Eurointervention最新文献

{"title":"Single-view angiographic microcirculatory resistance index after primary PCI: the EARLY-MYO-AMR study.","authors":"Zhiwen Zhang, Song Ding, Quan Guo, Cao Ma, Fei Lin, Xiaoyu Rao, Qingbo Shi, Yang Gao, Kaiyuan Liu, Haosen Yu, Ming Nie, Chao Liu, Shengli Li, Yuting Gao, Hongjie Gao, Liang Peng, Zhenzhou Zhao, Kang Zhao, Haiyu Tang, Ran You, Min Zhang, Jun Pu, Muwei Li","doi":"10.4244/EIJ-D-24-00952","DOIUrl":"10.4244/EIJ-D-24-00952","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular dysfunction (CMD) leads to inadequate myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The index of microcirculatory resistance (IMR) is an intraoperative diagnostic tool for CMD. However, its widespread application is hindered by the requirement for pressure wires and hyperaemic agents. The angiographic microcirculatory resistance (AMR) index is concise, convenient, accurate, and serves as a pressure wire-free alternative to the IMR.</p><p><strong>Aims: </strong>This study aimed to demonstrate the ability of AMR to detect CMD in patients with STEMI undergoing PPCI therapy and to assess its predictive value for long-term prognosis.</p><p><strong>Methods: </strong>The EARLY-MYO-AMR trial comprised two cohorts. The derivation cohort included 495 patients with STEMI who underwent PPCI within 12 h and cardiac magnetic resonance (CMR) within 14 days of symptom onset. The optimal AMR cutoff value for diagnosing CMD using CMR was determined by analysing the receiver operating characteristic curves. The validation cohort enrolled 2,663 patients with STEMI who underwent PPCI within 12 h of symptom onset from January 2012 to April 2022 across 5 medical centres. All patients were followed up for at least 1 year. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), including cardiac death, hospitalisation for heart failure, repeat myocardial infarction, and target lesion revascularisation.</p><p><strong>Results: </strong>The derivation cohort identified an AMR cutoff >26.6 mmHg*s/dm for predicting CMD post-PPCI (area under the curve 0.721, 95% confidence interval [CI]: 0.677-0.763). Multivariable logistic regression analysis indicated that AMR >26.6 mmHg*s/dm was a CMD risk factor (odds ratio 4.10, 95% CI: 2.56-6.56; p<0.001). The MACE incidence was significantly higher among patients in the validation cohort with AMR >26.6 mmHg*s/dm than among those with AMR ≤26.6 mmHg*s/dm (30.9% vs 21.5%, adjusted hazard ratio [HR] 1.47, 95% CI: 1.20-1.80; p<0.001). MACE incidence increased with AMR, with an adjusted HR of 1.30 (95% CI: 1.17-1.46; p<0.001) per 10 mmHg*s/dm increase. The Bland-Altman and Kappa analyses showed good intra- and interobserver agreement for AMR (intraobserver: bias=-0.104, k=0.914; interobserver: bias=-0.032, k=0.958).</p><p><strong>Conclusions: </strong>AMR >26.6 mmHg*s/dm predicts CMD during PPCI and increased MACE incidence in patients with STEMI. This convenient tool helps in risk stratification and treatment guidance for STEMI prognosis.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e1015-e1027"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979144","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":"Angina and coronary microvascular dysfunction: unravelling the links.","authors":"Colin Berry, Rebecca Hanna","doi":"10.4244/EIJ-E-25-00037","DOIUrl":"https://doi.org/10.4244/EIJ-E-25-00037","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e989-e991"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978952","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 preclinical study of combined hepatic and renal artery denervation.","authors":"Felix Mahfoud, Stefan Tunev, David E Kandzari, Eric A Secemsky, Pam R Taub, Raven A Voora, Lucas Lauder, Cian Ryan, Julie Trudel, Douglas A Hettrick, Markus Schlaich","doi":"10.4244/EIJ-D-25-00349","DOIUrl":"https://doi.org/10.4244/EIJ-D-25-00349","url":null,"abstract":"<p><strong>Background: </strong>Overactivity of the hepatic and renal sympathetic nerves is associated with chronic cardiovascular and metabolic conditions, including hypertension.</p><p><strong>Aims: </strong>We studied the effect of combined renal and hepatic denervation through treatment of the common hepatic artery and the renal arteries.</p><p><strong>Methods: </strong>Denervation was performed in the common hepatic artery and both renal arteries and their major branch vessels in normotensive swine using the same multielectrode radiofrequency (RF) ablation catheter (Symplicity Spyral). Renal and liver tissue samples were obtained for histological examination in two cohorts at 7 and 28 days post-procedure (n=5 sham, n=10 denervation for each timepoint).