Eurointervention最新文献

{"title":"Lower noradrenaline-mediated mean arterial pressure target in patients with acute myocardial infarction-related cardiogenic shock: rationale and design of the NORshock study.","authors":"Sanne Ten Berg, Elma J Peters, Margriet Bogerd, Luuk C Otterspoor, Annemarie E Engström, Wim K Lagrand, Mina Karami, Niels J W Verouden, Jose M Montero-Cabezas, Adriaan O Kraaijeveld, Erik Lipšic, Sakir Akin, Corstiaan A den, Alexander D Cornet, Pascalle S Monraats, Krischan D Sjauw, Christian Hassager, Martin S Frydland, Christian Jung, Ibrahim Akin, Tim Balthazar, Pascal Frederiks, Pieter Jan Palmers, Tomaz Goslar, Jure Fluher, Arash Mokhtari, Andreas S Triantafyllis, Jan Bělohlávek, Alastair G Proudfoot, Olusegun Olusanya, Gard F T Svingen, David Fagnoul, Vasileios Panoulas, Matthew Govier, Marcel G W Dijkgraaf, Alexander P J Vlaar, Jose P S Henriques","doi":"10.4244/EIJ-D-26-00112","DOIUrl":"10.4244/EIJ-D-26-00112","url":null,"abstract":"<p><p>Acute myocardial infarction-related cardiogenic shock (AMI-CS) is commonly clinically characterised by low blood pressure. Noradrenaline is the guideline-recommended first-line vasopressor therapy in patients in cardiogenic shock to increase blood pressure. Although no strict criteria exist, noradrenaline is commonly titrated to a mean arterial pressure (MAP) of above 65 mmHg. No evidence exists, however, that targeting a pharmacologically induced MAP of above 65 mmHg improves clinical outcome. Furthermore, noradrenaline is associated with unwanted effects such as elevated afterload, increased myocardial oxygen demand, and arrhythmias. Therefore, we sought to investigate whether treatment with a lower noradrenaline-mediated MAP-target regimen in AMI-CS patients leads to improved outcomes. In this international, open-label, multicentre, randomised superiority trial, 776 patients will be allocated in a 1:1 ratio to either the index treatment of a lower noradrenaline-mediated MAP-target regimen (MAP of 55 mmHg) or a standard noradrenaline-mediated MAP-target regimen (MAP of at least 65 mmHg). The NORshock trial tests the hypothesis that a permissive hypotension treatment strategy with reduced use of noradrenaline in patients with AMI-CS is superior to standard care in terms of a combined endpoint of all-cause death and renal replacement therapy within 30 days. The NORshock trial is the first randomised trial investigating a strategy of a lower noradrenaline-mediated MAP-target regimen (MAP of 55 mmHg) compared with a standard noradrenaline-mediated MAP-target regimen (MAP of at least 65 mmHg) on clinical outcomes in AMI-CS patients.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 17","pages":"e955-e961"},"PeriodicalIF":9.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901589","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":"Dual antiplatelet therapy after left atrial appendage closure: time to move on.","authors":"Xavier Freixa, Giovanni Occhipinti","doi":"10.4244/EIJ-D-26-00863","DOIUrl":"10.4244/EIJ-D-26-00863","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 17","pages":"e913-e915"},"PeriodicalIF":9.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901522","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":"Reduced-dose direct oral anticoagulant versus antiplatelet strategies after left atrial appendage occlusion.","authors":"Laurent Fauchier, Mathieu Nasarre, Bertrand Pierre, Arnaud Bisson, Gregory Y H Lip","doi":"10.4244/EIJ-D-26-00102","DOIUrl":"10.4244/EIJ-D-26-00102","url":null,"abstract":"<p><strong>Background: </strong>The optimal antithrombotic therapy after left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) remains uncertain. Reduced-dose direct oral anticoagulation (DOAC) is increasingly used in clinical practice as an alternative to antiplatelet-based strategies, but comparative outcome data are limited.</p><p><strong>Aims: </strong>We sought to compare the clinical outcomes associated with low-dose DOAC therapy versus dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) after LAAO.</p><p><strong>Methods: </strong>Using the TriNetX Global Network, we identified adult patients with AF who underwent percutaneous LAAO between 2010 and 2025. Three parallel propensity score-matched analyses were conducted: reduced-dose DOAC versus DAPT, SAPT versus DAPT, and reduced-dose DOAC versus SAPT. Outcomes included all-cause death, thromboembolic events, device-related thrombosis, bleeding events, and net clinical benefit (NCB).</p><p><strong>Results: </strong>After matching, 1,773 patients were included in each group for the reduced-dose DOAC versus DAPT comparison (mean follow-up 1.4±1.0 years). Reduced-dose DOAC was associated with lower risks of all-cause death (hazard ratio [HR] 0.79, 95% confidence interval [CI]: 0.65-0.96) and major bleeding (HR 0.87, 95% CI: 0.77-0.98), with no significant differences in ischaemic stroke, thromboembolism, or device-related thrombosis. NCB favoured reduced-dose DOAC (HR 0.87, 95% CI: 0.78-0.96). SAPT was also associated with fewer bleeding events and favourable outcomes compared with DAPT. In the reduced-dose DOAC versus SAPT comparison (1,582 matched patients per group), reduced-dose DOAC showed estimates compatible with a slightly higher risk of major bleeding compared with SAPT (HR 1.14, 95% CI: 1.00-1.30; p=0.06), while mortality, thromboembolic outcomes, and NCB did not differ significantly.