Faculty Bibliography

BACKGROUND:Emerging therapies for acute PE highlight the need for a more granular risk classification. AIMS/OBJECTIVE:The objective of this study was to validate a novel risk model-the RIsk claSsification Adapted to SCAI shock stages in acute PE (RISA-PE), which applies the SCAI shock staging framework to right ventricular failure due to acute PE. METHODS:We retrospectively analyzed consecutive patients with acute intermediate- or high-risk PE treated with LBMT at a tertiary academic center (October 2020 to May 2025). Patients were stratified by RISA-PE stage (A-E) as previously described. Clinical data, including invasive pulmonary artery catheter hemodynamics and clinical outcomes were compared across stages. The primary endpoint was a composite of 30-day PE-related death, resuscitated cardiac arrest, or hemodynamic instability. RESULTS:) rising from 25% in Stage A to 75% in Stage C (p < 0.001). Clinical outcomes paralleled stage severity. Median hospital length-of-stay increased from 5 to 6 days (Stages A/B) to 19.9 days (Stage E, p < 0.001), and ICU stay from 2.5 to 3 days to 9.5 days, respectively (p < 0.001). The primary composite outcome occurred in 0% of Stage A, 5% of Stage B, 12% of Stage C, 15% of Stage D, and 50% of Stage E patients (p < 0.001). CONCLUSIONS:The RISA-PE staging system demonstrates strong correlation with RV dysfunction severity, invasive hemodynamics, and adverse outcomes in patients with acute PE treated with LBMT. RISA-PE provides a graded framework for identifying patients at highest risk of deterioration and may guide escalation of therapy.

BACKGROUND:Recent societal guidelines provide a Class I recommendation for intracoronary imaging (ICI)-guided percutaneous coronary intervention (PCI) for complex or left main coronary artery disease; however, recent trials have failed to show a benefit. OBJECTIVES/OBJECTIVE:The study aim was to re-evaluate the efficacy of ICI-guided PCI and to explore heterogeneity of results across trials. METHODS:PubMed, Embase, Cochrane Central, and ClinicalTrials.gov databases were searched through June 3, 2026, for randomized controlled trials (RCTs) comparing outcomes with ICI-guided PCI vs angiography-guided PCI in the drug-eluting stent era. Direct comparison meta-analyses, mixed treatment comparison meta-analyses, trial sequential analyses, fragility analysis, and Bayesian meta-analyses were performed. Meta-regression analysis was performed to evaluate heterogeneity using the following variables: stent length (surrogate for lesion length), stent diameter, difference in postdilatation (percentage) between the groups, publication year, and geographic location. RESULTS:= 0%) compared with angiography-guided PCI. Trial sequential analysis confirmed evidence for at least a 20% reduction in all outcomes with ICI-guided PCI. The fragility index was robust, ranging from 9 to 50. The posterior probability for benefit was >99% for all outcomes. Trial differences in geography and lesion characteristics explained most of the between-trial variance (residual tau = 0). CONCLUSIONS:In this updated meta-analysis of RCTs, after accounting for modifier effects from recent studies, ICI-guided PCI was associated with significantly reduced cardiovascular events compared with angiography-guided PCI. Geographic heterogeneity across trials was present mainly for target vessel revascularization, explained in large part by differences in lesion characteristics and procedural technique.

BACKGROUND:Coronary artery anomalies, increasingly recognized as a cause of angina because of higher use of noninvasive imaging, can lead to debilitating symptoms and increased risk of sudden death. CASE SUMMARY/METHODS:A 49-year-old woman presented with years of daily exertional chest pain/dyspnea. Coronary computed tomography angiography revealed a left main coronary artery with a pinhole-like ostium, an inferior takeoff between the noncoronary and left coronary cusps, and poststenotic dilatation. The patient declined surgery and underwent successful intravascular ultrasound-guided percutaneous coronary intervention (PCI) with symptom resolution. DISCUSSION/CONCLUSIONS:This is a successful case report of PCI to correct a pinhole-like ostium of the left main coronary artery. Given the patient's progressive symptoms, the benefit of preventing a life-threatening arrhythmia and improving her function outweighed the procedural risks. TAKE-HOME MESSAGES/CONCLUSIONS:This case demonstrates that PCI is a safe and feasible approach to treat critical pinhole-like left main stenosis in select patients, to prevent life-threatening ischemia-induced arrhythmias and improve functional capacity. Careful longitudinal surveillance will be essential to monitor continued stent patency and freedom from symptoms.

