accuracy: 83% vs 79%; p=0.58), suggesting an enhanced capability to avoid unnecessary ICA. At the lesion level, the ability of FFR-CT to detect significant lesions was significantly better than that of CCTA (receiver operating characteristic curves: 0.84 vs 0.65 respectively; p<0.01).</p><p><strong>Conclusions: </strong>In patients with high-risk NSTE-ACS, FFR-CT offers better diagnostic accuracy - though not statistically significant - and a higher ability to rule out haemodynamically significant stenoses as compared to CCTA. This indicates that FFR-CT can reduce unnecessary invasive procedures by more accurately identifying patients requiring further intervention.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":"73-81"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523689","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":"Direct oral anticoagulants for ventricular thrombus resolution: pilot trials show reassuring efficacy and safety compared to warfarin.","authors":"Felicita Andreotti, Francesco Burzotta","doi":"10.4244/EIJ-E-24-00068","DOIUrl":"https://doi.org/10.4244/EIJ-E-24-00068","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"20-21"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958898","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":"High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the ESC Working Group on Cardiovascular Surgery.","authors":"Andreas Schäfer, Mirvat Alasnag, Daniele Giacoppo, Carlos Collet, Tanja K Rudolph, Ariel Roguin, Piotr P Buszman, Roisin Colleran, Giulio Stefanini, Thierry Lefevre, Nicolas Van Mieghem, Guillaume Cayla, Christoph Naber, Andreas Baumbach, Adam Witkowski, Francesco Burzotta, Davide Capodanno, Dariusz Dudek, Rasha Al-Lamee, Adrian Banning, Philip MacCarthy, Roman Gottardi, Florian S Schoenhoff, Martin Czerny, Matthias Thielmann, Nikos Werner, Giuseppe Tarantini","doi":"10.4244/EIJ-D-23-01100","DOIUrl":"10.4244/EIJ-D-23-01100","url":null,"abstract":"<p><p>This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.g., residual symptoms), and for whom the Heart Team estimates that revascularisation may have a prognostic benefit (e.g., left main, last remaining vessel, multivessel disease with large areas of ischaemia); however, there is a lack of data regarding the size of this patient population. This document aims to guide interventional cardiologists on how to proceed with PCI in such high-risk patients with reduced left ventricular ejection fraction after the decision of the Heart Team is made that CABG - which overall is the guideline-recommended option for revascularisation in these patients - is not an option and that PCI may be beneficial for the patient. Importantly, when a high-risk PCI is planned, a multidisciplinary decision by interventional cardiologists, cardiac surgeons, anaesthetists and non-invasive physicians with expertise in heart failure management and intensive care should be agreed upon after careful consideration of the possible undesirable consequences of PCI, including futility, similar to the approach for structural interventions.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"22-34"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958900","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":"Avoiding invasive angiography in non-ST-elevation MI patients: are coronary CT angiography and FFR-CT the answer?","authors":"Nick Curzen","doi":"10.4244/EIJ-E-24-00059","DOIUrl":"https://doi.org/10.4244/EIJ-E-24-00059","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"18-19"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958766","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":"Comprehensive diagnosis in chronic coronary syndromes combining angiography and intracoronary testing: the AID-ANGIO study.","authors":"Adrián Jerónimo, José G Paredes-Vázquez, Alejandro Travieso, Asad Shabbir, Pilar Jiménez-Quevedo, Fernando Macaya-Ten, Luis Nombela-Franco, Iván J Núñez-Gil, Pablo Salinas, Juan Carlos Gómez-Polo, Daniel García-Arribas, Isidre Vilacosta, Javier García Pérez-Velasco, Eva García-Romo, Alberto García-Lledó, Juan Manuel Grande-Ingelmo, Inmaculada Fernández-Rozas, Javier Alonso-Belló, Alejandro Curcio, Antonio I Fernández-Ortiz, Julián P Villacastín, Hernán Mejía-Rentería, Nieves Gonzalo, Javier Escaned","doi":"10.4244/EIJ-D-24-00499","DOIUrl":"10.4244/EIJ-D-24-00499","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic yield of invasive coronary angiography (ICA) in patients with chronic coronary syndromes (CCS) in contemporary practice is uncertain.</p><p><strong>Aims: </strong>We investigated the value of an advanced invasive diagnosis (AID) strategy combining angiography and intracoronary testing.