Pub Date : 2026-02-09DOI: 10.1016/j.jcin.2025.11.012
Arsalan Abu-Much MD , Ajay J. Kirtane MD, SM
{"title":"All Roads Can Lead to Stent Expansion if Guided by the Map of Intravascular Imaging","authors":"Arsalan Abu-Much MD , Ajay J. Kirtane MD, SM","doi":"10.1016/j.jcin.2025.11.012","DOIUrl":"10.1016/j.jcin.2025.11.012","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 3","pages":"Pages 342-344"},"PeriodicalIF":11.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762878","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 : 2026-02-09DOI: 10.1016/j.jcin.2025.10.058
Chantal Y. Asselin MD, MSc, Kostantinos Koulogiannis MD, Robert Kipperman MD, John Brown III MD, David Freilich MD, Linda Gillam MD, Philippe Généreux MD, Gennaro Giustino MD
{"title":"Transseptal BATMAN for Re-Do Valve-in-MAC With Near-Zero Neo-LVOT and Commissural Misalignment","authors":"Chantal Y. Asselin MD, MSc, Kostantinos Koulogiannis MD, Robert Kipperman MD, John Brown III MD, David Freilich MD, Linda Gillam MD, Philippe Généreux MD, Gennaro Giustino MD","doi":"10.1016/j.jcin.2025.10.058","DOIUrl":"10.1016/j.jcin.2025.10.058","url":null,"abstract":"","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 3","pages":"Pages 386-389"},"PeriodicalIF":11.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759992","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 : 2026-02-09DOI: 10.1016/j.jcin.2025.10.051
Rikke Sørensen MD, PhD , Jacob Eifer Møller MD, DMSc , Christophe Vandenbriele MD , Christian Hassager MD, DMSc , Hans Eiskjær MD, DMSc , Norman Mangner MD , Amin Polzin MD , P. Christian Schulze MD , Carsten Skurk MD , Peter Nordbeck MD , Peter Clemmensen MD, DMSc , Vasileios Panoulas MD , Sebastian Zimmer MD , Andreas Schäfer MD , Steffen Christensen MD, PhD , Thomas Engstrøm MD, DMSc , Rasmus Paulin Beske MD , Martin Frydland MD, PhD , Lisette Okkels Jensen MD, DMSc , Anders Junker PhD , Lene Holmvang MD, DMSc
Background
The microaxial flow pump (mAFP) has demonstrated improved outcomes in selected patients with ST-segment elevation acute myocardial infarction and cardiogenic shock (STEMI-CS). However, its use has been associated with bleeding events.
Objectives
The authors analyzed bleeding in the international multicenter randomized DanGer Shock (Danish German Shock) trial.
Methods
A total of 355 patients with ST-segment elevation acute myocardial infarction and cardiogenic shock were randomized to either mAFP (n = 179) or standard care alone (n = 176). Bleeding events were classified according to Bleeding Academic Research Consortium (BARC) type 3-5.
Results
In the mAFP group, 47 patients (26.3% [95% CI: 20.3%-33.2%]) experienced BARC type 3-5 bleeding, compared with 27 (15.3% [95% CI: 10.7%-21.4%]) in the standard care group; P < 0.001. Median follow-up was 121 days (Q1-Q3: 3-180 days). Among the 210 patients treated with any mechanical circulatory support (MCS), 2 of 74 bleeding events (2.7%) occurred in the cath lab, 35 (47.3%) while on MCS, and 37 (50.0%) after the MCS was removed. Bleeding increased with complexity of MCS: OR for BARC 3-5 bleeding with mAFP was 4.94 (95% CI: 2.30-10.65); P < 0.001, with venoarterial extracorporeal membrane oxygenation (VA-ECMO) 8.06 (95% CI: 2.81-23.09); P < 0.001, and with combined mAFP+VA-ECMO 27.40 (95% CI: 9.82-76.43); P < 0.001, no device as reference. Multivariable logistic regression identified use of mAFP, renal replacement therapy, and escalation to VA-ECMO as predictors of BARC type 3-5 bleeding.
