BACKGROUND AND AIMS:Frailty is increasingly recognized as an important determinant of adverse outcomes in older adults with acute myocardial infarction (AMI), but its impact in younger patients remains underexplored. The aims of this study were to evaluate the association of frailty with adverse outcomes in AMI patients, stratified by age. METHODS:This population-based epidemiological study utilized linked national administrative data from England and Wales. Patients were stratified into three age groups: <55 years, 55-74 years, and ≥75 years. Frailty was assessed using the Secondary Care Administrative Records Frailty index with patients categorized into fit, mild, moderate, and severe groups. All-cause mortality at 1 year was the primary outcome. Secondary outcomes were cardiovascular and bleeding-related events. RESULTS:A total of 931 133 patients were included of which 13% of patients were severely frail. In patients with severe frailty, adjusted hazard ratios for all-cause mortality were 6.69 [95% confidence interval (CI) 5.76-7.76] for young patients, 4.33 (95% CI 4.11-4.57) for middle-aged patients, and 2.31 (95% CI 2.23-2.39) for older patients. The interaction between age and frailty revealed that younger patients with severe frailty had a 3.51-fold (95% CI 3.11-3.96) higher risk of all-cause mortality compared with older patients with severe frailty (P < .001). CONCLUSIONS:Frailty is independently associated with poor outcomes after AMI, with the strongest impact observed in younger patients, highlighting the need for frailty assessment across all age groups.

BACKGROUND:In the assessment of patients with suspected coronary artery disease (CAD), the diagnostic role of stress-perfusion cardiovascular magnetic resonance (CMR) is well established. However, its reliance on gadolinium-based contrast agents may restrict its application in certain populations. T1 mapping during vasodilatory stress has been proposed as a contrast-free alternative for detecting CAD. This study sought to compare the diagnostic accuracy of adenosine-stress T1 reactivity (ΔT1) with that of stress-perfusion CMR for identifying hemodynamically significant CAD. METHODS:Patients with suspected angina referred for diagnostic invasive coronary angiography underwent 3-Tesla CMR consisting of the following: (1) T1 mapping at rest and following intravenous adenosine using a modified Look-Locker inversion recovery sequence, (2) stress and rest perfusion, and (3) late-gadolinium enhancement. Significant CAD was defined invasively as fractional flow reserve ≤0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if unavailable). A ΔT1 vessel threshold (% increase in T1 from rest to stress) was derived from receiver operating characteristic analysis, using invasive coronary angiography as the reference standard. Stress-perfusion CMR was assessed qualitatively with CAD determined by the presence of ischemia and/or infarction, (A) per-vessel (as determined by two independent readers) and (B) per-patient (following consensus read). RESULTS:Of 121 prospectively recruited patients, 115 had paired T1 mapping and coronary angiography data (mean age 66 ± 9 years, 72% [83/115] male, CAD prevalence 51% [59/115]). ΔT1 demonstrated poor diagnostic performance for detecting significant CAD (area under the curve 0.59 [95% CI: 0.52, 0.65], p = 0.011), with an optimal vessel threshold ≤4.36% giving accuracy 54.9%, sensitivity 68.3%, and specificity 49.2%. Stress-perfusion CMR demonstrated superior diagnostic accuracy compared to ΔT1: (A) per-vessel (for the two independent reads, +26.2% [19.4%, 32.6%] and +26.7% [19.9%, 33.3%], both p<0.001) and (B) per-patient (for consensus read, +21.7% [10.2%, 32.6%], p<0.001). CONCLUSION:In patients with suspected angina, ΔT1 demonstrates limited diagnostic accuracy for the detection of obstructive CAD. Future efforts should be directed toward alternative contrast-free methods for the reliable detection of CAD in this population.

