(1) Background: Endovascular therapy is widely used for lower limb peripheral artery disease (PAD), yet device performance varies across vascular territories due to anatomical and biomechanical differences. This study evaluated territory- and lesion-specific outcomes following contemporary endovascular strategies in a real-world cohort. (2) Methods: This retrospective single-center study included consecutive patients undergoing endovascular revascularization of the iliac, superficial femoral (SFA), or popliteal arteries between 2010 and 2023. The primary endpoint was 12-month binary restenosis (≥50% diameter loss) assessed by duplex ultrasonography, CT angiography, or invasive angiography. Secondary outcomes included target lesion revascularization and procedural complications. Kaplan–Meier analysis was used to evaluate restenosis-free survival. Multivariable Cox models were constructed separately for each vascular territory, adjusting for relevant clinical and anatomical covariates. (3) Results: A total of 283 lesions were included (iliac n = 135; SFA n = 145; popliteal n = 102). At 12 months, restenosis rates differed substantially by treatment modality and arterial territory. In the iliac segment, covered stents demonstrated the lowest restenosis (12.8%), whereas in the SFA, interwoven nitinol stents yielded the most favorable profile (15.4%). In the popliteal artery, drug-coated balloons were associated with the lowest restenosis rate (16.7%). In multivariable analysis, covered stents (iliac), interwoven nitinol stents (SFA), and drug-coated balloons (popliteal) were independently associated with lower restenosis risk. Procedural success was high and complication rates were low. (4) Conclusions: Endovascular device performance is strongly influenced by arterial territory and lesion characteristics. Tailoring the treatment strategy to vessel biomechanics and lesion morphology may optimize mid-term patency in lower limb PAD. Larger prospective studies are warranted to validate these findings.

BACKGROUND:Patients with marginalised characteristics experience delayed ST-elevation myocardial infarction (STEMI) diagnosis despite fast-track protocols. We aimed to determine whether patients with phonetically uncommon surnames in our community experience delays from first medical contact (FMC) to STEMI diagnosis compared with patients with common surnames within an established fast-track network. METHODS:The Fast-Track Protocol for ST-Elevation Myocardial Infarction prospective registry enrolled consecutive STEMI patients from June 2008 to November 2024. Patient surnames were classified as phonetically common or uncommon using standardised phonetic matching against Canton Fribourg population data. Generalised linear models examined FMC-to-diagnosis time, FMC-to-balloon time and infarct size markers. Cox regression assessed major adverse cardiac and cerebrovascular events (MACE) at 30 days, 1 year and 5 years. RESULTS:Among 1208 patients, 284 (23.5%) had phonetically uncommon surnames. Patients with uncommon names experienced prolonged FMC-to-diagnosis time (59.4±87.6 vs 40.6±37.6 min; mean difference +16.8 min; p=0.009) and FMC-to-balloon time (116.8±90.5 vs 97.5±45.7 min; mean difference +17.5 min; p=0.016). Patients with uncommon names were significantly more likely to exceed the 90 min FMC-to-balloon threshold (39.2% vs 48.4%; p=0.010) and the 120 min threshold (16.4% vs 23.5%; p=0.018). Diagnosis-to-balloon time remained unaffected (p>0.80). Peak creatine kinase muscle-brain showed non-significant elevation (mean difference +52.0 U/L; p=0.077). No differences were observed in MACE at 30 days and 5 years between patients with common and uncommon names. CONCLUSIONS:Patients with phonetically uncommon surnames experienced significant STEMI diagnostic delays within an efficient fast-track network. Protocol-driven care following diagnosis operated equitably, leading to no difference in long-term MACE.