Conclusions
Patients randomized to mAFP experienced more bleeding than the standard care group. Bleeding was associated with the complexity of MCS, with one-half of the bleeding events occurring after device removal. (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502)
{"title":"Bleeding in Patients With Infarct-Related Cardiogenic Shock","authors":"Rikke Sørensen MD, PhD , Jacob Eifer Møller MD, DMSc , Christophe Vandenbriele MD , Christian Hassager MD, DMSc , Hans Eiskjær MD, DMSc , Norman Mangner MD , Amin Polzin MD , P. Christian Schulze MD , Carsten Skurk MD , Peter Nordbeck MD , Peter Clemmensen MD, DMSc , Vasileios Panoulas MD , Sebastian Zimmer MD , Andreas Schäfer MD , Steffen Christensen MD, PhD , Thomas Engstrøm MD, DMSc , Rasmus Paulin Beske MD , Martin Frydland MD, PhD , Lisette Okkels Jensen MD, DMSc , Anders Junker PhD , Lene Holmvang MD, DMSc","doi":"10.1016/j.jcin.2025.10.051","DOIUrl":"10.1016/j.jcin.2025.10.051","url":null,"abstract":"<div><h3>Background</h3><div>The microaxial flow pump (mAFP) has demonstrated improved outcomes in selected patients with ST-segment elevation acute myocardial infarction and cardiogenic shock (STEMI-CS). However, its use has been associated with bleeding events.</div></div><div><h3>Objectives</h3><div>The authors analyzed bleeding in the international multicenter randomized DanGer Shock (Danish German Shock) trial.</div></div><div><h3>Methods</h3><div>A total of 355 patients with ST-segment elevation acute myocardial infarction and cardiogenic shock were randomized to either mAFP (n = 179) or standard care alone (n = 176). Bleeding events were classified according to Bleeding Academic Research Consortium (BARC) type 3-5.</div></div><div><h3>Results</h3><div>In the mAFP group, 47 patients (26.3% [95% CI: 20.3%-33.2%]) experienced BARC type 3-5 bleeding, compared with 27 (15.3% [95% CI: 10.7%-21.4%]) in the standard care group; <em>P <</em> 0.001. Median follow-up was 121 days (Q1-Q3: 3-180 days). Among the 210 patients treated with any mechanical circulatory support (MCS), 2 of 74 bleeding events (2.7%) occurred in the cath lab, 35 (47.3%) while on MCS, and 37 (50.0%) after the MCS was removed. Bleeding increased with complexity of MCS: OR for BARC 3-5 bleeding with mAFP was 4.94 (95% CI: 2.30-10.65); <em>P <</em> 0.001, with venoarterial extracorporeal membrane oxygenation (VA-ECMO) 8.06 (95% CI: 2.81-23.09); <em>P <</em> 0.001, and with combined mAFP+VA-ECMO 27.40 (95% CI: 9.82-76.43); <em>P <</em> 0.001, no device as reference. Multivariable logistic regression identified use of mAFP, renal replacement therapy, and escalation to VA-ECMO as predictors of BARC type 3-5 bleeding.</div></div><div><h3>Conclusions</h3><div>Patients randomized to mAFP experienced more bleeding than the standard care group. Bleeding was associated with the complexity of MCS, with one-half of the bleeding events occurring after device removal. (Danish Cardiogenic Shock Trial [DanShock]; <span><span>NCT01633502</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 3","pages":"Pages 302-312"},"PeriodicalIF":11.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152686","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 : 2026-02-09DOI: 10.1016/j.jcin.2025.09.030
Carlo A. Pivato MD, PhD , Emanuele Di Angelantonio MD, PhD , Francesco Tartaglia MD , Gianluigi Condorelli MD, PhD , Nicole Fontana MS , Francesca Ieva PhD , Cosmo Godino MD , Masaaki Nakase MD , Karsten Hug MD , Tobias Rheude MD , Antonio J. Munoz-Garcia MD, PhD , Victor Alfonso Jimenez Diaz MD , Alfonso Ielasi MD , Marco Barbanti MD , Giuliano Costa MD, PhD , Angelo Anzuini MD , Giorgio Quadri MD , Diego Lopez-Otero MD , Philippe Garot MD , Ferdinando Varbella MD , Giulio Stefanini MD, PhD
Background
Coronary access after transcatheter aortic valve replacement (TAVR) remains challenging, particularly with tall-framed valves (TFVs), raising concerns about long-term percutaneous coronary intervention (PCI).
