Pub Date : 2025-12-19DOI: 10.1093/eurheartj/ehaf1050
Caio A M Tavares,Patricia O Guimarães,Marcelo Franken,Karla Santo,Guy F A Prado,Felipe M T Bezerra,Vagner Madrini-Junior,Willterson C Bandeira,Délcio G S Junior,Gabriela Montenegro,Jose A R Forte,Walter Alvarenga,Fernando de Martino,Marcos M Seki,Jose F K Saraiva,Jamil A Saad,Adriano Caixeta,João L de A A Falcão,Weimar K S Barroso,George C X Meireles,Thiago B Dias,Frederico Monfardini,Silvia R L Assis,José C Nicolau,Andrei C Sposito,Renato D Lopes,Yoshinobu Onuma,Marco Valgimigli,Dominick J Angiolillo,Patrick W J C Serruys,Otavio Berwanger,Fernando Bacal,Pedro A Lemos
BACKGROUND AND AIMSThe optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention in patients with acute coronary syndrome remains uncertain. This analysis examined the temporal patterns of ischaemic and bleeding risks of early aspirin withdrawal compared with DAPT.METHODSNEO-MINDSET randomized 3410 acute coronary syndrome patients undergoing successful percutaneous coronary intervention with drug-eluting stents within 4 days of hospital admission to either potent P2Y12 inhibitor monotherapy (prasugrel or ticagrelor) or standard DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months. This prespecified landmark analysis examined early (0-30 days) and late (31-365 days) follow-up events. Co-primary outcomes were (i) the composite of all cause death, myocardial infarction, stroke, or urgent target-vessel revascularization (ischaemic outcome) and (ii) Bleeding Academic Research Consortium type 2, 3, or 5 bleeding.RESULTSAt 30 days, the composite ischaemic outcome occurred in 3.3% of patients receiving monotherapy vs 1.8% with DAPT (risk difference 1.5%, 95% confidence interval .4%-2.6%; P = .006). Bleeding occurred in .6% vs 1.5% (risk difference -.8%, 95% confidence interval -1.5%-.1%; P = .018). In the landmark analysis between Days 31 and 365, ischaemic outcome rates were similar between study groups (3.8% each; P = .977), while bleeding remained less frequent with monotherapy (1.3% vs 3.5%; risk difference -2.2%, 95% confidence interval -3.2%-1.1%; P > .001).CONCLUSIONSThis prespecified 30-day landmark analysis suggests an excess of ischaemic risk with monotherapy vs DAPT in the first 30 days but not thereafter, whereas an aspirin-free strategy was consistently associated with fewer bleeding events within and after 30 days.
背景和目的急性冠脉综合征患者经皮冠状动脉介入治疗后双重抗血小板治疗（DAPT）的最佳持续时间仍不确定。该分析检查了与DAPT相比，早期停药阿司匹林的缺血和出血风险的时间模式。方法sno - mindset随机选择3410例急性冠状动脉综合征患者，这些患者在入院4天内成功接受经皮冠状动脉介入治疗，接受强效P2Y12抑制剂单药治疗（prasugrel或替格瑞洛）或标准DAPT（阿司匹林加强效P2Y12抑制剂）治疗12个月。该预先指定的里程碑分析检查了早期（0-30天）和晚期（31-365天）随访事件。共同主要结局是(i)全因死亡、心肌梗死、卒中或紧急靶血管重建术（缺血结局）的复合结局和（ii）出血，学术研究联盟2、3或5型出血。结果在30天内，单一治疗组的复合缺血发生率为3.3%，DAPT组为1.8%（风险差异为1.5%，95%可信区间为0.4% -2.6%;P = 0.006）。出血发生于。6% vs 1.5%（风险差- 0.8%，95%置信区间-1.5%- 0.1%;P = 0.018）。在第31天至第365天的里程碑式分析中，各研究组之间的缺血转归率相似（各3.8%;P = 0.977），而单药治疗的出血发生率仍然较低（1.3% vs 3.5%；风险差异-2.2%，95%可信区间-3.2%-1.1%;P = 0.001）。这项预先指定的30天里程碑式分析表明，与DAPT相比，单药治疗在前30天的缺血性风险较高，但此后没有，而无阿司匹林策略在30天内和30天后出血事件始终较少。
{"title":"Prasugrel or ticagrelor monotherapy vs dual antiplatelet treatment after percutaneous coronary intervention in acute coronary syndromes: a landmark analysis from the NEOMINDSET trial.","authors":"Caio A M Tavares,Patricia O Guimarães,Marcelo Franken,Karla Santo,Guy F A Prado,Felipe M T Bezerra,Vagner Madrini-Junior,Willterson C Bandeira,Délcio G S Junior,Gabriela Montenegro,Jose A R Forte,Walter Alvarenga,Fernando de Martino,Marcos M Seki,Jose F K Saraiva,Jamil A Saad,Adriano Caixeta,João L de A A Falcão,Weimar K S Barroso,George C X Meireles,Thiago B Dias,Frederico Monfardini,Silvia R L Assis,José C Nicolau,Andrei C Sposito,Renato D Lopes,Yoshinobu Onuma,Marco Valgimigli,Dominick J Angiolillo,Patrick W J C Serruys,Otavio Berwanger,Fernando Bacal,Pedro A Lemos","doi":"10.1093/eurheartj/ehaf1050","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1050","url":null,"abstract":"BACKGROUND AND AIMSThe optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention in patients with acute coronary syndrome remains uncertain. This analysis examined the temporal patterns of ischaemic and