Eurointervention最新文献

{"title":"The future of sirolimus-coated balloon use in percutaneous coronary intervention.","authors":"Robert W Yeh, Christina Lalani","doi":"10.4244/EIJ-E-24-00053","DOIUrl":"10.4244/EIJ-E-24-00053","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1320-e1321"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569594","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":"Temporal modulation (early escalation and late de-escalation) of antiplatelet therapy in patients undergoing complex high-risk PCI: rationale and design of the TAILORED-CHIP trial.","authors":"Hanbit Park, Do-Yoon Kang, Jung-Min Ahn, Sung-Cheol Yun, Kyoung-Ha Park, Se-Hun Kang, Jon Suh, Jang-Whan Bae, Sangwoo Park, Jang Hyun Cho, Jung-Won Suh, Bong-Ki Lee, Seung-Woon Rha, Hoyoun Won, Jae-Sik Jang, Moo Hyun Kim, Cheol Hyun Lee, Young Keun Ahn, Jun-Hyok Oh, Jae-Seok Bae, Chul Soo Park, Jaewoong Choi, Jin-Bae Lee, Se-Whan Lee, Sung-Ho Hur, Osung Kwon, Seung-Jung Park, Duk-Woo Park, On Behalf Of The Tailored-Chip Trial Investigators","doi":"10.4244/EIJ-D-24-00437","DOIUrl":"10.4244/EIJ-D-24-00437","url":null,"abstract":"<p><p>Despite the use of conventional dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), the risk of adverse events remains high among patients with increased thrombotic risk. Until recently, the optimal antiplatelet strategy to balance the ischaemic and bleeding risks in patients who are undergoing complex high-risk PCI has been unclear. The TAILored Versus COnventional AntithRombotic StratEgy IntenDed for Complex HIgh-Risk PCI (TAILORED-CHIP) trial is an investigator-initiated, multicentre, prospective randomised trial to evaluate the efficacy and safety of a time-dependent tailored antiplatelet therapy with an early (<6 months post-PCI) escalation (low-dose ticagrelor at 60 mg twice daily plus aspirin) and a late (>6 months post-PCI) de-escalation (clopidogrel monotherapy) in patients undergoing complex high-risk PCI as compared with standard DAPT (clopidogrel plus aspirin for 12 months). Eligible patients had to have at least one high-risk anatomical or procedural feature or clinical characteristic associated with an increased risk of ischaemic or thrombotic events. The primary endpoint was the net clinical outcome, a composite of death from any cause, myocardial infarction, stroke, stent thrombosis, urgent revascularisation, or clinically relevant bleeding (Bleeding Academic Research Consortium type 2, 3, or 5) at 12 months after randomisation. (ClinicalTrials.gov: NCT03465644).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1355-e1362"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569195","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":"Natural history of a newly developed calcified nodule: incidence, predictors, and clinical outcomes.","authors":"Yoichiro Sugizaki, Mitsuaki Matsumura, YuWei Chen, Takunori Tsukui, Evan Shlofmitz, Susan V Thomas, Sarah Malik, Ali Dakroub, Mandeep Singh, Doosup Shin, Matthew J Granville, Jordan M Busch, Eric H Wolff, Genie M Miraglia, Jeffrey W Moses, Omar K Khalique, David J Cohen, Gary S Mintz, Richard A Shlofmitz, Allen Jeremias, Ziad A Ali, Akiko Maehara","doi":"10.4244/EIJ-D-24-00362","DOIUrl":"10.4244/EIJ-D-24-00362","url":null,"abstract":"<p><strong>Background: </strong>Calcified nodules (CNs) are an increasingly important, high-risk lesion subset.</p><p><strong>Aims: </strong>We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development.</p><p><strong>Methods: </strong>Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated calcified lesion at baseline and follow-up were included. New CNs were an accumulation of small calcium fragments at follow-up that were not present at baseline. Cardiac death, myocardial infarction (MI), or clinically driven revascularisation related to OCT-imaged, but untreated, calcified lesions were then evaluated.