Reviews
Fauchier et al.: reduced-dose DOAC versus antiplatelet strategies after left atrial appendage occlusionAfter LAAO, the SAPT advantage over DAPT survives the paper's own sensitivity analyses. The reduced-dose DOAC advantage over DAPT does not.SELUTION DeNovo HBR: sirolimus-eluting balloon versus DES in high bleeding riskThe SELUTION DeNovo HBR substudy describes good results with a sirolimus balloon but has too few events to compare it with DES.TRIC-I-HF: transcatheter tricuspid repair in heart failureIn TRIC-I-HF, heart failure hospitalization carries most of the effect, and the decision to admit was made unblinded.A-CLOSE: clopidogrel monotherapy versus extended DAPT after drug-eluting stentsA-CLOSE met noninferiority on the primary endpoint because excess ischemic events and fewer bleeds cancelled out.PECTUS-obs at 5 years: OCT high-risk plaques in FFR-negative non-culprit lesionsThe association between high-risk plaque and 5-year MACE in PECTUS-obs rests on 57 events, a change in endpoint definition and events outside the imaged lesion.OCVC-BIF OCT substudy: adjunctive side branch DCB after kissing balloonThe lumen volume gain with side branch DCB rests on a t-test over a skewed distribution and does not survive the nonparametric test.SELUTION4ISR: sirolimus-eluting balloon versus DES or balloon angioplasty for in-stent restenosisSELUTION4ISR met its primary endpoint against a blended control but failed the comparison with DES in single-layer restenosis.PARTNER 2A at 10 years: TAVI versus surgery at intermediate riskThe 10-year PARTNER 2A mortality result holds; the reintervention result rests on follow-up that lost more than half of the surgical cohort.DOUBLE-CHOICE: ACURATE neo2 versus EvolutThe ACURATE neo2 advantage in DOUBLE-CHOICE comes from pacemakers, and the 26.5% rate in the Evolut arm sits above all recent literature on the same valve.STOP-IMH: ticagrelor without aspirin right after primary PCI in STEMIA 200-patient pilot with about 4 ischaemic events per arm. It lacks the power to establish ischaemic safety of ticagrelor monotherapy.ViV-TMVR versus redo-SMVR: the Sá et al. meta-analysisThe Sá et al. meta-analysis shows less acute morbidity with ViV-TMVR; the late mortality reversal fits durability and confounding by indication equally well.Raona, Mehran et al.: 2024 ESC high-ischaemic-risk criteria in 15,336 chronic coronary syndrome patientsThe modified ESC criteria stratify an event gradient, but 71.4% of patients classify as high risk and part of the measured risk is general mortality.NOBLE at 10 years: PCI versus CABG for unprotected left main diseaseNOBLE at 10 years showed no mortality difference between PCI and CABG for left main disease, but the design does not support the equivalence claim in the paper.PRO-TAVI: deferring PCI in patients undergoing TAVIIn PRO-TAVI, noninferiority of PCI deferral came from less bleeding; for ischemic events, the trial cannot exclude an increase of up to 71%.Doma et al.: chronic total occlusion PCI in acute MI with cardiogenic shockSingle-arm cohort identified by billing codes, with no control group. Lower mortality than historical registries is explained by selection and immortal time bias.Index of Device Efficiency: an IVUS metric for the cutting balloon in the RODIN-CUT techniqueIDE proposes an endpoint for cutting balloon preparation of calcified lesions. Threshold and validation come from the same 50 lesions, and the predictive analysis rests on 4 lesions.Tsai et al.: five angio-IMR methods compared with pressure-wire IMR in a core labThe five angio-IMR methods had AUCs of 0.53 to 0.58 against invasive IMR; part of the problem lies in the variability of the IMR used as reference.Koeckerling et al.: 10-year mortality after PCI or CABG for left main disease, reconstructed IPD meta-analysisThe meta-analysis of the 5 left main randomized trials showed equal 10-year mortality with PCI and CABG; EXCEL stops at 5 years and non-fatal outcomes were left out.ORBITA-CTO: chronic total occlusion PCI versus placebo in stable anginaThe first blinded, placebo-controlled trial of CTO PCI. PCI reduced angina beyond placebo in selected lesions at experienced centers.CHIP-BCIS3: Impella CP versus no mechanical support in high-risk elective PCIImpella support did not improve the hierarchical outcome, and the death and myocardial injury tiers favored standard care.HI-PEITHO: ultrasound-facilitated catheter-directed fibrinolysis versus anticoagulation in intermediate-risk pulmonary embolismHI-PEITHO's positive primary endpoint rests on cardiorespiratory decompensation, measured partly by a vital-sign score in an open-label trial.ROLLING STONE: intravascular lithotripsy versus atherectomy in calcified coronary arteriesA well-run prospective registry. Procedural success was equal. The 12-month advantage of lithotripsy depends on a propensity model with limitations and on 11 vs 23 events.PIONEER IV (interim analysis): QFR-guided PCI versus usual carePIONEER IV declared QFR-guided PCI non-inferior to usual care, but 59% of the comparator used no physiology, and for those patients the question should be superiority.SPACIOUS: sirolimus versus paclitaxel DCB for bifurcation side branchesSPACIOUS showed angiographic noninferiority with a 15-point margin; the binary restenosis difference may be measurement noise.CLOSURE-AF: left atrial appendage closure versus medical therapy in high-risk patientsCLOSURE-AF was negative, but stroke rates were the same in both arms. The failure came from procedural complications, DAPT in frail elderly patients and an RMST truncated at 3 years.Gim et al.: imaging-guided PCI versus CABG in diabetic patients with left main or three-vessel diseaseThe observational comparison of imaging-guided PCI and CABG in diabetic patients did not test equivalence and has heavy censoring, different eras and unbalanced anatomy.