Background Frailty is an important predictor of outcomes in patients with coronary artery disease (CAD) and following transcatheter aortic valve replacement (TAVR). The NOTION-3 (Third Nordic Aortic Valve Intervention) trial demonstrated that performing percutaneous coronary intervention (PCI) in addition to TAVR reduced the risk for major adverse cardiac events (MACE). Whether this benefit applies to frail patients remains uncertain. Objectives The aim of this study was to evaluate efficacy and safety of PCI in frail TAVR patients with CAD. Methods NOTION-3 was an international, open-label, randomized superiority trial enrolling patients with CAD and severe aortic stenosis undergoing TAVR. Patients were randomized 1:1 to PCI or conservative treatment. Frailty was assessed post hoc using a calculated frailty score derived from baseline data on symptom-related limitations, daily function, and quality of life. Primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), and urgent coronary revascularization. Safety endpoints included bleeding and acute kidney injury. Results Frailty data were available for 407 patients (90%), of whom 130 (32%) were frail. During median follow-up of 2 years (Q1-Q3: 1-4 years), PCI reduced MACE in nonfrail patients (15% vs 33%; HR: 0.42; 95% CI: 0.25-0.69; P < 0.001), as well as death of any cause (P = 0.019), MI (P = 0.004), and urgent revascularization (P = 0.005). No differences were observed in frail patients. In contrast, frail patients undergoing PCI had more bleeding events (HR: 2.51; 95% CI: 1.23-5.11; P = 0.011). Conclusions In nonfrail patients with CAD undergoing TAVR, PCI lowered the risk for MACE, all-cause mortality, and MI compared to conservative treatment. In frail patients, PCI increased bleeding without clinical benefit. These findings require confirmation in larger prospective studies.

BACKGROUND:Optimal treatment of coronary artery disease in patients undergoing transcatheter aortic valve implantation remains debated. Here, our aim was to analyze the impact of the diameter and location of coronary stenosis on outcomes in patients undergoing percutaneous coronary intervention (PCI) with transcatheter aortic valve implantation. METHODS:This study was a prespecified subanalysis of the NOTION-3 trial (Nordic Aortic Valve Intervention), which randomized patients with severe symptomatic aortic stenosis and physiologically significant stable coronary artery disease to receive either PCI or conservative treatment of coronary artery disease with transcatheter aortic valve implantation. In this substudy, patients were stratified according to diameter stenosis (<90% or ≥90%) and stenosis location (proximal or nonproximal). The primary outcome was major adverse cardiovascular events, a composite of all-cause death, myocardial infarction, and urgent revascularization. RESULTS:Of 455 randomized patients, 184 (40%) had diameter stenosis <90% and 271 (60%) ≥90%. A total of 294 (65%) patients had at least 1 proximal stenosis, while in 161 (35%) patients, stenoses were nonproximal. At a median follow-up of 2 years (interquartile range, 1-4), PCI reduced the absolute risk of major adverse cardiovascular event by 13% in patients with diameter stenosis ≥90% (PCI 24% versus conservative treatment 37%; hazard ratio, 0.53 [95% CI, 0.34-0.82]), whereas no benefit was observed in patients with diameter stenosis <90% (31% versus 33%; hazard ratio, 1.04 [95% CI, 0.62-1.73]; P for interaction=0.051). PCI reduced major adverse cardiovascular events in case of proximal stenosis (26% versus 38%; hazard ratio, 0.61 [95% CI, 0.40-0.93]), although the difference in effect remained nonsignificant when compared with patients with nonproximal stenosis (28% versus 32%; hazard ratio, 0.91 [95% CI, 0.52-1.61]; P for interaction=0.27). CONCLUSIONS:The beneficial effect of PCI in patients undergoing transcatheter aortic valve implantation with physiologically significant stable coronary artery disease was seemingly pronounced in patients with high-grade stenosis, while stenosis location was not found to modify the outcome despite an almost similar beneficial effect with PCI in patients with proximal stenosis.

