Cath Lab After Hours

🚨 LEFT MAIN PCI vs CABG trial: 20 years of follow-up produced no survival winner — and no proof of equivalence. In this paper published simultaneously at #ESC26, no statistically significant difference in all-cause mortality was detected among 201 selected patients suitable for either strategy, But the confidence interval was broad and the 20-year tail was thin. Absence of a significant difference is not evidence that the strategies are interchangeable. 🧵 1/7

🚨NOTION-4 trial: Does DOAC after TAVR (instead of ASA) reduce HALT? 👉🏻Let's focus on the recently published trial! 3 months of DOAC suppressed HALT after TAVR — but the between-group difference was no longer evident 9 months after treatment stopped. At 12 months, the primary endpoint was neutral and death, stroke or major/life-threatening bleeding occurred more often with the DOAC strategy. A short course changed the scan while patients were treated, not the 12-month result. 🧵 1/7

New to Cath Lab After Hours🤔? Start here. Original visual appraisals of interventional cardiology latest evidence: the clinical question, the key result, the limitation that matters, and the source. Explore three appraisals below, follow for the next one.

🚨 ACASA-TAVI trial: DOAC monotherapy nearly halved subclinical leaflet thrombosis (HALT) after TAVI without increasing bleeding. But HALT is a CT surrogate, the safety margin deserves scrutiny, and this study does not establish clinical benefit. Here is what the result changes - and what it does not. 🧵 1/7

🚨 TAVI PCI trial: TAVI first was noninferior to PCI first in patients already selected for both procedures. A clinically useful result — but not proof that the strategies are equivalent, not evidence that TAVI first is superior, and not an answer to whether PCI was needed at all. The data behind the headline. 🧵 1/7

2/7 — Trial in brief SWITCH-SWEDEHEART was an investigator-initiated, registry-based, open-label, stepped-wedge cluster-randomized trial. • 17,095 unselected patients undergoing PCI for ACS • 7 Swedish regions grouped into only 3 randomized clusters • Regions switched from default ticagrelor to default prasugrel across four 9-month periods • Mean age 69.8 years; 36.8% aged ≥75; 27.8% women • STEMI 39.4%; NSTEMI 43.7%; unstable angina 16.8% • Previous stroke and oral-anticoagulation indications were retained • Complete 1-year registry follow-up; no patient lost The question was pragmatic: what happens when a health system changes its default policy?

🚨 SWITCH-SWEDEHEART trial: making prasugrel 🇸🇪Sweden’s default P2Y12 inhibitor did not reduce death, MI, or stroke after ACS PCI. This large pragmatic trial challenges the idea that one potent P2Y12 inhibitor should routinely be preferred over the other. But it tested regional prescribing policies — NOT guaranteed head-to-head drug exposure. That distinction is central. 🧵 1/7

🚨 TRIC-I-HF trial: tricuspid repair moved beyond symptom relief — but the 3-year tail needs caution. In selected patients with advanced right-sided heart failure and severe tricuspid regurgitation, transcatheter repair reduced the composite of death or heart-failure hospitalization. This is the hard-outcomes signal the field lacked. It is also a result that needs careful framing. Here is what TRIC-I-HF shows — and what still needs caution. 🧵 1/7

🚨 TARGET-CTCA trial: CT coronary angiography found more disease and increased treatment - but did not prevent MI or cardiac death. In patients discharged after MI was ruled out, a targeted outpatient CTCA strategy increased preventive therapy without improving the primary clinical outcome at 3 years. Here is what this neutral result means (and what does not): 🧵 1/7

🚨 AIR-STEMI: physiology treated fewer non-culprit vessels — and patients had fewer events. After successful culprit-lesion PCI in STEMI, functional coronary angiography outperformed conventional visual guidance for complete revascularization. The result is compelling. But this was not simply “FFR vs angiography.” It tested an integrated, core-lab-supported strategy of lesion selection plus PCI planning. Here is what AIR-STEMI shows — and what still needs caution. 🧵1/7