</p><p><strong>Methods: </strong>AID-ANGIO is an all-comers, prospective, multicentre study enrolling CCS patients referred for ICA. Obstructive coronary artery disease (CAD) was investigated with angiography and pressure guidewires. In the absence of obstructive CAD, intracoronary testing for ischaemia with non-obstructive coronary arteries (INOCA) was performed. The primary endpoint was the proportion of patients with a cause of ischaemia identified by the AID strategy. To assess the effect of AID on decision-making, an initial therapeutic plan was first prepared by clinical cardiologists based on ICA and medical information. Subsequently, based on AID data, a final therapeutic plan was drafted by clinical and interventional cardiologists (Ischaemia Team).</p><p><strong>Results: </strong>We enrolled 317 patients (44.2% female). Based on ICA, obstructive CAD was diagnosed in 32.2% of patients. With the AID strategy, a cause of myocardial ischaemia was identified in 84.2% (p<0.001): obstructive CAD in 39.1% and INOCA in 45.1%. Only 15.8% of patients did not show any abnormalities. Modification of the original treatment plan with the AID strategy occurred in 59.9% of cases.</p><p><strong>Conclusions: </strong>In assessing ischaemia-generating coronary abnormalities, prespecified use of the AID strategy was associated with a 2.6-fold increase in diagnostic yield compared with ICA (84.2% vs 32.2%, respectively), largely due to the identification of INOCA. Modification of the therapeutic plan with the AID strategy occurred in 59.9% of cases. (ClinicalTrials.gov: NCT05635994).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 1","pages":"35-45"},"PeriodicalIF":7.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958897","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":"Coronary revascularisation deferral based on quantitative flow ratio or fractional flow reserve: a post hoc analysis of the FAVOR III Europe trial.","authors":"Birgitte K Andersen, Niels R Holm, Lone J H Mogensen, Luc Maillard, Truls Råmunddal, Andrea Erriquez, Evald H Christiansen, Javier Escaned, On Behalf Of The Favor Iii Europe Study Team","doi":"10.4244/EIJ-D-24-01001","DOIUrl":"10.4244/EIJ-D-24-01001","url":null,"abstract":"<p><strong>Background: </strong>Safe deferral of revascularisation is a key aspect of physiology-guided percutaneous coronary intervention (PCI). While recent evidence gathered in the FAVOR III Europe trial showed that quantitative flow ratio (QFR) guidance did not meet non-inferiority to fractional flow reserve (FFR) guidance, it remains unknown if QFR might have a specific value in revascularisation deferral.</p><p><strong>Aims: </strong>We aimed to evaluate the safety of coronary revascularisation deferral based on QFR as compared with FFR.</p><p><strong>Methods: </strong>Patients randomised in the FAVOR III trial in whom PCI was deferred in at least one coronary artery, based on QFR or FFR>0.80, were included in the present substudy. The primary outcome was the 1-year rate of major adverse cardiac events (MACE), with results reported for two subsets of deferred patients: (1) any study lesion deferral and (2) complete study lesion deferral.</p><p><strong>Results: </strong>A total of 523 patients (55.2%) in the QFR group and 599 patients (65.3%) in the FFR group had at least one coronary revascularisation deferral. Of these, 433 patients (82.8%) and 511 (85.3%) patients, respectively, had complete study lesion deferral. In the \"complete study lesion deferral\" patient group, the occurrence of MACE was significantly higher in QFR-deferred patients as compared with FFR-deferred patients (24 [5.6%] vs 14 [2.8%], adjusted hazard ratio [HR] 2.07, 95% confidence interval [CI]: 1.07-4.03; p=0.03). In the subgroup of \"any study lesion deferral\", the MACE rate was 5.6% vs 3.6% (QFR vs FFR), adjusted HR 1.55, 95% CI: 0.88-2.73; p=0.13.</p><p><strong>Conclusions: </strong>QFR-based deferral of coronary artery revascularisation resulted in a higher incidence of 1-year MACE as compared with FFR-based deferral.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924089","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":"Is next-day discharge after uncomplicated transcatheter aortic valve implantation the new standard of care?","authors":"Giuliano Costa, Sofia Sammartino","doi":"10.4244/EIJ-E-24-00056","DOIUrl":"10.4244/EIJ-E-24-00056","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 24","pages":"e1488-e1489"},"PeriodicalIF":7.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830851","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}