Objectives
The aim of this study was to evaluate the impact of bioprosthetic aortic valve type on long-term clinical outcomes in patients undergoing PCI following TAVR.
Methods
Data were derived from the multicenter REVIVAL-PCI registry, which included patients from 21 European centers who underwent PCI after TAVR between 2008 and 2023. Patients were classified according to valve frame height: TFVs or short-framed valves (SFVs). The primary endpoint was the 4-year incidence of major adverse cardiovascular events, defined as the composite of cardiovascular death, myocardial infarction, or stroke. Cumulative event rates were estimated using Kaplan-Meier method, and weighted Cox regression models using an entropy balance approach were used to adjust for imbalances in clinical and procedural confounders.
Results
The analysis included 441 patients, with 230 having undergone TAVR with SFVs (30.9% women) and 211 with TFVs (44.1% women). The median follow-up after PCI was 908 days (Q1-Q3: 322-1,728 days). The 4-year incidence of major adverse cardiovascular events was comparable between the SFV and TFV groups (38.1% [95% CI: 24.6%-43.9%] vs 31.9% [95% CI: 24.8%-41.0%]; HR: 1.04; 95% CI: 0.71-1.52; P = 0.846). Similar findings were observed after adjustment for potential confounders.
Conclusions
In current practice, long-term outcomes after PCI in TAVR patients do not appear to be significantly different between those receiving SFVs and TFVs. Future investigations with newer generation valves and refined implantation techniques are needed to clarify these associations and optimize management strategies.
经导管主动脉瓣置换术（TAVR）后的冠状动脉通路仍然具有挑战性，特别是高框架瓣膜（tfv），这引起了对长期经皮冠状动脉介入治疗（PCI）的担忧。目的：本研究的目的是评估生物人工主动脉瓣类型对TAVR术后PCI患者长期临床结果的影响。方法数据来自多中心REVIVAL-PCI注册表，其中包括来自21个欧洲中心的2008年至2023年间TAVR后接受PCI的患者。根据瓣膜架高度对患者进行分类：TFVs或短框架瓣膜（SFVs）。主要终点是4年主要心血管不良事件的发生率，定义为心血管死亡、心肌梗死或中风的综合发生率。使用Kaplan-Meier方法估计累积事件率，并使用加权Cox回归模型使用熵平衡方法来调整临床和程序混杂因素的不平衡。结果纳入441例患者，其中230例合并SFVs（30.9%女性），211例合并TFVs（44.1%女性）。PCI术后中位随访时间为908天（Q1-Q3: 322- 1728天）。SFV组和TFV组的4年主要不良心血管事件发生率相当（38.1% [95% CI: 24.6%-43.9%] vs 31.9% [95% CI: 24.8%-41.0%]; HR: 1.04; 95% CI: 0.71-1.52; P = 0.846）。在对潜在混杂因素进行校正后，观察到类似的结果。结论在目前的实践中，接受sfv和tfv的TAVR患者PCI后的长期结果似乎没有显著差异。未来的研究需要新一代的瓣膜和完善的植入技术来澄清这些关联并优化管理策略。
{"title":"Impact of Valve Frame Height on PCI Outcomes After TAVR","authors":"Carlo A. Pivato MD, PhD , Emanuele Di Angelantonio MD, PhD , Francesco Tartaglia MD , Gianluigi Condorelli MD, PhD , Nicole Fontana MS , Francesca Ieva PhD , Cosmo Godino MD , Masaaki Nakase MD , Karsten Hug MD , Tobias Rheude MD , Antonio J. Munoz-Garcia MD, PhD , Victor Alfonso Jimenez Diaz MD , Alfonso Ielasi MD , Marco Barbanti MD , Giuliano Costa MD, PhD , Angelo Anzuini MD , Giorgio Quadri MD , Diego Lopez-Otero MD , Philippe Garot MD , Ferdinando Varbella MD , Giulio Stefanini MD, PhD","doi":"10.1016/j.jcin.2025.09.030","DOIUrl":"10.1016/j.jcin.2025.09.030","url":null,"abstract":"<div><h3>Background</h3><div>Coronary access after transcatheter aortic valve replacement (TAVR) remains challenging, particularly with tall-framed valves (TFVs), raising concerns about long-term percutaneous coronary intervention (PCI).</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the impact of bioprosthetic aortic valve type on long-term clinical outcomes in patients undergoing PCI following TAVR.</div></div><div><h3>Methods</h3><div>Data were derived from the multicenter REVIVAL-PCI registry, which included patients from 21 European centers who underwent PCI after TAVR between 2008 and 2023. Patients were classified according to valve frame height: TFVs or short-framed valves (SFVs). The primary endpoint was the 4-year incidence of major adverse cardiovascular events, defined as the composite of cardiovascular death, myocardial infarction, or stroke. Cumulative event rates were estimated using Kaplan-Meier method, and weighted Cox regression models using an entropy balance approach were used to adjust for imbalances in clinical and procedural confounders.