AIMS:ST-elevation myocardial infarction (STEMI) in very elderly patients (≥85 years) poses a major clinical challenge due to frailty and comorbidities. In the general population, left anterior descending (LAD) artery involvement predicts adverse outcomes, but data in the very elderly are limited. We aimed to evaluate the impact of LAD culprit lesions on 30-day mortality in this population. METHODS:In this multicenter registry (six Italian Hub hospitals, 2010-2023), 586 consecutive STEMI patients aged ≥85 years undergoing coronary angiography and percutaneous coronary intervention (PCI) were retrospectively analyzed. Patients were stratified by culprit vessel: LAD (n = 288) vs. non-LAD (n = 298). Demographic, clinical, procedural characteristics, and 30-day outcomes, including mortality and major adverse cardiovascular events, were collected. Multivariable analysis identified independent predictors of mortality. RESULTS:Baseline differences included prior myocardial infarction (MI) (9.4% vs. 18.5%, P < 0.01), prior CABG (0.3% vs. 4.7%, P < 0.01), and dyslipidemia (35.4% vs. 45.6%, P = 0.02), less frequent in LAD STEMI. Single-vessel disease was more common in LAD STEMI (42.0% vs. 31.5%, P = 0.01). Overall, 30-day mortality was 19.3% (113/586), higher in the LAD group [hazard ratio (HR) 1.57; 95% confidence interval (CI) 1.06-2.33; P = 0.024]. In LAD STEMI, cardiogenic shock at presentation was the strongest independent predictor of death (HR 6.10; 95% CI 3.70-10.35; P = 0.01), while dyslipidemia was associated with lower mortality (HR 0.51; 95% CI 0.28-0.92; P = 0.03). CONCLUSIONS:In very elderly STEMI patients, LAD culprit lesions are associated with higher short-term mortality. Cardiogenic shock at presentation and absence of dyslipidemia identify a high-risk subgroup, emphasizing the need for tailored risk stratification and careful procedural planning in this vulnerable population.

BACKGROUND:Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedures are expected to rise in number. Yet, real-world evidence on the procedural safety and efficacy of redo-TAVI remains limited. AIMS:We aimed to evaluate the 30-day procedural and clinical outcomes of redo-TAVI using the balloon-expandable SAPIEN 3 platform. METHODS:The ReTAVI registry is a prospective, international study enrolling consecutive patients with a failed aortic THV undergoing redo-TAVI with a balloon-expandable SAPIEN 3 THV. Data were collected across 59 international centres. All imaging was centrally analysed, and major clinical events were adjudicated by an independent committee. RESULTS:â¨A total of 143 patients (median age 84 years; 40.6% female; median Society of Thoracic Surgeons risk score 7.0%) were enrolled. The predominant failing THVs were balloon-expandable SAPIEN 3 (30.1%), self-expanding CoreValve/Evolut (53.1%), and ACURATE (14.0%) platforms. The most common failure mode was isolated regurgitation (48.6%), followed by stenosis (35.2%) and a mixed pathology (16.2%). The replacement valve was successfully implanted in 95.1% of patients, with a 30-day mortality rate of 3.5%. The 30-day stroke and pacemaker implantation rates were 0.7% and 6.3%, respectively. Redo-TAVI significantly improved valve haemodynamics, with mean gradients decreasing overall (Δ=-12.0 mmHg), and a more pronounced reduction in stenotic failures (Δ=-29.0 mmHg). Coronary obstruction was observed in 1.4% of cases. CONCLUSIONS:Redo-TAVI with a balloon-expandable SAPIEN 3 THV platform is a safe and effective reintervention strategy across diverse failed THV types, when guided by the Heart Team, standardised procedural planning, and comprehensive imaging. CLINICALTRIALS:gov: NCT05601453.

