Pub Date : 2026-01-12DOI: 10.1016/j.jcin.2025.10.055
Sant Kumar MD , Maksymilian P. Opolski MD, PhD , Jung-Min Ahn MD , Carlos Collet MD, PhD , Pedro E.P. Carvalho MD , Farouc Jaffer MD, PhD , Gerald S. Werner MD , Jonathon Leipsic MD , Byeong-Keuk Kim MD , Joao Cavalcante MD , Victor Y. Cheng MD , Sandeep Jalli DO , John Lesser MD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be technically complex. Coronary computed tomography angiography (CTA) is increasingly being used for planning CTO PCI. Coronary CTA can help evaluate cap morphology, lesion length, calcification, and distal vessel quality. The use of coronary CTA for CTO PCI may be enhanced by integration with artificial intelligence and real-time imaging. In a randomized controlled trial, preprocedural coronary CTA increased the success of CTO PCI. In this review, the authors describe how coronary CTA can help diagnose and characterize CTO lesions, estimate the time needed for guidewire crossing time, predict and facilitate CTO PCI technical success, and provide real-time procedural guidance.
{"title":"The Role of Coronary Computed Tomography Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention","authors":"Sant Kumar MD , Maksymilian P. Opolski MD, PhD , Jung-Min Ahn MD , Carlos Collet MD, PhD , Pedro E.P. Carvalho MD , Farouc Jaffer MD, PhD , Gerald S. Werner MD , Jonathon Leipsic MD , Byeong-Keuk Kim MD , Joao Cavalcante MD , Victor Y. Cheng MD , Sandeep Jalli DO , John Lesser MD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.jcin.2025.10.055","DOIUrl":"10.1016/j.jcin.2025.10.055","url":null,"abstract":"<div><div>Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be technically complex. Coronary computed tomography angiography (CTA) is increasingly being used for planning CTO PCI. Coronary CTA can help evaluate cap morphology, lesion length, calcification, and distal vessel quality. The use of coronary CTA for CTO PCI may be enhanced by integration with artificial intelligence and real-time imaging. In a randomized controlled trial, preprocedural coronary CTA increased the success of CTO PCI. In this review, the authors describe how coronary CTA can help diagnose and characterize CTO lesions, estimate the time needed for guidewire crossing time, predict and facilitate CTO PCI technical success, and provide real-time procedural guidance.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 1-14"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950303","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 : 2026-01-12DOI: 10.1016/j.jcin.2025.11.021
Pedro E.P. Carvalho MD , Vanio L.J. Antunes , Vinicius Bittar de Pontes , Wilton Francisco Gomes MD , Beatriz Polachini Assunes Goncalves , Adriano Caixeta MD, PhD , Dimitrios Strepkos MD , Michaella Alexandrou MD , Deniz Mutlu MD , C. Michael Gibson MD , Gregg W. Stone MD , Deepak L. Bhatt MD, MPH, MBA , Stephan Windecker MD , Manesh R. Patel MD , Dominick Angiolillo MD, PhD , Roxana Mehran MD , Marco Valgimigli MD, PhD , Marco A. Costa MD, PhD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD , Bruno R. Nascimento MD, PhD
Background
Intravascular imaging–guided percutaneous coronary intervention (PCI) reduces cardiovascular events compared with angiography-guided PCI alone. However, there is a paucity of data comparing these approaches in patients with complex coronary artery lesions and their respective subgroups.
Objectives
The aim of this study was to assess the impact of intravascular ultrasound (IVUS)–guided and optical coherence tomography (OCT)–guided PCI on reducing major adverse cardiovascular events (MACE) compared with angiography-guided PCI in different complex lesions subsets.
Methods
In this lesion-level network meta-analysis, the MEDLINE, Embase, and Cochrane databases were systematically searched to identify randomized controlled trials reporting outcomes following intravascular imaging–guided or angiography-guided PCI with drug-eluting stents (DES). OCT, IVUS, and angiography were separately compared as guidance for PCI. Using a frequentist random-effects model network meta-analysis, RRs with corresponding 95% CIs were calculated for each strategy. The primary endpoint was MACE, defined as a composite of cardiac death, myocardial infarction, or target vessel revascularization.