</div></div><div><h3>Results</h3><div>The analysis included 441 patients, with 230 having undergone TAVR with SFVs (30.9% women) and 211 with TFVs (44.1% women). The median follow-up after PCI was 908 days (Q1-Q3: 322-1,728 days). The 4-year incidence of major adverse cardiovascular events was comparable between the SFV and TFV groups (38.1% [95% CI: 24.6%-43.9%] vs 31.9% [95% CI: 24.8%-41.0%]; HR: 1.04; 95% CI: 0.71-1.52; <em>P</em> = 0.846). Similar findings were observed after adjustment for potential confounders.</div></div><div><h3>Conclusions</h3><div>In current practice, long-term outcomes after PCI in TAVR patients do not appear to be significantly different between those receiving SFVs and TFVs. Future investigations with newer generation valves and refined implantation techniques are needed to clarify these associations and optimize management strategies.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 3","pages":"Pages 345-355"},"PeriodicalIF":11.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357610","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 : 2026-02-09DOI: 10.1016/j.jcin.2025.11.028
George D. Dangas MD, PhD , Martin Unverdorben MD, PhD , Christian Hengstenberg MD , Roxana Mehran MD , Raúl Moreno MD, PhD , Luis Nombela-Franco MD , Tetsuya Kimura MS , Diego López-Otero MD, PhD , Peter Nordbeck MD , Yusuke Watanabe MD, PhD , Hyo-Soo Kim MD, PhD , Johny Nicolas MD , Johanna van Zyl PhD , Cathy Chen MD , Stéphane Noble MD , Nicolas M. Van Mieghem MD, PhD
Background
Estimating the probability of major bleeding (MB) in patients with atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR) is important for decision-making regarding anticoagulation strategy.
Objectives
The aim of this study was to identify independent predictors of MB to create a risk assessment score in patients with AF after successful TAVR.
Methods
In this ENVISAGE-TAVI AF (EdoxabaN Versus standard of care and their effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation-in Atrial Fibrillation; NCT02943785) on-treatment analysis, a stepwise Cox regression model identified MB predictors from baseline patient characteristics. A simple point-based additive score was constructed using the variable β estimates from the selected model. Patients were stratified into low-, moderate-, and high-risk groups according to their risk assessment scores; the likelihood of MB was compared between groups.
Results
Among 1,377 patients, 139 (10.1%) experienced MB (mean ± SD on-treatment follow-up: 1.3 ± 0.8 years). The independent predictors of MB formed the HARHP (low Hemoglobin, excessive Alcohol use, severe Renal impairment, history of Hypercholesterolemia, and Percutaneous coronary intervention performed within 30 days of TAVR) score, with each parameter given a weight of 1 or 2. The likelihood of MB for high-risk patients (score ≥ 4) was 6.5 times higher than for low-risk patients (score = 0 or 1) (HR: 6.54; 95% CI: 3.61-11.85; P < 0.0001) and 2.9 times higher than moderate-risk patients (score = 2 or 3) (HR: 2.86; 95% CI: 1.62-5.04; P = 0.0003). The C statistic for the HARHP score was 0.63 at 1-year follow-up and 0.62 at 2-year follow-up.
Conclusions
Five independent predictors of long-term MB were identified in patients with AF requiring oral anticoagulant agents after TAVR and formed the HARHP score to assess MB risk. Use of the HARHP score may improve patient outcomes.