BACKGROUND:Longer total stent length (TSL) increases the risk of target lesion failure (TLF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with second-generation drug-eluting stents (DES). We aimed to assess the long-term impact of TSL on patient- and stent-related outcomes in STEMI patients treated with different newer-generation DES designs. METHODS:We performed a post hoc subgroup analysis of the BIOSTEMI Extended Survival randomized trial (NCT05484310). Patients undergoing primary percutaneous coronary intervention for STEMI were randomized to ultrathin-strut biodegradable-polymer sirolimus-eluting stents (BP-SES) or thin-strut durable-polymer everolimus-eluting stents (DP-EES) and categorized according to TSL implanted at the culprit site (≤40 vs >40 mm). The device-oriented composite endpoint (TLF) was the composite of cardiac death, target-vessel myocardial reinfarction, or clinically indicated target lesion revascularization, and the patient-oriented composite endpoint was the composite of all-cause death, any myocardial reinfarction, any revascularization, or any stroke, at 5 years. RESULTS:A total of 1,686 STEMI patients were included (mean age, 62.4 years; female, 23%; mean TSL, 33.8 mm), of whom 423 (25%) were treated with TSL >40 mm. At 5 years, TSL >40 mm was associated with a significantly higher risk of patient-oriented composite endpoint compared with TSL ≤40 mm (31.7% vs 27.4%; hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.03-1.64; P = .029), whereas no difference was observed in TLF. However, there was a significant interaction between DES type and TSL for TLF at 5 years. Among patients with TSL >40 mm, BP-SES were associated with a lower risk of TLF compared with DP-EES (7.3% vs 17.1%; HR, 0.39; 95% CI, 0.21-0.74; P = .004; P for interaction = .032), a difference primarily driven by a lower rate of target vessel myocardial reinfarction. No significant differences between BP-SES and DP-EES were observed in patients with TSL ≤40 mm. After adjustment for multivessel treatment, increasing TSL with DP-EES, but not BP-SES, was independently associated with a higher risk of TLF (adjusted HR per 5-mm increase, 1.07; 95% CI, 1.02-1.11; P = .003). CONCLUSION:In STEMI patients treated with contemporary DES, TSL >40 mm was associated with an increased risk of patient-oriented, but not device-related, adverse outcomes at 5 years. Among patients requiring TSL >40 mm, ultrathin-strut BP-SES significantly reduced the risk of TLF compared with DP-EES, whereas no between-DES differences were observed in patients treated with TSL ≤40 mm. TRIAL REGISTRATION:The BIOSTEMI ES trial is registered at ClinicalTrials.gov (NCT05484310).

Percutaneous coronary intervention (PCI) is one of the most frequently performed invasive procedures in medicine, yet it remains technically demanding, carries a long operator learning curve, exposes both patients and staff to ionising radiation, and is a recognised source of patient anxiety. Virtual reality (VR), which represent immersive, computer-generated environments experienced through a head-mounted display, has been proposed as a potential tool across the PCI pathway. This narrative review synthesises literature from the last five years on four domains in which VR has been applied to PCI: (1) operator training and skill acquisition; (2) patient-specific pre-procedural planning and rehearsal; (3) intraprocedural visualisation and guidance (where VR overlaps with augmented and mixed reality); and (4) patient-centred applications including periprocedural anxiety and pain management, education, and rehabilitation after myocardial infarction or revascularisation. The evidence is heterogeneous and dominated by small studies, feasibility reports, and a growing number of randomised trials in the patient-anxiety domain. Immersive VR reduces periprocedural anxiety and represents the most clinically mature application to date, although its analgesic effect is less consistent and it has not proven non-inferior to pharmacological sedation for pain; VR-based simulation can transfer skills to real catheterisation laboratory performance; and patient-specific VR can support planning in anatomically complex PCI. The principal barriers are the absence of robust haptic feedback, cost, limited validation, cybersickness, and a scarcity of outcome-driven randomised trials. VR is best understood not as a competitor to digital twins, physics-based simulation, or augmented/mixed reality, but as one complementary layer within a broader extended-reality ecosystem for coronary intervention. We outline priorities for future research, including standardised validation frameworks, integration with patient-specific digital twins, and adequately powered trials with clinical endpoints.

Background: Intravascular lithotripsy (IVL) has emerged as a safe and effective modality for treating severely calcified coronary lesions. While the Shockwave™ system is well-established, clinical data on newer IVL platforms such as the Shunmei ShockFast™ system remain limited. Objectives: To evaluate the safety, feasibility, and procedural outcomes of the ShockFast IVL device in patients with heavily calcified de novo coronary artery disease. Methods: We conducted a prospective, single-center case series of 16 patients undergoing percutaneous coronary intervention (PCI) with the ShockFast IVL system between June and December 2025. Inclusion required angiographic or optical coherence tomography (OCT) evidence of severe coronary calcification. The primary efficacy endpoint was acute procedural success and absence of in-hospital MACE. Secondary endpoints included, among others, device deliverability, presence of calcium fracture and post-stent expansion metrics. Results: All patients underwent successful lithotripsy delivery with the ShockFast IVL system. Acute procedural success was 100%, with no intraprocedural complications, abrupt closure, or in-hospital MACE. OCT was performed in 50% of cases and demonstrated calcium fractures in all imaged lesions, with ≥2 fractures in 63% of cases. Median stent expansion was 90% [IQR 9], with no major malapposition or edge dissections. Quantitative coronary analysis showed a median acute lumen gain of 1.86 mm [0.62]. Conclusions: The ShockFast IVL system showed excellent safety and procedural performance in this first-in-center experience. Outcomes were encouraging and consistent with those reported in early-stage studies of other IVL platforms. These findings support the clinical feasibility of ShockFast as a novel tool for calcium modification in complex PCI.

