Gregg W. Stone MD

BRIGHT 4 1-year now publ in Circ CV Interv. In 6016 STEMI pts PCI w/bivalirudin vs heparin→↓death, major bleed, stent thrombosis at 30d persisting to 1 yr. Results support the class I recommendation for use of bival to reduce mortality and bleeding in the latest US guidelines.

Our meta-analysis of lesion prep of sev calcified lsns w/IVL vs BA now publ in Circ CV Int. Only 300 pts in 3 RCTs w/1-24 mo FU. IVL→↑stent area but has not yet been shown to ↓MACE. After ROTAXUS/ECLIPSE we need a large RCT. LOCATION trial in 3060 pts (NCT07388030) is ongoing.

Meta-analyses of intravascular imaging guidance of PCI show markedly improved outcomes, but only if you use this tool properly — pre-, intra- and post-PCI and with appropriate targets. How do you do it? Our new state-of-the-art review in EHJ takes you through it step by step.

Now publ in EHJ: In 3 RCTs (n=704), 2-3-mo Rx w/DOACs (low dose in 2 trials) ↓ device-related thrombosis (DRT) and major bleeding c/w DAPT, with NS Δ in death and stroke/SE. DRT has been associated with thromboembolic events, and the RR of 0.61 for stroke/SE favors DOAC use.

Our work from PREVENT now publ in Circ. Only 37% of FFR neg severe lsns (PB>70% & MLA<4mm2) were lipid-rich plaques (LRP) by NIRS. Event rates were much higher and preventive PCI was only effective in LRPs. PCI of "true vulnerable plaques" may improve prognosis and avoid over-Rx.