The edition · Cardiology
PCI around TAVI cut ischaemic events, at a bleeding price
A meta-analysis of revascularisation in TAVI candidates, calcium scoring on top of PREVENT, a factor XIa inhibitor that failed after ACS, and two kinds of drug-coated balloon compared.
The edition in brief
The edition closes on a meta-analysis of randomised trials in people with severe aortic stenosis and coronary disease referred for transcatheter valve implantation (TAVI). Routine percutaneous coronary intervention (PCI) was associated with fewer major adverse cardiovascular events than conservative care (RR 0.80, 95% CI 0.65 to 0.98) and far less unplanned revascularisation, but more major bleeding (RR 1.57). Physiology-guided PCI ranked best in a network analysis, which is weaker evidence. In the Multi-Ethnic Study of Atherosclerosis, adding a coronary calcium score to the PREVENT equations only modestly improved prediction overall, but separated borderline-risk adults well: 10-year event rates ran from 1.9% with a score of zero to 14.3% with a score of 300 or more. The phase 3 LIBREXIA ACS trial of milvexian, an oral factor XIa inhibitor, added to antiplatelet therapy after acute coronary syndrome, stopped for futility in 14,194 patients (HR 1.05) with no excess of serious bleeding. A meta-analysis of eight small trials found sirolimus- and paclitaxel-coated balloons broadly similar for late lumen loss. The pearl covers low-flow, low-gradient aortic stenosis.
Calcium score sharpened PREVENT risk mainly at borderline risk
Order a calcium score when PREVENT risk is borderline or intermediate and the statin decision is genuinely uncertain, not routinely.
Milvexian after acute coronary syndrome stopped for futility
Do not expect factor XIa inhibitors to reduce events after ACS; standard antiplatelet therapy stands.
Sirolimus and paclitaxel balloons performed similarly on lumen loss
Choose between sirolimus and paclitaxel balloons on lesion type and device data; neither is clearly better.
When severe aortic stenosis hides behind a modest gradient
A small valve area with a low gradient needs flow assessed before severe stenosis is dismissed.
Routine PCI in TAVI candidates cut ischaemic events but raised bleeding
In TAVI candidates with significant coronary disease, consider physiology-guided PCI rather than conservative care, with bleeding risk weighed openly.
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