Transcatheter aortic valve implantation (TAVI) after aortic valve neocuspidization is associated with a high risk of coronary artery obstruction due to the height of the neocusps, and is currently not recommended. We report the case of a 74-year-old patient who had a successful procedure for severe regurgitation after two consecutive neocuspidization surgeries.

BACKGROUND:Drug-coated balloon (DCB) angioplasty has emerged as a potential stent-free strategy for percutaneous coronary intervention (PCI) in de novo coronary artery disease, but robust randomised evidence on safety and efficacy compared with drug-eluting stents (DES) remains limited. METHODS:We conducted a comprehensive systematic review and meta-analysis of randomised controlled trials comparing DCB angioplasty with DES for de novo coronary lesions in adult patients reporting clinical outcomes at ≥9 months. PubMed, Embase and Cochrane CENTRAL were searched from inception to October 2025 without language restriction; trial registries and reference lists were screened manually. Studies limited to in-stent restenosis, bifurcation PCI or observational designs were excluded. Data were extracted independently by two reviewers. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models (DerSimonian-Laird method with Hartung-Knapp adjustment). Heterogeneity was assessed with I² and τ² statistics and 95% prediction intervals were reported. Risk of bias was appraised with the Cochrane Risk of Bias 2 tool. RESULTS:Seven trials encompassing 7138 patients (DCB 3570; DES 3568) were included. At 12 months, the device-oriented composite endpoint (cardiac death, target vessel myocardial infarction and target lesion revascularisation) showed no difference between strategies (RR 1.02, 95% CI 0.63 to 1.64; p=0.93; I²=52%). Secondary outcomes were comparable: cardiac death (1.26, 0.75 to 2.14), target vessel MI (0.71, 0.36 to 1.39), target lesion revascularisation (1.09, 0.52 to 2.30) and target vessel revascularisation (0.98, 0.58 to 1.65). Sensitivity analysis supported the stability of the primary findings. Trials using sirolimus coated balloons demonstrated similar results. CONCLUSIONS:DCB angioplasty shows comparable short-term safety and efficacy to modern DES for de novo coronary disease. Long-term follow-up is necessary to confirm whether avoidance of permanent implants translates into clinical benefit. PROSPERO REGISTRATION NUMBER:CRD420251175063.

OBJECTIVES:Coronary artery disease affects nearly half of patients undergoing transcatheter aortic valve implantation (TAVI), but the accuracy of angiography-derived, wire-free coronary physiology in severe aortic stenosis remains uncertain. The authors evaluated its diagnostic performance for detecting fractional flow reserve (FFR)-defined significant stenoses in TAVI candidates and assessed whether accuracy differed when invasive FFR was measured before vs after TAVI. METHODS:A diagnostic accuracy meta-analysis was performed including studies reporting lesion-level comparisons between angiography-derived physiology (threshold ≤0.80) and invasive FFR (≤0.80) in patients undergoing TAVI evaluation. All included studies evaluated quantitative flow ratio (QFR) or Murray-law-based QFR; no eligible studies using FFRangio or vFFR were identified. Pooled sensitivity and specificity were calculated using random-effects models. Diagnostic odds ratios (DOR), likelihood ratios, and post-test probabilities were derived. Meta-regression evaluated the impact of FFR timing (CRD420261332222). RESULTS:Five studies met inclusion criteria. Four studies (422 lesions) contributed to the primary analysis and 3 studies (250 lesions) to the secondary analysis. In the primary analysis, pooled sensitivity was 0.79 (95% CI, 0.68-0.87) and specificity 0.88 (95% CI, 0.80-0.93) (DOR 28). In the secondary analysis, sensitivity was 0.71 (95% CI, 0.57-0.82) and specificity 0.95 (95% CI, 0.90-0.98) (DOR 46.5), with comparable global discrimination (Youden index 0.66 vs 0.67). Meta-regression showed no significant interaction by reference timing (P = .39). CONCLUSIONS:Angiography-derived coronary physiology demonstrates good diagnostic performance in patients undergoing TAVI evaluation, with comparable overall discrimination when referenced to both pre- and post-TAVI FFR, although interpretation is limited by the absence of a stable reference standard across hemodynamic states.

