The radial artery access is frequently used in coronary interventions. However, anatomical variations, such as loops, can pose significant challenges, leading to an increased number of access site crossovers. This study presents a four-step protocol introducing the “Serpentine” technique, a novel approach based on specific maneuvers using the Tiger-II catheter to navigate radial artery loops. This was based on a prospective registry of patients who underwent transradial coronary angiography at our tertiary hospital between 2020 and 2022 and our predefined four-step protocol was applied. Procedural success was defined as the completion of coronary angiography without the need for access site crossover. The incidence of access site crossover was evaluated. A total of 2,389 patients underwent coronary angiography at our center during the study period, and 130 patients (5.44 https://BioRender.com/z57kwul .

Background Radial artery occlusion (RAO) is the most common complication of transradial access. Existing revascularization protocols are not yet standardized, and different revascularization techniques may be employed across centers. Aims An innovative protocol named RETRY, which targets the recanalization of the proximal radial artery via distal radial access using specific wire techniques and drug-coated balloons, could be feasible and safe. Methods We prospectively collected and analyzed data from 12 consecutive patients undergoing attempted recanalization of RAO via distal radial access between January 2024 and July 2025. Demographic, clinical, and procedural variables were recorded. The primary endpoint was technical success, defined as successful recanalization with restoration of antegrade radial flow on angiography. Secondary outcomes included complications and radial patency at follow-up. Results Mean patient age was 61.5 ± 12.1 years; mean body mass index was 29.1 ± 3.3 kg/m2. Retrograde guidewire passage was achieved in all 12 patients (100%), with no crossover. Percutaneous coronary intervention was performed in 3 cases (25%). Mean procedural time was 50.0 ± 15.6 min, with fluoroscopy time 12.6 ± 6.5 min, and contrast volume 106.7 ± 47.2 mL. No complications were recorded. Patency was confirmed in 91.7% at 48 hours and 83.3% at 1 month. Conclusions The RETRY protocol for RAO recanalization, based on ultrasound-guided distal radial access and drug-coated balloon angioplasty, is feasible, safe, and associated with excellent technical success and favorable short-term patency. As a prospective feasibility study, these findings warrant validation in larger, comparative trials with longer follow-up.

Chronic total occlusions (CTOs) are often treated with long, overlapping drug-eluting stents (DES), increasing metal burden and potentially limiting vasomotion and future revascularization. Drug-coated balloons (DCBs) offer a metal-sparing alternative by delivering an antiproliferative drug without a permanent implant. This narrative review summarizes the mechanistic rationale and current clinical evidence for DCB use in CTO PCI, including de novo CTOs, in-stent CTOs (ISR-CTOs), and hybrid DCB-DES strategies. In selected de novo CTOs, DCB-only treatment after successful recanalization and meticulous lesion preparation appears feasible, with frequent late lumen enlargement. In ISR-CTOs, DCB angioplasty appears broadly comparable to repeat DES implantation while avoiding additional metallic layers. Hybrid strategies may reduce total stent length with comparable mid-term outcomes. However, most CTO data are observational and influenced by selection bias, surveillance intensity, and heterogeneous endpoint definitions, while CTO-specific randomized evidence remains limited. DCB-based CTO PCI should therefore be regarded as an option for carefully selected lesions rather than a standard strategy for all CTOs. Randomized trials with standardized procedural definitions and longer follow-up are needed to define the roles of DCB-only, hybrid, and full-DES strategies in contemporary CTO practice.

RATIONALE:Transradial access (TRA) constitutes the cornerstone for cardiac catheterization and is recommended by the multiple recent guidelines, irrespective of clinical presentation. The existing literature has evaluated distal transradial access (dTRA), as a feasible and safe approach in patients with chronic and acute coronary syndrome, excluding although patients presenting with ST- elevation myocardial infraction (STEMI). PRIMARY HYPOTHESIS:The current randomized clinical trial compares dTRA versus conventional TRA access in patients with STEMI undergoing coronary angiography and interventions regarding peri‑ and postprocedural characteristics. DESIGN:DR-STEMI is a prospective, open label, European, multicenter randomized-control trial which will include 554 patients (277 patients in each treatment arm). Patients with STEMI, will be screened on an all-comers basis for study inclusion and exclusion criteria, and those eligible will be allocated randomly (1:1), to dTRA versus TRA approach. The primary hypothesis of the study is that dTRA is noninferior to conventional TRA regarding the required time between the puncture of the radial artery and wire crossing of the infarct-related artery (i.e., needle-to-wire time). CURRENT STATUS:Enrollment for the DR-STEMI trial began in May 2024, and as of April 15th, 2025, 309 patients have been enrolled in the study. Recruitment is expected to continue for approximately 12 months. TRIAL REGISTRATION:clinicaltrials.gov: NCT05605288.