AIMS:We aimed to investigate the potential role of polygenic risk in early-onset coronary artery disease (CAD) and recurrence of major adverse coronary events (MACE) in patients with low prevalence of traditional cardiovascular risk factors (CVRFs). METHODS:This was a prospective study enrolling a cohort of patients with early-onset CAD (<50 years) despite no/few traditional CVRFs. Baseline CAD risk was calculated according to Systematic Coronary Risk Evaluation 2 (SCORE2). The CAD-polygenic risk score (PGS) developed by Khera et al. was computed for the patients and compared with a local control population of unselected individuals. MACE were collected at long term follow-up. RESULTS:We enrolled 42 patients [81% males; median age 44 years, interquartile range (IQR) 40-46] presenting with early-onset CAD from 2014 to 2021. The majority of them (72%) had ≤1 modifiable CVRF with a 3.9% mean risk of developing CV event at 10 years. The control population consisted of 1408 individuals (51% males; median age 39 years, IQR 29-49). We found a significant positive shift in CAD-PGS distribution among early-CAD patients compared with controls (P value < 0.0001). Over a median follow-up of 104 months, 40.5% of patients experienced a new MACE, with an annual incidence rate of 8 (IQR 5-13) per 100 persons/year. CONCLUSIONS:In patients with early-onset CAD despite low clinical risk score, we found CAD-PGS values significantly higher than in the general population and a high rate of recurrence of MACE. These findings highlight the potential of PGS in refining CAD risk stratification, properly tailoring prevention strategies.

Background Recurrence of acute myocarditis (AM) is challenging. The management and natural history of patients who experience a recurrence of AM (Re‐AM) remain poorly characterized. The aim of this study is to investigate clinical characteristics and outcomes of patients with Re‐AM. Methods In this international multicenter study, 141 consecutive patients with biopsy‐proven or cardiac magnetic resonance‐proven Re‐AM (35 [26–45] years, 77% male, median left ventricular ejection fraction 55%) were investigated and compared with 372 consecutive patients with single acute myocarditis (S‐AM). The primary outcome was a composite of all‐cause mortality, heart transplant and major ventricular arrhythmias. Results Patients with Re‐AM had more frequently a family history of cardiomyopathy (19% in Re‐AM versus 2.8% in S‐AM, P<0.001) and a diffuse late gadolinium enhancement compared with patients with S‐AM (46% in Re‐AM versus 34% in S‐AM, P=0.019). The extent of late gadolinium enhancement also increased between the first and the second AM episode in patients with Re‐AM (P=0.001). During a median follow‐up of 33 months (interquartile range, 23–52) patients with Re‐AM had a higher risk of primary outcome (P=0.001) compared with patients with S‐AM, as well as a significantly elevated competing risk of major ventricular arrhythmias (P<0.001), which remained independently associated even after adjustment (hazard ratio, 2.15 [95% CI, 1.15–4.04], P=0.017). A family history of cardiomyopathy, autoimmune diseases, and ring‐like late gadolinium enhancement was independently associated with a higher risk of recurrent AM. Conclusions Re‐AM is a distinct clinical subgroup of AM associated with generally worse prognosis and a specific increased arrhythmic risk compared with S‐AM.