BACKGROUND:Obesity is increasing in all regions of Switzerland. Multiple studies have described the "obesity paradox" suggesting a protective effect of obesity on the occurrence of major adverse cardiovascular events (MACE) after ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). OBJECTIVE:This study aimed to assess the impact of obesity on MACE in STEMI patients undergoing PCI. METHODS:We analyzed data from the Fribourg STEMI Fast-Track prospective registry in a retrospective, single-center cohort study. Adult patients were classified as obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2) and followed for 12 months. The primary endpoint was a composite MACE including all-cause death, recurrent acute coronary syndrome (ACS) (STEMI, NSTEMI and unstable angina (UA)), stroke, stent thrombosis, unscheduled revascularisation, and major bleeding (BARC 3-5). Secondary endpoints included stratification according three obesity stages to evaluate 1-year MACE-free survival, as well as assessment of individual MACE components, delays in care, mode of presentation, and clinical and procedural characteristics. Kaplan-Meier analysis with log-rank testing and Cox regression were used to evaluate outcomes. RESULTS:A total of 1043 patients were included between June 2008 and October 2025, of whom 214 (21%) were obese and 829 (79%) were non-obese. Obese patients were slightly younger (60.00 (53.00, 70.00) vs 62.00 (53.00, 72.00) years, p = 0.037), with a similar proportion of women (21% vs 25%, p = 0.299). At 12 months, MACE-free survival was similar between groups (log-rank p = 0.76), and obesity was not associated with MACE after adjustment. No differences were observed in individual components of the composite endpoint. Pre-hospital delay was comparable, whereas first medical contact-to-revascularisation (FMC-to-REVASC) time was longer in obese patients (0.78 vs 0.57 h, p < 0.001), with no difference in total ischemic time. Obese patients were less likely to present via ambulance (31% vs 38%) and more likely to self-present to the emergency department (32% vs 24%; p = 0.037). Clinical presentation, procedural characteristics, and coronary anatomy were similar between groups. CONCLUSIONS:In this contemporary STEMI cohort, obese patients treated with primary PCI did not experience higher 1-year MACE rates than non-obese patients. However, obesity was associated with differences in care pathways and longer in-hospital delays, without impact on clinical outcomes.

BACKGROUND:Since their creation in 2002, drug-eluting stents (DES) have proven their superiority over their bare-metal counterparts and significantly evolved. Efforts are now concentrated on improving the DES platform, particularly by integrating thinner stent design. We aimed to compare outcomes between a broad range of current generation DES to evaluate the impact of thinner strut design in a real-world setting. METHODS:We analysed data from 3092 patients who underwent percutaneous coronary intervention (PCI) with thin (≤80 μm) or thick (>80 μm) DES in the Cardio-FR database. Of these, 2551 (1567 thick DES and 984 thin DES) met the inclusion and exclusion criteria and completed a two-year follow-up: The primary outcome was the device-oriented composite endpoint (DOCE) of cardiac death, non-fatal target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR). RESULTS:The mean age was 67 years, and 75% were male. After multivariable adjustment, thick-strut DES were associated with higher 2-year DOCE compared with thin-strut DES (adjusted OR for thick vs thin: 1.298; 95% CI: 1.006-1.674; p = 0.045). In contrast, stroke was less frequent with thick-strut DES (2.0% vs 3.4%; p = 0.041). All other event rates were similar between the groups. CONCLUSION:Clinical follow-up up to two years shows treatment with thin strut DES significantly lowers DOCE rates compared with thick strut DES. More research is needed to assess the impact of thinner strut design on performance.