Results
Seventeen randomized controlled trials, encompassing 13,751 patients with complex coronary lesions undergoing PCI with DES were incorporated into the analysis. In the network comparison, both OCT (RR: 0.63; 95% CI: 0.55-0.72; P < 0.001) and IVUS (RR: 0.67; 95% CI: 0.56-0.79; P < 0.001) demonstrated superiority over angiography-guided PCI in preventing MACE in complex lesions. These results were consistent in the subgroups of patients with chronic total occlusions, left main coronary artery disease, bifurcation lesions, multivessel coronary artery disease, and moderately or severely calcified lesions. No significant difference in MACE was observed between OCT and IVUS (RR: 0.94; 95% CI: 0.78-1.14; P = 0.52).
Conclusions
In patients with complex coronary lesions undergoing PCI with DES, both OCT-guided PCI and IVUS-guided PCI are more effective at reducing MACE compared with angiography-guided PCI. These findings were consistent across various types of complex coronary lesions and suggest that intravascular imaging–guided PCI should be the preferred approach for this population.
背景：与单独的血管造影引导下的PCI相比，血管成像引导下的经皮冠状动脉介入治疗（PCI）可减少心血管事件。然而，在复杂冠状动脉病变患者及其各自亚组中比较这些入路的数据缺乏。目的本研究的目的是评估血管内超声（IVUS）引导和光学相干断层扫描（OCT）引导下的PCI与血管造影引导下的PCI在不同复杂病变亚群中减少主要不良心血管事件（MACE）的影响。方法在这项病变水平网络荟萃分析中，系统检索MEDLINE、Embase和Cochrane数据库，以确定报告血管内成像引导或血管造影术引导下PCI药物洗脱支架（DES）治疗结果的随机对照试验。分别比较OCT、IVUS和血管造影作为PCI的指导。使用频率随机效应模型网络元分析，计算每种策略对应95% ci的rr。主要终点为MACE，定义为心源性死亡、心肌梗死或靶血管重建术的综合结果。结果17项随机对照试验，13751例复杂冠状动脉病变患者行PCI + DES纳入分析。在网络比较中，OCT （RR: 0.63; 95% CI: 0.55-0.72; P < 0.001）和IVUS （RR: 0.67; 95% CI: 0.56-0.79; P < 0.001）在预防复杂病变中MACE方面均优于血管造影引导的PCI。这些结果在慢性全闭塞、左主干冠状动脉疾病、分叉病变、多支冠状动脉疾病和中度或重度钙化病变的患者亚组中是一致的。OCT与IVUS间MACE无显著差异（RR: 0.94; 95% CI: 0.78 ~ 1.14; P = 0.52）。结论在复杂冠状动脉病变患者行DES PCI时，oct引导下和ivus引导下的PCI均比血管造影引导下的PCI更能有效降低MACE。这些发现在各种类型的复杂冠状动脉病变中是一致的，表明血管内成像引导的PCI应该是这类人群的首选方法。
{"title":"IVUS, OCT, or Angiography as Guidance for PCI in Complex Coronary Artery Lesions","authors":"Pedro E.P. Carvalho MD , Vanio L.J. Antunes , Vinicius Bittar de Pontes , Wilton Francisco Gomes MD , Beatriz Polachini Assunes Goncalves , Adriano Caixeta MD, PhD , Dimitrios Strepkos MD , Michaella Alexandrou MD , Deniz Mutlu MD , C. Michael Gibson MD , Gregg W. Stone MD , Deepak L. Bhatt MD, MPH, MBA , Stephan Windecker MD , Manesh R. Patel MD , Dominick Angiolillo MD, PhD , Roxana Mehran MD , Marco Valgimigli MD, PhD , Marco A. Costa MD, PhD , Yader Sandoval MD , Emmanouil S. Brilakis MD, PhD , Bruno R. Nascimento MD, PhD","doi":"10.1016/j.jcin.2025.11.021","DOIUrl":"10.1016/j.jcin.2025.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Intravascular imaging–guided percutaneous coronary intervention (PCI) reduces cardiovascular events compared with angiography-guided PCI alone. However, there is a paucity of data comparing these approaches in patients with complex coronary artery lesions and their respective subgroups.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the impact of intravascular ultrasound (IVUS)–guided and optical coherence tomography (OCT)–guided PCI on reducing major adverse cardiovascular events (MACE) compared with angiography-guided PCI in different complex lesions subsets.</div></div><div><h3>Methods</h3><div>In this lesion-level network meta-analysis, the MEDLINE, Embase, and Cochrane databases were systematically searched to identify randomized controlled trials reporting outcomes following intravascular imaging–guided or angiography-guided PCI with drug-eluting stents (DES). OCT, IVUS, and angiography were separately compared as guidance for PCI. Using a frequentist random-effects model network meta-analysis, RRs with corresponding 95% CIs were calculated for each strategy. The primary endpoint was MACE, defined as a composite of cardiac death, myocardial infarction, or target vessel revascularization.