2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6be,To evaluate clinical profile and coronary perfusion of patients with ostial occlusion of all epicardial coronary arteries. From 2009-2025, 165 adults (age=72±9.8 years; n=152[92%] male) with prior CABG had complete ostial occlusion of right coronary artery (RCA) and either left main (n=120[73%]) or left main equivalent (n=45[27%]). An additional patient without prior CABG presented in cardiogenic shock and was bridged to transplant. Graft patency and collateralization (Rentrop and collateral connections scores) were assessed by angiography and ischemia and scar burden by stress positron emission tomography (PET; n=89). Of the 165, 88(53%) presented with symptoms primarily related to ischemia, 67(41%), with symptoms primarily related to heart failure; 19(12%) were asymptomatic; 64/89(72%) had positive stress imaging. Of 543 existing grafts, 344(63%) were patent. Of 64 patients with a patent ITA to LAD and had PET tests, 9(14%) showed scar only, 25(39%) ischemia only, and 19(30%) both. Collaterals supplied LAD, circumflex, and RCA territories in 50, 83, and 100 patients, respectively, with LAD 28/50(56%) receiving collaterals from RCA. Of 233 collaterals, 103(44%) were Rentrop grade 1 (filling without epicardial vessels); 81/165(49%) had complete vascularization (patent grafts or high-grade collaterals to all territories). Post-diagnosis, 14(8.4%) patients underwent CABG, 50(30%) percutaneous intervention, and 100(61%) medical management, with median survival of 7.6, 6.0, and 3.0 years, respectively (P=.027). Patent bypass grafts can sustain survival in patients even after ostial occlusion of all epicardial coronary arteries, an advantage not previously reported by other coronary disease therapies.31:T870,The optimal timing of complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease complicated by heart failure remains uncertain. The OPTION-STEMI (Optimal Timing of Fractional Flow Reserve-Guided Complete Revascularization for Non-Infarct-Related Artery in ST-segment Elevation Myocardial Infarction with Multivessel Disease) trial compared immediate vs staged complete revascularization during the index admission in patients with STEMI and multivessel disease. In the OPTION-STEMI trial, immediate complete revascularization was not found to be non-inferior for the primary endpoint compared with staged complete revascularization. Pre-specified subgroup analysis was performed according to heart failure at admission, defined as Killip class II or III. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularization at 1 year. Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11-2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05-3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50-1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043). In the OPTION-STEMI trial, among patients with STEMI and multi-vessel disease who were not in cardiogenic shock, immediate complete revascularization was not non-inferior compared with staged complete revascularization. However, subgroup analysis suggests that the worse outcomes with immediate complete revascularization may be limited to patients with heart failure at admission. Further studies are required to demonstrate the non-inferiority of immediate complete revascularization compared with staged complete revascularization in patients without heart failure.32:Tafc,Abstract Background and Aims The optimal timing of complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease complicated by heart failure remains uncertain. Methods The OPTION-STEMI (Optimal Timing of Fractional Flow Reserve-Guided Complete Revascularization for Non-Infarct-Related Artery in ST-segment Elevation Myocardial Infarction with Multivessel Disease) trial compared immediate vs staged complete revascularization during the index admission in patients with STEMI and multivessel disease. In the OPTION-STEMI trial, immediate complete revascularization was not found to be non-inferior for the primary endpoint compared with staged complete revascularization. Pre-specified subgroup analysis was performed according to heart failure at admission, defined as Killip class II or III. The primary endpoint was a composite of death from any cause, non-fatal myocardial infarction, or any unplanned revascularization at 1 year. Results Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11–2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05–3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50–1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043). Conclusions In the OPTION-STEMI trial, among patients with STEMI and multi-vessel disease who were not in cardiogenic shock, immediate complete revascularization was not non-inferior compared with staged complete revascularization. However, subgroup analysis suggests that the worse outcomes with immediate complete revascularization may be limited to patients with heart failure at admission. Further studies are required to demonstrate the non-inferiority of immediate complete revascularization compared with staged complete revascularization in patients without heart failure. 33:T683,Subintimal tracking and re-entry (STAR) with staged stenting may increase the success and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) when used as a bailout strategy. The optimal timing for staged stenting is unknown. In this study, the authors sought to evaluate the timing of staged PCI after STAR by randomizing to an earlier (5-7 weeks) or later (12-14 weeks) timeframe. Patients undergoing CTO PCI with the use of STAR (n = 150) were randomized at 6 centers to early or late staged PCI. The primary endpoint was partial technical success of the staged procedure, defined as TIMI flow grade 2-3 with <30% residual stenosis into at least 1 ≥2.5 mm distal branch. Study outcomes were compared between groups with the use of chi-square and Fisher exact tests. Seventy-three patients were randomized to the early group and 77 to the late group. The mean Japanese-CTO score was 2.9 ± 1.1. Differences in the primary endpoint between the early group and the late group did not reach statistical significance (83.6% vs 71.4%; P = 0.08). TIMI flow grade 2-3 in the target vessel at the start of staged procedure was higher in the early group (64.4% vs 44.2%; P = 0.012; P = 0.048 after adjustment). Among patients undergoing STAR with deferred stenting after an unsuccessful index CTO PCI attempt, the partial technical success rate of staged procedures was high. Although vessel patency was higher at the start of early staged procedures, there were no statistically significant differences for partial technical success of the staged procedure with early or late treatment. (STAR and Deferred Stenting Study [STAR]; NCT05089864).25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Percutaneous Coronary Intervention: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Percutaneous Coronary Intervention (modality). Clinician-written summaries and actionable practice insights. 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Summary details are based solely on the abstract; specific event rates, hazard ratios, and per-trial results could not be verified from the full text.","value_numeric":null},{"paper_doi":"10.1038/s41569-026-01342-3","tag_type":"warning","value":"Study design tagged as 'Systematic Review / Narrative Review' based on abstract framing; the paper is described as a 'Review' synthesizing RCT evidence rather than a formal meta-analysis.","value_numeric":null},{"paper_doi":"10.1038/s41569-026-01342-3","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the synthesis of eight large RCTs and the authors' stated aim of reshaping clinical decision-making for ICI use in PCI; individual trial results were mixed.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the clinical use of intracoronary imaging (ICI) — specifically IVUS and OCT — to guide percutaneous coronary intervention (PCI) in patients with coronary artery disease, synthesizing findings from eight large (n > 1,000) international randomized trials: ILUMIEN IV, IVUS-ACS, IVUS-CHIP, IVUS-XPL, OCCUPI, OCTOBER, RENOVATE-COMPLEX-PCI, and ULTIMATE.","key_result":"Across eight large randomized trials, ICI-guided PCI generally improved clinical outcomes compared with angiography-guided PCI, though results were heterogeneous; benefits were most consistent in complex lesion subsets and high-risk populations, while routine use in all-comers showed mixed findings.","limitations":"- Full text page content was not extractable, limiting granular data verification (e.g., absolute event rates per trial).\n- Heterogeneity in study populations and lack of standardized ICI optimization criteria across trials complicates cross-trial comparisons.\n- Mixed trial results leave uncertainty about which specific patient or lesion subgroups benefit most from ICI guidance in real-world practice.","practice_takeaway":"Clinicians should prioritize ICI guidance — IVUS or OCT — for complex PCI cases (e.g., ACS, calcified or long lesions), where the evidence for outcome benefit is most consistent. Patient selection and standardized ICI protocols are key to translating trial benefits to everyday practice."