Aims: To summarize the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets. Methods and results: We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratios (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of 21 studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high bleeding risk (PRECISE-DAPT score ≥25), and when compared to those at low bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24–3.29; P-value <0.001) and major bleedings (OR: 3.51; 95% CI: 2.71–4.55; P-value <0.001). Pooling data on c-stat whenever available, the PRECISE-DAPT score showed a moderate discriminative power in predicting major bleeding events at 1 year (pooled c-stat: 0.71; 95% CI: 0.64–0.77). Conclusion: This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.

Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review explores ranolazine’s mechanisms of action and its potential role in cardiac arrhythmias treatment in light of previous clinical studies.

Intravascular imaging has revolutionized the assessment and management of coronary artery disease, providing unparalleled insights into plaque morphology, lesion severity, and percutaneous coronary intervention (PCI) optimization. This comprehensive review explores the current landscape of intravascular imaging, detailing the principles and clinical utility of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We discuss the role of these technologies in various clinical scenarios, ranging from stable coronary artery disease to acute coronary syndromes, emphasizing their ability to refine diagnostic accuracy and therapeutic decision-making. A key focus is placed on their application in identifying vulnerable plaques, a critical step in preventing adverse cardiovascular events. Furthermore, we highlight the role of intravascular imaging in guiding PCI, improving stent deployment, and reducing procedural complications. Finally, we explore emerging imaging modalities and technological advancements poised to further enhance coronary assessment, including hybrid imaging techniques. In addition to established modalities, this review examines emerging imaging technologies and the growing integration of artificial intelligence (AI) and hybrid imaging systems, which hold promise for automated plaque characterization, improved reproducibility, and enhanced decision support during PCI. By summarizing the latest evidence and future directions, this review aims to provide a comprehensive reference for clinicians and researchers seeking to optimize the use of intravascular imaging in contemporary cardiovascular practice.

Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate–high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions.

The coronary sinus reducer (CSR) is a percutaneous device designed to improve coronary blood flow and alleviate symptoms of refractory angina in patients with severe coronary artery disease (CAD) who are unsuitable for revascularization therapy. CSR originated from earlier surgical techniques, such as coronary sinus ligation (CSL), and functions by narrowing the coronary sinus to enhance perfusion in ischemic myocardial territories—particularly in the subendocardial regions—while also reducing microvascular resistance and increasing capillary recruitment. CSR is currently recognized as an effective treatment for patients with chronic refractory angina, especially those deemed ineligible for revascularization according to current European Society of Cardiology (ESC) guidelines. Moreover, emerging studies are expanding the understanding of the mechanism of action involved in CSR, demonstrating that this technique may also improve microvascular function, particularly in patients with coronary microvascular dysfunction. These trials have shown significant improvements in coronary microcirculation and reductions in angina symptoms, suggesting that CSR may have therapeutic potential beyond obstructive CAD. Thus, CSR may represent a promising treatment option for microvascular ischemia, thereby broadening its clinical applicability to patients with angina/ischemia and non-obstructive coronary arteries (ANOCA/INOCA).