</div></div><div><h3>Results</h3><div>Seventeen randomized controlled trials, encompassing 13,751 patients with complex coronary lesions undergoing PCI with DES were incorporated into the analysis. In the network comparison, both OCT (RR: 0.63; 95% CI: 0.55-0.72; <em>P</em> < 0.001) and IVUS (RR: 0.67; 95% CI: 0.56-0.79; <em>P</em> < 0.001) demonstrated superiority over angiography-guided PCI in preventing MACE in complex lesions. These results were consistent in the subgroups of patients with chronic total occlusions, left main coronary artery disease, bifurcation lesions, multivessel coronary artery disease, and moderately or severely calcified lesions. No significant difference in MACE was observed between OCT and IVUS (RR: 0.94; 95% CI: 0.78-1.14; <em>P</em> = 0.52).</div></div><div><h3>Conclusions</h3><div>In patients with complex coronary lesions undergoing PCI with DES, both OCT-guided PCI and IVUS-guided PCI are more effective at reducing MACE compared with angiography-guided PCI. These findings were consistent across various types of complex coronary lesions and suggest that intravascular imaging–guided PCI should be the preferred approach for this population.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 31-43"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950306","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 : 2026-01-12DOI: 10.1016/j.jcin.2025.10.050
Yusuke Kobari MD, PhD , Annette Maznyczka MD, PhD , Arif A. Khokhar BMBCh, MA , Louise Marqvard Sørensen MD , Davorka Lulic MD , Gintautas Bieliauskas MD , Anna Axelsson Raja MD, PhD , Mads Kristian Ersbøll MD, PhD , Kasper Rossing MD, PhD , Finn Gustafsson MD, PhD , Lars Køber MD, PhD , Bernard Prendergast MD, PhD , Emil Fosbøl MD, PhD , Ole De Backer MD, PhD
Background
There are limited data concerning the impact of heart failure (HF) guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF) who undergo transcatheter aortic valve replacement (TAVR).
Objectives
The aims of this study were to determine whether TAVR patients with HFrEF receive optimal HF-GDMT and to investigate the prognostic significance of HF-GDMT in this setting.
Methods
In a prospective registry, consecutive TAVR patients with HFrEF were stratified into 4 groups (quadruple, triple, double, or single or no therapy) according to prescription of HF-GDMT at discharge post-TAVR and after a 3-month GDMT optimization period. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular mortality or hospitalization for heart failure. The median follow-up time was 699 days (Q1-Q3: 510-961 days).
Results
Among 336 TAVR patients with HFrEF, the rates of quadruple, triple, double, and single or no HF-GDMT were 15%, 19%, 28%, and 38% at discharge and 27%, 21%, 21%, and 27% at 3 months postprocedure, respectively. Among 280 patients (83.3%) eligible for quadruple HF-GDMT, only 27% (n = 76) received this combination at 3 months post-TAVR. Following a 3-month HF-GDMT optimization period, 2-year MACE rates were lower in patients taking quadruple (15.0%; 95% CI: 5.2%-24.8%) compared with triple (22.6%; 95% CI: 10.4%-34.8%), double (24.2%; 95% CI: 13.8%-34.6%), and single or no therapy (43.6%; 95% CI: 31.8%-55.4%; log-rank P < 0.001).