评估心房颤动（AF）患者经导管主动脉瓣置换术（TAVR）后大出血（MB）的概率对抗凝策略的决策具有重要意义。目的：本研究的目的是确定独立的MB预测因素，以建立AF患者在TAVR成功后的风险评估评分。方法在这项envisagtavi AF（依多沙班与标准护理及其对经导管主动脉瓣置入术心房颤动患者临床结局的影响；NCT02943785）治疗分析中，逐步Cox回归模型从基线患者特征中确定了MB预测因子。使用所选模型的变量β估计构建了一个简单的基于点的加性评分。根据患者的风险评估得分将患者分为低、中、高风险组；比较两组间发生MB的可能性。结果1377例患者中，139例（10.1%）发生MB（治疗期平均±SD: 1.3±0.8年）。MB的独立预测因子形成了HARHP评分（低血红蛋白、过量饮酒、严重肾功能损害、高胆固醇血症史和TAVR后30天内进行的经皮冠状动脉介入治疗），每个参数的权重为1或2。高危患者（评分≥4）发生MB的可能性是低危患者（评分= 0或1）的6.5倍（HR: 6.54; 95% CI: 3.61-11.85; P < 0.0001），是中危患者（评分= 2或3）的2.9倍（HR: 2.86; 95% CI: 1.62-5.04; P = 0.0003）。随访1年HARHP评分的C统计值为0.63，随访2年为0.62。结论在TAVR后需要口服抗凝药物的AF患者中，确定了5个独立的长期MB预测因素，并形成了HARHP评分来评估MB风险。使用HARHP评分可以改善患者的预后。
{"title":"Major Bleeding Risk Assessment With Atrial Fibrillation Post-TAVR","authors":"George D. Dangas MD, PhD , Martin Unverdorben MD, PhD , Christian Hengstenberg MD , Roxana Mehran MD , Raúl Moreno MD, PhD , Luis Nombela-Franco MD , Tetsuya Kimura MS , Diego López-Otero MD, PhD , Peter Nordbeck MD , Yusuke Watanabe MD, PhD , Hyo-Soo Kim MD, PhD , Johny Nicolas MD , Johanna van Zyl PhD , Cathy Chen MD , Stéphane Noble MD , Nicolas M. Van Mieghem MD, PhD","doi":"10.1016/j.jcin.2025.11.028","DOIUrl":"10.1016/j.jcin.2025.11.028","url":null,"abstract":"<div><h3>Background</h3><div>Estimating the probability of major bleeding (MB) in patients with atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR) is important for decision-making regarding anticoagulation strategy.</div></div><div><h3>Objectives</h3><div>The aim of this study was to identify independent predictors of MB to create a risk assessment score in patients with AF after successful TAVR.</div></div><div><h3>Methods</h3><div>In this ENVISAGE-TAVI AF (EdoxabaN Versus standard of care and their effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation-in Atrial Fibrillation; <span><span>NCT02943785</span><svg><path></path></svg></span>) on-treatment analysis, a stepwise Cox regression model identified MB predictors from baseline patient characteristics. A simple point-based additive score was constructed using the variable β estimates from the selected model. Patients were stratified into low-, moderate-, and high-risk groups according to their risk assessment scores; the likelihood of MB was compared between groups.</div></div><div><h3>Results</h3><div>Among 1,377 patients, 139 (10.1%) experienced MB (mean ± SD on-treatment follow-up: 1.3 ± 0.8 years). The independent predictors of MB formed the HARHP (low Hemoglobin, excessive Alcohol use, severe Renal impairment, history of Hypercholesterolemia, and Percutaneous coronary intervention performed within 30 days of TAVR) score, with each parameter given a weight of 1 or 2. The likelihood of MB for high-risk patients (score ≥ 4) was 6.5 times higher than for low-risk patients (score = 0 or 1) (HR: 6.54; 95% CI: 3.61-11.85; <em>P</em> < 0.0001) and 2.9 times higher than moderate-risk patients (score = 2 or 3) (HR: 2.86; 95% CI: 1.62-5.04; <em>P</em> = 0.0003). The C statistic for the HARHP score was 0.63 at 1-year follow-up and 0.62 at 2-year follow-up.</div></div><div><h3>Conclusions</h3><div>Five independent predictors of long-term MB were identified in patients with AF requiring oral anticoagulant agents after TAVR and formed the HARHP score to assess MB risk. Use of the HARHP score may improve patient outcomes.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"19 3","pages":"Pages 359-368"},"PeriodicalIF":11.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152679","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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