Impact of obesity on palpation-guided distal radial access for coronary procedures: subgroup analysis of the multicenter, prospective KODRA registry.

Background: There is limited data on the impact of body mass index (BMI) on distal radial access (DRA). Using a large-scale prospective registry, the influence of obesity on DRA outcomes was evaluated, including cannulation and complications.

Methods: Using data from the prospective, multicenter KODRA (Korean Prospective Registry for Evaluation the Safety and Efficacy of Distal Radial Approach) registry data, 4,638 patients who planned palpation-guided distal radial artery puncture were enrolled into two groups, both with body mass index (BMI) information available: obese (n = 2,205; BMI ≥ 25 kg/m²) and non-obese (n = 2,433).

Immediate versus staged complete revascularisation during index admission in patients with ST-segment elevation myocardial infarction and multivessel disease (OPTION-STEMI): a multicentre, non-inferiority, open-label, randomised trial.

Background: The optimal timing of complete revascularisation for patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. We aimed to assess whether immediate complete revascularisation was non-inferior to staged complete revascularisation during the index admission.

Methods: We conducted an open-label, randomised, non-inferiority trial at 14 hospitals in South Korea.

Clinical Relevance of Fractional Flow Reserve-Guided Percutaneous Coronary Interevention According to Left Ventricular Ejection Fraction in Patients With Acute Myocardial Infarction and Multivessel Disease.

Background: Fractional flow reserve (FFR)-guided or angiography-guided complete revascularization has not been evaluated in patients with acute myocardial infarction (AMI) with multivessel disease and reduced left ventricular ejection fraction (LVEF). This study sought to evaluate the impact of FFR-guided percutaneous coronary intervention (PCI) for patients with AMI with multivessel disease according to left ventricular systolic function.

Methods: We performed a prespecified analysis of the FRAME-AMI (Fractional Flow Reserve Versus Angiography-Guided Strategy in Acute Myocardial Infarction With Multivessel Disease) trial, which randomly allocated 562 patients to undergo either FFR-guided PCI (FFR ≤0.

Intravascular Imaging-Guided PCI vs Coronary Artery Bypass Grafting for Left Main or 3-Vessel Disease.

Background: Previous trials have shown that coronary artery bypass graft (CABG) has better clinical outcomes compared with percutaneous coronary intervention (PCI) for patients with left main coronary artery or 3-vessel disease. However, it is unclear whether intravascular imaging (IVI)-guided PCI would reduce the difference in clinical events compared to CABG.

Objectives: The present study sought to compare the clinical outcomes of patients with left main or 3-vessel disease who underwent IVI-guided PCI with those who underwent CABG.

Anatomical Snuffbox Versus Dorsum of the Hand for Optimal Access Site in Distal Radial Access: Insight From the KODRA Registry.

Background And Objectives: Distal radial access (DRA) has been recognized as an alternative to conventional radial access, with potential puncture sites at the anatomical snuffbox and on the dorsum of the hand. However, the optimal puncture site remains unknown. This study aims to evaluate the efficacy and safety of DRA at these two sites.

Distal radial access in elderly patients aged 70 years and older for coronary procedures: Lessons from the KODRA registry.

Background: While distal radial access (DRA) is increasingly adopted for coronary procedures, evidence supporting its use in elderly patients remains limited. This study evaluated the feasibility and safety of DRA in elderly patients using data from the KODRA registry.

Methods: A total of 4941 patients were divided into elderly (≥70 years; n = 2091) and non-elderly (<70 years; n = 2850) groups.

Non-culprit Lesion Location and FFR-guided Revascularization in Acute Myocardial Infarction With Multivessel Disease: FRAME-AMI Substudy.

Background And Objectives: The prognosis of unrevascularized non-culprit lesions (NCLs) and the benefits of non-culprit percutaneous coronary intervention (PCI) may depend on their functional significance and location in patients with acute myocardial infarction (AMI) and multivessel coronary disease (MVD). We investigated the differential outcomes of fractional flow reserve (FFR) versus angiography-guided PCI for NCL between the left anterior descending artery (LAD) and non-LAD arteries.

Methods: This was a prespecified post hoc analysis of the FRAME-AMI trial.

Deescalation From Ticagrelor to Clopidogrel for Myocardial Infarction With Chronic Kidney Disease: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Chronic kidney disease (CKD) is a significant risk factor for both ischemic and bleeding complications following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Optimizing dual antiplatelet therapy (DAPT) is essential for improving clinical outcomes.

Objective: To evaluate whether an 11-month, unguided deescalation strategy from ticagrelor to clopidogrel was associated with reduced bleeding without an increase in ischemic events in stabilized patients with CKD after AMI.

Distal Radial Access and Women: Implications for Access Site Outcomes in Coronary Procedures.

