Background The impact of COVID-19 in hypertrophic cardiomyopathy (HCM), particularly in the post-vaccine era, remains incompletely understood. We evaluated whether pre-existing cardiovascular magnetic resonance (CMR) phenotypes are associated with COVID-19 outcomes and recovery. Methods In 1704 participants from the international HCM Registry with prior CMR phenotyping, COVID-19 infection and outcomes were assessed using patient-reported questionnaires. Associations between baseline CMR features and hospitalisation or impaired recovery (≥3 months) were evaluated using multivariable logistic regression. Results Among 767 participants with reported COVID-19 infection (mean age 49±11 years), 4% required hospitalisation, 19% reported impaired recovery at ≥3 months and 2 (0.26%) non-cardiac deaths occurred. Persistent symptoms were common particularly fatigue (67%) and dyspnoea (33%). After adjustment, adverse CMR features, including hypertrophy, fibrosis (late gadolinium enhancement) and extracellular volume, were not associated with hospitalisation or impaired recovery. Female sex and younger age were associated with persistent symptoms. Conclusions In this large HCM cohort, COVID-19 was associated with a substantial burden of persistent symptoms, but pre-existing CMR phenotype was not associated with adverse outcomes. These findings suggest that baseline structural disease severity may not identify patients at higher risk of post-COVID-19 complications, although results should be interpreted in the context of self-reported outcomes and limited event rates.

Clinicians from around the world presented prominent interventional cardiology trials at Cardiovascular Research Technologies (CRT) 2026. The trials raise important discussions for the past, present, and future for coronary interventions. Medical professionals from the field of interventional cardiology, electrophysiology, heart failure, cardiac imaging, non-invasive cardiology, cardiac and vascular surgery, endovascular specialists, allied health professionals, and more attend this meeting. We designed this article to discuss the hypotheses, trial findings, and future directions of all late-breaking coronary intervention clinical trials from CRT 2026.

BACKGROUND:The Danish-German (DanGer) Shock trial demonstrated that the use of a microaxial flow pump (Impella) reduced mortality compared to medical management in patients with acute ST elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS). However, patients in the control arm of the DanGer Shock trial were not treated with an intra-aortic balloon pump (IABP), and data directly comparing Impella to IABP in this population is limited. METHODS:We identified STEMI-CS patients treated with percutaneous coronary intervention (PCI) and IABP at our institution between January 1, 2013, and February 20, 2025. These patients were screened according to the selection criteria of the DanGer Shock trial and were compared to the Impella MCS device 2.5 or CP and standard-of-medical-care (SoMC) arms of the DanGer Shock trial. RESULTS:Our cohort included 102 STEMI-CS patients treated with IABP. Compared to Impella CP patients from the DanGer Shock trial, IABP patients had significantly higher rates of hypertension, diabetes mellitus, heart failure, and SCAI stage E cardiogenic shock, but significantly lower rates of mechanical ventilation, vasopressor, and inotrope use. At 180 days, IABP patients had similar all-cause mortality compared to Impella CP patients (35.9 % vs. 45.8 %, p = 0.06), and lower rates of major bleeding (6 % vs. 39 %, p < 0.001) and renal replacement therapy (8 % vs. 75 %, p < 0.001). Additionally, IABP patients had lower mortality compared to SoMC patients (35.9 % vs. 58.5 %, p = 0.0004). CONCLUSION:These findings support the hypothesis that STEMI-CS patients treated with IABP have comparable 180-day mortality to those treated with Impella CP and lower mortality than those receiving standard medical care. STEMI-CS cohort is heterogenous and IABP use may be beneficial in certain patients. Well-designed randomized trials comparing Impella CP and IABP in this patient population are warranted to inform clinical decision-making. CONDENSED ABSTRACT:Acute ST elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS) portends a high mortality risk. New American guidelines now recommend a peripherally inserted left ventricular assist device, such as Impella, as a Class II indication for the management of STEMI-CS patients. Further, guidelines now give intra-aortic balloon pump (IABP) as a class III indication for these patients. However, there is a need of direct head-to-head comparison of these two mechanical support modalities in this specific subset of patients. In this analysis, we identified STEMI-CS patients treated with IABP at our institution and compared them to the Impella CP cohort from the DanGer Shock trial. We found that both modalities had similar mortality rates, and IABP has lower mortality rates when compared to standard medical cohort from the trial. However, despite applying DanGer Shock selection criteria, group differences exists. The complications rate was lower with IABP as compared to Impella CP. These findings support the use of IABP in the management of certain STEMI-CS patients and its clinical utility should not be underestimated.