</p><p><strong>Results: </strong>Among 372 untreated calcified lesions, with a median of 1.5 (first and third quartiles: 0.7-2.9) years between baseline and follow-up OCTs, new CNs were observed in 7.0% (26/372) of lesions at follow-up. Attenuated calcium representing residual lipid (odds ratio [OR] 3.38, 95% confidence interval [CI]: 1.15-9.98; p=0.03); log₁₀ calcium volume index (length×maximum arc×maximum thickness; OR 2.76, 95% CI: 1.10-6.95; p=0.03); angiographic Δangle between systole and diastole, per 10° (OR 2.30, 95% CI: 1.25-4.22; p=0.01); and time since baseline OCT, per year (OR 1.36, 95% CI: 1.05-1.75; p=0.02) were all associated with new CN development. Clinical events were revascularisation and/or MI and were more frequent in lesions with versus without a new CN (29.3% vs 15.3%; p=0.04).</p><p><strong>Conclusions: </strong>New CNs developed in untreated, lipid-containing, severely calcified lesions with a larger angiographic hinge motion (between systole and diastole), compared with lesions without CNs, and were associated with worse clinical outcomes.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1330-e1339"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568888","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 sirolimus- versus paclitaxel-coated balloons for de novo coronary lesions.","authors":"Bruno Scheller, Norman Mangner, Raban V Jeger, Samuel Afan, Felix Mahfoud, Felix J Woitek, Gregor Fahrni, Carsten Schwenke, Beatrix Schnorr, Franz Kleber","doi":"10.4244/EIJ-D-23-00868","DOIUrl":"10.4244/EIJ-D-23-00868","url":null,"abstract":"<p><strong>Background: </strong>Paclitaxel-coated balloons (PCB) are a viable alternative to drug-eluting stents in the treatment of de novo coronary lesions. Whether sirolimus represents an alternative to paclitaxel for drug-coated balloons remains elusive.</p><p><strong>Aims: </strong>This randomised, controlled, multicentre, non-inferiority trial investigated a novel sirolimus-coated balloon (SCB) with a crystalline coating versus a PCB in de novo coronary lesions.</p><p><strong>Methods: </strong>To compare a novel SCB with a clinically proven PCB, 70 patients with de novo coronary lesions were enrolled at 4 centres in Germany and Switzerland. The primary endpoint was non-inferiority regarding angiographic late lumen loss (LLL) at 6 months, with a predefined margin of δ=0.35 mm. Secondary endpoints included procedural success, major adverse cardiac events, and individual clinical endpoints.</p><p><strong>Results: </strong>Quantitative coronary angiography revealed no differences in baseline parameters. At 6 months, in-segment LLL was 0.04±0.39 mm in the PCB group versus 0.11±0.37 mm in the SCB group (non-significant), respectively. The mean difference between SCB and PCB was 0.07 mm (95% confidence interval: -0.12 to 0.26). Non-inferiority at the predefined margin of 0.35 was shown. Clinical event rates up to 12 months were not different between the groups (3 target lesion revascularisations in the PCB group versus 2 in the SCB group, no myocardial infarctions, no deaths).</p><p><strong>Conclusions: </strong>The novel SCB showed similar angiographic outcomes in the treatment of de novo coronary disease as compared with a clinically proven PCB (ClinicalTrials.gov: NCT03908450).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1322-e1329"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568639","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":"Treatment of in-stent restenosis with ultrathin-strut versus thin-strut drug-eluting stents or drug-eluting balloons: a multicentre registry.","authors":"Ovidio De Filippo, Wojciech Wańha, Tiziana Sanavia, Rafal Januszek, Federico Giacobbe, Gianluca Campo, Tineke H Pinxterhuis, Davide Capodanno, Brunon Tomasiewicz, Mario Iannaccone, Attilio Leone, Rafał Wolny, Francesco Bruno, Giuseppe Patti, Giuseppe Musumeci, Gaetano Liccardo, Roberto Verardi, Sergio Raposeiras Roubin, Giuseppe Tarantini, Łukasz Kuźma, Leor Perl, Andrea Gagnor, Krzysztof Reczuch, Federico Conrotto, Domenico Tuttolomondo, Eline H Ploumen, Piotr Niezgoda, Serena Caglioni, Pierluigi Omedè, Antonio Greco, Jacek Kubica, Robert J Gil, Raffaele Piccolo, Ran Kornowski, Jacek Bil, Arianna Morena, Paolo Zocca, Mauro Pennone, Mariusz Gąsior, Miłosz Jaguszewski, Clemens von Birgelen, Piero Fariselli, Gaetano M De Ferrari, Wojciech Wojakowski, Fabrizio D'Ascenzo","doi":"10.4244/EIJ-D-24-00491","DOIUrl":"10.4244/EIJ-D-24-00491","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on ultrathin-strut drug-eluting stent (ultrathin DES) performance in DES in-stent restenosis (ISR).