Background. Despite technological innovations and improvements in stents and devices, sex-related discrepancies are still reported in the outcomes after ST-segment elevation myocardial infarction (STEMI), depending on biological and sex-specific pathophysiological differences, which have not been completely understood. The aim of the present study was to provide real-world data on the prognostic role of sex among patients with STEMI, enclosed into a recent up-to-date international registry. Methods. The ISACS-STEMI COVID-19 is a large-scale retrospective registry, including STEMI patients treated with mechanical reperfusion between 1 March and 30 June, 2019 and 2020. Patients, treated in 109 centers across Europe, Latin America, Southeast Asia, and North Africa, were grouped according to sex. Primary endpoint: In-hospital mortality; secondary endpoints: Time delay, 30-day mortality, and postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow. Results. We included 16,083 patients, 24.3% females (54.3% hospitalized in 2019, 45.7% in 2020). Women with STEMI were older, more often diabetic and hypertensive (p < 0.001), with a higher prevalence of hypercholesterolemia (p = 0.02), longer ischemia time (p = 0.01), ambulance referral (p = 0.03) and cardiogenic shock at presentation (p = 0.05), but less frequently smokers, with a previous cardiovascular event (p < 0.001) or anterior STEMI (p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (p < 0.001 and p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (p < 0.001, p < 0.001 and p = 0.001, respectively) were also more common in men. Impaired postprocedural epicardial reperfusion (TIMI flow 0-2) was observed more frequently in females as compared to males (10% vs. 7.2%; adjusted OR [95% CI] = 1.30 [1.13-1.49], p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%, p < 0.001, adjusted HR [95% CI] = 1.26 [1.06-1.5], p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%, p < 0.001, adjusted HR [95% CI] = 1.22 [1.06-1.38], p = 0.007). Conclusions. Among STEMI patients being treated with the most updated standard of care for primary percutaneous coronary intervention, female sex is still associated with higher complexity and impaired prognosis, displaying suboptimal epicardial reperfusion and increased in-hospital and 30-day mortality.

BACKGROUND:Several scores have been developed to facilitate risk stratification and early discharge following primary angioplasty, particularly the Zwolle Risk Score (ZRS). However, validation in large-sized studies is still lacking. Therefore, the aim of the current study was to validate the use of the ZRS in a contemporary global population, including patients who were treated during the SARS-CoV-2 pandemic and enrolled in a large intercontinental observational study. METHODS:The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia, and NorthAfrica, including patients treated from March 1st until June 30th, in 2019 and 2020]. ZRS was calculated for each patient. The patients were additionally categorized according to the following values of the ZRS [≤3; 4-6; 7-9; ≥10]. Our study outcomes were in-hospital and 30-day mortality. The discriminatory capacity of the ZRS was assessed by the area under the ROC curve [c statistic] as an index of model performance. RESULTS:Our population is represented by 16084 STEMI patients undergoing mechanical reperfusion enrolled in 109 centers. The score showed a very good performance in the predicting mortality both in-hospital [AUC=0.83 [0.82-0.85], p<0.0001] and at 30- day follow-up [AUC=0.82 [0.81-0.84, p<0.0001]. The results were confirmed when the ZRS was separately applied to patients treated in 2019 and 2020, with good stability across time. ZRS was able to identify a large cohort [n=10672, 66.3%] of low-risk patients [score ≤3] with a very low mortality rate at 2 days [1%] and between 3 and 10 days [0.7%], with a very good negative predictive value for in-hospital [98.3%] and 30-day mortality [97.7%], with similar results in 2019 and 2020. CONCLUSION:This study is the first to demonstrate the good prognostic performance of the ZRS in a large-scale contemporary global multicenter validation set. Similar results were obtained both in the pre-pandemic and the COVID-19 era. ZRS ≤3 identified a very low-risk population that could be discharged early, even during the COVID-19 pandemic, with expected advantages in the availability of hospital beds and nursing staff, costs of medical care, and in-hospital risk of contagion.

Chronic coronary syndrome (CCS) represents a heterogeneous and dynamic manifestation of coronary artery disease characterized by persistent atherosclerotic burden and ongoing risk of atherothrombotic events. Antithrombotic therapy remains a cornerstone of secondary prevention in CCS, yet optimal treatment strategies have evolved substantially in recent years. The 2024 European Society of Cardiology (ESC) guidelines provide updated recommendations that reflect emerging evidence from randomized clinical trials and meta-analyses evaluating antiplatelet and anticoagulant strategies. This narrative review summarizes key updates in the 2024 ESC CCS guidelines and the clinical evidence underpinning these changes. Contemporary management has moved beyond a uniform antithrombotic approach toward individualized treatment strategies based on ischemic and bleeding risk. Single antiplatelet therapy remains the foundation of long-term management, although clopidogrel is now recognized as a Class I, Level A alternative to aspirin in selected patients. For patients undergoing percutaneous coronary intervention (PCI), the guideline maintains a default strategy of 6 months of dual antiplatelet therapy (DAPT) while providing stronger recommendations for abbreviated DAPT in patients at high bleeding risk. Emerging evidence supporting de-escalation strategies and early aspirin withdrawal following PCI has further contributed to risk-adapted treatment pathways. Conversely, in patients with persistently high ischemic risk and low bleeding risk, intensified strategies-including prolonged DAPT, ticagrelor-based therapy, or dual pathway inhibition with low-dose rivaroxaban and aspirin-may provide additional protection against recurrent ischemic events. The updated recommendations underscore the importance of patient-centered risk stratification and periodic reassessment of ischemic and bleeding risk. Integrating clinical judgment with structured tools such as ARC-HBR and PRECISE-DAPT enables clinicians to tailor antithrombotic therapy in CCS, optimizing net clinical benefit in routine practice.