}},{"doi":"10.1016/j.jcin.2026.06.024","pmid":"42637295","title":"Rapid Inflation-Deflation vs Pressure-Optimized Stenting During Primary PCI","journal_title":"JACC: Cardiovascular Interventions","journal_issn":"1936-8798","published_at":"2026-08-24T00:00:00.000Z","url":"https://doi.org/10.1016/j.jcin.2026.06.024","source_score":33,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-28T06:25:21.039Z","updated_at":"2026-08-28T06:25:21.039Z","tags":[{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"condition","value":"ST-Segment Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"modality","value":"Coronary Stenting","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"sample_size","value":"n=607","value_numeric":607},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously given short follow-up and underpowered MACE endpoint; the authors themselves call for larger trials.","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"warning","value":"No brand or generic drug tags applied — the intervention is a procedural technique, not a pharmacological agent.","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.06.024","tag_type":"warning","value":"The 30-day MACE result was not statistically significant; the trend toward benefit should not be interpreted as confirmed clinical superiority without a larger powered trial.","value_numeric":null}],"summaries":{"what_studied":"This multicenter RCT (RAPID-POP; n=607) compared pressure-optimized stenting (POP — inflation to ≥14 atm held until pressure stability) vs. conventional rapid inflation-deflation stenting in STEMI patients undergoing primary PCI, with a primary hierarchical endpoint of reperfusion success at 90 minutes and 30-day MACE follow-up.","key_result":"POP significantly improved the hierarchical reperfusion endpoint (WIN ratio 1.42; 95% CI 1.11–1.79; P=0.004), driven by higher ST-segment resolution ≥70% (+5.70%) and TIMI 3 flow rates (+5.95%), with far less need for postdilation (65.3% vs. 91.0%; P<0.001). Thirty-day MACE trended lower with POP (2.0% vs. 4.1%; HR 0.49; P=0.15) but did not reach significance.","limitations":"- Short follow-up (median 30 days) limits assessment of longer-term clinical outcomes such as mortality or target vessel failure.\n- The MACE reduction was numerically large but underpowered to reach statistical significance (P=0.15), so clinical benefit remains uncertain.\n- Blinding was at the endpoint assessment level only; operators were unblinded, introducing potential performance bias.","practice_takeaway":"In STEMI patients undergoing primary PCI, maintaining stent inflation pressure ≥14 atm until pressure stabilizes improves reperfusion success and reduces the need for postdilation compared to rapid deflation — consider adopting POP as a default technique while awaiting larger trials to confirm MACE benefit."}},{"doi":"10.1161/circinterventions.126.016897","pmid":"42619585","title":"Intracoronary Low-Dose Thrombolysis in Primary PCI for STEMI: A Systematic Review and Meta-Analysis","journal_title":"Circulation: Cardiovascular Interventions","journal_issn":"1941-7640","published_at":"2026-08-20T00:00:00.000Z","url":"https://eprints.gla.ac.uk/view/author/3069.html>","source_score":25,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-30T06:19:58.612Z","updated_at":"2026-08-30T06:19:58.612Z","tags":[{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"condition","value":"ST-Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"modality","value":"Thrombolytic Therapy","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"warning","value":"Full paper text was not provided — only title, journal, DOI, and publication date were available. All extracted content is inferred from metadata only. Key quantitative results (pooled effect sizes, sample size, number of trials, heterogeneity) could not be confirmed. Tags and summaries should be verified against the full publication.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"warning","value":"Sex of study population could not be determined from available metadata.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016897","tag_type":"warning","value":"Specific thrombolytic agents (e.g., alteplase, tenecteplase) used in included trials could not be extracted without full text access.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis evaluated the efficacy and safety of intracoronary low-dose thrombolysis as an adjunct to primary PCI in patients with STEMI, comparing outcomes against standard primary PCI alone.","key_result":"Specific pooled outcome numbers are not available from the provided source text; the review assessed endpoints likely including reperfusion success, TIMI flow, and clinical outcomes such as mortality and major adverse cardiac events across included trials.","limitations":"Full paper text was not provided, limiting extraction of precise effect estimates, trial counts, heterogeneity statistics, and risk-of-bias assessments. Conclusions are based on title and metadata only.","practice_takeaway":"Clinicians managing STEMI with large thrombus burden should monitor this emerging evidence on intracoronary low-dose thrombolysis as a PCI adjunct; full meta-analysis results should be reviewed before changing practice."}},{"doi":"10.1002/ccd.70815","pmid":"42596520","title":"Percutaneous Coronary Stentectomy: Redefining Stent Failure Management in the Modern Era","journal_title":"Catheterization and Cardiovascular Interventions","journal_issn":"1522-1946","published_at":"2026-08-13T00:00:00.000Z","url":"https://doi.org/10.1002/ccd.70815","source_score":48,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-20T06:47:52.757Z","updated_at":"2026-08-20T06:47:52.757Z","tags":[{"paper_doi":"10.1002/ccd.70815","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"condition","value":"Coronary In-Stent Restenosis","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"condition","value":"Coronary Stent Malapposition","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"condition","value":"Coronary Stent Thrombosis","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"modality","value":"Drug-Coated Balloon","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"modality","value":"Intravascular Ultrasound","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"sample_size","value":"n=5","value_numeric":5},{"paper_doi":"10.1002/ccd.70815","tag_type":"study_design","value":"Narrative Review with Illustrative Cases","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"warning","value":"Only 5 illustrative cases are included; no systematic cohort or comparative data are present, so findings reflect expert opinion and case experience rather than controlled evidence.","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"warning","value":"Sex of patients is not reported in the abstract; the sex tag was omitted accordingly.","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"warning","value":"Study design sits between a narrative review and a case series; level of evidence classified as 5 (expert opinion/case series).","value_numeric":null},{"paper_doi":"10.1002/ccd.70815","tag_type":"warning","value":"The 'reverse hairpin-assisted snare extraction technique' is described as novel and is reported in a single case — generalizability is highly uncertain.","value_numeric":null}],"summaries":{"what_studied":"This narrative review plus 5 illustrative cases from 3 academic centers evaluated percutaneous coronary stentectomy — intentional retrieval of a fully deployed coronary stent — across acute, subacute, and late settings, covering indications such as malapposition, longitudinal deformation, and excessive aorto-ostial protrusion.","key_result":"Stentectomy was feasible across all time settings; snare-based retrieval through guide extension catheters was the dominant technique, with stents having ≤3 inter-ring connectors allowing more predictable extraction. Drug-coated balloons enabled metal-free revascularization post-removal, and a novel reverse hairpin-assisted snare technique facilitated pre-TAVR retrieval in one case.","limitations":"Evidence base is limited to a narrative review plus only 5 cases across 3 centers, with no systematic comparison of outcomes or controls. Case selection bias and lack of long-term follow-up data are inherent to this design.","practice_takeaway":"When a deployed coronary stent causes ongoing complications (malapposition, thrombosis, aorto-ostial protrusion, or interference with structural interventions), percutaneous stentectomy — guided by intravascular ultrasound and Heart Team evaluation — is a viable structured strategy. Stents with ≤3 inter-ring connectors are more amenable to extraction; drug-coated balloons can provide metal-free revascularization after removal."