bleeding risks of early aspirin withdrawal compared with DAPT.METHODSNEO-MINDSET randomized 3410 acute coronary syndrome patients undergoing successful percutaneous coronary intervention with drug-eluting stents within 4 days of hospital admission to either potent P2Y12 inhibitor monotherapy (prasugrel or ticagrelor) or standard DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months. This prespecified landmark analysis examined early (0-30 days) and late (31-365 days) follow-up events. Co-primary outcomes were (i) the composite of all cause death, myocardial infarction, stroke, or urgent target-vessel revascularization (ischaemic outcome) and (ii) Bleeding Academic Research Consortium type 2, 3, or 5 bleeding.RESULTSAt 30 days, the composite ischaemic outcome occurred in 3.3% of patients receiving monotherapy vs 1.8% with DAPT (risk difference 1.5%, 95% confidence interval .4%-2.6%; P = .006). Bleeding occurred in .6% vs 1.5% (risk difference -.8%, 95% confidence interval -1.5%-.1%; P = .018). In the landmark analysis between Days 31 and 365, ischaemic outcome rates were similar between study groups (3.8% each; P = .977), while bleeding remained less frequent with monotherapy (1.3% vs 3.5%; risk difference -2.2%, 95% confidence interval -3.2%-1.1%; P > .001).CONCLUSIONSThis prespecified 30-day landmark analysis suggests an excess of ischaemic risk with monotherapy vs DAPT in the first 30 days but not thereafter, whereas an aspirin-free strategy was consistently associated with fewer bleeding events within and after 30 days.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"6 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777361","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}
Pub Date : 2025-12-19DOI: 10.1093/eurheartj/ehaf974
Flavio L Ribichini,Roberto Scarsini,Gabriele Pesarini,Tommaso Fabris,Marco Barbierato,Gianpiero D'Amico,Chiara Zanchettin,Dario Gregori,Giulia Lorenzoni,Tommaso Piva,Elisa Nicolini,Caterina Gandolfo,Ketty La Spina,Massimo Fineschi,Francesco Gallo,Bernardo Baccani,Anna Sonia Petronio,Marco De Carlo,Sergio Berti,Andrea Drago,Francesco Saia,Rocco Sclafani,Giovanni Esposito,Fabrizio D'Ascenzo,Giuseppe Tarantini,
BACKGROUND AND AIMSThe optimal approach to coronary revascularization in patients undergoing transcatheter aortic valve implantation (TAVI) remains debated. Fractional flow reserve (FFR) may improve the identification of ischaemia-producing lesions compared to angiographic assessment alone, but data in the TAVI population are lacking.METHODSIn this multicentric, open-label, randomized, superiority trial with blind adjudication of adverse events, patients with aortic stenosis and intermediate coronary lesions undergoing TAVI were randomized 1:1 to FFR-guided or angiography-guided percutaneous coronary intervention (PCI). The trial was registered at ClinicalTrials.gov (NCT03360591). All randomized patients were included in the primary analysis according to the intention-to-treat principle. The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE) at 12 months of follow-up, defined as a composite of all-cause death, myocardial infarction, ischaemia-driven target vessel revascularization, disabling stroke, or major bleeding.RESULTSA total of 320 patients were enrolled across 15 Italian centres. The median age of the patients was 86 years [interquartile range (IQR) 83-90], and the median STS score was 3% (IQR 2-5). The median SYNTAX score was 7 (IQR 5-11). FFR-guided PCI was associated with a significantly lower rate of MACCE at 12 months compared with angiography-guided PCI (8.5% vs 16.0%; hazard ratio .52; 95% confidence interval .27-.99; P = .047). The difference in the primary endpoint was primarily driven by a reduction in all-cause mortality (hazard ratio .31; 95% confidence interval .10-.96). Other components of the composite were numerically lower but not statistically significant.CONCLUSIONSIn patients undergoing TAVI with intermediate coronary lesions, FFR-guided PCI was associated with a reduced risk of MACCE at 12 months. These findings support a physiology-based revascularization strategy in this frail, elderly population.
