1. Kite TA, Kurmani SA, Bountziouka V, Cooper NJ, Lock ST, Gale CP, et al. Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials. Eur Heart J 2022;43:3148–3161. In all-comers with NSTE-ACS, an early invasive strategy does not reduce all-cause mortality, MI, admission for HF, repeat revascularization, or increase major bleeding or stroke when compared with a delayed invasive strategy. Risk of recurrent ischaemia and length of stay are significantly reduced with an early invasive strategy.
2. Galli M, Benenati S, Franchi F, Rollini F, Capodanno D, Biondi-Zoccai G, et al. Comparative effects of guided vs. potent P2Y12 inhibitor therapy in acute coronary syndrome: a network meta-analysis of 61 898 patients from 15 randomized trials. Eur Heart J 2022;43:959–967. A guided selection of P2Y12-inhibiting therapy represents the strategy associated with the most favourable balance between safety and efficacy. These findings support a broader adoption of guided P2Y12 inhibiting therapy in patients with acute coronary syndrome.
3. Hwang D, Lim YH, Park KW, Chun KJ, Han JK, Yang HM, et al. Prasugrel dose de- escalation therapy after complex percutaneous coronary intervention in patients with acute coronary syndrome. A post hoc analysis from the HOSTREDUCE-POLYTECH-ACS trial. JAMA Cardiol 2022;7:418–426. https://doi. org/10.1001/ jamacardio.2022.0052. In this post hoc analysis of patients with ACS, prasugrel dose de-escalation compared with conventional therapy was not associated with an increased risk of ischemic outcomes but may reduce the risk of minor bleeding events at 1 year, irrespective of PCI complexity.
4. Valgimigli M, Smits PC, Frigoli E, Bongiovanni D, Tijssen J, Hovasse T, et al. Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial subanalysis. Eur Heart J 2022;43:3100–3114. In high bleeding risk patients free from recurrent ischaemic events at 1 month, dual antiplatelet therapy (DAPT) discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.
5. Perera D, Clayton T, O’Kane PD, Greenwood JP, Weerackody R, Ryan M, et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N Engl J Med 2022; 387:1351–1360. https://doi.org/10.1056/NEJMoa2206606. Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure.
6. Koo BK, Hu X, Kang J, Zhang J, Jiang J, Hahn JY, et al. Fractional flow reserve or intravascular ultrasonography to guide PCI. N Engl J Med 2022;387:779–789. https://doi. org/10.1056/NEJMoa2201546. In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months.
7. Beohar N, Ailawadi G, Kotinkaduwa LN, Redfors B, Simonato M, Zhang Z, et al. Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial. Eur Heart J 2022;43: 1639–1648. Baseline renal dysfunction was common in the heart failure (H)F patients with severe mitral regurgitation enrolled in COAPT and strongly predicted 2-year death and hospitalization for HF. MitraClip treatment reduced new-onset end-stage renal disease and the need for renal replacement therapy, contributing to the improved prognosis after transcatheter mitral valve repair.
8. Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, et al. Randomized comparison of transcatheter edge-to-edge repair for degenerative mitral regurgitation in prohibitive surgical risk patients. JACC Cardiovasc Interv 2022:S1936–8798(22) 01704-6. https://doi.org/10.1016/j.jcin.2022. 09.005. The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic degenerative mitral regurgitation.
9. Kapadia SR, Makkar R, Leon M, Abdel-Wahab M, Waggoner T, Massberg S, et al. Cerebral embolic protection during transcatheter aortic-valve replacement. N Engl J Med 2022;387(14):1253–1263. https://doi. org/10.1056/NEJMoa2204961. Among patients with aortic stenosis undergoing transfemoral TAVI, the use of cerebral embolic protection (CEP) did not have a significant effect on the incidence of periprocedural stroke, but on the basis of the 95% confidence interval around this outcome, the results may not rule out a benefit of CEP during TAVI.
10. Toma C, Jaber WA, Weinberg MD, Bunte MC, Khandhar S, Stegman B, et al. Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism. Eurointervention 2022: EIJ-D-22-00732. https://doi.org/10.4244/ EIJ-D- 22-00732. Mechanical thrombectomy with the FlowTriever System demonstrates a favourable safety profile, improvements in haemodynamics and functional outcomes, and low 30-day mortality for intermediateand high-risk pulmonary embolism.
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