BACKGROUND:Elective left ventricular (LV) unloading during high-risk percutaneous coronary intervention (PCI) is hypothesized to mitigate hemodynamic instability and myocardial stunning, but has not been evaluated in a randomized trial. OBJECTIVES:This prespecified substudy of the CHIP-BCIS3 (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading) trial evaluated whether elective LV unloading with a microaxial flow pump (mAFP) reduces hemodynamic instability and postprocedural stunning. METHODS:Patients with severe LV systolic dysfunction undergoing complex PCI were randomized to elective LV unloading with an mAFP or standard care. Invasive hemodynamics were assessed using pulmonary artery catheterization at baseline and post-PCI. The coprimary outcomes were systolic blood pressure reduction, loss of pulse pressure (LOPP), and requirement for inotropes. Secondary outcomes included changes in cardiac index, LV filling pressure, and frequency of peri-procedural myocardial injury. RESULTS:Of 125 eligible patients, 97 were enrolled (50 mAFP; 47 standard care). Baseline cardiac index was 2.10 ± 0.55 L/min/m2. The incidence of systolic blood pressure reduction was similar between groups (relative risk [RR]: 0.86; 95% CI: 0.58-1.29), whereas inotrope use was lower with mAFP (RR: 0.57; 95% CI: 0.34-0.97). LOPP was more frequent with mAFP (RR: 7.83; 95% CI: 2.53-24.24) and was associated with peri-procedural myocardial injury (OR: 3.00; 95% CI: 1.00-9.03). Changes in cardiac index (-0.25 vs -0.24 L/min/m2; P = 0.20) and pulmonary capillary wedge pressure (2 vs 3 mm Hg; P = 0.79) were similar between groups. CONCLUSIONS:In patients undergoing complex PCI, elective LV unloading with mAFP reduced inotrope requirements but increased LOPP and did not prevent myocardial stunning. (Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading [CHIP-BCIS3]; NCT05003817).

AIMS:In patients with suspected coronary artery disease (CAD), the role of adenosine-stress cardiovascular magnetic resonance (CMR) is well established. However, to meet increasing demand, improving its time efficiency and cost-effectiveness is critical. Recent advances in accelerated, free-breathing cine and scar imaging now enable accelerated stress-perfusion protocols. This study evaluated whether an accelerated, stress-only perfusion protocol achieves non-inferior diagnostic accuracy compared with a standard stress-rest perfusion CMR protocol for detecting significant CAD. METHODS AND RESULTS:Patients with suspected angina referred for invasive coronary angiography (ICA) underwent two 3-Tesla CMR scans (standard and accelerated protocols), on separate days in randomized order. Significant CAD was defined as fractional flow reserve (FFR) ≤ 0.80 in epicardial vessels ≥2 mm diameter (or quantitative flow ratio ≤0.80 if FFR unavailable). CMR images were evaluated qualitatively with (i) primary per-vessel analysis (determined by two independent readers) and (ii) secondary per-patient analysis (following consensus read). Of 167 prospectively recruited patients, 150 completed both CMR protocols and ICA (mean age 66 ± 10 years, 71% male, CAD prevalence 51%). The accelerated scan was better tolerated by patients, with scan duration 19 ± 5 min (24 min shorter than the standard protocol [95% CI: 23, 25], P < 0.001). Compared with standard CMR, accelerated CMR achieved non-inferior per-vessel diagnostic accuracy at a pre-specified 5% non-inferiority margin (+0.7% [-2.7%, 4.0%], pnon-inferiority = 0.001 and +3.4% [-0.1%, 6.8%], pnon-inferiority < 0.001 for the two readers). Accelerated CMR also achieved comparable per-patient accuracy (+4.6% [-1.5%, 11.0%], P = 0.189 for consensus read; accuracy 88.6%, sensitivity 84.2%, and specificity 93.2%). CONCLUSION:Compared to standard stress-perfusion CMR, an accelerated stress-perfusion protocol achieves non-inferior diagnostic accuracy at the vessel level, with a time saving of over 20 min per scan. Accelerated imaging may prove effective in the clinical arena to evaluate patients with suspected angina.

BACKGROUND:Complex percutaneous coronary intervention (PCI) in patients with severely impaired left ventricular function carries a high risk of death and complications. Whether percutaneous left ventricular unloading improves outcomes remains unclear. METHODS:We randomly assigned 300 patients with severe left ventricular dysfunction and extensive coronary artery disease in a 1:1 ratio to a strategy of elective unloading with a microaxial flow pump or to standard care during planned complex PCI. The primary outcome was a hierarchical composite that included death from any cause, disabling stroke, spontaneous myocardial infarction, hospitalization for cardiovascular causes, or periprocedural myocardial injury at a minimum of 12 months, as analyzed according to a win ratio. RESULTS:A total of 148 patients were assigned to receive a microaxial flow pump and 152 to receive standard care. At a median of 22 months (interquartile range, 16 to 30), 36.6% of pairwise comparisons favored the microaxial flow pump, and 43.0% favored standard care (win ratio, 0.85; 95% confidence interval [CI], 0.63 to 1.15; difference, -6.4 percentage points; P = 0.30). Death from any cause occurred in 47 patients in the microaxial-flow-pump group and 33 in the standard-care group (hazard ratio, 1.54; 95% CI, 0.99 to 2.41). There was no material between-group difference in the risk of bleeding or vascular complications. CONCLUSIONS:Among patients with severely impaired left ventricular function undergoing complex PCI, elective left ventricular unloading with a microaxial flow pump did not reduce the risk of major adverse clinical outcomes at a minimum of 12 months. (Funded by the U.K. National Institute for Health and Care Research; CHIP-BCIS3 ClinicalTrials.gov number, NCT05003817.).