Conclusions
HF-GDMT is underused in patients with HFrEF who undergo TAVR, and suboptimal HF-GDMT is associated with increased MACE in this setting. Strategies to improve the initiation and up-titration of HF-GDMT in TAVR patients with HFrEF are needed.
{"title":"Clinical Application of Guideline-Directed Medical Therapy in TAVR Patients With Heart Failure and Reduced Ejection Fraction","authors":"Yusuke Kobari MD, PhD , Annette Maznyczka MD, PhD , Arif A. Khokhar BMBCh, MA , Louise Marqvard Sørensen MD , Davorka Lulic MD , Gintautas Bieliauskas MD , Anna Axelsson Raja MD, PhD , Mads Kristian Ersbøll MD, PhD , Kasper Rossing MD, PhD , Finn Gustafsson MD, PhD , Lars Køber MD, PhD , Bernard Prendergast MD, PhD , Emil Fosbøl MD, PhD , Ole De Backer MD, PhD","doi":"10.1016/j.jcin.2025.10.050","DOIUrl":"10.1016/j.jcin.2025.10.050","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data concerning the impact of heart failure (HF) guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF) who undergo transcatheter aortic valve replacement (TAVR).</div></div><div><h3>Objectives</h3><div>The aims of this study were to determine whether TAVR patients with HFrEF receive optimal HF-GDMT and to investigate the prognostic significance of HF-GDMT in this setting.</div></div><div><h3>Methods</h3><div>In a prospective registry, consecutive TAVR patients with HFrEF were stratified into 4 groups (quadruple, triple, double, or single or no therapy) according to prescription of HF-GDMT at discharge post-TAVR and after a 3-month GDMT optimization period. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular mortality or hospitalization for heart failure. The median follow-up time was 699 days (Q1-Q3: 510-961 days).</div></div><div><h3>Results</h3><div>Among 336 TAVR patients with HFrEF, the rates of quadruple, triple, double, and single or no HF-GDMT were 15%, 19%, 28%, and 38% at discharge and 27%, 21%, 21%, and 27% at 3 months postprocedure, respectively. Among 280 patients (83.3%) eligible for quadruple HF-GDMT, only 27% (n = 76) received this combination at 3 months post-TAVR. Following a 3-month HF-GDMT optimization period, 2-year MACE rates were lower in patients taking quadruple (15.0%; 95% CI: 5.2%-24.8%) compared with triple (22.6%; 95% CI: 10.4%-34.8%), double (24.2%; 95% CI: 13.8%-34.6%), and single or no therapy (43.6%; 95% CI: 31.8%-55.4%; log-rank <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>HF-GDMT is underused in patients with HFrEF who undergo TAVR, and suboptimal HF-GDMT is associated with increased MACE in this setting. Strategies to improve the initiation and up-titration of HF-GDMT in TAVR patients with HFrEF are needed.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 47-58"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950308","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 : 2026-01-12DOI: 10.1016/j.jcin.2025.09.047
Frank A. Medina BA , Ramya C. Mosarla MD , Joseph M. Kim MD , Siling Li MSc , Yang Song MSc , Robert W. Yeh MD, MBA, MSc , Eric A. Secemsky MD, MSc
Background
The dual use of intravascular imaging (IVI) and invasive physiology (IP) during percutaneous coronary intervention (PCI) is not well described in the United States.
Objectives
The aim of this study was to measure trends, clinical outcomes, and costs associated with the use of IVI and IP, alone and together, during PCI.
Methods
Medicare fee-for-service claims were used to analyze trends in the use of IVI and/or IP during PCI from 2016 to 2023. Beneficiaries ≥65 years of age with a first PCI during the study period were included in the outcomes analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, repeat revascularization, and all-cause death at 2 years. Multivariable Cox proportional regression was used to assess outcomes. Gamma regression was used to assess costs.