}},{"doi":"10.1097/lvt.0000000000000967","pmid":"42546287","title":"Staged percutaneous coronary intervention and simultaneous coronary artery bypass grafting in living donor liver transplantation: A single-center retrospective cohort study","journal_title":"Liver Transplantation","journal_issn":"1527-6465","published_at":"2026-07-30T00:00:00.000Z","url":"https://doi.org/10.1097/lvt.0000000000000967","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-10T13:22:08.477Z","updated_at":"2026-08-10T13:22:08.477Z","tags":[{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"condition","value":"End-Stage Liver Disease","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"condition","value":"Liver Transplantation","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"modality","value":"Coronary Artery Bypass Grafting","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"modality","value":"Off-Pump Coronary Artery Bypass","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"sample_size","value":"n=26","value_numeric":26},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"warning","value":"All reported deaths were from sepsis, not cardiac causes, so cardiac safety conclusions are subject to competing-risk considerations not formally addressed in the study.","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"warning","value":"The PCI (n=15) and CABG (n=11) groups had markedly different baseline disease severity — MELD-Na and Child-Pugh scores were substantially higher in the CABG group — making any between-group outcome comparison unreliable.","value_numeric":null},{"paper_doi":"10.1097/lvt.0000000000000967","tag_type":"warning","value":"Wide confidence intervals throughout (e.g., 90-day mortality 95% CI 0.1–19.6%) reflect the very small sample size; findings should be considered preliminary and hypothesis-generating only.","value_numeric":null}],"summaries":{"what_studied":"Single-center retrospective cohort study evaluating outcomes of coronary revascularization strategies — staged PCI vs. simultaneous CABG — in 26 adult LDLT candidates with significant CAD, between January 2017 and April 2025; primary outcomes were 90-day and 1-year all-cause mortality and MACE.","key_result":"90-day all-cause mortality was 3.8% (1/26); 1-year mortality was 7.7% (2/26), both deaths from non-cardiac sepsis in the CABG group. Cardiac mortality was 0% in both groups; 1-year MACE was 0%; 1-year survival in the CABG group was 81.8%. No stent thrombosis occurred in the PCI group despite highly variable PCI-to-LDLT intervals (20–1,505 days).","limitations":"- Very small cohort (n=26) with wide confidence intervals, limiting any definitive conclusions.\n- Single-center, retrospective design with no randomization and likely selection bias in revascularization strategy assignment.\n- The two groups differed substantially in baseline disease severity (e.g., MELD-Na, coronary anatomy), making direct comparison unreliable.","practice_takeaway":"Both staged PCI and simultaneous OPCAB-LDLT appear feasible when strategy is tailored to coronary anatomy and hepatic reserve, with 0% cardiac mortality and MACE at 1 year in this small series. Clinicians should note that the flexible scheduling window of living donor programs may allow safe deferral of LDLT after PCI, but multicenter data are needed before broad adoption."}},{"doi":"10.1016/j.annemergmed.2026.02.025","pmid":"42476685","title":"Managing Transient ST-Segment Elevation","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-07-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.02.025","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:46.343Z","updated_at":"2026-07-31T13:36:54.322Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"Coronary Vasospasm","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"ST-Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"ST-Segment Elevation","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Anticoagulation","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Coronary Angiography","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"study_design","value":"Case Report with Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Key quantitative data cited (TRANSIENT trial, ELISA-3 subgroup) are from referenced external studies, not generated by this article itself.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or conclusions. All summary fields have been set to null due to insufficient source content. Please provide the full text or abstract for a complete extraction.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the publisher landing page was provided — no abstract, methods, results, or conclusions are accessible. All summary fields are null due to insufficient source text. Full-text access is required to extract meaningful clinical data.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the publisher landing page was provided — no abstract, methods, results, or full text were accessible. All summary fields are null due to insufficient source data.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all clinical details are indeterminable from the available content.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all other structured details cannot be determined from the available text.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all other structured fields cannot be determined from the available information.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design tag 'Case Report with Narrative Review' reflects the hybrid format; standard RCT-level evidence is not produced here.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Tags and suggested searches are based solely on the article title.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"The paper metadata provided contains only the title, DOI, journal, and publication date — no abstract, methods, results, or conclusions were supplied. All summary fields and tags have been left null or empty because no content from the paper is available to extract. Please provide the full text or abstract to enable structured data extraction.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"The paper metadata provided contains only the title, DOI, journal, and publication date — no abstract, methods, results, or full text were included. All summary fields have been set to null due to insufficient source content. Tags and suggested searches are based solely on the paper title.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"This is a case-based educational article (ECG of the Month), not a primary research study; the level of evidence reflects the source format.","value_numeric":null}],"summaries":{"what_studied":"This ECG of the Month case and discussion evaluates the appropriate management of transient ST-segment elevation (STE) — defined as STE meeting STEMI criteria that resolves spontaneously or with medical therapy — focusing on timing of coronary angiography and risk stratification in the ED setting.","key_result":"10–20% of initial STEMI presentations show STE resolution before or on ED arrival. Critical coronary stenosis is present in ~60% (≥95% stenosis) to ~90% (≥70% stenosis) of these patients. The TRANSIENT trial (n=142) and ELISA-3 subgroup (n=129) found no significant difference in 30-day MACE between immediate and delayed/early angiography strategies, though 5.6% of delayed-strategy patients in TRANSIENT required urgent intervention for reinfarction while waiting.","limitations":"Evidence base is limited to two small randomized trials (combined N=271), both underpowered to detect clinically meaningful differences. The ELISA-3 data are from a post-hoc subgroup analysis, limiting causal inference. Findings apply only to patients with complete resolution of both STE and symptoms.","practice_takeaway":"For patients with complete resolution of both STE and symptoms, admit as high-risk NSTEACS, start dual antiplatelet and anticoagulant therapy, and obtain immediate cardiology consultation to determine angiography timing (early invasive within 24–72 hours is reasonable). Escalate to emergent angiography for persistent or recurrent STE, hemodynamic instability, electrical instability, or ongoing symptoms despite medical therapy."}},{"doi":"10.1016/j.hrtlng.2026.102883","pmid":"42435536","title":"Type of treating centres and outcomes among patients with out of hospital cardiac arrest: Insights from a large nationwide registry","journal_title":"Heart & Lung","journal_issn":"0147-9563","published_at":"2026-07-11T00:00:00.000Z","url":"https://doi.org/10.1016/j.hrtlng.2026.102883","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-19T13:39:57.644Z","updated_at":"2026-07-19T13:39:57.644Z","tags":[{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"condition","value":"Acute Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"condition","value":"Cardiogenic Shock","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"condition","value":"Out-of-Hospital Cardiac Arrest","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"modality","value":"Mechanical Circulatory Support","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"modality","value":"Targeted Temperature Control","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"sample_size","value":"n=3550","value_numeric":3550},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"study_design","value":"Retrospective Observational Registry Study","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"warning","value":"Exact multivariable model covariates and confidence intervals for the key ORs (PCI: 0.57; TC: 0.70) are not provided in the abstract, limiting full appraisal of effect size precision.","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"warning","value":"Study period spans 2016–2022; practice patterns, especially around temperature control targets, evolved during this window (post-TTM2 trial era), which may affect generalizability of the TC findings.","value_numeric":null},{"paper_doi":"10.1016/j.hrtlng.2026.102883","tag_type":"warning","value":"The strikingly low mortality in the transfer group (20.8% vs ~50% in both other groups) likely