Following the recently upgraded recommendations for intravascular imaging use from the European Society of Cardiology and the American Heart Association, we present a UK consensus statement on the use of intravascular ultrasound (IVUS) in percutaneous coronary intervention. Developed by 26 senior interventional cardiologists across a range of UK centres, this statement reflects growing evidence and changing expectations for IVUS use. We discuss the indications for IVUS, the current patterns of use in the UK, anticipated future standards and the need for broader adoption. We propose a standardised workflow and recommend routine documentation of a core IVUS dataset to support quality and as a mechanism for improvement. Persistent barriers, such as perceived cost, training variability and procedural integration, are addressed with practical solutions, including the introduction of national training curricula incorporating intravascular imaging accreditation for operators and targeted education for allied health professionals. Our goal is to support clinicians, catheter lab teams and service leads in embedding IVUS more consistently into practice to optimise patient outcomes.

Background: Bioresorbable coronary stents (BRS) were designed with the aim of reducing the risk of late adverse events of permanent drug-eluting stents (DES) by dissolving once vessel patency had been restored and the requirement for acute mechanical support resolved. Bioresorbable poly-L-lactic acid (PLLA) scaffold designs, while initially appearing as promising technology, were unsuccessful in widespread clinical use due to an observed high rate of late stent thrombosis. Magnesium-based BRS (MgBRS) have provided an alternative to this original design and have shown promise in early-phase clinical trials. This review aims to address the clinical question: How does the current safety and efficacy evidence for MgBRS in all patients requiring percutaneous coronary intervention compare with the randomised data assessing PLLA-BRS and contemporary DES? Methods: Two parallel systematic reviews were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilising MEDLINE, EMBASE and Web of Science: the first assessing clinical outcomes of all observational and randomised MgBRS trials, the second assessing clinical outcomes of PLLA-BRS versus DES in randomised clinical trials. The primary safety and efficacy outcomes collected were cardiac death, target vessel failure (TVF) and stent thrombosis. Results: A total of 3582 MgBRS patients (24 trials), 6370 PLLA-BRS and 5413 DES patients (16 trials) were included for analysis. Cardiac death was similar across all three stent designs in all time intervals. MgBRS performed similarly to contemporary DES and superiorly to PLLA-BRS at 12- and 24-month intervals with regard to TVF and stent thrombosis. Longer follow-up was suggestive of a poorer performance of MgBRS relative to DES, although with limited patient numbers. Conclusion: MgBRS appear to perform similarly to DES and superiorly to PLLA-BRS at 12 and 24 months in regard to key clinical safety and efficacy measures. Further randomised studies are required before recommending this technology for widespread clinical use over DES.

The ability to manage more complex coronary disease has evolved with the development of new technologies, techniques, and practitioner experience. The increasing technical difficulty of interventional procedures is known to be associated with an increased risk of complications. This can include coronary perforation, coronary dissection, coronary thrombosis, and aortic valve dysfunction. Permanent aortic valve damage caused by guide catheter, wire instrumentation or stent migration is a rare occurrence. We report the case of a woman in her 50s who developed acute severe aortic regurgitation requiring aortic valve replacement post-percutaneous coronary intervention.

Intravascular ultrasound (IVUS) plays a central role in complex percutaneous coronary interventions (PCI). While guidance for stenting and optimization is the most common reason for IVUS use, the technical application of IVUS for greater procedural efficiency is becoming increasingly important. The impact of IVUS has been only partially investigated in its technical aspect. We analyzed 15,226 CTO-PCIs from the EuroCTO registry between January 2022 and December 2023. We compared CTO PCI procedures performed with or without IVUS and further categorized IVUS use based on its application (technical reasons or stent optimization). IVUS was used in 22