Abstract Background Angina is common in patients with coronary artery disease and severe aortic stenosis. Whether angina should guide coronary revascularization in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. Aims This study aims to assess whether angina modifies the effect of percutaneous coronary intervention (PCI) on clinical outcomes and whether PCI influences angina burden after TAVI. Methods and results This prespecified secondary analysis of the NOTION-3 trial included patients with severe aortic stenosis and significant coronary artery disease randomized to TAVI with PCI or optimal medical therapy (OMT). Baseline angina was assessed by Seattle Angina Questionnaire-7 Angina Frequency score, supplemented by Canadian Cardiovascular Society class when questionnaire data were missing. Of 454 patients, 229 (50%) had angina and 225 (50%) had no angina. In the baseline angina subgroup, the primary outcome MACE, a composite of death from any cause, myocardial infarction, or urgent revascularization, occurred in 27% randomized to PCI vs 37% randomized to OMT. Without angina, rates were 26% vs 35%. Hazard ratios for PCI vs OMT were 0.71 (95% CI 0.45–1.13) in patients with angina and 0.69 (95% CI 0.43–1.12) in those without, with no interaction by baseline angina (P = .97). SAQ-7 summary scores improved at 1 year in angina groups, with no between-group difference in change (16 vs 17; P = .78). Conclusions We found no evidence that baseline angina modified the relative effect of PCI on clinical outcomes, although the study was not powered to exclude clinically meaningful heterogeneity.

Transcatheter aortic valve implantation (TAVI) has become the preferred treatment for severe aortic stenosis. Nonetheless, interplay between aortic valve disease, transcatheter valve implantation, and the coronary arteries is frequent and clinically relevant. Coronary intervention in the context of TAVI encompasses distinct but interrelated scenarios, including the management of concomitant coronary artery disease and the prevention or treatment of coronary artery obstruction. These aspects introduce additional complexity to procedural planning and long-term management. This review provides a comprehensive and practical overview of coronary interventions related to TAVI, encompassing coronary evaluation and physiological assessment, the indications and timing of percutaneous coronary intervention before and after valve implantation, and strategies for managing coronary obstruction. Particular emphasis is placed on anatomical and device-related factors influencing coronary access, including transcatheter heart valve design, aortic root anatomy, and commissural alignment. By structuring coronary interventions according to distinct clinical scenarios, this article aims to support tailored decision-making and optimise procedural safety, feasibility, and long-term coronary management in patients undergoing TAVI.

Background and Aims Plaque rupture can occur at non-obstructive lesions in non-infarct-related coronary arteries (non-IRAs) without inducing ischaemia. This study aimed to: (1) assess the frequency and lesion characteristics of plaque rupture in non-IRAs of acute myocardial infarction (AMI) patients, (2) evaluate morphological changes in rupture sites over 52 weeks, and (3) investigate the baseline morphology of new-onset ruptures.Methods This study analysed pooled data from the IBIS-4 and PACMAN-AMI trials. Patients presenting with AMI underwent multimodality intracoronary imaging of non-IRAs at baseline and after 52 weeks.Results Among 783 lesions from 336 patients evaluated at baseline, plaque rupture was observed in 41 lesions of 40 patients (12%). Biomarkers including lipid and inflammation markers were comparable between patients with and without rupture in non-IRAs. Lesions with rupture showed larger percent atheroma volume (53.3 +/- 6.4 vs. 49.5 +/- 5.8%, estimated difference 3.6[1.9 to 5.4]), larger external elastic membrane area (20.5 +/- 4.8 vs. 15.7 +/- 5.6 mm2, 4.1[2.5 to 5.7]), and smaller minimum fibrous cap thickness (69 +/- 49 vs. 116 +/- 84 mu m, -43[-75 to -11]) compared to those without. Among 41 rupture sites assessed serially, 21 (51%) healed by 52 weeks. At follow-up, 10 rupture sites were newly identified, and thin-cap fibroatheroma was the most frequent baseline morphology of those.Conclusions Plaque rupture in non-obstructive lesions of non-IRAs was present in 12% of AMI patients. Larger plaque volume, positive remodeling, and thinner fibrous cap were associated with rupture. More than half of untreated ruptures transitioned into stable morphologies. Thin-cap fibroatheroma was the most frequent underlying morphology of new-onset rupture.