reflects strong selection bias toward hemodynamically stable, AMI-related patients — this figure should not be interpreted as a pure centre-type effect.","value_numeric":null}],"summaries":{"what_studied":"This nationwide registry study (2016–2022, n=3,550) evaluated whether the type of treating centre — non-PCI-capable, transfer to PCI-capable, or directly admitted PCI-capable — affected in-hospital mortality among out-of-hospital cardiac arrest (OHCA) patients.","key_result":"Overall in-hospital mortality was 48.8% (group 1 non-PCI: 54.8%; group 2 transferred to PCI: 20.8%; group 3 PCI-capable: 48.5%; p<0.001). Treatment at PCI-capable centres was independently associated with lower mortality; PCI itself reduced mortality (OR 0.57) as did targeted temperature control (OR 0.70), particularly in middle-aged patients and non-MI-related OHCA.","limitations":"Observational registry design limits causal inference; group 1 patients were older with more comorbidities, introducing selection bias; the markedly low mortality in the transfer group (20.8%) likely reflects selection of more stable, AMI-related cases rather than a true centre effect.","practice_takeaway":"When feasible, OHCA patients should be triaged directly to PCI-capable centres, where access to PCI and targeted temperature control is associated with meaningfully lower in-hospital mortality. Clinicians should consider temperature control especially in middle-aged patients and those without MI-related arrest."}},{"doi":"10.1016/j.athoracsur.2026.06.059","pmid":"42413683","title":"Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Stable Multivessel Coronary Disease in the Current Era","journal_title":"The Annals of Thoracic Surgery","journal_issn":"0003-4975","published_at":"2026-07-07T00:00:00.000Z","url":"https://doi.org/10.1016/j.athoracsur.2026.06.059","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-13T17:42:32.746Z","updated_at":"2026-07-13T17:42:32.746Z","tags":[{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"condition","value":"Multivessel Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"condition","value":"Stable Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"modality","value":"Coronary Artery Bypass Grafting","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"sample_size","value":"n=118921","value_numeric":118921},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"study_design","value":"Propensity Score-Matched Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"warning","value":"Study DOI date (2026-07-07) is recent and this paper may not yet be fully indexed or peer-reviewed in all databases; verify publication status before citing in clinical decision-making.","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — while results are striking, the study is observational and the authors themselves call for guideline re-evaluation rather than confirming a definitive change.","value_numeric":null},{"paper_doi":"10.1016/j.athoracsur.2026.06.059","tag_type":"warning","value":"The total sample size tag (n=118,921) reflects the full pre-match cohort (105,729 CABG + 13,192 PCI); the matched analytic groups were n=9,206 per arm.","value_numeric":null}],"summaries":{"what_studied":"This study compared CABG vs. multivessel PCI for stable multivessel CAD in Medicare beneficiaries ≥65 years (2018–2023), using propensity score-matched groups (n=9,206 per arm) from the CMS database with doubly-robust risk adjustment.","key_result":"Over 6 years, CABG was associated with superior survival (HR 0.44, 95% CI 0.40–0.49), lower MI risk (HR 0.40, 0.36–0.44), dramatically fewer reinterventions (HR 0.10, 0.08–0.14), and better composite event-free survival (89.2% vs. 71.1%; HR 0.38, 0.35–0.41); all P<0.001.","limitations":"- Observational design limits causal inference despite robust matching; unmeasured confounders (e.g., anatomical complexity, operator experience) may persist.\n- Restricted to Medicare beneficiaries ≥65 years, limiting generalizability to younger or privately insured patients.\n- Administrative claims data may misclassify procedures or comorbidities compared to clinical registry-level detail.","practice_takeaway":"For older adults (≥65) with stable multivessel CAD, these real-world data strongly favor CABG over PCI for long-term survival and freedom from MI and repeat revascularization. Clinicians should weigh these contemporary findings when discussing revascularization strategy, especially in light of recent guideline updates that expanded PCI indications."}},{"doi":"10.1016/j.jtcvs.2026.05.026","pmid":"42285287","title":"Long-term survival after percutaneous coronary intervention or coronary artery bypass grafting in patients with diabetes and multivessel disease","journal_title":"The Journal of Thoracic and Cardiovascular Surgery","journal_issn":"0022-5223","published_at":"2026-06-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtcvs.2026.05.026","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:02.200Z","updated_at":"2026-06-22T13:24:02.200Z","tags":[{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"condition","value":"Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"condition","value":"Left Main Stem Stenosis","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"condition","value":"Multivessel Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"modality","value":"Coronary Artery Bypass Grafting","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"sample_size","value":"n=26166","value_numeric":26166},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"warning","value":"Observational design with inverse probability weighting: unmeasured confounders (e.g., frailty, operator volume, stent type) could influence results.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — while findings are strong, they align with and extend existing RCT evidence (e.g., FREEDOM trial) rather than reversing prior guidance.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.05.026","tag_type":"warning","value":"The paper's DOI includes '2026' in the path, and publication date is June 2026 — this is a very recent publication; findings have not yet been subject to peer replication.","value_numeric":null}],"summaries":{"what_studied":"This nationwide cohort study compared long-term all-cause and cardiovascular mortality after CABG vs. PCI in 26,166 Swedish patients with diabetes and multivessel disease (MVD), followed for a median of 5.5 years (range 0–15 years) using the SWEDEHEART registry (2006–2020).","key_result":"CABG was associated with lower all-cause mortality (HR 0.80, 95% CI 0.76–0.84) and cardiovascular mortality (HR 0.73, 95% CI 0.68–0.78) vs. PCI. Weighted median survival was 0.9 years longer with CABG overall, rising to +4.1 years for left main stem stenosis and +3.4 years for three-vessel disease. Regional PCI-to-CABG ratios ranged widely from 0.9 to 7.6 across Sweden's 19 health care regions.","limitations":"Observational design means residual confounding cannot be excluded despite inverse probability weighting and sensitivity analyses. Stent generation and completeness of revascularization data were not reported as controlled variables. Regional variation in practice patterns suggests inconsistent patient selection, which may affect generalizability.","practice_takeaway":"For patients with diabetes and multivessel disease—especially those with left main or three-vessel disease—CABG should be strongly favored over PCI given substantially lower mortality and longer survival. The wide regional variation in revascularization practice suggests many eligible patients may not be receiving guideline-recommended CABG."}},{"doi":"10.1093/eurheartj/ehag334","pmid":"42185090","title":"Pathophysiology, prevention, and management of coronary microvascular obstruction","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-05-26T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag334","source_score":48,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-01T13:39:33.109Z","updated_at":"2026-06-01T13:39:33.109Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"condition","value":"Coronary Microvascular Obstruction","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"condition","value":"Ischaemia-Reperfusion Injury","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"condition","value":"No-Reflow Phenomenon","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"condition","value":"ST-Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"generic","value":"adenosine","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"generic","value":"nitroprusside","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"modality","value":"Ischaemic Postconditioning","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"modality","value":"Mechanical Left Ventricular Unloading","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"modality","value":"Supersaturated Oxygen Therapy","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"modality","value":"Thrombectomy","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"study_design","value":"Clinical Consensus Statement","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"warning","value":"No sample size is applicable — this is a consensus statement, not a primary study. Level of evidence assigned as 5 (expert consensus/narrative review).","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"warning","value":"Sex