INTRODUCTION:Despite the large use of renin-angiotensin system inhibitors (RASI) in STSegment Elevation Myocardial Infarction (STEMI) patients, few data have been reported on the prognostic impact of chronic RASI at admission in patients suffering from STEMI, especially during the COVID-19 pandemic. Therefore, the current study investigated the prognostic impact of chronic RASI at admission in patients suffering from STEMI, including both SARS-CoV-2 positive and negative individuals, enrolled before and during the COVID-19 pandemic. METHODS:We included STEMI patients who received primary percutaneous coronary intervention (PPCI) and were enrolled in the ISACS-STEMI COVID-19 registry. In the present sub-analysis, patients were allocated according to chronic RASI therapy at admission. The primary study endpoint was the occurrence of in-hospital mortality. Secondary endpoints were postprocedural TIMI 3 flow and mortality at 1 month. RESULTS:The overall population was 15,693 patients, including 6,213 patients pretreated with RASI. Several differences in baseline characteristics were observed between the two groups. No difference was observed in the prevalence of SARS-CoV-2 infection. After correction for all baseline confounders, including procedural features, chronic pretreatment with RASI was independently associated with improved postprocedural TIMI 3 flow (OR [95% CI] = 1.14 [1.03-1.35], p = 0.042), lower in-hospital mortality (adjusted OR [95% CI] = 0.64 [0.54-0.75], p < 0.001), and lower 30-day mortality (adjusted OR [95% CI] = 0.62 [0.53-0.73], p < 0.001). CONCLUSION:This is the largest study investigating the prognostic impact and benefits of chronic RASI pre-treatment in STEMI patients undergoing PPCI, including those treated during the COVID19 pandemic. We found that chronic RASI treatment at hospital admission was associated with significant improvement in reperfusion and reduction in mortality, without any negative effect in SARS-CoV-2 positive patients. Results should be interpreted considering the retrospective, nonrandomized nature of the study.

Endomyocardial biopsy (EMB) has evolved from a single-indication test for the early diagnosis and monitoring of heart transplant rejection to the gold-standard technique to reach a definite and aetiological diagnosis in different cardiac disorders such as myocarditis and cardiomyopathies. It is currently considered a fundamental tool in the diagnostic workup of unexplained acute heart failure with haemodynamic compromise. For interventional cardiologists, EMB represents a unique opportunity to bridge invasive diagnostics with personalised care. By embracing technological advancements, integrating EMB with non-invasive modalities, the field advances towards more precise and effective management of complex cardiac conditions. However, safety remains a concern when performing EMB; indeed, although rare, major complications occur in about 1-5% of cases. Correct indication for the procedure and specific expertise to minimise the risk of complications are fundamental to obtain an acceptable risk/benefit profile. Therefore, this review examines the contemporary use of EMB from the perspective of interventional cardiologists to provide a practical resource for clinical practice and to better understand when and how to perform both right and left ventricular EMB in current practice.

Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29–3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32–8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03–1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01–1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32–3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29–1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.