</p><p><strong>Aims: </strong>We aimed to assess the efficacy and safety of ultrathin DES compared to thin-strut DES and drug-eluting balloons (DEB) for DES-ISR.</p><p><strong>Methods: </strong>Patients from the DEB Dragon (ClinicalTrials.gov: NCT04415216) and ULTRA registries (ClinicalTrials.gov: NCT05205148) were divided into ultrathin DES, thin-strut DES, or DEB groups for DES-ISR treatment. Both propensity score matching (PSM) and inverse probability weighting (IPW) were considered to adjust the distribution of patients in each class. Cox regression was applied to the following main endpoints: device-oriented composite endpoints (DOCE; including cardiac death, target lesion revascularisation [TLR] and target vessel myocardial infarction), TLR and target vessel revascularisation (TVR).</p><p><strong>Results: </strong>A total of 269, 541, and 557 patients received an ultrathin DES, thin-strut DES, and DEB, respectively. After 3 years of follow-up, in the IPW-adjusted overall cohort, ultrathin DES were associated with a significantly reduced risk of DOCE compared to DEBs (hazard ratio [HR] 0.353, 95% confidence interval [CI]: 0.194-0.642; p<0.001), as well as thin-strut DES (HR 0.645, 95% CI: 0.457-0.911; p=0.013). Compared to DEBs, ultrathin DES also reduced the risks of both TLR (HR 0.184, 95% CI: 0.081-0.417; p<0.001) and TVR (HR 0.188, 95% CI: 0.093-0.379; p<0.001), while thin-strut DES did not (TLR: HR 0.686, 95% CI: 0.407-1.157; p=0.157; TVR: HR 0.706, 95% CI: 0.453-1.101; p=0.124). For diffuse ISR patients, ultrathin DES reduced the risk of DOCE (HR 0.364, 95% CI: 0.188-0.705; p=0.003), as did thin-strut DES (HR 0.602, 95% CI: 0.367-0.987; p=0.044), while a reduction of TLR (HR 0.220, 95% CI: 0.091-0.531; p<0.001) and TVR (HR 0.241, 95% CI: 0.113-0.513; p<0.001) was achieved only by ultrathin DES.</p><p><strong>Conclusions: </strong>Ultrathin DES were associated with reduced DOCE, TLR and TVR risks in diffuse ISR compared to DEBs.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 21","pages":"e1340-e1354"},"PeriodicalIF":7.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569878","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":"Cangrelor versus crushed ticagrelor in patients with acute myocardial infarction and cardiogenic shock: rationale and design of the randomised, double-blind DAPT-SHOCK-AMI trial.","authors":"Zuzana Motovska, Ota Hlinomaz, Jan Mrozek, Petr Kala, Tobias Geisler, Milan Hromadka, Ibrahim Akin, Jan Precek, Jiri Kettner, Pavel Cervinka, Gilles Montalescot, Jiri Jarkovsky, Jan Belohlavek, Josef Bis, Jan Matejka, Alexandra Vodzinska, Tamilla Muzafarova, Pavol Tomasov, Alexander Schee, Stanislav Bartus, Andrea Andrasova, Christoph B Olivier, Ales Kovarik, Petr Ostadal, Regina Demlova, Lenka Souckova, Ivan Vulev, Zdeněk Coufal, Janusz Kochman, Iuri Marinov, Jacek Kubica, Gregory Ducrocq, Michal Karpisek, Zdenek Klimsa, Martin Hudec, Petr Widimsky, Deepak L Bhatt, Dapt-Shockami Study Group","doi":"10.4244/EIJ-D-24-00203","DOIUrl":"10.4244/EIJ-D-24-00203","url":null,"abstract":"<p><p>Cardiogenic shock (CS) is a devastating and fatal complication of acute myocardial infarction (AMI). CS can affect the pharmacokinetics and pharmacodynamics of medications. The unique properties of cangrelor make it the optimal P2Y12 inhibitor for CS-AMI, in terms of both efficacy and safety. The DAPT-SHOCK-AMI trial (ClinicalTrials.gov: NCT03551964; EudraCT: 2018-002161-19) will assess the benefits of cangrelor in patients with an initial CS-AMI undergoing primary angioplasty. This randomised, multicentre, placebo-controlled trial of approximately 550 patients (with an allowed 10% increase) in 5 countries using a double-blind design will compare initial P2Y12 inhibitor treatment strategies in patients with CS-AMI of (A) intravenous cangrelor and (B) ticagrelor administered as crushed tablets at a loading dose of 180 mg. The primary clinical endpoint is a composite of all-cause death, myocardial infarction (MI), or stroke