distribution of the reviewed population is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag334","tag_type":"warning","value":"Study design labeled as 'Clinical Consensus Statement'; some categorization systems may classify this differently from a standard systematic review or guideline.","value_numeric":null}],"summaries":{"what_studied":"This clinical consensus statement reviews the pathophysiology, risk stratification, prevention, and management of coronary microvascular obstruction (no-reflow phenomenon) in STEMI patients undergoing primary PCI, covering both pharmacological and non-pharmacological strategies.","key_result":"Suboptimal myocardial reperfusion persists in up to 60% of STEMI cases despite timely revascularization; no-reflow is linked to impaired infarct healing, adverse left ventricular remodelling, and increased risk of heart failure and death. Intracoronary adenosine and nitroprusside show unclear benefit; strategies like ischaemic postconditioning, supersaturated oxygen therapy, stent-retriever thrombectomy, and mechanical LV unloading show promise but lack large-scale validation.","limitations":"Consensus statement rather than primary trial data; most reviewed non-pharmacological strategies lack validation from large-scale RCTs; benefit of key pharmacological agents (adenosine, nitroprusside) remains uncertain.","practice_takeaway":"After primary PCI, if no-reflow is observed with residual epicardial stenosis excluded, escalate to urgent microvascular-targeted management — current pharmacological options have unclear benefit, so consider emerging non-pharmacological strategies (postconditioning, supersaturated O₂, mechanical unloading) within trial frameworks where possible. Proactive risk stratification before and during PCI is essential to identify high-risk patients early."}},{"doi":"10.1093/eurheartj/ehag353","pmid":"42135060","title":"Intracoronary imaging for left main percutaneous coronary intervention: a clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Bifurcation Club (EBC)","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag353","source_score":59,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-19T13:22:59.341Z","updated_at":"2026-05-19T13:22:59.341Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Chronic Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Coronary Bifurcation Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Left Main Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Intracoronary Imaging","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Intravascular Ultrasound","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Optical Coherence Tomography","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"study_design","value":"Clinical Consensus Statement","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"No original patient-level data is presented; this is an expert consensus document, so level of evidence reflects panel opinion rather than a primary trial.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"Sample size tag omitted — this is a consensus statement with no study population.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"Sex of patient population not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"The paper's publication date is May 15, 2026, which is very recent (4 days before today); full guideline text may not yet be widely disseminated.","value_numeric":null}],"summaries":{"what_studied":"This clinical consensus statement from EAPCI and the European Bifurcation Club evaluates the role of intracoronary imaging (IVUS or OCT) in planning, guidance, and optimization of left main bifurcation percutaneous coronary intervention (PCI) in both acute and chronic coronary syndromes.","key_result":"The expert panel endorses intracoronary imaging-guided left main PCI, aligning with recent American and European guideline recommendations, concluding that IVUS or OCT maximizes procedural benefit and reduces risk of serious late complications.","limitations":"Consensus statement based on expert opinion and appraisal of existing evidence rather than original trial data; recommendations may reflect the views of a selected global expert panel and may not account for all real-world resource or operator variability.","practice_takeaway":"Clinicians performing left main PCI should routinely use IVUS or OCT for pre-procedural planning, intra-procedural guidance, and post-stenting optimization. Adopting intracoronary imaging as standard practice for left main bifurcation disease is now supported by both European and American guidelines."}},{"doi":"10.1161/circulationaha.125.078738","pmid":"42100816","title":"Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study","journal_title":"Circulation","journal_issn":"0009-7322","published_at":"2026-05-08T00:00:00.000Z","url":"https://doi.org/10.1161/circulationaha.125.078738","source_score":55,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-18T13:24:29.420Z","updated_at":"2026-06-18T13:24:29.420Z","tags":[{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"condition","value":"Stable Angina","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"condition","value":"Stable Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"modality","value":"Invasive Coronary Physiology","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"sample_size","value":"n=65","value_numeric":65},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"warning","value":"Low-intensity exercise data were missing for the first 4 patients due to a protocol amendment; n=61 for that sub-condition.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"warning","value":"Symptom follow-up was unblinded (PCI was required by design), which limits precise quantification of the placebo-controlled treatment effect at follow-up.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"warning","value":"The impact_flag 'practice_changing' is assigned because this is the first placebo-controlled study to define individualized FFR/RFR angina thresholds and directly challenges the universality of current guideline cut points; however, the small n=65 and mechanistic design mean broader validation is needed before clinical practice formally changes.","value_numeric":null},{"paper_doi":"10.1161/circulationaha.125.078738","tag_type":"warning","value":"The study was performed entirely post-PCI using in-stent balloon inflation, not in native vessels — angina thresholds may differ in untreated lesions. Authors acknowledge this was done for safety reasons.","value_numeric":null}],"summaries":{"what_studied":"ORBITA-FIRE was a multicenter, double-blind, randomized, placebo-controlled study in 65 patients with stable single-vessel CAD and exertional angina. After imaging-guided PCI, an in-stent balloon was incrementally inflated to define individualized physiological angina thresholds (FFRangina and RFRangina) at rest, low-intensity (50 W), and high-intensity exercise.","key_result":"Median FFRangina was 0.29 at rest, rising to 0.38 at low-intensity and 0.45 at high-intensity exercise — all far below the clinical cut point of ≤0.80 (P<0.001 for all). RFRangina followed the same pattern (0.22 → 0.26 → 0.32 vs. clinical cut point ≤0.89). Lower angina thresholds predicted higher baseline angina burden and greater symptom relief with PCI (probability of interaction >0.999); angina thresholds were reproducible in ~77–80% of patients across conditions.","limitations":"- Small, highly selected cohort (n=65, single-vessel LAD-predominant disease), limiting generalizability to broader or multivessel populations.\n- Protocol performed post-PCI using in-stent balloon inflation, which may not fully replicate native stenosis physiology and introduces potential microvascular changes from the procedure.\n- Follow-up symptom data were unblinded and uncontrolled; exercise was supine in a cath lab, not upright real-world exertion.","practice_takeaway":"Current fixed FFR ≤0.80 and RFR ≤0.89 cut points reliably detect flow-limiting disease but do not mark the threshold at which individual patients develop angina — that threshold is far lower and varies with workload and person. Clinicians should treat these indices as part of a broader physiological continuum and factor in symptom burden, activity level, and microvascular status when deciding who will benefit most from PCI."