Elmir Ömerovic

Authors’ reply to: “Stent-Free Is Not Risk-Free: Risk-Defined DAPT After DCB-Only PCI in ACS”

Intra-aortic isoprenaline induces regional dysfunction and cuts LVDP, reproducing the Takotsubo phenotype.

Supports intrinsic myocardial catecholamine responses in Takotsubo; leaves open translation to human disease and clinical relevance.

Review highlights significant knowledge gaps in women's cardiovascular conditions and calls for sex-specific research.

Knowledge gaps in women's CV conditions warrant cautious guideline application; leaves open targeted trials to advance sex-specific care.

SEP 26TsimikasEuropean Journal of Preventive Cardiology

Lower non–Lp(a) apoB/Lp(a) ratio is linked to ~62% higher odds of high-risk plaque vulnerability.

Differentiating Lp(a)-associated from non-Lp(a)-associated apoB particle pools provides complementary information on coronary plaque phenotype and vulnerability.

Obesity class I was associated with an increased risk of MACE compared to normal weight after myocardial infarction (HR 1.17; 95% CI 1.14-1.20).

Obesity is associated with an increased risk of MACE after myocardial infarction, largely mediated by diabetes, hypertension, and prior cardiovascular disease, challenging the concept of an 'obesity paradox'.

Drug-coated balloon inflation time ≥30 seconds was associated with lower rates of target segment revascularization compared with <30 seconds (3.2% vs 6.4%; HR 0.47; 95% CI 0.32-0.69; P≤0.001).

May support ≥30 s drug-coated balloon inflation to reduce revascularization; leaves open optimal technique pending randomized trials.

MAY 2025ErlingeJournal of the American College of Cardiology

Elevated Lp(a) is linked to focal vulnerable plaques rather than pancoronary plaque burden.

Elevated Lp(a) is uniquely associated with the presence of focal vulnerable coronary plaques, whereas other atherogenic lipoproteins correlate with overall plaque volume and lipid burden.

The paper reviews the pathophysiology of Takotsubo syndrome, highlighting evidence for microvascular dysfunction, myocardial beta-adrenergic signaling, inflammation, and electrophysiology, while noting the lack of specific and effective treatments.

This review highlights the current understanding of Takotsubo syndrome pathophysiology and emphasizes the urgent need for specific, evidence-based treatments.

Median survival time was 10.9 years (95% CI 10.6-11.2) in low-risk, 7.3 years (95% CI 7.0-7.9) in intermediate-risk, and 5.8 years (95% CI 5.4-6.5) in high-risk patients.

Informs prognosis counseling after bioprosthetic SAVR; leaves open optimal valve choice versus TAVR in younger low-risk patients.[[1]](https://pubmed.ncbi.nlm.nih.gov/34823657/)[[2]](https://www.jacc.org/doi/10.1016/j.jacc.2021.09.

Bivalirudin shows no benefit over unfractionated heparin for MACE or NACE in ACS but cuts bleeding.

BACKGROUND: Contrasting evidence exists on the comparative efficacy and safety of bivalirudin and unfractionated heparin (UFH) in relation to the planned use of glycoprotein IIb/IIIa inhibitors (GPIs). OBJECTIVES: This study assessed the efficacy and safety of bivalirudin compared with UFH with or without GPIs in patients with acute coronary syndrome (ACS) who underwent invasive management. METHODS: In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) program, 7,213 patients were randomly assigned to receive either bivalirudin or UFH with or without GPIs at discretion of the operator. The 30-day coprimary outcomes were major adverse cardiovascular events (MACEs) (a composite of death, myocardial infarction, or stroke), and net adverse clinical events (NACEs) (a composite of MACEs or major bleeding). RESULTS: Among 3,603 patients assigned to receive UFH, 781 (21.7%) underwent planned treatment with GPI before coronary intervention. Bailout use of GPIs was similar between the bivalirudin and UFH groups (4.5% and 5.4%) (p = 0.11). At 30 days, the 2 coprimary endpoints of MACEs and NACEs, as well as individual endpoints of mortality, myocardial infarction, stent thrombosis or stroke did not differ among the 3 groups after adjustment. Compared with the UFH and UFH+GPI groups, bivalirudin reduced bleeding, mainly the most severe bleeds, including fatal and nonaccess site-related events, as well as transfusion rates and the need for surgical access site repair. These findings were not influenced by the administered intraprocedural dose of UFH and were confirmed at multiple sensitivity analyses, including the randomly allocated access site. CONCLUSIONS: In patients with ACS, the rates of MACEs and NACEs were not significantly lower with bivalirudin than with UFH, irrespective of planned GPI use. However, bivalirudin significantly reduced bleeding complications, mainly those not related to access site, irrespective of planned use of GPIs. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX [MATRIX]; NCT01433627).

Takotsubo syndrome in women was associated with similar or more impaired left ventricular diastolic indices at 24 hours compared to anterior STEMI, with no significant differences at 30 days.

Diastolic indices similar or worse in TS than STEMI; leaves open alternative mechanisms for hemodynamic stability and requires prospective confirmation.

Isoprenaline enriches apical EV Gal-3, promoting NF-κB activation and reflecting myocardial stress rather than contractile dysfunction.

Caution against Gal-3 targeting for contractility in takotsubo syndrome; challenges its causal role in apical dysfunction and extends EV myocardial stress analysis.

IABP use shows no association with reduced 30-day mortality in MI-related cardiogenic shock.

In real-world patients with MI complicated by cardiogenic shock, routine IABP use does not improve short- or long-term survival but significantly increases the risk of in-hospital complications.

Paclitaxel-Coated Balloons Versus Sirolimus-Coated Balloons for Coronary Artery Lesions: A Nationwide Cohort Study From SCAAR

Background: Sirolimus-coated balloons (SCB) are a potential alternative to paclitaxel-coated balloons (PCB) in the context of percutaneous coronary intervention (PCI). However, comparative data between SCB and PCB remain limited. We aimed to compare the outcome of PCI with contemporary PCB or SCB in a real-world clinical setting. Methods: The Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to include all patients undergoing PCI with PCB or SCB between January 1, 2022 and May 16, 2025. The primary outcome was target segment revascularization assessed on coronary artery segment level. Outcome was assessed using multivariable-adjusted Cox regression. Results: A total of 7855 PCB-treated and 502 SCB-treated segments were included. PCB was less frequently used for in-stent restenosis (28.0% vs 34.3%). After a 1-year follow-up period, no difference was observed between PCB and SCB in terms of target segment revascularization (3.3% vs 5.8%; hazard ratio [HR], 1.37; 95% CI, 0.83-2.25), target vessel revascularization (5.2% vs 8.1%; HR, 1.24; 95% CI, 0.78-1.97), restenosis (2.8% vs 4.4%; HR, 1.44; 95% CI, 0.85-2.44), myocardial infarction (3.1% vs 4.9%; HR, 0.74; 95% CI, 0.41-1.32), repeat PCI (8.8% vs 10.8%; HR, 1.04; 95% CI, 0.72-1.51), or all-cause mortality (4.4% vs 3.2%; HR, 1.37; 95% CI, 0.34-1.15). Conclusions: In this study investigating outcome after PCI with drug-coated balloons, no statistically significant differences in 1-year clinical outcomes were observed between PCB and SCB.

Isoprenaline-induced takotsubo syndrome alters 238 proteins in extracellular vesicles from the rat cardiac apex.

Should not yet change clinical practice in Takotsubo syndrome; extends preclinical models by implicating extracellular vesicle-mediated inflammation, tissue repair, and mitochondrial dysfunction in regional pathology.