Results
A total of 2,538,154 PCIs were performed in 1,958,990 patients from 2016 to 2023. After exclusion, a total of 1,587,532 patients were included in the analysis. Overall, IVI was used in about 15%, IP in 7%, and dual IVI and IP in 2.5% of all PCIs. By 2023, the use of IVI and dual IVI and IP increased to about 30% and 4.7%, respectively. Dual IVI and IP was associated with lower rates of MACE at 2 years compared with angiography alone (adjusted HR: 0.87; 95% CI: 0.85-0.89; P < 0.0001). The cost analysis showed higher upfront procedural costs but lower long-term costs associated with any use of IVI and/or IP.
Conclusions
The dual use of IVI and IP has marginally increased and was associated with lower MACE and long-term costs compared with angiography alone.
{"title":"Adjunctive Imaging and Physiology During Percutaneous Coronary Intervention","authors":"Frank A. Medina BA , Ramya C. Mosarla MD , Joseph M. Kim MD , Siling Li MSc , Yang Song MSc , Robert W. Yeh MD, MBA, MSc , Eric A. Secemsky MD, MSc","doi":"10.1016/j.jcin.2025.09.047","DOIUrl":"10.1016/j.jcin.2025.09.047","url":null,"abstract":"<div><h3>Background</h3><div>The dual use of intravascular imaging (IVI) and invasive physiology (IP) during percutaneous coronary intervention (PCI) is not well described in the United States.</div></div><div><h3>Objectives</h3><div>The aim of this study was to measure trends, clinical outcomes, and costs associated with the use of IVI and IP, alone and together, during PCI.</div></div><div><h3>Methods</h3><div>Medicare fee-for-service claims were used to analyze trends in the use of IVI and/or IP during PCI from 2016 to 2023. Beneficiaries ≥65 years of age with a first PCI during the study period were included in the outcomes analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, repeat revascularization, and all-cause death at 2 years. Multivariable Cox proportional regression was used to assess outcomes. Gamma regression was used to assess costs.</div></div><div><h3>Results</h3><div>A total of 2,538,154 PCIs were performed in 1,958,990 patients from 2016 to 2023. After exclusion, a total of 1,587,532 patients were included in the analysis. Overall, IVI was used in about 15%, IP in 7%, and dual IVI and IP in 2.5% of all PCIs. By 2023, the use of IVI and dual IVI and IP increased to about 30% and 4.7%, respectively. Dual IVI and IP was associated with lower rates of MACE at 2 years compared with angiography alone (adjusted HR: 0.87; 95% CI: 0.85-0.89; <em>P</em> < 0.0001). The cost analysis showed higher upfront procedural costs but lower long-term costs associated with any use of IVI and/or IP.</div></div><div><h3>Conclusions</h3><div>The dual use of IVI and IP has marginally increased and was associated with lower MACE and long-term costs compared with angiography alone.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 15-27"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950304","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 : 2026-01-12DOI: 10.1016/j.jcin.2025.11.011
Robbert J. de Winter MD, PhD , Nico A. Blom MD, PhD
{"title":"Building Lifelong Management for the Right Ventricular Outflow Tract","authors":"Robbert J. de Winter MD, PhD , Nico A. Blom MD, PhD","doi":"10.1016/j.jcin.2025.11.011","DOIUrl":"10.1016/j.jcin.2025.11.011","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 93-95"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950312","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 : 2026-01-12DOI: 10.1016/j.jcin.2025.10.065
Caitlin W. Hicks MD, MS , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Scott Kinlay MBBS, PhD , Richard J. Powell MD , Michael B. Strong MA , Kenneth Rosenfield MD, MSc , Hanaa Aridi MD , Raghu Motaganahalli MD , Andrew Barleben MD , Jeffrey J. Siracuse MD , Ezana Azene MD , Mahmoud Malas MD , Michael S. Conte MD , Mohamed Zayed MD, PhD, MBA , Matthew T. Menard MD
Background
There are substantial data supporting the use of atherectomy for the treatment of coronary artery disease, but data regarding its efficacy for treating chronic limb-threatening ischemia (CLTI) are less robust.
Objectives
The authors aimed to evaluate the association of atherectomy with limb-based outcomes among patients managed with endovascular revascularization in the BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients With CLTI; NCT02060630) trial.