</p><p><strong>Conclusions: </strong>In contemporary practice after LAAO, reduced-dose DOAC therapy was associated with more favourable outcomes than DAPT but showed no clear advantage over SAPT, supporting simplified and individualised post-implantation antithrombotic strategies.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 17","pages":"e935-e945"},"PeriodicalIF":9.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901678","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":"Multimodality imaging for pre-, intra-, and postprocedural guidance of left atrial appendage closure: a European Left Atrial Appendage Closure Club (ELAACC) expert consensus statement.","authors":"Nina C Wunderlich, Laura Sanchis Ruiz, Adel Aminian, Sergio Berti, Lorenz Räber, Roberto Galea, Xavier Freixa, Christoph Hammerstingl, Jens Erik Nielsen-Kudsk, Tom De Potter, Andi Rroku, Ignacio Cruz-Gonzalez, Ole De Backer, Philippe Garot","doi":"10.4244/EIJ-D-25-01372","DOIUrl":"10.4244/EIJ-D-25-01372","url":null,"abstract":"<p><p>Left atrial appendage closure (LAAC) is an established alternative for stroke prevention in patients with non-valvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation. Imaging is central to procedural success and safety, yet variability in acquisition, measurement, and reporting contributes to inconsistent workflows and outcomes among centres. This expert consensus document from the European Left Atrial Appendage Closure Club provides a unified framework for pre-, intra-, and postprocedural imaging in LAAC with the aim of reducing variability, standardising workflows, and improving clinical reproducibility. The consensus emphasises high-quality image acquisition, reproducible measurements, and the prioritisation of three-dimensional (3D) imaging techniques and multiplanar reconstruction. Standardised terminology, core anatomical parameters, and device-oriented requirements are defined to support consistent procedural planning and device selection. Intraprocedural recommendations focus on real-time guidance using 3D transoesophageal echocardiography, intracardiac echocardiography, and fusion imaging for transseptal puncture, device alignment, deployment, and sealing assessment. Postprocedural guidance harmonises echocardiographic and cardiac computed tomography criteria and proposes structured follow-up pathways for the assessment of device-related thrombus, peridevice leak, and device stability. By promoting consistent nomenclature and structured, evidence-informed imaging strategies across the entire LAAC pathway, this consensus aims to enhance procedural safety, improve reproducibility, and support uniform, high-quality LAAC practice across centres.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 17","pages":"e918-e934"},"PeriodicalIF":9.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901505","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":"CT-FFR in females: a benefit in search of a mechanism?","authors":"Stephane Fournier, Georgios Tzimas","doi":"10.4244/EIJ-D-26-00883","DOIUrl":"10.4244/EIJ-D-26-00883","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 17","pages":"e916-e917"},"PeriodicalIF":9.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901577","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 randomised trial of carbon dioxide flushing to reduce vascular brain injury in patients undergoing TAVI.","authors":"Saud Ahmed Khawaja, Lydia Hanna, Abhinav Singh, Carla Lucarelli, Prerna Garg, Iqbal Malik, Nearchos Hadjiloizou, Neil Ruparelia, Adam Hartley, Ramzi Khamis, Matthew Shun Shin, Richard Gibbs, Ghada W Mikhail","doi":"10.4244/EIJ-D-26-00425","DOIUrl":"10.4244/EIJ-D-26-00425","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a significant concern in patients undergoing transcatheter aortic valve implantation (TAVI). Despite advances in TAVI technology and techniques, stroke rates have remained unchanged, with trials of cerebral embolic protection devices failing to reduce rates. The concept of air emboli has not been previously investigated in TAVI procedures. We hypothesised that gaseous emboli could play a significant role in TAVI and that carbon dioxide (CO₂) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI.</p><p><strong>Aims: </strong>We aimed to demonstrate the neuroprotective benefits of CO₂ flushing in TAVI patients.</p><p><strong>Methods: </strong>INTERCEPTavi is a single-centre, blinded, randomised controlled pilot trial that studied the effects of flushing TAVI valves with CO₂ versus conventional saline on neurological outcomes post-TAVI, assessed using magnetic resonance imaging (MRI) and transcranial Doppler (TCD). Patients with aortic stenosis were randomised after obtaining vascular access. Periprocedural TCD assessed solid and gaseous emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here, we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD outcomes.