Minneapolis Heart Institute Foundation, Inc.

Drug-coated balloons are the preferred treatment for in-stent restenosis (ISR), avoiding the need for a second metallic layer. While both paclitaxel-coated balloons (PCB) and limus-coated balloons (LCB, typically sirolimus or biolimus) are used, direct comparative evidence is limited, particularly regarding their long-term angiographic efficacy and clinical safety. We conducted a systematic review and study-level meta-analyzis of studies comparing LCB with PCB for coronary ISR. A comprehensive search was performed across PubMed, Embase, Cochrane, Scopus, Web of science for randomized controlled trials. Outcomes were compared using risk ratios (RR) for categorical data and mean differences for continuous data in a random-effects model. Heterogeneity was assessed using the I² statistic. Six randomized controlled trials involving 1,038 patients were included (552 in the LCB group and 481 in the PCB group). Compared with PCB, LCB were associated with a significantly higher risk of clinically driven target lesion revascularization (RR: 1.48; 95% CI: 1.02 to 2.14; p = 0.04; I² = 0%) and target lesion failure (RR: 1.19; 95% CI: 0.87 to 1.62; p = 0.27; I² = 0%). In contrast, both platforms demonstrated no differences in all-cause mortality (RR: 0.98; p = 0.96), myocardial infarction (RR: 0.73; p = 0.46), stent thrombosis (RR: 0.66; p = 0.57), or MACE (RR: 1.09; p = 0.58). Angiographic outcomes were comparable, including late lumen loss (mean differences: -0.00 mm; p = 0.65; I² = 74.7%) and minimal lumen diameter (mean differences: -0.12 mm; p = 0.07). In patients with ISR, PCB reduced repeat revascularization compared with LCB. These data suggest a modest advantage for PCB in preventing restenosis following drug-coated balloon angioplasty for ISR.

High‐potency P2Y12 receptor inhibitors (ticagrelor and prasugrel) reduce ischemic outcomes compared with clopidogrel among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). This study aims to examine contemporary trends and identify predictors of their use among patients with AMI undergoing PCI in the United States.

This observational study used electronic health records from >95 US‐based health care organizations. Adults with AMI who underwent PCI between 2016 and 2023 were included. The primary outcome was the prescription of high‐potency P2Y12 receptor inhibitors versus clopidogrel. Multivariable logistic regression was used to identify independent predictors of P2Y12 inhibitor selection.

Among 182 986 patients with AMI who underwent PCI , clopidogrel was the most prescribed P2Y12 receptor inhibitor (101 136 patients, 55.2%), followed by ticagrelor (68 350, 37.4%) and prasugrel (13 500, 7.4%). Clopidogrel use declined from 66.2% in 2016 to 51.4% in 2023 ( Ptrend =0.002), whereas ticagrelor use increased from 27.8% to 39.4% ( Ptrend =0.022), and prasugrel use increased from 6.0% to 9.2% ( Ptrend =0.008), predominantly after 2019. High‐potency P2Y12 receptor inhibitors were more frequently used in younger patients (<60 years), those with prior PCI , prior MI , chronic kidney disease, and morbid obesity.

Among patients with AMI undergoing PCI, the use of high‐potency agents continues to rise. Prasugrel use increased notably after 2019, following the ISAR‐REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and the European guideline updates. These findings reflect an evolving prescribing landscape of P2Y12 receptor inhibitors in contemporary practice.

Whether an artificial intelligence-enhanced electrocardiogram (AI-ECG) improves detection of occlusive myocardial infarction (OMI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) compared with standard of care (SOC) remains uncertain.

The objective of the study was to evaluate an AI-ECG model for detecting OMI among patients with suspected high-risk NSTE-ACS using invasive coronary angiography (ICA) as the reference.

Consecutive adults undergoing emergent ICA under the institutional level 2 protocol for suspected high-risk NSTE-ACS (2022-2024) were included. Patients with ST-elevation myocardial infarction were excluded. Initial 12-lead ECGs were retrospectively analyzed using an investigational AI-ECG model (Queen of Hearts, Powerful Medical) validated against ICA findings. OMI was defined as an angiographic culprit lesion with TIMI flow grade 0 to 2 or TIMI flow grade 3 with marked troponin elevation or new regional wall motion abnormality.

Among 224 patients, OMI was present in 129 (58%). AI-ECG identified 75 (58%) of these as OMI and classified 96 patients (43%) as OMI overall. For rule in, specificity was 78% (95% CI: 68%-86%) and positive predictive value 78% (95% CI: 69%-86%). For rule out, sensitivity was 58% (95% CI: 49%-66%) and negative predictive value 57% (95% CI: 48%-66%). Serial ECGs reduced false negatives from 42% to 34%. Compared with the standard of care, an AI-augmented triage approach reduced false positives from 42% to 22% (P < 0.001).

In high-risk NSTE-ACS, AI-ECG improved rule in accuracy for OMI, potentially enhancing early identification of patients requiring urgent ICA. However, rule out performance from initial ECG alone was limited, supporting the need for serial ECGs and clinical judgment.