Purpose . Dietary habits are a major determinant of prognosis in coronary artery disease (CAD), yet adherence to recommendations remains suboptimal. In Switzerland, dietary patterns differ across linguistic regions, but data from bilingual settings are lacking. This study evaluated the diet quality of patients with CAD in the bilingual setting of the canton of Fribourg, and investigated potential differences between language, recurrence of CAD, sex and smoking status. Methods . This monocentric observational study included patients aged 18–75 years with angiographically confirmed CAD. Dietary intake was assessed using the Swiss eFFQ. Results . 186 participants were predominantly male (72.6%), with a mean age of 63.5 ± 7.9 years and a mean BMI of 27.4 ± 4.5 kg/m²; 35.5% were current smokers. Overall, dietary intake were suboptimal: low fruit (195 ± 144 g/day) and vegetable (143 ± 77 g/day) intake, low fiber intake (19 ± 8 g/day), and high consumption of meat (103 ± 54 g/day) and bread (96 ± 63 g/day), suggesting excessive sodium intake. No significant differences in dietary intake were observed between French- and German-speaking participants. Similarly, no differences were found between newly diagnosed and recurrent cases. Women reported higher fruit intake (+ 66 g/day, p = 0.005) and lower alcohol consumption (p = 0.001) than men. Current smokers had lower intakes of fruits, vegetables, nuts, and fiber compared with former smokers (p < 0.05). Conclusion . Diet quality in these patients with CAD was inadequate and not superior to those observed in the general population. Speaking language was not associated with dietary differences. These findings underline the need for more effective nutrition interventions in secondary prevention of CAD.

Large language models (LLMs) have rapidly emerged as a transformative class of artificial intelligence systems capable of understanding and generating human-like text from vast corpora of clinical and scientific literature. While their use in general cardiology has been extensively reviewed, their specific role in interventional cardiology and within the catheterization laboratory (cath lab) environment remains less well characterized. This narrative review synthesizes the current evidence on LLM applications across the interventional cardiology workflow, including coronary revascularization decision-making, multidisciplinary Heart Team support, structural heart intervention planning, periprocedural communication, and acute cath lab decision support. Recent studies suggest that contemporary LLMs such as ChatGPT-4 (OpenAI), Claude (Anthropic), and Gemini (Alphabet, Inc.) can achieve clinically meaningful concordance with expert Heart Team recommendations for percutaneous coronary intervention vs coronary artery bypass grafting, and that their outputs may approach or even match those of early-career interventional cardiologists in simulated emergency scenarios. However, important limitations persist, including variable accuracy across prompt formats, susceptibility to hallucinations, lack of multimodal integration with angiographic and intravascular imaging, opacity of training sources, and unresolved medicolegal issues. The authors discuss the current evidence base, highlight promising avenues such as multimodal LLMs and retrieval-augmented generation tools that leverage current guidelines, and outline regulatory and ethical considerations that must accompany clinical adoption. LLMs are unlikely to replace interventional cardiologists in the foreseeable future, but they may meaningfully support decision-making, education, and patient communication in a domain where speed, complexity, and risk converge.

Background: Obesity is increasing worldwide and remains a major contributor to cardiovascular morbidity and mortality. It is strongly associated with hypertension, dyslipidemia, diabetes mellitus, endothelial dysfunction, and chronic inflammation, all of which promote coronary artery disease and acute coronary syndrome (ACS). Despite this well-established risk profile, multiple studies have described an “obesity paradox,” suggesting that obese patients may experience better outcomes after percutaneous coronary intervention (PCI) for ACS than normal-weight individuals. Objective: This narrative review aims to discuss the pathophysiological basis of the obesity paradox and to synthesize contemporary evidence regarding the relationship between body mass index (BMI), major adverse cardiovascular events (MACE), and mortality after PCI in patients presenting with ACS. Results: Contemporary observational cohorts consistently suggest a non-linear relationship between BMI and MACE outcomes after PCI. Overweight and mildly obese patients often demonstrate lower crude mortality and fewer MACE, whereas underweight patients consistently show the poorest prognosis. However, after adjustment for age, left ventricular ejection fraction (LVEF), renal function, frailty, and nutritional status, obesity is less consistently associated with improved outcomes. Overweight status appears to be more reproducibly associated with better prognosis than obesity itself. Conclusions: The obesity paradox is likely driven less by a true protective effect of excess adiposity and more by younger age at presentation, preserved physiological reserve, lower frailty burden, and the limitations of BMI as a marker of cardiovascular risk. Underweight status emerges as the strongest predictor of adverse outcomes. Nutritional assessment and body composition should complement BMI in risk stratification after ACS.