BACKGROUND Left bundle branch area pacing (LBBAP) is an emerging pacing method that may prevent the deleterious effects of right ventricular pacing. The aim of this study is to compare the effects of LBBAP with right ventricular septal pacing (RVSP) in patients with advanced atrioventricular conduction abnormalities and preserved left ventricular ejection fraction. METHODS The effect of pacing was evaluated by echocardiographic indices of dyssynchrony, including global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). The primary endpoint was GWE postprocedural, at 3, 6, and 12 months after the procedure. RESULTS Twenty patients received LBBAP and 18 RVSP. Complete follow-up was accomplished in 37 patients (97.4%) due to the death of a patient (RVSP arm) from nonrelated cause. GWE was significantly increased in the group of LBBAP compared to RVSP at all time points (90.8% in LBBAP versus 85.8% in RVSP group at 12 months, p = 0.01). PSD was numerically lower in the LBBAP arm at all time points, yet not statistically significant (56.4 msec in LBBP versus 65.1 msec in RVSP arm at 12 months, p = 0.178). The implantation time was increased (median 93 min in LBBAP versus 45 min in RVSP group, p < 0.01), along with fluoroscopy time and dose area product (DAP), in the arm of LBBAP. There were no severe perioperative acute complications in either group. CONCLUSIONS LBBAP is an emerging and safe technique for patients with a pacing indication. Despite the longer procedural and fluoroscopy time, as well as higher DAP, LBBAP seems to offer better left ventricular synchrony compared to RVSP, according to GWE measurements. (c) 2024 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Current guidelines recommend the use of either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) for assessing intermediate coronary stenoses. However, FFR/iFR discordance occurs in approximately 20% of cases. This systematic review and meta-analysis aimed to investigate whether deferring lesions with discordant FFR/iFR classification is associated with worse prognosis compared to those with negative concordant results (FFR–/iFR–). Methods: A systematic search was conducted in literature repositories to identify all studies that compared the clinical prognosis of deferred lesions with discordant and concordant FFR/iFR results. The primary endpoint was a composite clinical outcome of the individual secondary endpoints (death, myocardial infarction, and revascularization). Results: Three eligible observational studies (1735 deferred vessels) were included in the meta-analysis. Overall, deferred lesions with FFR/iFR discordance presented numerically higher event rates for all primary and secondary endpoints compared to deferred lesions with negative concordance; however, none reached statistical significance. Deferred lesions with FFR–/iFR+ discordance were significantly associated with an increased risk of death (odds ratio [OR]: 3.19; p = 0.049), while deferred lesions with FFR+/iFR– discordance were associated with a greater risk of revascularization compared to deferred lesions with negative concordance (OR: 3.24; p = 0.01). Conclusions: Compared to deferred lesions with negative concordant results, deferred lesions with discordant FFR/iFR results were overall not significantly associated with worse clinical outcomes; however, there was a significantly greater risk of death for deferred lesions specifically with FFR–/iFR+ discordance, and an increased risk of revascularization for deferred lesions with FFR+/iFR– discordance. Further dedicated trials are needed to improve guidance in clinical decision-making. The PROSPERO Registration: CRD420251135424, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135424.

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Left main (LM) coronary artery disease remains a critical and high-risk clinical entity with considerable prognostic impact. While surgical revascularization has long been the standard of care, advances in percutaneous coronary intervention (PCI) techniques have significantly improved outcomes, challenging traditional treatment paradigms. Nevertheless, PCI in LM lesions continues to be associated with increased rates of repeat revascularization. This has underscored the importance of precise procedural planning and stent optimization, for which intravascular imaging is central. Among available modalities, intravascular ultrasound (IVUS) is well-established and widely endorsed in clinical guidelines for LM PCI. Optical coherence tomography (OCT), although increasingly utilized in other coronary settings, has a more limited but growing body of evidence in LM disease. This review explores the evolving application of OCT in LM interventions, focusing on its capabilities in plaque characterization, vessel sizing, stent selection, and identification of failure mechanisms such as malapposition and underexpansion. In addition, it discusses the utility of OCT in guiding bifurcation strategies and provides a comparative assessment with IVUS, integrating the most recent clinical data.

Cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing is the standard treatment for heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and electrical dyssynchrony. However, one in three patients remains a non-responder. Left bundle branch area pacing (LBBAP) could represent a more physiological alternative, but its effectiveness is limited in cases of atypical left bundle branch block (LBBB) or intraventricular conduction delay (IVCD). Left Bundle Branch Pacing Optimized cardiac resynchronization therapy (LOT-CRT) integrates LBBAP with coronary sinus (CS) lead pacing to improve electrical synchrony and clinical outcomes. This review evaluates the feasibility, advantages, disadvantages, and clinical outcomes of LOT-CRT. Additionally, we describe our center’s experience and propose an evidence-based implantation algorithm. A review of published studies investigating LOT-CRT was conducted, comparing its effectiveness with BiV-CRT and LBBAP alone using QRS narrowing, LVEF improvement, left ventricular remodeling, New York Heart Association (NYHA) class changes and NT-proBNP levels. It was found that LOT-CRT outperforms BiV-CRT or LBBAP alone in selected populations, at the cost of higher clinical skills, longer procedural times, and specific device setups. Randomized trials are underway to further define its role in clinical practice.

Background Gut-derived bacterial and endotoxin translocation induce systemic inflammation, which exerts a pivotal pathogenetic role in all phases of atherosclerosis. Objectives To investigate prospectively the gut barrier function, endotoxin translocation and inflammatory response in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary artery intervention (PPCI). Methods Twenty-seven patients with STEMI that underwent successful PPCI were subjected to peripheral blood sampling at 3-time points; before PPCI (day0), 24 h (day1) and 96 h (day4) after PPCI and were compared with 20 chronic coronary syndrome (CCS) patients and 11 healthy controls. Serum ZO-1, I-FABP and endotoxin concentrations were determined by ELISA. Concentrations of cytokines IL-1β, -6, -8, -10 and TNF-α were determined by flow cytometry. Results Patients with STEMI before PPCI (day0) had increased serum ZO-1 and endotoxin, both at significantly higher levels compared to CCS patients. STEMI induced also significant increases of the cytokines IL-6, -8 and -10. After PPCI, a significant improvement of gut barrier integrity (ZO-1) and endotoxemia was observed from the first day. At day4 post PPCI, systemic endotoxin and cytokines IL-6, -8 and -10 levels were reduced to control levels. Serum ZO-1 levels were positively correlated with systemic IL-10 concentrations (r = 0.471). Conclusion STEMI is associated with gut barrier dysfunction, systemic endotoxemia and inflammatory response, which improve rapidly following successful PPCI.

Atherosclerotic plaque development constitutes the primary substrate of coronary artery disease (CAD) and is the outcome of an intricate process involving endothelial damage, inflammation, and lipid retention. The clinical efficacy of many lipid-lowering therapies in patients with CAD has been well established. Over the past few decades, a substantial and significant advance regarding the use of invasive and non-invasive imaging modalities has been observed. Numerous studies have been conducted using these imaging techniques and have investigated the changes in morphology (e.g., atheroma volume) and composition (e.g., lipid burden, fibrous cap thickness, macrophage accumulation) at the plaque level that explain the improved clinical outcomes by various pharmacological interventions. Lipid-lowering agents, such as statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, demonstrate direct effects on plaque volume and composition that enhance plaque stabilization and/or regression beyond the reduction of low-density lipoproteins. An increasing amount of clinical research is also focused on the role of inflammation in plaque vulnerability and future adverse cardiac events. Consequently, there is a pressing need to explore therapeutic strategies that are capable of disrupting the inflammatory response as well as reducing atheroma burden and modifying high-risk plaque characteristics. This review provides a comprehensive analysis of the current evidence regarding the effects of traditional and novel therapeutic strategies targeting modification of the lipid profile and inflammatory processes on reversing plaque growth and attenuating vulnerable features, thereby promoting plaque stabilization and passivation.

Approximately 50% of individuals eligible for transcatheter aortic valve implantation (TAVI) have coronary artery disease (CAD). The influence of CAD, both its prevalence and severity, on post-TAVI clinical results has yielded conflicting findings. Recent research has shown positive results for the use of computed tomography angiography and functional percutaneous evaluation of coronary lesions in the pre-TAVI assessment, besides the classic coronary angiography. As we anticipate the outcomes of current randomized studies, it has become common practice to perform invasive revascularization on TAVI patients with obstructive CAD. Furthermore, there is a lack of comprehensive data about the occurrence, features, and treatment of coronary incidents after TAVI. There is also growing concern about the possible difficulties in accessing the coronary arteries in patients who need coronary angiography with or without intervention after TAVI. This review presents a comprehensive analysis of the contemporary treatment options of CAD in patients undergoing TAVI. In this context, it examines the incidence of CAD in TAVI candidates; its clinical significance; the assessment and management of CAD before, concomitant, and after the procedure, including patients’ unresolved concerns; and possible future aspects.