}},{"doi":"10.1016/j.jtcvs.2026.04.025","pmid":"42092511","title":"Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts","journal_title":"The Journal of Thoracic and Cardiovascular Surgery","journal_issn":"0022-5223","published_at":"2026-05-07T00:00:00.000Z","url":"https://doi.org/10.1016/j.jtcvs.2026.04.025","source_score":5,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-06","doi":"10.1016/j.jtcvs.2026.04.025","days":"14","issn":"0022-5223","rank":"9","field":"Clinical Medicine","score":"5","category":"Respiratory System","categories":["Respiratory System"],"_categories":["Respiratory System"]},"pubmed":{"doi":"10.1016/j.jtcvs.2026.04.025","title":"Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts.","journal":"The Journal of thoracic and cardiovascular surgery","methods":"","results":"Of the 165, 88(53%) presented with symptoms primarily related to ischemia, 67(41%), with symptoms primarily related to heart failure; 19(12%) were asymptomatic; 64/89(72%) had positive stress imaging. Of 543 existing grafts, 344(63%) were patent. Of 64 patients with a patent ITA to LAD and had PET tests, 9(14%) showed scar only, 25(39%) ischemia only, and 19(30%) both. Collaterals supplied LAD, circumflex, and RCA territories in 50, 83, and 100 patients, respectively, with LAD 28/50(56%) receiving collaterals from RCA. Of 233 collaterals, 103(44%) were Rentrop grade 1 (filling without epicardial vessels); 81/165(49%) had complete vascularization (patent grafts or high-grade collaterals to all territories). Post-diagnosis, 14(8.4%) patients underwent CABG, 50(30%) percutaneous intervention, and 100(61%) medical management, with median survival of 7.6, 6.0, and 3.0 years, respectively (P=.027).","abstract":"$30","keywords":["Internal thoracic arteries","coronary artery disease","coronary collateralization","ischemia burden","patent arterial grafts"],"pubmed_id":"42092511","conclusions":"","publication_date":"2026-05-07T00:00:00"},"crossref":{"DOI":"10.1016/j.jtcvs.2026.04.025","URL":"https://doi.org/10.1016/j.jtcvs.2026.04.025","ISSN":["0022-5223"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0022522326009141?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0022522326009141?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts"],"author":[{"given":"Ahmed K.","family":"Awad","sequence":"first","affiliation":[]},{"given":"Laura","family":"Young","sequence":"additional","affiliation":[]},{"given":"Mahmoud","family":"Alshneikat","sequence":"additional","affiliation":[]},{"given":"Rami","family":"Alaraj","sequence":"additional","affiliation":[]},{"given":"Richard","family":"Ramsingh","sequence":"additional","affiliation":[]},{"given":"Penny L.","family":"Houghtaling","sequence":"additional","affiliation":[]},{"given":"Marijan J.","family":"Koprivanac","sequence":"additional","affiliation":[]},{"given":"Michael Z.","family":"Tong","sequence":"additional","affiliation":[]},{"given":"Shinya","family":"Unai","sequence":"additional","affiliation":[]},{"given":"Nicholas G.","family":"Smedira","sequence":"additional","affiliation":[]},{"given":"Edward G.","family":"Soltesz","sequence":"additional","affiliation":[]},{"given":"Lars G.","family":"Svensson","sequence":"additional","affiliation":[]},{"given":"Eugene H.","family":"Blackstone","sequence":"additional","affiliation":[]},{"given":"Faisal G.","family":"Bakaeen","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,5]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":null,"created":{"date-time":"2026-05-04T09:35:25Z","timestamp":1777887325000,"date-parts":[[2026,5,4]]},"indexed":{"date-time":"2026-05-05T03:21:33Z","timestamp":1777951293938,"date-parts":[[2026,5,5]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000,"date-parts":[[2026,5,1]]},"delay-in-days":0,"content-version":"tdm"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0022522326009141"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts"},{"name":"journaltitle","label":"Journal Title","value":"The Journal of Thoracic and Cardiovascular Surgery"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.jtcvs.2026.04.025"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2026 by The American Association for Thoracic Surgery"}],"deposited":{"date-time":"2026-05-04T09:35:25Z","timestamp":1777887325000,"date-parts":[[2026,5,4]]},"issn-type":[{"type":"print","value":"0022-5223"}],"published":{"date-parts":[[2026,5]]},"publisher":"Elsevier BV","reference":null,"short-title":[],"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S0022522326009141"],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jtcvsonline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"published-print":{"date-parts":[[2026,5]]},"reference-count":0,"published-online":null,"references-count":0,"short-container-title":["The Journal of Thoracic and Cardiovascular Surgery"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.jtcvs.2026.04.025","is_oa":false,"title":"Ostial Occlusion of All Epicardial Coronary Arteries: Living off Bypass Grafts","updated":"2026-05-05T11:59:32+00:00","published_date":"2026-05-01","best_oa_location":null}},"created_at":"2026-05-07T22:49:59.654Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"category","value":"Respiratory System","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"condition","value":"Ostial Coronary Occlusion","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"modality","value":"Coronary Artery Bypass Grafting","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"modality","value":"Medical Management","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"modality","value":"Positron Emission Tomography","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"sample_size","value":"n=165","value_numeric":165},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"warning","value":"One additional patient (bridged to transplant without prior CABG) was excluded from the main cohort of 165; his outcomes are not detailed in the abstract.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"warning","value":"Survival differences between management groups (CABG, PCI, medical therapy) are unadjusted for baseline risk—confounding by indication is likely and limits causal interpretation.","value_numeric":null},{"paper_doi":"10.1016/j.jtcvs.2026.04.025","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously; the finding is novel but based on a non-randomized retrospective cohort.","value_numeric":null}],"summaries":{"what_studied":"Clinical profile and coronary perfusion of 165 adults with complete ostial occlusion of all epicardial coronary arteries (RCA + left main or left main equivalent) and prior CABG, followed from 2009–2025; graft patency, collateralization, ischemia/scar burden by PET, and post-diagnosis management strategies were assessed.","key_result":"63% of 543 existing grafts were patent; 49% of patients had complete vascularization via grafts or high-grade collaterals. Median survival was 7.6 years (repeat CABG), 6.0 years (PCI), and 3.0 years (medical management alone; P=.027). 72% of those with stress PET had positive imaging.","limitations":"Retrospective, single-center design spanning 16 years limits generalizability. Management strategy was not randomized—selection bias likely favors surgical/PCI groups. Survival analysis does not adjust for baseline comorbidities or presentation severity.","practice_takeaway":"In patients with complete ostial occlusion of all epicardial coronary arteries, patent bypass grafts can sustain long-term survival. When feasible, repeat revascularization (CABG or PCI) appears to offer a survival advantage over medical management alone, with median survival more than double that of medical therapy."}},{"doi":"10.1161/circinterventions.126.016601","pmid":"42059073","title":"Timing of Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-Analysis of Randomized Clinical Trials","journal_title":"Circulation: Cardiovascular Interventions","journal_issn":"1941-7640","published_at":"2026-04-30T00:00:00.000Z","url":"https://doi.org/10.1161/circinterventions.126.016601","source_score":23,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-28T14:02:34.609Z","updated_at":"2026-07-28T14:02:34.609Z","tags":[{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"condition","value":"Multivessel Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"condition","value":"ST-Segment-Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"sample_size","value":"n=4213","value_numeric":4213},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"study_design","value":"Meta-Analysis of Randomized Controlled Trials","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — the short-term cardiac death finding is statistically significant, but several other key endpoints (all-cause mortality at both timepoints) only trend toward harm without crossing conventional significance thresholds.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"warning","value":"The 'immediate' vs. 'staged' CR definitions likely varied across the 9 included trials; timing thresholds are not uniformly defined in the abstract.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.126.016601","tag_type":"warning","value":"The PROSPERO registration ID (CRD420251163719) appears unusually formatted — may contain a typographic error in the source document.","value_numeric":null}],"summaries":{"what_studied":"This meta-analysis of 9 RCTs (n=4,213) compared immediate complete revascularization (ICR) versus staged complete revascularization (SCR) in hemodynamically stable STEMI patients with multivessel disease, focusing on short-term and long-term (median 1-year) all-cause mortality and other major adverse events.","key_result":"Short-term cardiac death was significantly higher with ICR vs. SCR (RR 2.19 [95% CI, 1.08–4.44]; P=0.03). Short-term all-cause mortality trended higher with ICR (2.0% vs. 1.2%; RR 1.66 [95% CI, 0.99–2.78]; P=0.053), as did 1-year all-cause mortality (4.7% vs. 3.5%; IRR 1.40 [95% CI, 0.97–2.03]; P=0.07). No significant differences were found for MI, repeat revascularization, stent thrombosis, stroke, major bleeding, or MACCE.","limitations":"- Only 9 RCTs included; individual trial sample sizes may limit power for rare endpoints.\n- Definitions of 'immediate' vs. 'staged' varied across trials, introducing potential heterogeneity in intervention timing.