BACKGROUND One third of patients undergoing transcatheter aortic-valve implantation (TAVI) have an indication for oral anticoagulation owing to concomitant diseases. Interruption of oral anticoagulation during TAVI may decrease the risk of bleeding, whereas continuation may decrease the risk of thromboembolism. METHODS We conducted an international, open-label, randomized, noninferiority trial involving patients who were receiving oral anticoagulants and were planning to undergo TAVI. Patients were randomly assigned in a 1:1 ratio to periprocedural continuation or interruption of oral anticoagulation. The primary outcome was a composite of death from cardiovascular causes, stroke from any cause, myocardial infarction, major vascular complications, or major bleeding within 30 days after TAVI. RESULTS A total of 858 patients were included in the modified intention-to-treat population: 431 were assigned to continuation and 427 to interruption of oral anticoagulation. A primary-outcome event occurred in 71 patients (16.5%) in the continuation group and in 63 (14.8%) in the interruption group (risk difference, 1.7 percentage points; 95% confidence interval [CI], -3.1 to 6.6; P = 0.18 for noninferiority). Thromboembolic events occurred in 38 patients (8.8%) in the continuation group and in 35 (8.2%) in the interruption group (risk difference, 0.6 percentage points; 95% CI, -3.1 to 4.4). Bleeding occurred in 134 patients (31.1%) in the continuation group and in 91 (21.3%) in the interruption group (risk difference, 9.8 percentage points; 95% CI, 3.9 to 15.6). CONCLUSIONS In patients undergoing TAVI with a concomitant indication for oral anticoagulation, periprocedural continuation was not noninferior to interruption of oral anticoagulation during TAVI with respect to the incidence of a composite of death from cardiovascular causes, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days.

AimsThis study reports on the concerns about myocarditis and pericarditis following COVID-19 vaccination that have been raised worldwide. However, the heterogeneous diagnostic criteria for postvaccination inflammatory heart diseases may result in overestimating incidence rates. The aim of this multicentre Italian registry is to evaluate the impact of COVID-19 vaccines on the incidence of myocarditis and pericarditis in the Italian population.MethodsConsecutive patients admitted to Italian hospitals for endomyocardial and/or cardiac magnetic resonance proven acute myocarditis and/or pericarditis in the same period (1 June-31 October) of 2019 and 2021 were enrolled, irrespective of the potential association with the COVID-19 vaccines. Acute pericarditis and/or myocarditis were defined as 'vaccine-related' if clinical presentation occurred within 15 days after COVID-19 vaccination, independently of the dose.ResultsThere was a comparable incidence rate ratio (IRR) for inflammatory heart diseases in 2019 and 2021 (2019: IRR 0.67 versus 2021: IRR 0.74, P = 0.45). In particular, the IRR did not differ in myocardial involvement (2019: IRR 0.33 versus 2021: IRR 0.33, P = 1) and pericarditis (2019: IRR 0.37 versus 2021: IRR 0.49, P = 0.09) in both periods. Among 125 cases registered in 2021, 32 (25.6%) were 'vaccine-related'. Among those who experienced 'vaccine-related' myocarditis and/or pericarditis, men with age under 40 years were over-represented (53.12%, P = 0.021).ConclusionIn a nationwide Italian survey comparing pandemic with prepandemic periods, the overall data do not indicate an increase in the incidence of pericarditis and myocarditis, suggesting that the vaccine can be considered well tolerated for these specific conditions.