Objective: To present a novel pipeline for rapid and precise computation of fractional flow reserve from an analysis of routine two-dimensional coronary angiograms based on fluid mechanics equations (FFR2D). Material and methods: This was a pilot analytical study that was designed to assess the diagnostic performance of FFR2D versus the gold standard of FFR (threshold ≤ 0.80) measured with a pressure wire for the physiological assessment of intermediate coronary artery stenoses. In a single academic center, consecutive patients referred for diagnostic coronary angiography and potential revascularization between 1 September 2020 and 1 September 2022 were screened for eligibility. Routine two-dimensional angiograms at optimal viewing angles with minimal overlap and/or foreshortening were segmented semi-automatically to derive the vascular geometry of intermediate coronary lesions, and nonlinear pressure–flow mathematical relationships were applied to compute FFR2D. Results: Some 88 consecutive patients with a single intermediate coronary artery lesion were analyzed (LAD n = 74, RCA n = 9 and LCX n = 5; percent diameter stenosis of 45.7 ± 11.0%). The computed FFR2D was on average 0.821 ± 0.048 and correlated well with invasive FFR (r = 0.68, p < 0.001). There was very good agreement between FFR2D and invasive-wire FFR with minimal measurement bias (mean difference: 0.000 ± 0.048). The overall accuracy of FFR2D for diagnosing a critical epicardial artery stenosis was 90.9% (80 cases classified correctly out of 88 in total). FFR2D identified 24 true positives, 56 true negatives, 4 false positives, and 4 false negatives and predicted FFR ≤ 0.80 with a sensitivity of 85.7%, specificity of 93.3%, positive likelihood ratio of 13.0, and negative likelihood ratio of 0.15. FFR2D had a significantly better discriminatory capacity (area under the ROC curve: 0.95 [95% CI: 0.91–0.99]) compared to 50%DS on 2D-QCA (area under the ROC curve: 0.70 [95% CI: 0.59–0.82]; p = 0.0001) in predicting wire FFR ≤ 0.80. The median time of image analysis was 2 min and the median time of computation of the FFR2D results was 0.1 s. Conclusion: FFR2D may rapidly derive a precise image-based metric of fractional flow reserve with high diagnostic accuracy based on a single two-dimensional coronary angiogram.

Background: Distal radial artery access (DRA) has been emerged as an alternative for conventional transradial arterial access. While palpation of radial artery is mandatory prior coronary angiography, it remains unknown the clinical impact of palpation in DRA success. Aim of our study is to explore whether the palpability of distal radial artery is linked with higher rates of successful arterial access. Methods: We conducted a post-hoc analysis using data from two randomized-controlled trials on DRA. All patients with available data on distal radial artery palpability and cannulation’s success were included in our analysis. No procedure was performed with ultrasound guidance. Results: Data on the palpability of the distal radial artery and the DRA success were available for 435 patients. Successful distal radial artery cannulation was attempted in 255 and 98 of patients with and without palpable distal radial artery, respectively. No significant difference between the two groups was observed (81.5% vs 80.3%, p = 0.786). Univariate analysis revealed statistically significant difference in gender, height, known CAD, valvular disease as indication for angiography and number of skin punctures. Multivariate analysis included these variables, as well as palpability of the distal radial artery and found that number of skin punctures and valvular disease as indication are significantly associated with DRA success. Conclusion: According our post-hoc analysis, the palpability of the distal radial artery is not associated with higher rates of DRA success. Further studies are required for the validation of these results.

Patients with COVID-19 often experience significant cardiovascular complications, including heart failure, myocarditis, and acute coronary syndrome. We present the case of a male patient with severe COVID-19 pneumonia, complicated with inferior ST-segment elevation myocardial infarction (STEMI), which was attributed to spontaneous coronary artery dissection (SCAD). We also make a review of the literature on case reports of patients with COVID-19 and acute myocardial infarction due to SCAD. Through these clinical cases, a potential correlation between SCAD and COVID-19 infection is implied. Endothelial dysfunction, thrombotic complications, and disturbance of the vascular tone are established COVID-19 sequelae, triggered either by direct viral injury or mediated by the cytokines' storm. These abnormalities in the coronary vasculature and the vasa vasorum could result in SCAD. Moreover, disturbances of the vascular tone can cause coronary vasospasm, a reported precipitant of SCAD. Thus, SCAD should be considered in COVID-19 patients with acute coronary syndrome (ACS), and in the case of STEMI, an early angiographic evaluation, if feasible, should be performed rather than thrombolysis to avoid potential adverse events of the latter in the setting of SCAD.