Aims:In the assessment of myocardial ischaemia, vasoactive breathing manoeuvres have been proposed as a potential alternative to pharmacological vasodilator stress. However, it remains unclear whether the resultant physiological responses are comparable to those induced by adenosine in patients with suspected coronary artery disease (CAD). We sought to compare the myocardial oxygenation responses to a hyperventilation breath-hold (HVBH) manoeuvre with those elicited by adenosine, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR). Methods and results:Patients with suspected angina underwent 3-Tesla OS-CMR with (i) HVBH and (ii) adenosine (140-210 μg/kg/min) prior to invasive coronary angiography. The primary outcome was the maximal percentage change in OS-CMR signal intensity for (i) HVBH [breathing-induced myocardial oxygenation reserve (B-MOREmax)] and (ii) adenosine [adenosine-induced myocardial oxygenation reserve (A-MORE)]. Significant CAD was defined as fractional flow reserve ≤0.80 in epicardial vessels ≥2 mm diameter. From 53 prospectively recruited patients, 44 had complete, paired OS-CMR sequences (mean age 69 ± 9 years, 75% male, CAD prevalence 59%). The HVBH manoeuvre elicited a myocardial oxygenation response comparable to that of adenosine (B-MOREmax 7.0 ± 9.5% vs. A-MORE 8.6 ± 12.3%, mean difference: -1.6% [-6.0%, 2.8%]; P = 0.469), which remained similar at the segmental level following adjustment for age, sex, cardiovascular comorbidities, CAD, and infarction (mean difference: -1.7% [-4.0%, 0.5%]; P = 0.126). Conclusion:In patients with suspected CAD, HVBH induces a myocardial oxygenation response comparable to that elicited by adenosine. Future prospective studies evaluating the diagnostic accuracy of OS-CMR combined with vasoactive breathing manoeuvres for detecting significant CAD are warranted.

BACKGROUND:High radiation exposure is a significant risk with recanalizations for chronic total coronary occlusions (CTO). AIMS:To analyze the influence of radiographic equipment, radiation protocols, and operator experience on radiation exposure. METHODS:We analyzed 17,769 procedures by 27 operators from a multicenter European Registry between 2015 and 2023. Thirteen operators had an experience > 10 years (Gen1), and 14 entered the registry after 2015 (Gen2). AirKerma (AK), dose area product (DAP), the dose rate index (DRI) as AK per fluoroscopy time (FT), and the collimation index (CLI) as DAP per AK were calculated to assess inter-operator variability. RESULTS:Despite increased lesion complexity (2015-17: CASTLE score 1.83 ± 1.10, 2021-23: 2.20 ± 1.19; p < 0.001), AK and DAP were reduced by 45%. Gen1 operators treated more complex lesions than Gen 2 (2.05 ± 1.13 vs. 1.85 ± 1.16; p < 0.001) at more extended FT (38.4 [23-61] vs. 34.0 [20-57]; p < 0.001) than Gen2 with slightly higher AK (1.6 [0.89-2.8] Gy vs. 1.4 [0.8-2.54]; p < 0.001), but DRI was similar (42.9 [27.7-64.3] vs. [28.0-62.1]). In 2015-17, operators with Philips Clarity had a lower median AK (1.7 Gy; p < 0.001) than other vendors (Siemens 2.1 Gy; General Electric 2.8 Gy), but with updated equipment, Philips systems had slightly higher AK (1.2 Gy) than Siemens systems (1.0 Gy; p < 0.001). Inter-operator variability regarding DRI improved over time, but collimation did not change. CONCLUSIONS:Radiation exposure for CTO PCI was reduced for both long-time and recent CTO operators during 9 years. Equipment updates were instrumental to improved radiation management, but inter-operator differences remained regarding dose management and collimation.