Abstract Background Findings from the recent NOTION-3 trial suggest that percutaneous coronary intervention (PCI) improves outcomes in patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic valve implantation (TAVI). Whether the benefit of PCI is consistent across age groups is uncertain. Aims To investigate the impact of age on outcomes from NOTION-3. Methods A secondary analysis of 455 patients in the NOTION-3 trial, a randomized trial comparing PCI with conservative treatment in patients with aortic stenosis and coronary artery disease undergoing TAVI. Patients were stratified into four age groups based on the quartile distribution of age (<78, 78–81, 82–84, and ≥85 years) and followed for a median of 2 years (IQR: 1–4 years). The primary outcome was major adverse cardiac events defined as a composite of all-cause death, myocardial infarction, or urgent revascularization. Results The risk difference for the primary endpoint comparing PCI and conservative treatment was most pronounced in patients aged 78–81 years [17% vs 42%; hazard ratio (HR): 0.36, 95% confidence interval (CI): 0.17–0.77, P = .008]. For the age groups <78, 82–84 and ≥85 years this risk difference between treatment groups was (HR: 1.08, 95% CI: 0.48–2.40), (HR: 0.69, 95% CI: 0.35–1.35), and (HR: 0.90, 95% CI: 0.50–1.62), respectively. Conclusion In patients with coronary artery disease undergoing TAVI the benefit of PCI compared with conservative treatment on the composite of all-cause death, myocardial infarction, or urgent revascularization was most pronounced among patients aged 78–84 years.

AIMS:Intermediate high-risk pulmonary embolism (PE) is associated with increased risk of haemodynamic deterioration and death, but balancing the risk of thrombolytics or catheter-based treatment and efficacy has been challenging. This trial compared the additional efficacy of catheter-based ultrasound low-dose thrombolysis (USAT) over intravenous low-dose thrombolysis or heparin alone. METHODS AND RESULTS:In an investigator-initiated randomized clinical multicentre trial, we randomized 210 adult patients with acute, intermediate high-risk PE admitted to emergency departments in two regions of Denmark. Patients were allocated 1:1:1 to one of three treatment strata: low-dose thrombolysis (20 mg alteplase administered over 6 h) by USAT, by intravenous administration, or heparin alone. The efficacy of the interventions was assessed by comparing the refined Modified Miller Score, rmMS, (0-40 points, higher score indicating higher thrombus burden) from CT angiographies performed at baseline and 48-96 h post-randomization. Two comparisons were investigated: the reduction of rmMS with low-dose thrombolysis (USAT or intravenously) compared to heparin alone and the reduction of rmMS with low-dose thrombolysis administered by USAT compared to the intravenous route. The safety endpoint included the risk of bleeding.We included 210 patients with acute PE, 49% were female, the mean age was 70 (IQR 62-76), and the mean body mass index was 30 (26-34). Compared to heparin alone, low-dose thrombolysis reduced the rmMS by 3.6 points (95% CI 2.2-5.0, P < 0.001), but the reduction in rmMS was not different in the ultrasound-assisted thrombolysis (USAT) vs. the intravenous route, mean difference -0.1 (95% CI: -1.9-1.7), P = 0.88. Bleeding complications were numerically more frequent with low-dose thrombolysis, albeit not statistically significant. No differences in other outcomes were observed. CONCLUSION:Low-dose thrombolysis reduced thrombus burden more than heparin alone in patients with acute intermediate high-risk PE. However, USAT did not show greater thrombus reduction than intravenous thrombolysis. The rate of death and risk of bleeding complications were increased with low-dose thrombolysis. TRIAL REGISTRATION:clinicaltrials.gov, NCT04088292.

BACKGROUND:Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking. AIMS:We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance. METHODS:Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation. RESULTS:In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51). CONCLUSIONS:OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.