(1) Background: Ultrasound-guided axillary (USAX) vein puncture is a relatively new method to obtain venous access for the implantation of cardiac implantable electronic devices (CIED). However, its use is limited as most of the operators are not familiar with this technique. Our aim was to investigate the safety and efficacy of the USAX compared with the traditional cephalic vein dissection for venous access in CIED implantation. (2) Methods: This was a single-center, randomized, controlled, superiority trial. A total of 114 patients were randomized (1:1 ratio) to either USAX (u/s axillary group; 59 patients) or cephalic vein access (cephalic group; 55 patients). The primary study endpoint was defined as successful placement of all leads via the chosen access. Secondary study endpoints included time from local anesthetic injection to lead advancement in the SVC, total procedure time (skin to skin), procedure-related complications and pain perception. (3) Results: USAX was superior to cephalic access in terms of primary endpoint (OR: 4.3, 95% CI: 1.3, 14.0; p = 0.012). Total procedure duration was higher in the cephalic group (55.15 ± 16.62 vs. 48.35 ± 12.81 min, p = 0.017) but there was neither a significant difference in fluoroscopy time (p = 0.872) nor in total radiation dose (p = 0.815). The level of pain was higher in the cephalic group (p = 0.016), while the rates of complications were similar in both groups (p > 0.05). (4) Conclusion: USAX was superior to cephalic access regarding success rate, total procedure duration and level of pain, while having no difference in complication rates.

There is increasing evidence that COVID-19 induces endothelial dysfunction that may precede thrombotic and cardiovascular complications. The aim of this study is to evaluate endothelial function using peripheral arterial tonometry (EndoPAT). The primary endpoint is the hyperemic vascular response index (LnRHI) at two months post-discharge. Secondary endpoints include the LnRHI during hospitalization and at six-month follow-up, the proportion of patients with endothelial dysfunction (LnRHI ≤ 0.51), and the incidence of thrombotic events, cardiovascular complications, and mortality during the follow-up period. The study included 23 COVID-19 patients and 22 COVID-19-negative, matched controls. The patients exhibited a significant reduction in the LnRHI at two months post-discharge compared to the controls (median = 0.55 [IQR: 0.49–0.68] vs. median = 0.70 [IQR: 0.62–0.83]; p = 0.012). The difference in the LnRHI between patients and controls was evident from hospitalization and persisted at two and six months without significant temporal changes. The proportion of COVID-19 patients with endothelial dysfunction (LnRHI ≤ 0.51) was 61% during hospitalization and 55% at six months. There was no significant difference in thrombotic or cardiovascular events, nor in mortality. This study demonstrates that COVID-19 adversely affects endothelial function, as evidenced by a reduction in the hyperemic vascular response index, and endothelial dysfunction may also persist.

BACKGROUND: Coronary computed tomography angiography (CCTA) in patients with post-coronary artery bypass graft (CABG) has a high diagnostic accuracy for visualization of grafts. Invasive coronary angiography (ICA) in patients with CABG is associated with increased procedural time, contrast agent administration, radiation exposure, and complications, compared with non-CABG patients. The aim of this multicenter, randomized controlled trial was to compare the strategy of CCTA-guided ICA versus classic ICA in patients with prior CABG. METHODS: Patients with prior CABG were randomly assigned (1:1 ratio) to have a CCTA before ICA (CCTA-ICA, group A) or not (ICA-only, group B). The primary end point of the study was the total volume (milliliters) of the contrast agent administered. RESULTS: A total of 251 patients were randomized, and 225 were included in analysis; 110 in group A and 115 in group B. The total contrast volume was higher in group A (184.5 [143-255] versus 154 [102-240] mL; P=0.001). The contrast volume administered during the invasive procedure was lower in group A (101.5 [60-151] versus 154 [102-240]; P<0.001). Total fluoroscopy time was decreased in group A (480 [259-873] versus 594 [360-1080] seconds; P=0.027), but total effective dose was increased (24.1 [17.7-32] versus 10.8 [5.6-18] mSv; P<0.001). The rate of contrast-induced nephropathy, periprocedural complications, and major adverse cardiac events during 3 to 5 and 30 days did not differ significantly between the 2 groups. CONCLUSIONS: A CCTA-directed ICA strategy for patients with CABG is associated with expedition of the invasive procedure, and less fluoroscopy time, at the cost of higher total contrast volume and effective radiation dose, compared with the classic ICA approach.