BACKGROUND/UNASSIGNED:Patient-centered prognostic assessment in chronic coronary disease is vital for treatment optimization. Although the Seattle Angina Questionnaire Summary Score (SAQ-SS) correlates with clinical outcomes, clinicians lack guidance on how to weigh prior, current, or changes in scores, and whether prognostic significance varies by revascularization strategy. METHODS/UNASSIGNED:The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches; 2012-2019) was a global, multicenter, randomized controlled trial. This secondary analysis evaluated the prognostic value of serial SAQ-SS assessments. The SAQ-SS ranges from 0 to 100, with higher scores indicating better health status. To simulate routine clinical care, the follow-up in ISCHEMIA was equated to outpatient clinic visits-we defined the 3-month SAQ-SS as the prior score and the 6-month assessment as the current score in the clinic. Analyses were stratified by treatment strategy: conservative management and invasive management with revascularization. Cox proportional hazards models assessed the association of the prior score, the current score, and the change in scores with ISCHEMIA's primary composite end point (cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, and resuscitated cardiac arrest), adjusting for 17 clinical covariates. RESULTS/UNASSIGNED:This analysis included 3405 participants (1965 in conservative management: 77.4% male, mean age 64.3 years±9.5; 1440 in invasive management: 77.6% male, mean age 64.0 years±9.4). Over a median follow-up of 3.2 years, 215 (11.0%) and 96 (6.7%) participants in the conservative and invasive cohorts, respectively, experienced the primary composite end point. Higher prior, current, and change SAQ-SS were each independently associated with a lower risk of cardiovascular events. In the conservative cohort, each 5-point increase in the current SAQ-SS was associated with a 7% lower risk of the primary end point (hazard ratio, 0.93 [95% CI, 0.90-0.96]); in the invasive cohort, the association was 9% (hazard ratio, 0.91 [95% CI, 0.86-0.96]). CONCLUSIONS/UNASSIGNED:In patients with chronic coronary disease, the most recent SAQ-SS is the strongest health status predictor of future cardiovascular events. Serial SAQ-SS assessments provide a practical, dynamic, and patient-centered approach for updating prognosis in chronic coronary disease management. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

BACKGROUND:In August 2025, the American Heart Association and American College of Cardiology released updated hypertension guidelines. Under the new guidelines, therapy is advised at blood pressure ≥130/80 mm Hg in adults with diabetes, chronic kidney disease, or a Predicting Risk of Cardiovascular Disease Events-estimated 10-year cardiovascular disease risk ≥7.5%. The long-term population-level changes following these guidelines remains uncertain. METHODS:We analyzed NHANES (National Health and Nutrition Examination Survey) 2009 to 2018 data linked to mortality through 2019. Hypertensive adults without baseline cardiovascular disease were included. Treatment eligibility was defined using guideline criteria. Cox models estimated associations between antihypertensive therapy and all-cause and cardiovascular mortality. Simulation analyses projected lives saved under full and partial treatment uptake. RESULTS:The weighted cohort represented 81.0 million US adults with hypertension. Of these, 22.8 million (28%) were guideline eligible for therapy; 13.1 million (57%) were treated, and 9.7 million (43%) remained untreated. Antihypertensive therapy was associated with a 23% reduction in all-cause mortality (hazard ratio [HR], 0.77 [95% CI, 0.63-0.94]) and 50% reduction in cardiovascular mortality (HR, 0.50 [95% CI, 0.36-0.68]). At 10 years, universal treatment of eligible but untreated adults was projected to prevent ~200 900 all-cause and ~ 162 600 cardiovascular deaths. Benefits were greatest in adults with diabetes. CONCLUSIONS:In this nationally representative cohort, nearly 1 in 3 US adults with hypertension were newly eligible for therapy under the guideline, yet >2 in 5 remained untreated. Extending treatment to all eligible adults could prevent >200 000 all-cause and 160 000 cardiovascular deaths over the next decade.