</p><p><strong>Results: </strong>A total of 60 patients were recruited and randomised 1:1 to CO₂ and saline flushing (TAVI-CO₂) versus saline flushing only (TAVI-S). CO₂ flushing significantly reduced the average number of lesions per patient (TAVI-CO₂: 4 lesions/patient vs TAVI-S: 8.5 lesions/patient; p=0.031). The total infarct area was numerically lower in the TAVI-CO₂ group (40.32 mm² vs 93.20 mm²), although this did not reach statistical significance (p=0.111). Similarly, TCD showed fewer microembolic signals in the TAVI-CO₂ arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5).</p><p><strong>Conclusions: </strong>INTERCEPTavi is a pioneering, first-in-human randomised trial that demonstrated that CO₂ flushing of the TAVI valve reduces the number of cerebral lesions measured on MRI. CO₂ flushing is an accessible, cost-effective method that can be easily implemented in any catheter laboratory to provide neurological advantages.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":" ","pages":"883-890"},"PeriodicalIF":9.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037677","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 bioadaptors will replace drug-eluting stents: pros and cons.","authors":"David Erlinge, Giandomenico Mancini, Valeria Paradies","doi":"10.4244/EIJ-E-26-00014","DOIUrl":"https://doi.org/10.4244/EIJ-E-26-00014","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 16","pages":"837-839"},"PeriodicalIF":9.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801567","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":"Computational wireless indices for the assessment of myocardial ischaemia.","authors":"Gianluca Campo, Simone Biscaglia, Andrea Erriquez, William F Fearon","doi":"10.4244/EIJ-D-25-01315","DOIUrl":"https://doi.org/10.4244/EIJ-D-25-01315","url":null,"abstract":"<p><p>The assessment of myocardial ischaemia is entering a new computational era. Beyond the traditional boundaries of anatomical imaging and invasive fractional flow reserve (FFR), emerging techniques based on coronary computed tomography (CT) angiography and invasive coronary artery angiography now allow the derivation of physiological information without pressure wires, hyperaemic agents, or additional procedures. These image-based indices, commonly referred to as FFR-CT and angiography-derived FFR, are reshaping both diagnostic and interventional cardiology. This review provides an updated synthesis of the latest evidence on their clinical integration. FFR-CT has demonstrated its ability to refine diagnostic pathways, reduce unnecessary invasive angiography, and safely guide management decisions within precision diagnostic strategies. In parallel, angiography-derived FFR has matured into a real-time wire-free solution within the catheterisation laboratory. Randomised studies confirm that physiology-guided revascularisation improves procedural efficiency and optimises outcomes compared with angiography alone. Beyond ischaemia detection, these technologies now extend to virtual stenting, procedural simulation, and the identification of vulnerable plaques through haemodynamic indices such as endothelial shear stress and perivascular inflammation mapping. Together, these developments mark a paradigm shift: from anatomy-based to physiology-driven and, ultimately, prediction-guided coronary intervention. By merging artificial intelligence, computational modelling, and advanced imaging, CT- and angiography-derived physiology offer the prospect of fully integrated real-time functional assessment. This convergence defines a new frontier in coronary medicine, where precision, automation, and clinical impact coalesce to transform everyday cardiovascular practice.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 16","pages":"847-863"},"PeriodicalIF":9.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801543","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":"Stroke prevention in TAVI: beyond solid emboli.","authors":"Alexandra J Lansky, Laya Ohadi","doi":"10.4244/EIJ-E-26-00013","DOIUrl":"https://doi.org/10.4244/EIJ-E-26-00013","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 16","pages":"842-843"},"PeriodicalIF":9.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801723","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":"Low-dose catheter-directed thrombolysis in acute pulmonary embolism: progress with persistent uncertainty?","authors":"Felix Mahfoud, Felix Götzinger","doi":"10.4244/EIJ-D-26-00810","DOIUrl":"https://doi.org/10.4244/EIJ-D-26-00810","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"22 16","pages":"844-846"},"PeriodicalIF":9.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801577","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}