</p><p><strong>Results: </strong>Combined hepatic and renal denervation was successfully achieved in all animals. At 7 days, the mean lesion depth was 5.8±1.4 mm in the renal arteries and 4.7±0.7 mm in the hepatic artery. Compared with controls, the mean renal cortical norepinephrine (NE) levels were reduced by 88.2% in the 7-day model and by 84.5% in the 28-day model. Liver NE decreased by 94.6% at 7 days and by 91.1% at 28 days (p<0.0001 for all comparisons with baseline). No inadvertent injury was detected in the treated arteries or adjacent tissues.</p><p><strong>Conclusions: </strong>Combined hepatic and renal denervation using the same multielectrode RF denervation system resulted in a substantial reduction in both renal and hepatic tissue NE levels that was sustained up to 28 days without collateral tissue injury. These mechanistic findings may have implications for the treatment of chronic diseases impacted by hepatic and renal sympathetic nervous system overactivity.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e1028-e1036"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978985","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":"Chest pain patterns and coronary microvascular function in non-obstructive coronary artery disease.","authors":"Kai Nogami, Yoshihisa Kanaji, Takumi Toya, Jaskanwal Deep Singh Sara, Claire E Raphael, Rajiv Gulati, Abhiram Prasad, Tsunekazu Kakuta, Lilach O Lerman, Amir Lerman","doi":"10.4244/EIJ-D-25-00277","DOIUrl":"10.4244/EIJ-D-25-00277","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular dysfunction (CMD) is a common cause of chest pain (CP) in patients with angina and non-obstructive coronary arteries (ANOCA). Although both CMD and CP have distinct classifications, the relationship between them remains insufficiently understood.</p><p><strong>Aims: </strong>This study investigated the relationship between CMD and CP patterns and their prognostic impact in ANOCA patients.</p><p><strong>Methods: </strong>Serial patients with ANOCA who underwent coronary reactivity testing were enrolled. CP patterns were categorised as exertional, resting, or both. Endothelium-dependent CMD was defined as a <50% change in coronary blood flow (CBF) with intracoronary acetylcholine infusion and endothelium-independent CMD as a coronary flow reserve (CFR) <2.5 during adenosine-induced hyperaemia. Microvascular function and prognosis were compared between patients with exertional CP and resting CP.</p><p><strong>Results: </strong>Among 1,264 patients, the median age was 52 years, and 65.3% were women; 23.7% had exertional CP, 27.0% resting CP, and 49.4% both. Exertional CP patients had a lower CFR and a higher prevalence of endothelium-independent CMD compared to resting CP patients (2.8 vs 3.0; p=0.014, 32.1% vs 24.4%; p=0.034). Exertional CP patients showed a significantly lower CBF increase in response to acetylcholine (38.2% vs 50.7%; p=0.015). Survival analysis over a median 7-year follow-up revealed that endothelium-independent CMD significantly increased risk in exertional CP patients (p=0.002) but not in resting CP patients (p=0.388).</p><p><strong>Conclusions: </strong>ANOCA patients with exertional CP demonstrated worse microvascular function than those with resting CP, with endothelium-independent CMD showing a significant prognostic impact. Exertional CP patients may benefit more from treatment strategies specifically targeting CMD.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e995-e1004"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979010","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 Bayesian analysis of invasive treatment strategies for elderly patients with acute coronary syndromes.","authors":"George C M Siontis, Orestis Efthimiou","doi":"10.4244/EIJ-D-25-00147","DOIUrl":"https://doi.org/10.4244/EIJ-D-25-00147","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e1037-e1039"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979004","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":"Tip-in balloon grenadoplasty for uncrossable chronic total occlusions.","authors":"Alexandru Achim, Mihai Cocoi","doi":"10.4244/EIJ-D-24-01022","DOIUrl":"https://doi.org/10.4244/EIJ-D-24-01022","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e1040-e1041"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979062","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":"Letter: When gradients diverge: integrating invasive assessment into post-TAVI surveillance.","authors":"Ioannis Skalidis, Stephane Cook, Philippe Garot, Mariama Akodad","doi":"10.4244/EIJ-D-25-00463","DOIUrl":"https://doi.org/10.4244/EIJ-D-25-00463","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e1042"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979136","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":"Angiographic-based assessment of microvascular dysfunction: quo vadis?","authors":"Christos V Bourantas, Yoshinobu Onuma, Hector M Garcia-Garcia, Patrick W Serruys","doi":"10.4244/EIJ-E-25-00045","DOIUrl":"https://doi.org/10.4244/EIJ-E-25-00045","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"21 17","pages":"e992-e994"},"PeriodicalIF":9.