Ajay J. Kirtane

Impact of CKD and Hemodialysis on Treatment of Severely Calcified Lesions: The ECLIPSE Trial

Background: Chronic kidney disease (CKD) and coronary calcification increase risk for adverse events following drug-eluting stent (DES) implantation. We evaluated whether outcomes following vessel preparation with orbital atherectomy (OA) versus balloon angioplasty (BA) vary according to CKD. Methods: This pre-specified CKD sub-analysis of the prospective, multicenter ECLIPSE trial evaluated 2,001 patients with severely calcified lesions randomized to OA versus BA prior to DES. Independent predictors of two-year target-vessel failure (TVF)—a composite of cardiac death, target-vessel myocardial infarction (TV-MI), or ischemia-driven target-vessel revascularization (ID-TVR)—were determined using multivariable Cox proportional hazards modeling. Results: CKD (eGFR <60 mL/min/1.73m² or hemodialysis) was present in 694 (34.7%) patients; 112 required hemodialysis. Two-year TVF was significantly higher with versus without CKD (21.2% vs. 11.6%; p<0.001), driven by increased cardiac death and ID-TVR. Hemodialysis independently predicted TVF (adjusted HR 2.14, 95% CI 1.30-3.53; p=0.003), whereas reduced eGFR alone did not (p=0.070). In patients on hemodialysis, OA versus BA was associated with higher rates of TVF (52.3% vs. 30.7%; adjusted HR 2.50, 95% CI 1.16–5.41; P=0.020), driven by higher rates of TV-MI and ID-TVR, whereas TVF was similar after OA versus BA in patients not on hemodialysis (13.5% vs. 13.1%; adjusted HR 1.05, 95% CI 0.81–1.35; P=0.730); however, the interaction between treatment assignment and hemodialysis status was not significant (Pint=0.244). Conclusions: CKD remains a major predictor of adverse outcomes after DES implantation in severely calcified lesions, with the highest risks in patients on hemodialysis. In the ECLIPSE trial, higher two-year rates of TVF were observed after vessel preparation with OA compared with BA in patients on hemodialysis but not in patients with CKD not on hemodialysis or in those without CKD. Given the modest hemodialysis subgroup size and non-significant interaction testing, confirmation of these findings in additional studies is warranted.

Review examines anticipated future directions and clinical evolution of coronary interventions.

Highlights potential directions for coronary intervention evolution; leaves open empirical confirmation of clinical impact.

The use of platelet function testing to guide antithrombotic regimens post-percutaneous coronary intervention in patients requiring therapeutic anticoagulation

Laser-based quad-emitter IVL achieves calcium fracture in ~67% of severely calcified coronary lesions.

The novel laser-based quad-emitter intravascular lithotripsy system is a safe and effective option to modify severely calcified coronary lesions, achieving calcium fracture in 67% of OCT-evaluated lesions to facilitate stent implantation.

QFR-guided PCI reduces 3-year MACE ~35% vs angiography-guided PCI in multivessel disease.

In this prespecified secondary analysis of the FAVOR III China trial, QFR-guided PCI significantly reduced 3-year MACE compared to angiography-guided PCI in patients with multivessel disease, with consistent directional benefit regardless of MVD status.

Mild or trace mitral regurgitation is linked to ~5.5 g/m² higher LV mass index.

Mild and trace valvular abnormalities in older adults are associated with subclinical cardiac remodeling and elevated biomarkers, suggesting they have pathophysiological importance.

SEP 1BurkhoffJournal of the American College of Cardiology

Advancing Hemodynamic Understanding in High-Risk PCI

SEP 23BikdeliHarvard University

Coated or chewable Aspirin and a hybrid air pollution mitigation strategy in patients with atherosclerotic disease: Rationale and Design of the COATED-AIR Randomized Trial.

BACKGROUND: Although enteric-coated aspirin is widely used instead of chewable formulations in patients with atherosclerotic cardiovascular diseases (ASCVD), its effects on cardiovascular and gastrointestinal outcomes remain uncertain. Separately, air pollution is a driver of cardiovascular risk, yet individual-level interventions have not been tested in outcomes trials. METHODS AND RESULTS: The Coated Or Chewable Aspirin in Patients with Established AThErosclerotic Disease and a Hybrid Strategy to Mitigate the Adverse Effects of AIR Pollution (COATED-AIR) is a randomized trial with a 2x2 factorial design planned to address these knowledge gaps. Patients with ASCVD receiving low-dose aspirin are considered for inclusion. Major exclusion criteria consist of being within 72 hours of acute/unstable ASCVD or revascularization, triple antithrombotic therapy, active/recent bleeding, life expectancy <1 year, or other barriers or unwillingness for enrollment. Eligible consenting patients are randomized, in a double-blind fashion, to enteric coated vs chewable aspirin 81mg daily, and (via factorial randomization) to a hybrid strategy to mitigate the adverse effects of air pollution vs usual care. The hybrid strategy includes 1. an educational flashcard, 2. real-time air quality alerts via cellular text messages, and recommendations to 2a. limit outdoor activity or 2b. to use a KN-95 facemask when outdoors, and 2c. to increase citrus fruit intake on days with elevated pollution levels. The primary efficacy outcome for the aspirin randomization is a composite of fatal/nonfatal ischemic stroke, thrombotic/thromboembolic myocardial infarction, and acute limb ischemia. For the AIR randomization, other forms of cardiovascular death are additionally included in the primary composite outcome. The median planned duration of follow-up is 2 years. Enrollment was completed on 01/28/2026. Clinical follow-up and blinded event adjudications are ongoing. CONCLUSION: COATED-AIR will determine whether aspirin coating affects its safety or effectiveness, and whether individual-level strategies can mitigate cardiovascular risks from air pollution in patients with ASCVD.

Influence of Chronic Kidney Disease on Outcomes After Paclitaxel-Coated Balloon Angioplasty for Coronary In-Stent Restenosis

Demonstrates consistent benefit of drug-coated balloons for in-stent restenosis regardless of chronic kidney disease, suggesting renal function does not impair efficacy.

Predicting Ambulatory Blood Pressure Response After Ultrasound Renal Denervation Through Machine Learning

A Practical Approach to Left Main Coronary Artery Disease

Provides a practical, algorithm-based approach and emphasizes a heart team strategy for the complex management of left main coronary artery disease.

AUG 2015GénéreuxJournal of the American College of Cardiology

Post-discharge bleeding after PCI linked to ~403% higher 2-year all-cause mortality.

Post-discharge bleeding after successful PCI with DES is common and strongly associated with subsequent all-cause mortality, with an effect size greater than that of post-discharge myocardial infarction.

FEB 2014WilliamsJournal of the American College of Cardiology

TAVR reduces late mortality ~33% vs SAVR in high-risk females, but not in males.

Sex differences in TAVR versus SAVR outcomes merit discussion in shared decisions; leaves open confirmation via randomized trials.

Consensus and Update on the Definition of On-Treatment Platelet Reactivity to Adenosine Diphosphate Associated With Ischemia and Bleeding

Standardizes platelet function test thresholds for risk stratification post-PCI; leaves open whether routine testing and tailored.

Endovascular ultrasound renal denervation lowers daytime ambulatory SBP by ~6 mm Hg versus sham.

May support renal denervation as adjunctive hypertension therapy; leaves open long-term durability and optimal patient selection.