Background: We investigated the sex-specific variations in distal radial access (DRA)-associated outcomes, as well as the factors influencing these outcomes, by utilizing a comprehensive real-world registry.

Methods: In this post-hoc analysis of the KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial, we selected 4608 patients who underwent successful coronary procedures, including percutaneous coronary intervention or coronary angiography, via DRA. Primary end points were overall DRA site outcomes including bleeding, radial artery occlusion, tenderness, hand edema, numbness, perforation, and dissection.

Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial.

Background: The optimal strategy for long-term antiplatelet maintenance for patients who underwent percutaneous coronary intervention (PCI) remains uncertain. This study aimed to compare the efficacy and safety of clopidogrel versus aspirin monotherapy in patients who completed a standard duration of dual antiplatelet therapy (DAPT) following PCI with drug-eluting stents.

Methods: In this multicentre, randomised, open-label trial, patients aged 19 years or older at high risk of recurrent ischaemic events (previous myocardial infarction at any time before enrolment, medication-treated diabetes, or complex coronary lesions) who completed a standard duration of DAPT after PCI were randomly assigned (1:1) to receive clopidogrel (75 mg once a day) or aspirin (100 mg once a day) oral monotherapy at 26 sites in South Korea.

Intravascular Imaging-Guided Versus Angiography-Guided Complex PCI in Patients With High Bleeding Risk: A Secondary Analysis of the RENOVATE-COMPLEX PCI Trial.

Background: Although patients with high bleeding risk (HBR) often have complex coronary artery lesions, it is not known whether intravascular imaging-guided percutaneous coronary intervention (PCI) improves their prognosis. We sought to investigate the benefit of intravascular imaging-guided PCI for complex coronary artery lesions in patients with HBR.

Methods: This was a secondary analysis of the RENOVATE-COMPLEX-PCI trial (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) in which patients with complex coronary artery lesions undergoing PCI were enrolled at 20 sites in Korea from May 2018 through May 2021.

BMI and Deescalation From Ticagrelor to Clopidogrel in Patients With Acute Myocardial Infarction: A Post Hoc Analysis of the TALOS-AMI Trial.

Importance: The potential benefits of P2Y12 inhibitor deescalation for acute myocardial infarction after percutaneous coronary intervention may be influenced by body mass index (BMI).

Objectives: To investigate the association of BMI on deescalation outcomes after 12 months in patients with acute myocardial infarction after percutaneous coronary intervention who were initially treated with aspirin plus ticagrelor for 1 month, and to assess whether BMI-based switching from aspirin plus ticagrelor (active control strategy) to aspirin plus clopidogrel (deescalation strategy) is associated with individualized benefits.

Design, Setting, And Participants: This study is a post hoc analysis, based on BMI, of data from the TALOS-AMI (Ticagrelor vs Clopidogrel in Stabilized Patients with Acute Myocardial Infarction) randomized clinical trial.

Intravascular Imaging Predictors Associated With Cardiovascular Events After Complex PCIs.

Background: Intravascular imaging-guided percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes in patients with complex coronary artery lesions compared with angiography-guided PCI. However, the prognostic impact of suboptimal findings on intravascular imaging such as stent underexpansion, malapposition, or dissection is unclear in the era of contemporary drug-eluting stents.

Methods: From RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) which compared imaging-guided PCI with angiography-guided PCI in patients with complex lesions, post-PCI intravascular imaging findings, including minimum stent area (MSA), relative stent underexpansion (MSA≤80% of the average reference lumen area), malapposition, or dissection, were assessed in nonleft main target lesions.

Outcomes of intravascular imaging-guided percutaneous coronary intervention according to lesion complexity.

Background: Recent trials have shown that intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) improves clinical outcome, as compared to angiography-guided PCI, in complex coronary artery lesions. However, it is unclear whether this benefit is affected by overall lesion complexity in each patient.

Aims: The present study sought to investigate the impact of overall lesion complexity on the benefit of IVI-guided PCI.

Clinical Outcomes According to the Extent of Atherosclerotic Disease in Female Patients Undergoing Transcatheter Aortic Valve Replacement: An Analysis From the WIN-TAVI Registry.

Background: Limited data exist on the impact of polyvascular disease (PolyVD) on clinical outcomes in female patients undergoing transcatheter aortic valve replacement (TAVR). We therefore sought to investigate clinical outcomes in women with versus without PolyVD undergoing TAVR.

Methods: Female participants from the multicentre Women's International Transcatheter Aortic Valve Implantation (WIN-TAVI) registry were categorized based on the presence or absence of PolyVD.

Feasibility of Distal Radial Access in High Bleeding Risk Patients Who Underwent Percutaneous Coronary Intervention.

Backgrounds And Objectives: The distal radial access (DRA), a potential alternative to the trans-radial approach (TRA), may offer advantages in terms of access site complications due to its smaller vessel diameter, especially for high bleeding risk (HBR) patients. This study aims to investigate the feasibility of DRA in HBR patients.

