Eurointervention最新文献

{"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":"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":"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":"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":"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}

{"title":"A novel tricuspid flow optimiser for severe tricuspid regurgitation (TRiFlO).","authors":"Gian Paolo Ussia, Valeria Cammalleri, Massimiliano Carassiti, Francesco Grigioni, Antonio Mangieri, Antonio Colombo","doi":"10.4244/EIJ-D-24-00600","DOIUrl":"10.4244/EIJ-D-24-00600","url":null,"abstract":"","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 24","pages":"e1523-e1525"},"PeriodicalIF":7.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830835","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":"Readmissions after next-day discharge following transcatheter aortic valve implantation.","authors":"Rodrigo Bagur, Michael W A Chu, Conrad Kabali, Santiago Ordoñez, Ali S Husain, Sung-Han Yoon, Luis A Palma Dallan, Abdulmajeed Alosail, Jasem Althekrallah, Mathew Valdis, Patrick Teefy, Pantelis Diamantouros, John G Webb, Guilherme F Attizzani","doi":"10.4244/EIJ-D-24-00514","DOIUrl":"10.4244/EIJ-D-24-00514","url":null,"abstract":"<p><strong>Background: </strong>No data compare newer-generation transcatheter heart valves (THVs) in terms of next-day discharge (NDD) following transfemoral (TF) transcatheter aortic valve implantation (TAVI).</p><p><strong>Aims: </strong>We aimed to evaluate the safety of NDD in unselected patients who received ACURATE (neo/neo2), Evolut (PRO/PRO+/FX) and the SAPIEN (3/Ultra) THVs.</p><p><strong>Methods: </strong>This multicentre registry included patients who underwent TF-TAVI without a preprocedural permanent pacemaker implantation (PPI) and were discharged the next day without a new PPI. The primary endpoint was unplanned readmissions at 30 days. Multinomial gradient-boosted inverse probability of treatment-weighted (IPTW) propensity scores (stage 1) followed by the modified Poisson regression (stage 2) approach were used to compare the average effects of the THVs on the primary outcome.</p><p><strong>Results: </strong>A total of 963 all-comer patients (ACURATE=264, Evolut=306, and SAPIEN=393) were included in this study. ACURATE patients were older (p<0.001) and included a greater proportion of females (p<0.001), whereas Evolut patients had a higher risk profile as assessed by the Society of Thoracic Surgeons score (p=0.01). There were no differences between the groups in terms of right or left bundle branch block (p=0.75). At 30 days, the overall readmission rate was 8%, and there were no differences in cardiac (ACURATE 4.6% vs Evolut 4.2% vs SAPIEN 3.1%; p=0.56) or non-cardiac readmissions (ACURATE 4.6% vs Evolut 3.3% vs SAPIEN 4.6%; p=0.64). Readmission for new PPI was 2.7%, 1.0% and 1.8% (p=0.32) and for heart failure (HF) was 1.5%, 2.0% and 1.3% (p=0.76) in ACURATE, Evolut and SAPIEN patients, respectively. The IPTW propensity score model followed by modified Poisson regression indicate that, using ACURATE as the reference, no significant differences were found in 30-day readmissions (relative risk [RR] 0.76, 95% confidence interval [CI]: 0.38-1.52; p=0.38 for Evolut and RR 0.74, 95% CI: 0.44-1.22; p=0.28 for SAPIEN).</p><p><strong>Conclusions: </strong>In pacemaker-naïve patients undergoing TF-TAVI with newer-generation THVs, NDD was not associated with a negative impact on overall 30-day readmissions, cardiac or non-cardiac readmissions, readmissions for PPI or HF after discharge, or mortality, regardless of the type of THV.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 24","pages":"e1505-e1519"},"PeriodicalIF":7.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830855","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":"Lifetime management considerations to optimise transcatheter aortic valve implantation: a practical guide.","authors":"Karan Rao, Alexandra Baer, Vinayak N Bapat, Nicolo Piazza, Peter Hansen, Bernard Prendergast, Ravinay Bhindi","doi":"10.4244/EIJ-D-24-00332","DOIUrl":"10.4244/EIJ-D-24-00332","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for the treatment of aortic stenosis. With the recently broadened indications, there is a larger cohort of patients likely to outlive their first transcatheter heart valve (THV). This review discusses relevant lifetime planning considerations, focusing on the utility of preprocedural computed tomography imaging to help implanters future-proof their patients who are likely to outlive their first valve. The initial priority is to optimise the index procedure by maximising THV haemodynamic function and durability. This involves maximising the effective orifice area, minimising the risk of new pacemaker implantation, reducing paravalvular regurgitation, and preventing coronary obstruction and annular rupture. In patients requiring a second valve procedure, a significant proportion will require a TAVI-in-TAVI, and implanters should consider the key priorities for a redo procedure, including the increased risks of patient-prosthesis mismatch and conduction abnormalities, promoting coronary reaccessibility, and preventing coronary obstruction and sinus sequestration. Careful planning can identify potential hurdles as well as predict the feasibility and likely outcomes of redo-TAVI, to help individualise care over the lifetime of each patient.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 24","pages":"e1493-e1504"},"PeriodicalIF":7.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830853","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}