Background:Patients with COVID-19 and ST-elevation myocardial infarction (STEMI) from the North American COVID-19 Myocardial Infarction (NACMI) registry had elevated in-hospital mortality compared with COVID-19-negative patients and historical controls. We examined 1-year mortality outcomes from the NACMI registry. Methods:This was a substudy of NACMI centers that participated in long-term follow-up. Patients in the NACMI registry were stratified into COVID-19-positive and COVID-19-negative groups. A historical 2018-2019 control group was derived from the Midwest STEMI Consortium registry. The primary outcome was 1-year mortality. Results:A total of 2358 STEMI patients (30% female) were included in this study, divided into 3 subgroups: COVID-19-positive (n = 623), COVID-19-negative (n = 694), and historical controls (n = 1041). One-year mortality in COVID-19-positive patients was 45% (HR, 4.88; 95% CI, 3.73-6.39; P < .001), compared with 27% (HR, 3.93; 95% CI, 2.92-5.29; P < .001) in COVID-19-negative patients and 11% in matched controls (P < .001). Most deaths (86%) occurred during the index hospitalization, with a median time to death of 27 days (IQR 6, 343) in the COVID-19-positive group. Among survivors of index hospitalization, 1-year mortality was 12% (COVID-19-positive; HR, 2.20; 95% CI, 1.26-3.85; P = .006), 9.6% (COVID-19-negative; HR, 2.31; 95% CI, 1.26-4.21; P = .007), and 5.3% (controls) (P < .001). Conclusions:This study describes long-term outcomes in patients with STEMI and COVID-19. We demonstrate that the excess mortality risk associated with COVID-19 STEMI extends beyond the index hospitalization and exhibits a clear risk gradient. The cause is likely multifactorial, including pandemic-era disruptions in care, longer time-to-treatment, and the unique pathophysiology of COVID-19 STEMI.

The saphenous vein remains the most commonly used conduit for coronary artery bypass grafting despite its low long-term patency rate. This has prompted extensive research focused on understanding the pathophysiology of graft failure and improving both short- and long-term patency. Several mechanisms of venous graft failure have been discussed in the literature, and different methods have been proposed to prevent and slow this pathological process, with the goal of improving the longevity of grafts. This review aims to provide a comprehensive overview of the novel therapies, techniques, and strategies to improve saphenous vein graft longevity after coronary artery bypass grafting.