BACKGROUND:The potential benefits of the thin-walled 5F Glidesheath Slender sheath in the distal transradial access (dTRA) have not been investigated. This study aimed to compare the Glidesheath Slender versus conventional 5Fr arterial sheaths in patients undergoing diagnostic coronary angiography (CAG) through the dTRA.METHODS:A total of 352 consecutive patients with an indication for CAG were randomized (1:1) to Glidesheath Slender 5Fr versus a conventional 5Fr arterial sheath for dTRA. The primary endpoint was the rate of successful hemostasis at 30 minutes after sheath removal. Follow-up ultrasound of the right radial and distal radial artery was performed 7-10 days after the procedure.RESULTS:After exclusion of patients where a 6Fr sheath or crossover of access site was required, 108 patients in the Glidesheath Slender and 105 patients in the conventional 5Fr arterial sheath group were included in the analysis. The crossover rate to conventional radial access and the rate of successful hemostasis at 30 minutes after sheath removal were similar between the two groups (18.9% in the Glidesheath slender vs. 22% in the control group; P=0.460, and 62% vs. 51.4%; P=0.118, respectively). The level of pain associated with the procedure was significantly lower in the Glidesheath Slender group (2.69 vs. 3.29 in the control group; P=0.02). No significant difference was recorded between the two groups in the rate of access-related complications.CONCLUSIONS:Use of Glidesheath Slender for dTRA did not increase the rate of early hemostasis compared with conventional arterial sheath.

Introduction Advanced Clinical Practice (ACP) is an established structured university training programme available to registered non-medical healthcare professionals preparing them to safely manage clinical patient care incorporating complex clinical decisions and high degree of autonomy. Aim To assess the service impact, safety and efficiency of a clinical cardiology pharmacist with ACP training providing a sustainable, holistic and independent clinical care to non-predefined cohort of patient within a consultant-led cardiology clinic environment. Methods A pharmacist-prescriber undertaking ACP course within a tertiary cardiac centre autonomously reviewed randomly selected patients, face-to-face or virtually, in two consultant-led outpatient cardiology clinics, interventional and heart rhythm clinic, twice weekly over 12-month period. Clinical examination, diagnostic skills and IRMER training were completed prior to commencing. Data was collected from each clinic capturing number of patients reviewed, time spent per patient and consultation outcomes. Clinical decisions made for every patient were timely discussed with the relevant consultant to assess the safety of this service concept. Results A total of 358 patients were reviewed: 217 (60.6%) in the heart rhythm and 141 (39.4%) in the interventional cardiology clinic, 86 (24%) were newly referred, 196 (54.7%) were routine follow-up patients and 76 (21.3%) were booked for their first post-intervention cardiology outpatient review. Mean number of patients reviewed per clinic was 6.03 (+/-1.63) with 17.7 (+/-2.4) minutes spent per patient. Outcome data revealed 227 (63.4%) had further diagnostic tests organised, 127(35.5%) had their medications optimised, 63 (17.6%) were discharged, 44 (12.3%) patients were referred to a different specialist and 38 (10.6%) were referred for elective cardiac intervention e.g. coronary angiography, DCCV, or catheter ablation. No patients were admitted to hospital directly from clinic. 16 patients (4.5%) had their plan changed following consultant oversight safety discussion. Over the 12-month period ACP total discharge rate was 14.3% compared to 14.7% (p=0.88) by consultant, in the heart rhythm clinic and 22.7% compared to 50% (p<0.01) by consultant and 27.9% (p=0.32) by other senior cardiology specialist physicians, in the interventional cardiology clinic. Average clinic capacity increased by 26% (p<0.01) and 8.7% (p<0.01) respectively compared to the preceding year. Conclusion Our ACP-Physician Hybrid Clinic model is a safe, efficient and sustainable service that allows effective management of cardiology outpatients within a tertiary cardiac centre. It demonstrates that an ACP pharmacist can apply their ACP training programme derived skillsets to make safe and appropriate clinical decisions supporting the cardiac services. This model may improve the use of NHS staff resource and patient access to specialist services. Conflict of Interest None