Introduction Most acute coronary syndromes (ACS) originate from coronary plaques that are angiographically mild and not flow limiting. These lesions, often characterised by thin-cap fibroatheroma, large lipid cores and macrophage infiltration, are termed ‘vulnerable plaques’ and are associated with a heightened risk of future major adverse cardiovascular events (MACE). However, current imaging modalities lack robust predictive power, and treatment strategies for such plaques remain controversial.Methods and analysis The PREDICT-AI study aims to develop and externally validate a machine learning (ML)-based risk score that integrates optical coherence tomography (OCT) plaque features and patient-level clinical data to predict the natural history of non-flow-limiting coronary lesions not treated with percutaneous coronary intervention (PCI). This is a multicentre, prospective, observational study enrolling 500 patients with recent ACS who undergo comprehensive three-vessel OCT imaging. Lesions not treated with PCI will be characterised using artificial intelligence (AI)-based plaque analysis (OctPlus software), including quantification of fibrous cap thickness, lipid arc, macrophage presence and other microstructural features. A three-step ML pipeline will be used to derive and validate a risk score predicting MACE at follow-up. Outcomes will be adjudicated blinded to OCT findings. The primary endpoint is MACE (composite of cardiovascular death, myocardial infarction, urgent revascularisation or target vessel revascularisation). Event prediction will be assessed at both the patient level and plaque level.Ethics and dissemination The PREDICT-AI study will generate a clinically applicable, AI-driven risk stratification tool based on high-resolution intracoronary imaging. By identifying high-risk, non-obstructive coronary plaques, this model may enhance personalised management strategies and support the transition towards precision medicine in coronary artery disease.

OBJECTIVES:To compare the prognostic impact of heparin pretreatment versus intraprocedural administration in patients with ST-segment elevation myocardial infarction. BACKGROUND:There is a paucity of data regarding the best timing for heparin administration in STEMI. METHODS:We systematically searched the literature for studies evaluating the comparative efficacy and safety of heparin pretreatment versus intraprocedural administration for the treatment of STEMI from 1980 to 2024. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. RESULTS:11 observational studies and 4 clinical trials with a total of 72,249 patients were included. The patients either received UFH at the time of diagnosis or during the pPCI. A pretreatment approach showed a significant decrease in death both at 30 days (OR = 0.68; 95 % CI 0.56-0.84) as well as at longer follow-up (Mean follow-up time 14.4 months; OR = 0.67; 95 % CI 0.48-0.94). Moreover, UFH pretreatment increased the rate of infarct related artery patency (IRA) (defined as TIMI 2-3) at first coronary angiography (OR = 1.54; 95 % CI 1.37-1.74), and did not show increase in major bleedings (OR 0.96, 95 % CI 0.74-1.24). CONCLUSION:A heparin pretreatment strategy at the time of diagnosis of STEMI is associated with increased patency of the infarct related artery and with a decreased risk of death without any safety concern regarding bleeding complications.

BACKGROUND:Despite evidence supporting use of fractional flow reserve (FFR) and instantaneous waves-free ratio (iFR) to improve outcome of patients undergoing coronary angiography (CA) and percutaneous coronary intervention, such techniques are still underused in clinical practice due to economic and logistic issues. OBJECTIVES:We aimed to develop an artificial intelligence (AI)-based application to compute FFR and iFR from plain CA. METHODS AND RESULTS:Consecutive patients performing FFR or iFR or both were enrolled. A specific multi-task deep network exploiting 2 projections of the coronary of interest from standard CA was appraised. Accuracy of prediction of FFR/iFR of the AI model was the primary endpoint, along with sensitivity and specificity. Prediction was tested both for continuous values and for dichotomous classification (positive/negative) for FFR or iFR. Subgroup analyses were performed for FFR and iFR.A total of 389 patients from 5 centers were enrolled. Mean age was 67.9 ± 9.6 and 39.2% of patients were admitted for acute coronary syndrome. Overall, the accuracy was 87.3% (81.2-93.4%), with a sensitivity of 82.4% (71.9-96.4%) and a specificity of 92.2% (90.4-93.9%). For FFR, accuracy was 84.8% (77.8-91.8%), with a sensitivity of 81.9% (69.4-94.4%) and a specificity of 87.7% (85.5-89.9%), while for iFR accuracy was 90.2% (86.0-94.6%), with a sensitivity of 87.2% (76.6-97.8%) and a specificity of 93.2% (91.7-94.7%, all confidence intervals 95%). CONCLUSION:The presented machine-learning based tool showed high accuracy in prediction of wire-based FFR and iFR.