Aims:We aimed to investigate if non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) are associated with all-cause mortality or heart failure compared to mean arterial blood pressure (MAP), left ventricular ejection fraction (LVEF), and stroke volume (SV) in patients with revascularized ST-elevation myocardial infarction (STEMI). Methods and results:A total of 653 STEMI-patients from the DANAMI-3 trial underwent CMR and brachial blood pressure registration after revascularization. Volumetric CMR-data and brachial blood pressure were used to generate PV loops and calculate arterial elastance, contractility, energy per ejected volume, external power, potential energy, stroke work, ventricular efficiency, and ventriculoarterial coupling. The primary outcome was a composite endpoint of all-cause mortality or hospitalization for heart failure. A total of 39 patients met the primary outcome during a maximal follow-up time of 4.7 years. Potential energy (HR 1.38, 95% CI 1.02-1.88) and ventriculo-arterial coupling (HR 1.35, 95% CI 1.03-1.78) were associated with the primary outcome after adjustments for age, sex, and infarct size. LVEF (HR 0.74, 95% CI 0.49-1.10), MAP (HR 1.12, 95% CI 0.80-1.58), and SV (HR 1.02, 95% CI 0.68-1.54) did, however, not show an association with the primary outcome. Conclusion:Non-invasive pressure-volume loop variables are prognostic of all-cause mortality and hospitalizations for heart failure independent of age, sex, and infarct size and may provide incremental prognostic information to left ventricular ejection fraction and infarct size for clinical outcome after myocardial infarction. Thus, non-invasive PV-loop variables could potentially be used for early treatment guidance in post-STEMI patients.

Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit. To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction–related cardiogenic shock. This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024. Microaxial flow pump therapy plus standard care vs standard care alone. All-cause mortality at 180 days according to randomization SBP. Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings ( P for interaction = .02; P for nonlinearity = .01). Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating. ClinicalTrials.gov Identifier: NCT01633502

INTRODUCTION:Coronary microvascular dysfunction (CMD) is increasingly recognized as an important cause of anginal symptoms and poor outcomes. Angina with nonobstructive coronary arteries (ANOCA) is often related to CMD. While physiological assessment of microcirculatory function by coronary bolus thermodilution is widely practiced, more precise and reproducible methodology as well as systematic assessment are necessary. Recently, absolute flow measurements by coronary continuous thermodilution and the concept of Microvascular Resistance Reserve (MRR) have been introduced. AIM:The European microCirculatory Resistance and Absolute Flow Team (EuroCRAFT) registry aims to compare major adverse cardiac and cerebrovascular events (MACCE)-rates in patients with and without CMD based on MRR at 1-year follow-up. METHODS:This prospective international, investigator-initiated, multicenter study is enrolling patients with stable chest pain suggestive of angina and nonobstructive epicardial coronary arteries on invasive coronary angiography, defined as fractional flow reserve >0.80. Patients will undergo coronary angiography and microvascular assessment using bolus and continuous thermodilution methods. The primary endpoint is to compare the rate of MACCE in patients with and without CMD assessed with MRR at 1 year. Based on the sample size estimation, 671 patients are initially planned for enrollment. We hypothesize that coronary continuous thermodilution-derived MRR has superior prognostic value for MACCE at 1 year compared to bolus thermodilution-derived microvascular metrics. RESULTS:Study recruitment started in September 2022 and has been completed in May 2025, resulting in a total of 678 patients enrolled.

Glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment reduces cardiovascular events in type 2 diabetes. Yet, the impact of GLP-1RA treatment before ST-segment elevation myocardial infarction (STEMI) on long-term prognosis in patients with type 2 diabetes remains unclear. In patients with STEMI and type 2 diabetes, we aimed to investigate the association between long-term prognosis and GLP-1RA treatment before STEMI. This nationwide cohort study included consecutive patients admitted with type 2 diabetes and STEMI in Denmark from 2010 to 2016. All data were retrieved from nationwide Danish registries. Type 2 diabetes was defined by prior hospital admission with type 2 diabetes or anti-diabetic prescriptions within one year before STEMI. Dispensed GLP-1RA medication was retrieved within one year before STEMI. Of 1421 patients with STEMI and diabetes, 7