Methods: Based on data from the KODRA registry, a prospective, multicenter cohort, this study analyzed 1,586 patients who underwent successful percutaneous coronary intervention (PCI) via DRA.

Staged versus immediate complete revascularization for non-culprit arteries in acute myocardial infarction: a post-hoc analysis of FRAME-AMI.

Background And Objectives: The optimal timing for complete revascularization (CR) in patients with acute myocardial infarction (AMI) and multivessel disease (MVD) remain uncertain.

Methods: This post-hoc analysis of the FRAME-AMI trial included AMI patients with MVD ( = 549). They were classified into immediate ( = 329) and staged CR ( = 220) groups.

Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk: a post hoc analysis of a randomized clinical trial.

Introduction And Objectives: Recent randomized controlled trials support the use of intravascular imaging-guided percutaneous coronary intervention (PCI) to improve patient prognosis. However, the subsequent risk of clinical events in patients with coronary artery disease is not determined solely by lesion characteristics or how these lesions are treated. The current study investigated whether the effects of intravascular imaging in complex PCI vary according to atherothrombotic risks.

Efficacy and diabetes risk of moderate-intensity statin plus ezetimibe versus high-intensity statin after percutaneous coronary intervention.

Backgrounds: High-intensity statin is recommended for patients undergoing percutaneous coronary intervention (PCI), and ezetimibe is recommended to be added in patients not achieving low-density lipoprotein cholesterol (LDL-C) targets. Moderate-intensity statin plus ezetimibe can reduce LDL-C levels similar to high-intensity statin. The aim of this study is to examine the long-term efficacy and safety of moderate-intensity statin plus ezetimibe as the first-line strategy compared to high-intensity statin in patients undergoing PCI.

Long-Term Risk of Cardiovascular Death in Patients With Mildly Reduced Ejection Fraction After Acute Myocardial Infarction: A Multicenter, Prospective Registry Study.

Background: The prognostic implication of mildly reduced ejection fraction (mrEF) after acute myocardial infarction has not been clearly demonstrated. We investigated the long-term risk of cardiovascular death and its predictors in patients with mrEF following acute myocardial infarction.

Methods And Results: A total of 18 668 patients who presented with acute myocardial infarction were included in 2 prospective, multicenter registries.

Predictors and Long-Term Clinical Impact of Heart Failure With Improved Ejection Fraction After Acute Myocardial Infarction.

Background: Little is known about the characteristics and long-term clinical outcomes of patients with heart failure with improved ejection fraction (HFimpEF) after acute myocardial infarction.

Methods And Results: From a multicenter, consecutive cohort of patients with acute myocardial infarction undergoing percutaneous coronary intervention, patients with an initial echocardiogram with left ventricular ejection fraction ≤40% and at least 1 follow-up echocardiogram after 14 days and within 2 years of the initial event were considered for analyses. HFimpEF was defined as an initial left ventricular ejection fraction ≤40% and serial left ventricular ejection fraction >40% with an increase of ≥10% from baseline at follow-up.

Intravascular Imaging and Angiography Guidance in Complex Percutaneous Coronary Intervention Among Patients With Diabetes: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Data are limited regarding the effects of intravascular imaging guidance during complex percutaneous coronary intervention (PCI) in patients with diabetes.

Objective: To compare the clinical outcomes of intravascular imaging-guided vs angiography-guided complex PCI in patients with or without diabetes.

Design, Setting, And Participants: This prespecified secondary analysis of a subgroup of patients in RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention), an investigator-initiated, open-label multicenter trial, analyzed enrolled patients who underwent complex PCI at 20 sites in Korea from May 2018 through May 2021.

Impact of Intravascular Imaging-Guided Stent Optimization According to Clinical Presentation in Patients Undergoing Complex PCI.

Background: It is unclear whether the beneficial effects of intravascular imaging-guided stent optimization vary by clinical presentation during complex percutaneous coronary intervention (PCI).

Objectives: In this prespecified, stratified subgroup analysis from RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex PCI), we sought to compare the outcomes between intravascular imaging vs angiography guidance according to clinical presentation.

Methods: Patients with complex coronary artery lesions were randomly assigned to undergo either intravascular imaging-guided PCI or angiography-guided PCI in a 2:1 ratio.

Clinical Value of Single-Projection Angiography-Derived FFR in Noninfarct-Related Artery.

Background: The Murray law-based quantitative flow ratio (μFR) is an emerging technique that requires only 1 projection of coronary angiography with similar accuracy to quantitative flow ratio (QFR). However, it has not been validated for the evaluation of noninfarct-related artery (non-IRA) in acute myocardial infarction (AMI) settings. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesions with μFR >0.