BACKGROUND:Drug-coated balloons (DCBs) are increasingly used in percutaneous coronary intervention (PCI). Their application for chronic total occlusions (CTOs) is a promising option to limit stent length in diffuse disease and avoid stent underexpansion and malapposition in negatively remodeled distal vessel segments. OBJECTIVES:The aim of this study was to analyze CTO PCI procedures recorded in ERCTO (European Registry of Chronic Total Occlusion) to investigate frequency of use, patient and lesion characteristics, and in-hospital outcomes of DCBs. METHODS:CTO cases entered into the database from 2016 to 2023 were examined and categorized according to DCB use. DCB-treated patients were further divided into 2 groups: DCBs only and DCBs in association with drug-eluting stents. To minimize the potential impact of confounding factors, 1:1 propensity score matching was applied. RESULTS:Of 40,449 CTO PCIs performed at 184 centers, DCBs were used in 2,506 (6.2%), increasing from 3.4% (n = 185 of 5,498) in 2016 to 14.9% (n = 705 of 4,722) in 2023. In-hospital complications were infrequent, but DCB-treated CTOs had significantly lower rates of pericardial tamponade (0.1% [n = 2 of 2,506] vs 0.4% [n = 169 of 37,943]; P = 0.006). After propensity score matching, DCB use led to reduced drug-eluting stent length (44.2 ± 36.9 mm [95% CI: 42.7-45.7 mm] vs 58.1 ± 35.9 mm [95% CI: 56.7-59.5] mm; P < 0.001). Contrast volume was lower in the DCB-treated patients (202.4 ± 109.8 mL [95% CI: 198.1-206.7 mL] vs 211.6 ± 123 mL [95% CI: 206.8-216.4 mL]; P = 0.005). CONCLUSIONS:The use of DCBs in CTO recanalization is increasing and is associated with a reduction in the length of stents implanted, as well as a decrease in contrast volume and a lower rate of pericardial tamponade.

BACKGROUND:Calcification in a chronic total occlusion (CTO) is better visualised on Computed Tomography Coronary Angiography (CTCA) than invasive angiography. OBJECTIVES:The authors sought to assess the characteristics of calcification of a CTO on CTCA and correlate with CTO percutaneous coronary intervention (PCI) outcome. METHODS:Retrospective analysis of the PCI database was performed (April 2017-April 2024) (clinical trials registration: NCT06414551). Patients who underwent both CTO PCI and CTCA were grouped into successful CTO PCI and any failed attempt of CTO PCI and compared for characteristics of calcification on CTCA: site of calcification, density of calcification in Hounsfield Units (HU) and quantity of calcification in % of cross section of the vessel. RESULTS:Out of 499 CTO PCIs performed, 82 patients had undergone CTCA. 51/82 (62.2 ​%) patients had analysable CTCAs. Mean age was 68.5 (±10.9) years and 19.6 ​% were female. Patients in the failed group were more likely to have calcification in the proximal cap (failed 65.4 ​% vs. success 24 ​%, p ​= ​0.003), more dense calcification in the proximal cap (failed: 611.8 (±517) HU vs. success: 177.6 (±356) HU; p ​= ​0.001) and proximal cap calcification quantity ≥50 ​% (failed: 75 ​% vs. success 16.7 ​%, p ​= ​0.03). Proximal cap calcification ≥50 ​% was an independent predictor of CTO PCI failure (OR, 3.21, 95 ​% CI 1.29 to 7.98, p ​= ​0.012). CONCLUSIONS:Proximal cap calcification density and quantity on CTCA was associated with CTO PCI failure. Assessment of the proximal cap calcification may help with procedure planning in CTO PCI. Larger, prospective multicentre studies are required to corroborate these findings.

Background: In patients with suspected coronary artery disease (CAD), the optimal diagnostic algorithm remains uncertain. Non-invasive imaging plays a central role as a "gatekeeper" to invasive coronary angiography, with both cardiovascular magnetic resonance (CMR) and coronary computed tomography angiography (CCTA) with fractional flow reserve (FFRCT) proving effective in reducing unnecessary invasive procedures. However, direct comparisons between the two modalities are limited. Study design and Methodology: CONCORD is a prospective, single-center study comparing the diagnostic accuracy of CMR and CCTA/FFRCT to detect obstructive CAD in 300 patients with suspected angina referred for clinically indicated invasive coronary angiography. The primary outcome is the diagnostic accuracy of each imaging protocol against the reference standard of invasive fractional flow reserve. Key secondary outcomes include whether quantitative CMR is more accurate than qualitative CMR and/or CCTA/FFRCT, and whether hybrid imaging models may outperform single modality strategies (NCT04761991). Conclusion: CONCORD will comprehensively evaluate two frontline non-invasive functional imaging modalities in patients with suspected angina and determine the comparative accuracy of CCTA/FFRCT and CMR in patients with a moderate-high risk of CAD. Evaluation of these strategies has the potential to inform both the quality and cost-effectiveness of imaging services.

