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Background: There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries., Methods: Total 873 consecutive patients undergoing LM PCI (n = 256) and non-LM PCI (n = 617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events., Results: Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p <0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p = 0.026). Mean number of lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (p <0.001). Multivessel PCI was performed in 68.8% LM and 21% non-LM PCI patients (p <0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days postprocedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p = 0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p = 0.080) groups. One-year MACE was significantly higher in LM versus non-LM PCI (12.9% vs 8.4%, respectively; p = 0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p = 0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p = 0.074)., Conclusion: In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group., Competing Interests: Declaration of competing interest Subhash Banerjee: Honoraria: Medtronic, Boston Scientific Corporation, Kaneka; Research grants (institutional): Boston Scientific Corporation, Abbott Vascular, General Electric, Esperion, Novartis, AngioSafe. Robert Stoler: Proctor and advisory board: Medtronic, Boston Scientific and Edwards Advisory board: Biotronik. Zachary Rosol: Speaker: Shockwave, Penumbra. Sameh Sayfo: Consultant: Medtronic, Boston Scientific, Shockwave, Inari, Penumbra, Cagent, Angiodynamic, Terumo, Surmodic, Imperative Care; Advisory Board: Cagent, Medtronic, Boston Scientific Corporation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis., Competing Interests: Declaration of competing interest Dr. Butler reports financial support was provided by Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. Dr. Afzal reports a relationship with AstraZeneca that includes: speaking and lecture fees. Dr. Alhamdow reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Hartgers-Gubbels reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Martinez-Traba reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Butler reports a relationship with Abbott that includes: consulting or advisory. Dr. Butler reports a relationship with American Regent Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Amgen Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Applied Therapeutics Inc that includes: consulting or advisory. Dr. Butler reports a relationship with AskBio that includes: consulting or advisory. Dr. Butler reports a relationship with Astellas that includes: consulting or advisory. Dr. Butler reports a relationship with AstraZeneca that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Bayer that includes: consulting or advisory. Dr. Butler reports a relationship with Boehringer Ingelheim that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Boston Scientific Corporation that includes: consulting or advisory. Dr. Butler reports a relationship with Bristol Myers Squibb Co that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiac Dimensions Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiocell that includes: consulting or advisory. Dr. Butler reports a relationship with Cardior that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiorem that includes: consulting or advisory. Dr. Butler reports a relationship with CSL Behring that includes: consulting or advisory. Dr. Butler reports a relationship with CVRx Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Cytokinetics Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory. Dr. Butler reports a relationship with Daxor that includes: consulting or advisory. Dr. Butler reports a relationship with Element Science that includes: consulting or advisory. Dr. Butler reports a relationship with Faraday that includes: consulting or advisory. Dr. Butler reports a relationship with Foundry that includes: consulting or advisory. Dr. Butler reports a relationship with G3P that includes: consulting or advisory. Dr. Butler reports a relationship with Innolife that includes: consulting or advisory. Dr. Butler reports a relationship with Impulse Dynamics that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Imbria that includes: consulting or advisory. Dr. Butler reports a relationship with Inventiva that includes: consulting or advisory. Dr. Butler reports a relationship with Ionis that includes: consulting or advisory. Dr. Butler reports a relationship with Lexicon that includes: consulting or advisory. Dr. Butler reports a relationship with Eli Lilly and Company that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with LivaNova that includes: consulting or advisory. Dr. Butler reports a relationship with Janssen that includes: consulting or advisory. Dr. Butler reports a relationship with Medtronics that includes: consulting or advisory. Dr. Butler reports a relationship with Merck & Co Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Occlutech that includes: consulting or