Methods
BEST-CLI was a prospective randomized trial comparing open and endovascular revascularization strategies for patients with CLTI. We included all patients treated with endovascular revascularization and stratified them according to whether they were treated with or without atherectomy. We evaluated whether atherectomy was associated with major adverse limb events (MALE) (including major reintervention or above-ankle amputation in the index limb) and secondary outcomes using Kaplan-Meier analyses and Cox proportional hazards models.
Results
923 patients underwent an endovascular intervention in the BEST-CLI trial (mean age 67.3 ± 10.0 years, 71.1%[656/923] male, 72.3%[662/916] White race), of which 132 (14.3%) received an atherectomy. After risk adjustment, MALE (adjusted HR [aHR]: 1.30; 95% CI: 0.92-1.84), major reintervention (aHR: 1.07; 95% CI: 0.67-1.73), above-ankle amputation (aHR: 1.32; 95% CI: 0.81-2.15), and all-cause death (aHR: 1.06; 95% CI: 0.75-1.49) were similar for patients who were treated with and without atherectomy. In a sensitivity analysis limited to patients with technical success, atherectomy was associated with higher MALE (unadjusted log-rank P = 0.02; aHR: 1.51; 95% CI: 1.03-2.22).
Conclusions
Atherectomy was associated with similar or slightly worse limb-based outcomes among patients undergoing endovascular revascularization for CLTI compared with other available endovascular technologies.
{"title":"Atherectomy Is Not Associated With Improved Limb-Based Outcomes Among Patients in the BEST-CLI Trial Undergoing Endovascular Revascularization","authors":"Caitlin W. Hicks MD, MS , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Scott Kinlay MBBS, PhD , Richard J. Powell MD , Michael B. Strong MA , Kenneth Rosenfield MD, MSc , Hanaa Aridi MD , Raghu Motaganahalli MD , Andrew Barleben MD , Jeffrey J. Siracuse MD , Ezana Azene MD , Mahmoud Malas MD , Michael S. Conte MD , Mohamed Zayed MD, PhD, MBA , Matthew T. Menard MD","doi":"10.1016/j.jcin.2025.10.065","DOIUrl":"10.1016/j.jcin.2025.10.065","url":null,"abstract":"<div><h3>Background</h3><div>There are substantial data supporting the use of atherectomy for the treatment of coronary artery disease, but data regarding its efficacy for treating chronic limb-threatening ischemia (CLTI) are less robust.</div></div><div><h3>Objectives</h3><div>The authors aimed to evaluate the association of atherectomy with limb-based outcomes among patients managed with endovascular revascularization in the BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients With CLTI; <span><span>NCT02060630</span><svg><path></path></svg></span>) trial.</div></div><div><h3>Methods</h3><div>BEST-CLI was a prospective randomized trial comparing open and endovascular revascularization strategies for patients with CLTI. We included all patients treated with endovascular revascularization and stratified them according to whether they were treated with or without atherectomy. We evaluated whether atherectomy was associated with major adverse limb events (MALE) (including major reintervention or above-ankle amputation in the index limb) and secondary outcomes using Kaplan-Meier analyses and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>923 patients underwent an endovascular intervention in the BEST-CLI trial (mean age 67.3 ± 10.0 years, 71.1%[656/923] male, 72.3%[662/916] White race), of which 132 (14.3%) received an atherectomy. After risk adjustment, MALE (adjusted HR [aHR]: 1.30; 95% CI: 0.92-1.84), major reintervention (aHR: 1.07; 95% CI: 0.67-1.73), above-ankle amputation (aHR: 1.32; 95% CI: 0.81-2.15), and all-cause death (aHR: 1.06; 95% CI: 0.75-1.49) were similar for patients who were treated with and without atherectomy. In a sensitivity analysis limited to patients with technical success, atherectomy was associated with higher MALE (unadjusted log-rank <em>P =</em> 0.02; aHR: 1.51; 95% CI: 1.03-2.22).</div></div><div><h3>Conclusions</h3><div>Atherectomy was associated with similar or slightly worse limb-based outcomes among patients undergoing endovascular revascularization for CLTI compared with other available endovascular technologies.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 1","pages":"Pages 96-107"},"PeriodicalIF":11.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950313","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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