Background Despite recent improvements in radiation safety, interventionalists are increasingly exposed to radiation during cardiac catheterization laboratory (CCL) procedures. The RADPAD was designed as a protective scatter-radiation absorbing shield with early studies demonstrating a 20% to 62% reduction in scatter-radiation. The objective of this study was to examine the impact of the protective scatter-radiation absorbing shield in a large contemporary randomized controlled trial across multiple CCL procedures. Methods The investigator-initiated, prospective, randomized, controlled ATTENUATE (rAdpad proTecTion drapE iN redUcing rAdiaTion Exposure) trial randomized CCL procedures 1:1 to use of the RADPAD vs no use of the RADPAD. The primary outcome of interest was the most proximal operator’s dose area product (DAP)-normalized operator dose (E). Results A total of 1000 CCL procedures were randomized 1:1 to use of the protective scatter-radiation absorbing shield (n = 500) vs no use (n = 500). The use of the protective scatter-radiation absorbing shield was associated with a 45.1% relative reduction in the DAP-normalized operator dose compared with no use of the protective scatter-radiation absorbing shield (0.64 vs 0.35 μSv/Gy⋅cm2; P < .0001). Coronary cases (n = 720) saw a 21.9% relative reduction in the DAP-normalized E using the RADPAD (0.33 vs 0.43 μSv/Gy⋅cm2; P < .001), and structural cases (n = 210) saw a 54.4% relative reduction in the DAP-normalized E using the RADPAD (0.30 vs 0.66 μSv/Gy⋅cm2; P = .1094). Conclusions In the largest randomized controlled trial to date evaluating the RADPAD protective scatter-radiation absorbing shield, encompassing contemporary coronary and structural CCL procedures, use of the protective scatter-radiation absorbing shield led to a marked decrease in proximal operator radiation exposure when adjusted for the total radiation delivered during each procedure.

BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic introduced a surge in cardiovascular complications, with myocarditis emerging as a concern due to both direct viral effects and rare vaccine-associated events. AIMS:This analysis examines the incidence and outcomes of myocarditis in patients across a large healthcare system in the Washington, DC Metropolitan Area, focusing on periods before, during, and after the COVID-19 pandemic. METHODS:A retrospective cohort study was conducted using electronic health records from the MedStar Health System (2017-2024). Myocarditis cases were identified using ICD-10 codes, with cases stratified by pre- (2017-2019), peri- (2020-2022), and post-COVID-19 (2023-2024) pandemic periods, as well as by association with COVID-19 infection and/or vaccination. The overall incidence and inpatient mortality of myocarditis were compared over these eras. RESULTS:This study included 778 myocarditis patients admitted between January 2017 and December 2024, categorized into pre-COVID-19 (n = 207), peri-COVID-19 (n = 370), and post-COVID-19 (n = 201) periods. Total myocarditis incidence surged during the peri-pandemic period, peaking in 2022, and declined in 2023-2024. In the post-pandemic period, total myocarditis remained elevated and higher than in the pre-pandemic era. During the pandemic and post-pandemic periods, myocarditis patients were older, included a higher proportion of African American individuals, and had a greater burden of cardiometabolic comorbidities, compared to pre-pandemic myocarditis hospitalizations. CONCLUSION:This study demonstrates a marked increase in myocarditis cases during the COVID-19 pandemic, driven initially by a surge in COVID-19-related myocarditis. Notably, total myocarditis cases remained elevated in the post-pandemic period compared to pre-pandemic levels. These findings, particularly the increased post-pandemic myocarditis patients, warrant further investigation into underlying risk factors and long-term outcomes.

The safety and efficacy of cangrelor during percutaneous coronary intervention (PCI) in high-bleeding-risk (HBR) acute coronary syndrome (ACS) patients remain unclear. We evaluated the impact of cangrelor on outcomes after PCI in HBR ACS patients. ACS patients with data available to identify HBR status (per 2019 Academic Research Consortium criteria) who underwent PCI at our institution between 2018 and 2023 (n = 2509) were screened. Those presenting with cardiogenic shock or requiring thrombectomy or glycoprotein 2b/3a inhibitors during PCI were excluded (n = 201) and 1007 were categorized as HBR. In-hospital composite ischemic events (inpatient mortality, target vessel revascularization, stent thrombosis, and ischemic stroke) and major bleeding (intracranial hemorrhage, blood transfusion for hemoglobin drop >3g/dl) were compared between cangrelor and noncangrelor groups. The cohort had a mean age of 71.8 years and 54.5% were male. Cangrelor group had fewer chronic comorbidities but presented with higher acuity, with increased rates of ST-elevation (STE-ACS) (33.4% vs 6%, p <0.001), greater new-onset congestive heart failure (CHF) (10.3% vs 3.5%, p <0.001), intra-aortic balloon pump use (11.9% vs 4.4%, p <0.001), and new acute kidney injury (AKI) (10.9% vs 5.7%, p = 0.003). Multivariate analysis adjusting for age, STE-ACS, new onset CHF, and AKI showed similar ischemic (OR [CI]: 1.52 [0.68 to 3.27], p = 0.30) and major bleeding (OR [CI]: 1.65 [0.92 to 2.93], p = 0.09) outcomes among cangrelor and noncangrelor patients. In conclusion, cangrelor use in HBR ACS patients undergoing PCI was not associated with improved outcomes versus oral P2Y12 inhibitors, although similar event rates despite higher acuity in the cangrelor group may suggest potential benefit in select patients without added bleeding risk.