advisory. Dr. Butler reports a relationship with Owkin Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Novartis that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Novo Nordisk Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Pfizer that includes: consulting or advisory. Dr. Butler reports a relationship with Pharmacosmos that includes: consulting or advisory. Dr. Butler reports a relationship with PharmaIN that includes: consulting or advisory. Dr. Butler reports a relationship with Prolaio that includes: consulting or advisory. Dr. Butler reports a relationship with Regeneron that includes: consulting or advisory. Dr. Butler reports a relationship with Renibus Therapeutics, Inc. that includes: consulting or advisory. Dr. Butler reports a relationship with Roche that includes: consulting or advisory. Dr. Butler reports a relationship with Salamandra that includes: consulting or advisory. Dr. Butler reports a relationship with Sanofi that includes: consulting or advisory. Dr. Butler reports a relationship with SC Pharma that includes: consulting or advisory. Dr. Butler reports a relationship with Secretome that includes: consulting or advisory. Dr. Butler reports a relationship with Sequana that includes: consulting or advisory. Dr. Butler reports a relationship with SQ Innovation that includes: consulting or advisory. Dr. Butler reports a relationship with Tenex that includes: consulting or advisory. Dr. Butler reports a relationship with Tricog that includes: consulting or advisory. Dr. Butler reports a relationship with Ultromics that includes: consulting or advisory. Dr. Butler reports a relationship with Vifor that includes: consulting or advisory. Dr. Butler reports a relationship with ZOLL that includes: consulting or advisory. Dr. Gottlieb reports a relationship with Alnylam Pharmaceuticals Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Dr. Gottlieb reports a relationship with AstraZeneca that includes: consulting or advisory and funding grants. Dr. Gottlieb reports a relationship with Eli Lilly and Company that includes: consulting or advisory and funding grants. Dr. Gottlieb reports a relationship with Pfizer that includes: funding grants and speaking and lecture fees. Dr. Gottlieb reports a relationship with Johnson & Johnson that includes: funding grants. Dr. Priest reports a relationship with AstraZeneca that includes: funding grants. Dr. Priest reports a relationship with Owkin Inc that includes: funding grants. The remaining authors have no competing interests to declare., (Copyright © 2024. Published by Elsevier Inc.)

Data on the long-term outcomes of prosthesis patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. This study aimed to investigate the incidence and clinical outcomes of measured PPM (PPM M ) and predicted PPM (PPM P ) in patients who underwent TAVI. This is a retrospective analysis of 3,016 patients who underwent TAVI at a large health care system between 2012 and 2021. Effective orifice area indexed to body surface area (EOAi) was measured at discharge using the continuity equation. EOAi was predicted according to the published predictive tables for each model and size of the valve. Primary end point was 5-year survival rate. Mean age was 80 years, and 55.6% were male. The mean Society of Thoracic Surgeons risk score was 4.66%. 74.9% of patients received a balloon-expandable valve (BEV), and 25.1% received a self-expanding valve (SEV). The incidence of severe PPM was markedly lower when defined by predicted versus measured EOAi (0.8% vs 6.3%, p <0.001) and when assessed in SEV versus BEV (5.3% vs 6.6%, p = 0.02). Neither severe PPM p nor severe PPM M was associated with 5-year mortality (hazard ratio 1.26, 95% confidence interval 0.96 to 1.66, p = 0.095; hazard ratio 1.03, 95% confidence interval 0.42 to 2.49, p = 0.954, respectively), irrespective of the presence of high residual pressure gradient. Neither BEV nor SEV was associated with an increased 5-year mortality, irrespective of PPM definition or severity. In this large health care system analysis, neither severe PPM P nor severe PPM M was associated with 5-year all-cause mortality. There was no difference between BEV and SEV in terms of mortality, irrespective of the definition or severity of PPM., Competing Interests: Declaration of competing interest Dr. Al-Azizi: proctor/consultant Edwards Lifesciences, consultant/Advisory Board Medtronic, consultant Boston Scientific, and Speaker Bureau Philips. Dr. Szerlip: Edwards Lifesciences, proctor, speaker, and consultant; Abbott Vascular, advisory board, consultant, and proctor; Medtronic, steering committee; and Boston Scientific, speaker. Dr. Stoler: proctor and advisory board: MDT, BSCI, and Edwards; advisory board: Biotronik. Dr. Mack: Abbott, Trial Co-PI; Edwards Life Sciences, Trial Co-PI; and Medtronic, Trial Study Chair; all uncompensated. Dr. Potluri: advisory board, proctor, and speaker: Medtronic, Boston Scientific, Abbott, and Cordis; proctor and speaker: Edwards, Terumo, and AstraZeneca. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)