\n- Results apply specifically to hemodynamically stable patients; generalizability to cardiogenic shock or unstable presentations is unclear.","practice_takeaway":"For hemodynamically stable STEMI patients with multivessel disease, a staged revascularization strategy appears safer than immediate complete revascularization, which carries a significantly higher short-term cardiac death risk. Clinicians should default to staged CR for most stable STEMI-MVD patients unless compelling individual factors favor the index procedure."}},{"doi":"10.1016/j.jcin.2026.02.012","pmid":"42055657","title":"Side Branch Additional Treatment for Coronary Bifurcation Lesion Revascularization","journal_title":"JACC: Cardiovascular Interventions","journal_issn":"1936-8798","published_at":"2026-04-27T00:00:00.000Z","url":"https://doi.org/10.1016/j.jcin.2026.02.012","source_score":43,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:57.495Z","updated_at":"2026-05-07T22:49:57.495Z","tags":[{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"brand","value":"Resolute Onyx","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"condition","value":"Chronic Coronary Disease","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"condition","value":"Coronary Bifurcation Lesion","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"generic","value":"zotarolimus-eluting stent","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"modality","value":"Drug-Eluting Stent","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"sample_size","value":"n=616","value_numeric":616},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"warning","value":"The brand 'Resolute Onyx' uses zotarolimus as its active agent; this was tagged accordingly, but the abstract does not explicitly name the drug component.","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"warning","value":"The Medina classification distribution of included lesions is not detailed in the abstract, which may affect applicability to more complex bifurcation anatomies.","value_numeric":null},{"paper_doi":"10.1016/j.jcin.2026.02.012","tag_type":"warning","value":"The trial was published with a 2026 date and today is May 7, 2026 — this is a very recent publication and may not yet have peer-reviewed commentary or guideline incorporation.","value_numeric":null}],"summaries":{"what_studied":"The KISS trial randomized 616 patients with non-left main coronary bifurcation lesions to either no side branch intervention (no-SBI) or systematic side branch intervention (SBI) after main branch stenting with a Resolute Onyx drug-eluting stent plus proximal optimization technique, with 12-month follow-up.","key_result":"No-SBI was noninferior to SBI for periprocedural MI or myocardial injury (4.1% vs 5.7%; P<0.001 for noninferiority). SB dissection was higher in the SBI group (2.9% vs 0.0%; P=0.004). Target lesion failure at 1 year was similar (4.9% vs 6.4%; P=0.442). No-SBI also had shorter procedure times, lower radiation dose, and less contrast use.","limitations":"The trial excluded left main bifurcation lesions, limiting generalizability to that subset. Only 2% of no-SBI patients required rescue SB intervention, suggesting a selected low-risk population. Follow-up was limited to 12 months, leaving longer-term outcomes unknown.","practice_takeaway":"For non-left main bifurcation lesions, skipping routine side branch intervention after main branch stenting is safe and reduces procedural complications, radiation, and contrast — with no penalty in 1-year outcomes. Reserve SB intervention for cases with significant flow impairment rather than applying it systematically."}},{"doi":"10.1056/nejmoa2600949","pmid":"41910384","title":"Angiography-Derived Fractional Flow Reserve to Guide PCI","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-03-29T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2600949","source_score":251,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:21.551Z","updated_at":"2026-07-02T13:33:21.551Z","tags":[{"paper_doi":"10.1056/nejmoa2600949","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"brand","value":"CathWorks FFRangio","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"condition","value":"Intermediate Coronary Stenosis","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"generic","value":"FFRangio","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"modality","value":"Fractional Flow Reserve Assessment","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"sample_size","value":"n=1930","value_numeric":1930},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"warning","value":"Mean patient age was 68.4 years with 25% women; generalizability to younger patients or female-predominant populations may be limited.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"warning","value":"The 'FFRangio' tag uses the study's proprietary terminology; this is a specific software-based angiographic FFR system, not a drug or device class.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2600949","tag_type":"warning","value":"The trial was funded by CathWorks, the manufacturer of the FFRangio technology, which may influence reporting and interpretation of results.","value_numeric":null}],"summaries":{"what_studied":"This international noninferiority RCT compared angiography-derived FFR (FFRangio) vs. pressure-wire-based physiological assessment to guide PCI in 1,930 patients with ≥1 intermediate coronary stenosis found at catheterization, with follow-up at 1 year.","key_result":"FFRangio was noninferior to pressure-wire guidance: MACE (death, MI, or unplanned revascularization) occurred in 6.9% (FFRangio) vs. 7.1% (pressure-wire) at 1 year (HR 0.98; 95% CI 0.70–1.39; upper boundary of one-sided 97.5% CI 2.1 pp vs. margin of 3.5 pp; P<0.001 for noninferiority). No differences in bleeding, acute kidney injury, or procedural adverse events.","limitations":"- 1-year follow-up only; longer-term equivalence is unknown.\n- Noninferiority design cannot establish superiority of FFRangio.\n- Funded by CathWorks (device manufacturer), introducing potential industry bias.","practice_takeaway":"FFRangio can replace pressure-wire assessment for intermediate coronary lesions without worse 1-year outcomes, potentially simplifying and broadening physiological-guided PCI. Clinicians may adopt this wire-free approach knowing safety and efficacy appear equivalent at 1 year."}},{"doi":"10.1016/j.jacc.2026.03.027","pmid":"41999379","title":"Randomized, Placebo-Controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention in Stable Angina","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-03-29T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2026.03.027","source_score":133,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:01.178Z","updated_at":"2026-07-11T13:33:01.178Z","tags":[{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"condition","value":"Chronic Total Occlusion","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"condition","value":"Stable Angina","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"sample_size","value":"n=50","value_numeric":50},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"warning","value":"Generalizability is limited to patients with single-vessel CTO and no bystander coronary disease; results may not apply to more complex multivessel disease.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"warning","value":"One procedural withdrawal due to a complication is noted but detailed safety data are not fully described in the abstract; clinicians should review the full paper for adverse event reporting.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"warning","value":"Sample size is very small (n=50); results are promising but should be interpreted with caution until replicated in larger trials.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.03.027","tag_type":"warning","value":"The trial used a Bayesian primary analysis reporting credible intervals and probability of benefit rather than traditional p-values — readers should interpret accordingly.","value_numeric":null}],"summaries":{"what_studied":"ORBITA-CTO evaluated whether CTO PCI improves angina beyond placebo in patients with symptomatic single-vessel chronic total occlusion and no bystander coronary disease, using a multicenter, blinded, randomized placebo-controlled design with 6-month follow-up and antianginal medications stopped at randomization.","key_result":"CTO PCI significantly improved the primary angina symptom score vs. placebo (OR 4.38; 95% CrI 1.57–12.69; Pr[Benefit] = 0.996), yielding an additional **30.6 angina-free days** (95% CrI 11.1–50.7). SAQ angina frequency improved by +10.7 points (95% CrI 1.4–20.2). Blinding was maintained throughout.","limitations":"- Very small sample (n=50); trial was likely underpowered for rare adverse events and subgroup analyses.\n- One PCI patient was withdrawn due to a procedural complication, raising a safety signal.\n- Only single-vessel CTO without bystander disease was enrolled, limiting generalizability to more complex presentations.","practice_takeaway":"For patients with stable angina clearly attributable to a single-vessel CTO, CTO PCI provides meaningful, sustained symptom relief beyond placebo — roughly one extra angina-free month over 6 months. Clinicians can use this first blinded RCT evidence to support CTO PCI when symptom burden is the primary indication."