BackgroundAortic stenosis is a life-limiting condition for which transcatheter aortic valve implantation (TAVI) is an established therapy. Coronary artery disease (CAD) is frequently found in this patient group and optimal management in these patients remains uncertain.ObjectivesWe sought to examine the association of coexistent CAD on mortality and hospital readmission in patients undergoing TAVI.MethodsIn this observational cohort study, we examined patients who underwent TAVI and segregated them by the presence of obstructive epicardial CAD. The primary outcome was 3-year mortality with secondary outcomes being readmission for (1) all-causes, (2) a MACE (Major Adverse Cardiovascular Event) composite endpoint and (3) acute coronary syndrome. Subsidiary outcomes included patient angina and breathlessness scores.Results898 patients underwent TAVI, of which 488 (54.3%) had unobstructed coronary arteries and 410 (45.7%) had obstructive CAD. Overall, n=298 (33.2%) patients experienced the primary mortality endpoint with no significant difference when stratified according to CAD (n=160 (32.9%) vs n=136 (33.2%), HR 0.98, CI 0.78 to 1.24). After multivariate analysis, the presence of CAD had no effect on the primary outcome (HR 0.98, CI 0.68 to 1.40). There was no significant difference in readmission for any cause (n=181, 37.1% (CAD) vs n=169, 41.2% (no CAD), p=0.23), including no significant difference on readmission for MACE (n=48, 9.8% (CAD) vs n=45, 11.0% (no CAD), p=0.11). CAD at the time of TAVI also did not alter breathlessness or angina scores before/after TAVI (p>0.05).ConclusionCoexistent CAD had no significant association with mortality, any-cause readmission or symptoms for patients undergoing TAVI in our cohort.

BACKGROUND:The CTO-ARC (Chronic Total Occlusion Academic Research Consortium) recognized that a nonstandardized definition of chronic total occlusion (CTO) percutaneous coronary intervention approaches can bias the complications' attribution to each crossing strategy. OBJECTIVES:The study sought to describe the numbers, efficacy, and safety of each final CTO crossing strategy according to CTO-ARC recommendations. METHODS:In this cross-sectional study, data were retrieved from the European Registry of Chronic Total Occlusions between 2021 and 2022. RESULTS:Out of 8,673 patients, antegrade and retrograde approach were performed in 79.2% and 20.8% of cases, respectively. The antegrade approach included antegrade wiring and antegrade dissection and re-entry, both performed with or without retrograde contribution (antegrade wiring without retrograde contribution: n = 5,929 [68.4%]; antegrade wiring with retrograde contribution: n = 446 [5.1%]; antegrade dissection and re-entry without retrograde contribution: n = 353 [4.1%]; antegrade dissection and re-entry with retrograde contribution: n = 137 [1.6%]). The retrograde approach included retrograde wiring (n = 735 [8.4%]) and retrograde dissection and re-entry (n = 1,073 [12.4%]). Alternative antegrade crossing was associated with lower technical success (70% vs 86% vs 93.1%, respectively; P < 0.001) and higher complication rates (4.6% vs 2.9% vs 1%, respectively; P < 0.001) as compared with retrograde and true antegrade crossing. However, alternative antegrade crossing was applied mostly as a rescue strategy (96.1%). CONCLUSIONS:The application of CTO-ARC definitions allowed the reclassification of 6.7% of procedures as alternative antegrade crossing with retrograde or antegrade contribution which showed higher MACCE and lower technical success rates, as compared with true antegrade and retrograde crossing.

Objectives. Cardiac surgery for coronary artery disease was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with disease ordinarily treated with coronary artery bypass grafting (CABG) instead underwent percutaneous coronary intervention (PCI). We sought to describe 12-month outcomes following PCI in patients who would typically have undergone CABG. Methods. Between March 1, 2020 and July 31, 2020, patients who received revascularization with PCI when CABG would have been the primary choice of revascularization were enrolled in the prospective, multicenter UK-ReVasc Registry. We evaluated the following major adverse cardiovascular events at 12 months: all-cause mortality, myocardial infarction (MI), repeat revascularization, stroke, major bleeding, and stent thrombosis. Results. A total of 215 patients were enrolled across 45 PCI centers in the United Kingdom. Twelve-month follow-up data were obtained for 97% of the cases. There were 9 deaths (4.3%), 5 MIs (2.4%), 12 repeat revascularizations (5.7%), 1 stroke (0.5%), 3 major bleeds (1.4%), and no cases of stent thrombosis. No difference in the primary endpoint was observed between patients who received complete vs incomplete revascularization (residual SYNTAX score <=8 vs > 8) (P = .22). Conclusions. In patients with patterns of coronary disease in whom CABG would have been the primary therapeutic choice outside of the pandemic, PCI was associated with acceptable outcomes at 12 months of follow-up. Contemporary randomized trials that compare PCI to CABG in such patient cohorts may be warranted.