within 30 days. The main secondary endpoints are (1) the net clinical endpoint, defined as death, MI, urgent revascularisation of the infarct-related artery, stroke, or major bleeding as defined by the Bleeding Academic Research Consortium criteria; (2) cardiovascular-related death, MI, urgent revascularisation, or heart failure; (3) heart failure; and (4) cardiovascular-related death, all (1-4) within 1 year after study enrolment. A platelet reactivity study that tests the laboratory antiplatelet benefits of cangrelor, when given in addition to standard antiplatelet therapy, will be conducted using vasodilator-stimulated phosphoprotein phosphorylation. The primary laboratory endpoints are the periprocedural rate of onset and the proportion of patients who achieve effective P2Y12 inhibition. The DAPT-SHOCK-AMI study is the first randomised trial to evaluate the benefits of cangrelor in patients with CS-AMI.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1309-e1318"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480991","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":"Phoenix rising: a credible signal for CABG from ISCHEMIA?","authors":"John A Bittl","doi":"10.4244/EIJ-E-24-00046","DOIUrl":"10.4244/EIJ-E-24-00046","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1260-e1261"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480995","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":"Transcatheter vacuum-assisted aspiration of large intracardiac and intravascular masses.","authors":"Laura Besola, Alessandro Fiocco, Nicola Nencioni, Martina Dini, Giacomo Ravenni, Danilo Ruggiero, Michele Celiento, Andrea Colli","doi":"10.4244/EIJ-D-24-00245","DOIUrl":"10.4244/EIJ-D-24-00245","url":null,"abstract":"<p><p>Intravascular and intracardiac masses are usually represented by thrombi, tumours, and vegetations. They can affect both the right and left chambers of the heart and the venous and arterial circulation. Traditionally, their treatment is surgical or, in some circumstances, based on systemic anticoagulation/fibrinolysis. However, the complexity and frailty of patients who sometimes present with these conditions have pushed surgeons to find alternative minimally invasive effective treatments. While small masses can be removed with multiple devices, large masses are a more challenging problem. Vacuum-assisted aspiration systems such as the AngioVac System were developed to treat intravenous and right-sided heart thrombi. The application of the AngioVac System was widened to right-sided endocarditis and, later, to left-sided thrombi and vegetations. This review summarises the clinical results of different uses of the vacuum-assisted aspiration system to treat intravenous and intracardiac masses.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1267-e1275"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480997","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":"Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.","authors":"Sripal Bangalore, Grace Rhodes, David J Maron, Rebecca Anthopolos, Sean M O'Brien, Philip G Jones, Daniel B Mark, Harmony R Reynolds, John A Spertus, Gregg W Stone, Harvey D White, Yifan Xu, Stephen E Fremes, Judith S Hochman, On Behalf Of The Ischemia Research Group","doi":"10.4244/EIJ-D-24-00240","DOIUrl":"10.4244/EIJ-D-24-00240","url":null,"abstract":"<p><strong>Background: </strong>Whether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain.</p><p><strong>Aims: </strong>Our objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD.</p><p><strong>Methods: </strong>ISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included. Outcomes following initial invasive management (INV) with REV (PCI or CABG) versus initial conservative management (CON) with medical therapy alone were evaluated. Regression modelling was used to estimate the outcomes if all participants were to undergo prompt REV versus those assigned to CON. Outcomes were cardiovascular (CV) death/myocardial infarction (MI), death, CV death, and quality of life. Bayesian posterior probability for benefit (Pr [benefit]) for 1 percentage point lower 4-year rates with REV versus CON were evaluated.