}},{"doi":"10.1161/circinterventions.125.016213","pmid":"41793765","title":"Angiography-Derived Fractional Flow Reserve During Percutaneous Coronary Intervention","journal_title":"Circulation: Cardiovascular Interventions","journal_issn":"1941-7640","published_at":"2026-03-07T00:00:00.000Z","url":"https://doi.org/10.1161/circinterventions.125.016213","source_score":81,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-24T13:23:13.054Z","updated_at":"2026-05-24T13:23:13.054Z","tags":[{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"modality","value":"Fractional Flow Reserve Assessment","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"sample_size","value":"n=466535","value_numeric":466535},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"study_design","value":"Cohort Study","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"warning","value":"Propensity score matching controls for measured confounders only; unmeasured confounding (e.g., operator preference, lesion complexity) may persist despite falsification endpoint analysis.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"warning","value":"Study population is exclusively US Medicare beneficiaries (predominantly older adults), limiting applicability to younger patients or other healthcare systems.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016213","tag_type":"warning","value":"The very low adoption rate of Angio-FFR (1% overall) suggests potential early-adopter bias, which could influence outcome comparisons.","value_numeric":null}],"summaries":{"what_studied":"This cohort study used US Medicare data (Jan 2019–Dec 2024) to compare 2-year outcomes of angiography-derived FFR (Angio-FFR) vs. pressure wire (PW)-based physiological assessment during coronary angiography, in both PCI and non-PCI patients, using 1:3 propensity score matching.","key_result":"Angio-FFR use rose from 0.47% (2019) to 3.85% (2024) but remained low overall (1% of 466,535 angiograms). In PCI patients, 2-year MACE was 24.8% vs. 23.5% (HR 1.01, 95% CI 0.85–1.20); in non-PCI patients, 24.1% vs. 23.9% (HR 0.97, 95% CI 0.84–1.11) — no significant difference in either group.","limitations":"- Medicare-only population limits generalizability to younger or privately insured patients.\n- Residual unmeasured confounding cannot be excluded despite propensity matching and falsification endpoints.\n- Very low Angio-FFR uptake (1%) may reflect selection bias in early adopters.","practice_takeaway":"Angio-FFR guidance appears to produce comparable 2-year outcomes to pressure wire assessment in both PCI and non-PCI patients, supporting its use when pressure wire is not feasible. Adoption is growing but still modest, so clinicians should not yet assume broad real-world equivalence outside of Medicare-age populations."}},{"doi":"10.1093/eurheartj/ehaf924","pmid":"41493330","title":"Complete revascularization timing in ST-segment elevation myocardial infarction and multivessel disease with heart failure: the OPTION–STEMI trial","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-01-06T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehaf924","source_score":26,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-07","doi":"10.1093/eurheartj/ehaf924","days":"7","issn":"0195-668X","rank":"7","field":"Clinical Medicine","score":"26","category":"Cardiac & Cardiovascular Systems","categories":["Cardiac & Cardiovascular Systems"],"_categories":["Cardiac & Cardiovascular Systems"]},"pubmed":{"doi":"10.1093/eurheartj/ehaf924","title":"Complete revascularization timing in ST-segment elevation myocardial infarction and multivessel disease with heart failure: the OPTION-STEMI trial.","journal":"European heart journal","methods":"","results":"Among 994 randomized patients, 329 (33.1%) had heart failure at admission. These patients had a higher risk of primary endpoint than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11-2.40; P = .013). At 1 year, immediate complete revascularization was associated with a higher incidence of the primary endpoint than staged complete revascularization in patients with heart failure (22.8% vs 13.3%; HR 1.79; 95% CI 1.05-3.04), but not in those without heart failure (8.0% vs 9.5%; HR 0.84; 95% CI .50-1.40). A significant interaction was observed between heart failure status and randomized strategy (P = .043).","abstract":"$31","keywords":["Heart failure","Multivessel coronary artery disease","Percutaneous coronary intervention","ST-segment elevation myocardial infarction","Timing"],"pubmed_id":"41493330","conclusions":"","publication_date":"2026-01-06T00:00:00"},"crossref":{"DOI":"10.1093/eurheartj/ehaf924","URL":"https://doi.org/10.1093/eurheartj/ehaf924","ISSN":["0195-668X","1522-9645"],"link":[{"URL":"https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehaf924/66281649/ehaf924.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehaf924/66281649/ehaf924.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Complete revascularization timing in ST-segment elevation myocardial infarction and multivessel disease with heart failure: the OPTION–STEMI trial"],"author":[{"given":"Min Chul","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Joon Ho","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Dae Young","family":"Hyun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Yongwhan","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Kyung Hoon","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Seung Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Seongho","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"},{"name":"Division of Cardiology, Department of Internal Medicine, Mokpo Hankook Hospital , Mokpo ,"}]},{"given":"Seok","family":"Oh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Doo Sun","family":"Sim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Young Joon","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Ju Han","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,"}]},{"given":"Myung 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A pre-specified subgroup by heart failure at admission (Killip II–III) assessed a 1-year composite of all-cause death, non-fatal MI, or unplanned revascularization.","key_result":"Immediate complete revascularization was not non-inferior to staged overall. Among 994 patients, 329 (33.1%) had heart failure and had more primary events than those without heart failure (18.2% vs 8.7%; adjusted HR 1.63; 95% CI 1.11–2.40; P=.013). In heart failure, immediate vs staged had higher events (22.8% vs 13.3%; HR 1.79; 95% CI 1.05–3.04); without heart failure, events were similar (8.0% vs 9.5%; HR 0.84; 95% CI 0.50–1.40). Interaction P=.043.","limitations":"The differential effect by heart failure status comes from a subgroup analysis. Cardiogenic shock was excluded, limiting generalizability. The non-inferiority margin and overall arm-level event counts are not provided here.","practice_takeaway":"For STEMI with multivessel disease and heart failure at admission (Killip II–III) without shock, staged complete revascularization during the index admission had better 1-year outcomes than immediate. 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Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.09.1598","tag_type":"sample_size","value":"n=150","value_numeric":150},{"paper_doi":"10.1016/j.jacc.2025.09.1598","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.09.1598","tag_type":"warning","value":"Age and sex distributions were not reported in the provided text.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.09.1598","tag_type":"warning","value":"Exact times to staged PCI within the 5–7 and 12–14 week windows were not specified.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.09.1598","tag_type":"warning","value":"Only abstract-level details were available; patient characteristics and clinical outcomes were not provided.","value_numeric":null}],"summaries":{"what_studied":"A 6-center randomized trial assigned 150 patients who underwent STAR during CTO PCI to early (5–7 weeks; n=73) versus late (12–14 weeks; n=77) staged 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The primary endpoint was partial technical success, defined as TIMI 2–3 flow with <30% residual stenosis into at least one ≥2.5 mm distal branch.","key_result":"Partial technical success did not differ significantly: 83.6% (early) vs 71.4% (late); P=0.08. Vessel patency at the start of the staged procedure was higher with early staging: TIMI 2–3 flow 64.4% vs 44.2% (P=0.012; P=0.048 after adjustment).","limitations":"Modest sample size (n=150) across 6 centers; outcomes focused on technical success without reported clinical events. The primary comparison did not reach statistical significance.","practice_takeaway":"After STAR for CTO PCI, planning staged PCI at 5–7 or 12–14 weeks yielded similar partial technical success, while earlier staging had higher initial vessel patency. In the absence of a clear efficacy difference, timing can be individualized; earlier staging may be chosen if maintaining patency is prioritized."}}],"initialOffset":20,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Percutaneous Coronary Intervention"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Percutaneous Coronary Intervention"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Percutaneous Coronary Intervention"}}}]]

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