Long-term clinical data on biodegradable-polymer (BP) drug-eluting stents (DES) are limited. The objective of this study was to assess the long-term safety and efficacy of the BP-DES SYNERGY compared to XIENCE V, a durable-polymer (DP)-DES. We compared patients treated with BP-DES or DP-DES at our center from 2008 to 2020. The primary outcome was major adverse cardiac events (MACE), defined as the composite of all-cause death, Q-wave myocardial infarction (MI), and target vessel revascularization (TVR). Secondary endpoints were all-cause death, Q-wave MI, target lesion revascularization (TLR), and stent thrombosis (ST). A total of 4255 patients underwent propensity-score matching, and 380 patients from each cohort were matched. There was no significant difference between BP-DES and DP-DES concerning MACE (5-year estimates: 21.6% vs. 26.6%, log-rank p  = 0.259). Furthermore, there was no difference in the TLR rate (5-year estimates: 7.3% vs. 8.6%, log-rank p  = 0.781). All-cause death (5-year estimates: 13.6% vs. 12.9%, log-rank p  = 0.72) and Q-wave MI (5-year estimates: 0.53% vs. 1.7%, log-rank p  = 0.427) were also comparable between the two groups. Of note, the rate of very late ST was very low and similar between the groups (5-year estimates: 0.26% vs. 0.64%, log-rank p  = 0.698). BP-DES and DP-DES demonstrate similar safety and efficacy at 5-year follow-up. Both can be used for the effective treatment of coronary artery disease.

BACKGROUND:Intravascular ultrasound (IVUS) is essential for assessing complex coronary lesions, but remains underutilized in part due to difficulties in image interpretation. The AVVIGO IVUS Automated Lesion Assessment (ALA) software, which uses machine learning (ML) for automatic segmentation, promises to simplify lesion assessment. This study evaluated the agreement in stent size selection between ALA, an independent core laboratory (CL), and an expert interventional cardiologist (IC) for complex lesions. AIMS:The primary endpoint was the agreement in stent size selection, within 0.25 mm, of AVVIGO ALA automatic segmentation of Class I lesions against the gold-standard measurement by an independent CL analysis and against an expert IC, (H. H.). The secondary endpoint was to assess the relative differences between AVVIGO ALA and CL, AVVIGO ALA and IC, and CL and IC, in vessel and lumen areas. METHODS:Patients with complex coronary lesions, including left main bifurcation, long, and severely calcified lesions, were retrospectively analyzed using IVUS with ALA. Stent size selection and area measurements by ALA were compared against a CL and IC using established sizing methods. RESULTS:In 48 patients, ALA demonstrated high agreement with CL (92%-100%) and IC (91%-98.5%) in stent size selection across lesion subtypes using recommended sizing methods. Lumen-based sizing achieved higher agreement than vessel-based sizing, particularly in calcified lesions (100% vs. 87%). The variability in relative difference in measurements between ALA and CL was greater than IC and CL in distal vessel and lesion vessel areas. The relative difference in measurements between ALA and IC was greater in vessel-based sizing compared to lumen-based sizing in the distal reference marker. CONCLUSION:AVVIGO ALA demonstrated high agreement in stent size selection compared to a CL and expert IC. ML's ability to automate IVUS analysis may improve operator efficiency, reduce radiation exposure, and enhance the adoption of intravascular imaging in routine practice. It remains to be seen if it will impact of adoption of IVUS to guide complex PCI.

