Aims: Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. Methods and Results: This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. Conclusions: An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

OBJECTIVES: Vascular complications (VC) are the most frequent drawback of transcatheter aortic valve implantation (TAVI), affecting up to 20% of overall procedures. Data on the treatment and their long-term impact are scarce. The goal of this study was to report on the incidence, management and impact on the long-term outcomes of VC following TAVI. METHODS: This was a multicentric retrospective analysis of consecutive patients undergoing TAVI. The primary endpoint was freedom from major adverse cardiac and cerebrovascular events at long-term follow-up. Adverse events were evaluated according to Valve Academic Research Consortium-2 criteria. RESULTS: A total of 2145 patients were included: VC occurred in 188 (8.8%); of which 180 were limited to the access site. Two-thirds of the VC were minor; 8% required surgical treatment; the remaining were repaired percutaneously. The major adverse cardiac and cerebrovascular events-free survival at 2 years was 83.0% for patients with VC and 86.7% for those without (P = 0.143), but 71.9% for patients with major compared to 89.0% in those with minor VC (P = 0.022). Major VC and diabetes mellitus independently predicted worse outcomes at 2 years. The major adverse cardiac and cerebrovascular events-free survival rate and the occurrence of vascular adverse events in the long term among patients with VC at the access site treated by endovascular techniques (covered stent implantation or angioplasty) were similar to those without VC (84.2% vs 86.7%; P = 0.635). CONCLUSIONS: Major but not minor VC impact long-term survival after TAVI. Covered stents implanted to manage VC at the access site have no impact on the long-term clinical outcome of TAVI.

Background: Percutaneous treatment for ostial left circumflex artery (LCx) lesions is known to be associated with suboptimal results.Aims: The present study aims to assess the procedural and long‐term clinical outcomes of percutaneous coronary intervention (PCI) for de novo ostial LCx lesions overall and according to the coronary revascularization strategy.Methods: Consecutive patients undergoing PCI with second generation drug eluting stents or drug coated balloons for de novo ostial LCx lesions in three high‐volume Italian centers between 2012 and 2021 were retrospectively evaluated. The primary endpoint was target‐vessel revascularization (TVR) at 2 years. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), target lesion revascularization, myocardial infarction, stroke, all‐cause death, and repeat revascularization.Results: A total of 366 patients were included in the analysis with a median follow‐up of 901 (IQR: 450−1728) days. 79.5% of the patients were male, 33.6% were diabetic, 49.7% had a previous PCI, and 23.1% a prior surgical revascularization. Very ostial LCx stenting was performed in 34.1%, crossover from left main to LCx in 17.3%, and a two‐stent strategy in 48.6% of cases, respectively. In the overall population, the incidence of TVR at 2 years was 19.0% while MACCE rate was 25.7%. No major differences in clinical outcomes were found according to the stenting strategy. Use of intracoronary imaging was associated with fewer MACCE (HR: 0.47, 95% CI: 0.25−1.13, p = 0.01), while the diameter of the stent implanted in the ostial LCx was associated with less TVR (HR: 0.43, 95% CI: 0.25−0.75, p = 0.002).Conclusions: Percutaneous revascularization of the ostial LCx is associated with a high rate of TVR, regardless of the stenting strategy. Intracoronary imaging and proper stent sizing may reduce the failure rates.

Objectives: To report the experience of a high‐volume center with balloon‐expandable (BE) stents implantation to manage vascular complications after transcatheter aortic valve replacement (TAVR).Background: Despite increased operator experience and better devices, vascular complications after TAVR are still a major issue and covered stent implantation is often required.Methods: We retrospectively collected baseline and procedural data about 78 consecutive patients who underwent BE stent implantation to manage a vascular complication after transfemoral TAVR. Primary endpoints were technical success, incidence of new‐onset claudication and need for vascular interventions during long‐term follow‐up. Secondary endpoints included length of hospitalization, in‐hospital and 30‐day mortality, and major postoperative complications.Results: BE stents implantation to manage vascular complications after TAVR was successfully performed in 96.2% of the cases, with bailout surgery required in two cases. One patient suffered in‐hospital death. Predischarge Doppler Ultrasound revealed no cases of in‐stent occlusion or fracture. At a median follow‐up of 429 days (interquartile range, 89−994 days), no cases of symptomatic leg ischemia were reported and only one patient experienced new‐onset claudication.Conclusions: Our experience showed good periprocedural and long‐term results of BE covered stent implantation to manage vascular complication after TAVR. Their great radial outward force may guarantee effective hemostasis without necessarily being associated with stent deformation/fracture resulting in restenosis or further interventions. More research is needed to define the role of BE covered stents in this setting.

Background: Diabetic patients are at higher risk of recurrent adverse events following percutaneous coronary intervention (PCI) than the nondiabetics. Despite the introduction of new generation drug‐eluting stents, their efficacy in the diabetics is still limited.Aims: To evaluate the efficacy of the Abluminus DES+ biodegradable polymer sirolimus‐eluting stent in reducing neointimal hyperplasia in diabetic patients, compared to a durable polymer everolimus‐eluting stent (DP‐EES).Methods: A total of 131 patients with diabetes and coronary artery disease were enrolled in six Italian centers and randomized in a 2:1 fashion to PCI with Abluminus DES+ or DP‐EES: 85 were assigned to Abluminus DES+ and 46 to DP‐EES. The primary endpoint was optimal coherence tomography (OCT)‐derived neointimal volume at 9–12 months. Secondary endpoints included OCT‐derived neointimal area, neointimal volume obstruction and adverse clinical events.Results: The primary endpoint, neointimal volume, did not differ between Abluminus DES+ and DP‐EES (29.11 ± 18.90 mm³ vs. 25.48 ± 17.04 mm³, p = 0.40) at 9–12‐month follow‐up. This finding remained consistent after weighing for the sum of stents lengths (1.14 ± 0.68 mm³ vs. 0.99 ± 0.74 mm³ for Abluminus DES+ and DP‐EES, respectively, p = 0.38). Similarly, other OCT‐derived and clinical secondary endpoints did not significantly differ between the two groups. Rate of target lesion failure was high in both groups (21.2% for Abluminus DES+ and 19.6% for DP‐EES).Conclusions: This preliminary study failed to demonstrate the superiority of the Abluminus DES+ over the DP‐EES in diabetic patients in terms of neointimal proliferation.

Background: Coronary artery dissections are caused by a tear in the vessel endothelium, resulting in blood extravasation into the subintimal space, with subsequent intramural hematoma (IMH). One potential technique to deal with this complication is the use of cutting balloons, however, a significant number of cases experienced distal propagation of the hematoma. We describe a novel technique that enhances the possibility of creating intimal tears between the false and true lumen, aiding in hematoma drainage and restoring distal coronary flow.Methods: We conducted a retrospective analysis of seven consecutive patients who underwent percutaneous coronary intervention complicated by flow‐limiting intramural hematomas. All patients were treated using the “Cuttering Technique,” based on the operators’ preference. Procedural success was defined as achieving a distal thrombolysis in myocardial infarction 3 (TIMI 3) flow.Results: In five out of seven patients treated with “Cuttering Technique” we observed a complete restoration of TIMI 3 flow into the dissected segment.Conclusions: Our cases show the effectiveness of the “Cuttering Technique” as a viable approach for managing IMHs. This technique enhances the possibility of creating intimal tears between the false and true lumens, aiding in hematoma drainage and restoring distal coronary flow.