{"title":"Physiology vs angiography-guided percutaneous coronary intervention in transcatheter aortic valve implantation: the FAITAVI trial.","authors":"Flavio L Ribichini,Roberto Scarsini,Gabriele Pesarini,Tommaso Fabris,Marco Barbierato,Gianpiero D'Amico,Chiara Zanchettin,Dario Gregori,Giulia Lorenzoni,Tommaso Piva,Elisa Nicolini,Caterina Gandolfo,Ketty La Spina,Massimo Fineschi,Francesco Gallo,Bernardo Baccani,Anna Sonia Petronio,Marco De Carlo,Sergio Berti,Andrea Drago,Francesco Saia,Rocco Sclafani,Giovanni Esposito,Fabrizio D'Ascenzo,Giuseppe Tarantini, ","doi":"10.1093/eurheartj/ehaf974","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf974","url":null,"abstract":"BACKGROUND AND AIMSThe optimal approach to coronary revascularization in patients undergoing transcatheter aortic valve implantation (TAVI) remains debated. Fractional flow reserve (FFR) may improve the identification of ischaemia-producing lesions compared to angiographic assessment alone, but data in the TAVI population are lacking.METHODSIn this multicentric, open-label, randomized, superiority trial with blind adjudication of adverse events, patients with aortic stenosis and intermediate coronary lesions undergoing TAVI were randomized 1:1 to FFR-guided or angiography-guided percutaneous coronary intervention (PCI). The trial was registered at ClinicalTrials.gov (NCT03360591). All randomized patients were included in the primary analysis according to the intention-to-treat principle. The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE) at 12 months of follow-up, defined as a composite of all-cause death, myocardial infarction, ischaemia-driven target vessel revascularization, disabling stroke, or major bleeding.RESULTSA total of 320 patients were enrolled across 15 Italian centres. The median age of the patients was 86 years [interquartile range (IQR) 83-90], and the median STS score was 3% (IQR 2-5). The median SYNTAX score was 7 (IQR 5-11). FFR-guided PCI was associated with a significantly lower rate of MACCE at 12 months compared with angiography-guided PCI (8.5% vs 16.0%; hazard ratio .52; 95% confidence interval .27-.99; P = .047). The difference in the primary endpoint was primarily driven by a reduction in all-cause mortality (hazard ratio .31; 95% confidence interval .10-.96). Other components of the composite were numerically lower but not statistically significant.CONCLUSIONSIn patients undergoing TAVI with intermediate coronary lesions, FFR-guided PCI was associated with a reduced risk of MACCE at 12 months. These findings support a physiology-based revascularization strategy in this frail, elderly population.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"234 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786158","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}
Pub Date : 2025-12-19DOI: 10.1093/eurheartj/ehaf1027
Harold Mathijssen,Parag H Bawaskar,Chetan Shenoy
{"title":"Cardiovascular magnetic resonance phenotyping in cardiac sarcoidosis: simplicity is indeed the ultimate sophistication for primary prevention implantable cardioverter-defibrillator decisions.","authors":"Harold Mathijssen,Parag H Bawaskar,Chetan Shenoy","doi":"10.1093/eurheartj/ehaf1027","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf1027","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"26 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786172","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}
Pub Date : 2025-12-19DOI: 10.1093/eurheartj/ehaf862
Julie De Backer,Kristina H Haugaa
{"title":"The 'Ten Commandments' for the 2025 ESC Guidelines on Cardiovascular Disease and Pregnancy.","authors":"Julie De Backer,Kristina H Haugaa","doi":"10.1093/eurheartj/ehaf862","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf862","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"16 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777360","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}
Pub Date : 2025-12-19DOI: 10.1093/eurheartj/ehaf995
Daniela Pedicino,Carlo Patrono
{"title":"Weekly Journal Scan: Aspirin and oral anticoagulation-more of a bloody mary than an AQUATIC mix.","authors":"Daniela Pedicino,Carlo Patrono","doi":"10.1093/eurheartj/ehaf995","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf995","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"24 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786159","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}
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