Patients with type 2 diabetes mellitus (DM) are more susceptible to microvascular complications. However, whether DM is associated with coronary microvascular dysfunction (CMD) is unclear. This observational study used data from the Coronary Microvascular Disease Registry (CMDR) (NCT05960474) and included patients with angina and no obstructive coronary artery disease (ANOCA) who underwent invasive CMD evaluation using the CoroVentis CoroFlow System (Abbott Vascular, Santa Clara, CA). Patient demographics, comorbidities, laboratory data, echocardiography, coronary angiography, and microvascular physiology results were analyzed. Among the 271 patients, 73 (26.9%) had DM. These patients were more likely to be African American (68.1% vs. 47.0%) and had higher rates of hypertension (93.2% vs. 74.2%), hyperlipidemia (89.0% vs. 68.7%), and chronic kidney disease (17.8% vs. 8.1%) than those without DM. Invasive coronary functional testing showed no significant differences in the index of microcirculatory resistance (IMR) (17.82 ± 8.17 vs. 19.37 ± 13.14, p = 0.268) or coronary flow reserve (CFR) (3.24 ± 1.73 vs. 3.21 ± 1.86, p = 0.909) between diabetic and nondiabetic patients. Similarly, in those testing positive for CMD, there were no significant differences in IMR (27.8 ± 7.4 vs. 32.35 ± 15.22, p = 0.108) or CFR (2.42 ± 1.09 vs. 2.05 ± 0.94, p = 0.199). Although patients with DM exhibited more comorbidities, CMD physiology indices were comparable between the groups.

The Cardiovascular Research Technologies (CRT) 2025 conference, a prominent gathering in the field of cardiology, convened more than three thousand attendees from around the world. CRT provides a forum for exemplary education for interventional cardiologists, general cardiologists, cardiothoracic and vascular surgeons, catheterization laboratory managers, nurses and technologists, scientists, and those with an interest in cardiovascular medicine (CRTonline.org [1]). Dozens of late-breaking trials (LBT) were presented at CRT 2025. In this review article, a curated selection of LBT is presented. A summary table is presented in Table 1.

BACKGROUND:Coronary microvascular dysfunction (CMD) contributes to angina without obstructive coronary artery disease (ANOCA). Although aging is known to impact cardiovascular health, its effect on coronary microvascular function remains unclear. This study examined the relationship between age and microvascular function in patients with ANOCA. METHODS:We analyzed 304 patients from the Coronary Microvascular Disease Registry (CMDR) who underwent invasive microvascular assessment using bolus thermodilution. The patients were stratified into three age groups: <50 years (14.1 %), 50-65 years (50 %), and > 65 years (35.8 %). CMD was defined as a coronary flow reserve (CFR) <2.0, and an index of microcirculatory resistance (IMR) ≥25. CFR, IMR, and microvascular resistance reserve (MRR) were compared across age groups. RESULTS:The mean age was 61.6 ± 11 years, and 66.1 % were female. CFR declined with age (3.56 ± 1.6, 3.38 ± 1.98, 2.76 ± 1.53; p < 0.05), but CMD prevalence was similar across groups (16.3 %, 28.9 %, 31.2 %; p = 0.16). No significant differences were observed in IMR (p = 0.4) or MRR (p = 0.055). CONCLUSIONS:Although CFR decreases with advancing age, increased age does not appear to significantly influence the prevalence of CMD or other key microvascular parameters such as IMR and MRR. CLINICAL TRIAL REGISTRATION:Coronary Microvascular Disease Registry, clinicaltrials.gov, NCT05960474.