Aims:This study aimed to assess the predictive value of non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) for determining development of adverse remodelling 3 months after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methods and results:In total, 181 STEMI patients examined with CMR during the index admission (baseline) after primary PCI and at 3-month follow-up in The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3) study were retrospectively analysed. A time-varying elastance model for generating PV loops from CMR volumetry and brachial blood pressure was used to calculate contractility, arterial elastance, stroke work, potential energy, efficiency, external power, ventriculoarterial coupling, and energy per ejected volume. Adverse remodelling was seen in 28 patients (15%), defined as a concomitant increase in end-diastolic and end-systolic volume of ≥12% from baseline to follow-up. PV loop variables measured at baseline showed predictive value for adverse remodelling, independent of age, sex, and infarct size (IS) by a logistic regression analysis: contractility [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8-12.4] and efficiency (OR 1.05, 95% CI 1.00-1.11). Furthermore, females showed a higher increase in contractility between the timepoints (ΔContractility = 0.4 ± 0.4 mmHg/mL vs. 0.1 ± 0.4 mmHg/mL, P < 0.0001). A higher energy expenditure was seen at baseline in left arterial descending artery infarctions compared to left circumflex artery and right coronary artery infarctions. Conclusion:Non-invasive PV loop variables by CMR have incremental predictive value to age, sex, and IS for determining development of adverse cardiac remodelling in STEMI patients treated with primary PCI. Furthermore, the PV loop variables show significant differences in post-infarct cardiovascular adaptation between sexes and culprit vessels.

Background The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear. Objectives The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR. Methods Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months. Results Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001). Conclusions Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627)

BACKGROUND:Microvascular injury in patients with ST-segment elevation myocardial infarction (STEMI) occurs in up to 50%, yet no therapeutic target exists. Inflammation contributes directly to myocardial damage in STEMI and may also cause deleteriously effects on the microcirculation. The aim of this prespecified sub-study was to determine the effect of prehospital pulse-dose glucocorticoid on the microcirculation determined by index of microvascular resistance (IMR) and its relation to inflammation. The PULSE-MI trial was a 1:1 randomized, blinded, placebo-controlled clinical trial in patients with STEMI transferred for primary percutaneous coronary intervention (PCI) investigating the cardioprotective effects of prehospital pulse-dose glucocorticoid (methylprednisolone 250 mg) compared with placebo. In this prespecified sub-study, we investigated microvascular function as IMR by thermodilution after primary PCI and inflammation defined by C-reactive protein (CRP) at 24 hours after onset of STEMI. RESULTS:Of 530 patients included in the PULSE-MI trial, 295 (56%) were assessed with coronary physiology of whom 142 (48%) were treated with glucocorticoid and 153 (52%) with placebo. Baseline characteristics were overall well-balanced in both groups. The median IMR in the glucocorticoid group was 23 (interquartile range (IQR), 11-38) and 18 (IQR, 11-42) in the placebo group (p=0.49). CRP upon arrival did not differ between treatment groups (p=0.81), but CRP at 24 hours was significantly lower in the glucocorticoid group compared to placebo (p<0.001). CONCLUSIONS:Prehospital glucocorticoid did not impact IMR assessed immediately after primary PCI, albeit this compound, demonstrated significant anti-inflammatory effects as determined by CRP levels at 24 hours. TRIAL REGISTRATION:http://www. CLINICALTRIALS:gov ; Unique Identifier: NCT05462730.

Higher on-treatment levels of low-density lipoprotein cholesterol in statin-treated patients were reportedly associated with the occurrence of neoatherosclerosis after drug-eluting stent (DES) implantation. We aimed to investigate the impact of alirocumab added to high-intensity statin therapy on neoatherosclerosis formation among patients with acute myocardial infarction (AMI) treated with DES. This was a pre-specified substudy of the PACMAN-AMI trial, a randomized, double-blind trial comparing alirocumab versus placebo added to high-intensity statin therapy in AMI patients. The present study included patients undergoing optical coherence tomography assessment of DES in the culprit lesion at one year. The frequency of neoatherosclerosis, neointimal thickness, and strut malapposition were compared between treatment groups. Among 191 patients (95 with alirocumab and 96 with placebo), neoatherosclerosis was observed in 13 patients (6.8