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978995","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":"Effect of beta blocker withholding or withdrawal after myocardial infarction without reduced ejection fraction on ischaemic events: a post hoc analysis from the REBOOT trial.","authors":"Xavier Rossello, Pedro L Sánchez, Ruth Owen, Sergio Raposeiras-Roubín, Fabrizio Poletti, José A Barrabés, Manuel Anguita, Alberto Dominguez-Rodriguez, Mario Lombardi, Stuart Pocock, Pablo Díez-Villanueva, Miguel Vives-Borrás, María J Rollán, Simona D'Orazio, Noemí Escalera, Ana Isabel-Santos, Andrea Chiampan, Oriol de Diego, María López-Benito, Eduardo Moreno, Luis M Rincón-Díaz, Hugo París, Roberto Latini, Valentín Fuster, Borja Ibanez","doi":"10.4244/EIJ-D-25-00826","DOIUrl":"https://doi.org/10.4244/EIJ-D-25-00826","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend beta blockers after myocardial infarction (MI) regardless of left ventricular ejection fraction (LVEF), aiming to reduce reinfarction and ventricular arrhythmias. However, recent trials have challenged this practice in patients without reduced LVEF. Whether beta blocker withdrawal in these patients increases short-term or recurrent ischaemic events remains uncertain.</p><p><strong>Aims: </strong>We aimed to evaluate the short-term ischaemic safety of beta blocker withholding or withdrawal at hospital discharge in patients with MI and LVEF >40% and to determine the effect of beta blocker therapy on a broad composite ischaemic endpoint.</p><p><strong>Methods: </strong>This is a post hoc analysis of the REBOOT trial, in which patients with MI and LVEF >40% were randomised to beta blocker therapy or no beta blocker at discharge. The incidence of short-term (3-month) and recurrent ischaemic events (a composite of cardiac death, reinfarction, sustained ventricular tachycardia/fibrillation, resuscitated cardiac arrest, or unplanned revascularisation) was assessed overall and according to prior beta blocker use.</p><p><strong>Results: </strong>From the 8,438 patients in the intention-to-treat population of the trial, information regarding beta blocker history was available for 8,401. Of these, 12.1% were on chronic beta blocker therapy before MI. Overall, withholding or withdrawing beta blockers was not associated with increased short-term ischaemic risk (hazard ratio [HR] 1.13, 95% confidence interval [CI]: 0.74-1.72). Over a median follow-up of 3.7 years, there were no differences in recurrent ischaemic events between groups (HR 0.98, 95% CI: 0.82-1.16), nor significant interactions with prior beta blocker therapy. In patients who were on a beta blocker before the index MI, randomisation to no beta blocker (withdrawal) was not associated with an increased risk of ischaemic events during trial follow-up (composite ischaemic endpoint HR 0.93, 95% CI: 0.64-1.34).</p><p><strong>Conclusions: </strong>In patients with MI and LVEF >40%, beta blocker withholding or withdrawal at discharge was not associated with increased short-term or recurrent ischaemic events, supporting the safety of this strategy in contemporary clinical practice.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women.","authors":"Suzanne J Baron, Josephine C Chou, Tayyab Shah, Amanda R Vest, J Dawn Abbott, Mirvat Alasnag, Cristina Aurigemma, Emanuele Barbato, Lavanya Bellumkonda, Anna E Bortnick, Alaide Chieffo, Robert-Jan van Geuns, Cindy L Grines, Sigrun Halvorsen, Christian Hassager, Navin K Kapur, Srihari S Naidu, Vivian G Ng, Jacqueline Saw, Alexandra J Lansky","doi":"10.4244/EIJ-D-24-01126","DOIUrl":"10.4244/EIJ-D-24-01126","url":null,"abstract":"<p><p>Cardiovascular disease is the leading cause of death for women worldwide, with mortality rates due to cardiogenic shock (CS) remaining exceedingly high. Sex-based disparities in the timely delivery of optimal CS treatment contribute to poor outcomes; addressing these disparities is a major priority to improve women's cardiovascular health. This consensus statement provides a comprehensive summary of the current state of treatment of CS in women across the spectrum of cardiovascular disease states and identifies important gaps in evidence. As sex-based data are limited in contemporary literature, clinicians may use this document as a resource to guide practice. Further investigations are necessary to inform best practices for the diagnosis and treatment of women with CS.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":"894-909"},"PeriodicalIF":9.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095894","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}