</p><p><strong>Results: </strong>Among 1,236 participants with 3V-CAD (612 INV/624 CON), REV was associated with lower 4-year CV death/MI (adjusted 4-year difference: -4.4, 95% credible interval [CrI] -8.7 to -0.3 percentage points, Pr [benefit]=94.8%) when compared with CON, with similar results for PCI versus CON (-5.8, 95% CrI: -10.8 to -0.5 percentage points, Pr [benefit]=96.4%) and CABG versus CON (-3.7, 95% CrI: -8.8 to 1.5 percentage points, Pr [benefit]=84.7%). Adjusted 4-year REV versus CON differences were as follows: death -1.2 (95% CrI: -4.7 to 2.2) percentage points, CV death -2.3 (95% CrI: -5.5 to 0.8) percentage points, with similar results for PCI and for CABG. The Pr (benefit) for death with REV (PCI or CABG) versus CON was 49-63%. The adjusted 12-month Seattle Angina Questionnaire-7 summary score differences favoured REV: REV versus CON 4.6 (95% CrI: 2.7-6.4) percentage points; PCI versus CON 3.6 (95% CrI: 1.2-5.8) percentage points and CABG versus CON 4.3 (95% CrI: 1.5-6.9) percentage points with high Pr (benefit).</p><p><strong>Conclusions: </strong>In participants with 3V-CAD, REV (either PCI or CABG) was associated with a lower 4-year CV death/MI rate and improved quality of life, with similar results for PCI versus CON and CABG versus CON. The differences in all-cause mortality between REV and CON were small with wide confidence intervals. (ClinicalTrials.gov: NCT01471522).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1276-e1287"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480994","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":"Accuracy of coronary computed tomography angiography-derived quantitative flow ratio for onsite assessment of coronary lesions.","authors":"Tingwen Weng, Daixin Ding, Guanyu Li, Shaofeng Guan, Wenzheng Han, Qian Gan, Ming Li, Lin Qi, Cheng Li, Yang Chen, Liang Zhang, Tianqi Li, Xifeng Chang, Yankai Chen, William Wijns, Xinkai Qu, Shengxian Tu","doi":"10.4244/EIJ-D-24-00336","DOIUrl":"10.4244/EIJ-D-24-00336","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA)-derived Murray law-based quantitative flow ratio (CT-μFR) is a novel non-invasive method for fast computation of fractional flow reserve (FFR) from CCTA images, yet its diagnostic performance remains to be prospectively validated.</p><p><strong>Aims: </strong>We aimed to evaluate the diagnostic performance of onsite CT-μFR in patients with coronary artery disease.</p><p><strong>Methods: </strong>This prospective, single-centre trial enrolled patients with ≥1 lesion with 30-90% diameter stenosis on CCTA and planned invasive coronary angiography (ICA) within 30 days. CT-μFR, ICA-derived μFR and FFR were evaluated separately in a blinded fashion. The primary endpoint was the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis defined by the invasive standard: FFR ≤0.80, or μFR ≤0.80 when FFR was not available.</p><p><strong>Results: </strong>Between December 2020 and August 2023, 260 patients were consecutively enrolled. Paired comparison between CT-μFR and the invasive standard was obtained in 706 vessels from 260 patients. The patient-level accuracy of CT-μFR was 89.6% (95% confidence interval [CI]: 85.9-93.4%), which was significantly higher than the prespecified target of 72.0% (p<0.001). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for CT-μFR were 93.1%, 86.1%, 87.1%, 92.5%, 6.7, and 0.1, respectively. Out of the 231 vessels investigated by FFR, the accuracy of CT-μFR in vessels without extensive calcification was non-inferior to that of μFR (90.6% vs 88.9%; difference=1.8% [95% CI: -2.8 to 5.5%]; p for non-inferiority<0.001).</p><p><strong>Conclusions: </strong>The study met its prespecified primary endpoint of the diagnostic accuracy of CT-μFR in identifying patients with haemodynamically significant coronary stenosis. CT-μFR was non-inferior to ICA-derived μFR in vessels without extensive calcification. (ClinicalTrials.gov: NCT04665817).</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 20","pages":"e1288-e1297"},"PeriodicalIF":7.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480990","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}