Background: Inflammation plays a pivotal role in coronary artery disease (CAD). The anti‐inflammatory drug colchicine seems to reduce ischemic events in patients with CAD. So far there is equipoise about its safety and impact on mortality. Methods and Results: To evaluate the utility of colchicine in patients with acute and chronic CAD, we performed a systematic review and meta‐analysis. MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from January 1975 to October 2020. Randomized trials assessing colchicine compared with placebo/standard therapy in patients with CAD were included. Data were combined using random‐effects models. The reliability of the available data was tested using trial sequential analyses . Of 3108 citations, 13 randomized trials (n=13 125) were included. Colchicine versus placebo/standard therapy in patients with CAD reduced risk of myocardial infarction (odds ratio [OR] 0.64; 95% CI, 0.46–0.90; P =0.01; I ² 41%) and stroke/transient ischemic attack (OR 0.50; 95% CI, 0.31–0.81; P =0.005; I ² 0%). But treatment with colchicine compared with placebo/standard therapy had no influence on all‐cause and cardiovascular mortality (OR 0.96; 95% CI, 0.65–1.41; P =0.83; I ² 24%; and OR 0.82; 95% CI, 0.55–1.22; P =0.45; I ² 0%, respectively). Colchicine increased the risk for gastrointestinal side effects ( P <0.001). According to trial sequential analyses, there is only sufficient evidence for a myocardial infarction risk reduction with colchicine. Conclusions: Among patients with CAD, colchicine reduces the risk of myocardial infarction and stroke, but has a higher rate of gastrointestinal upset with no influence on all‐cause mortality.

Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.

The study aimed to describe the safety and long-term outcomes of patients with coronary chronic total occlusions undergoing percutaneous coronary interventions with the latest generation of drug-coated balloons vs novel drug-eluting stents. Original Contribution from Journal of Invasive Cardiology. Drug-coated balloons Chronic Total Occlusion percutaneous coronary intervention Drug-eluting stent

Background: In‐stent restenosis (ISR) and recurrent ISR (Re‐ISR) remain significant challenges of percutaneous coronary intervention (PCI), especially in complex lesions where conventional therapies are less effective. Rotational atherectomy (RA) combined with super high‐pressure noncompliant (NC) balloons represents a potential strategy for addressing severe ISR or Re‐ISR. Objectives and Methods: This study investigated the procedural success and safety as well as clinical outcomes of RA combined with super high‐pressure NC balloons in patients with severe or Re‐ISR. Consecutive patients treated for severe or Re‐ISR between January 2020 and September 2024 were retrospectively analyzed. The primary endpoint was major adverse cardiovascular events (MACEs) at follow‐up, including target vessel myocardial infarction (TV‐MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Periprocedural complications were also recorded. Results: Out of 13 treated patients, 6 (46%) patients experienced periprocedural events, including 3 (23%) Type A dissections, 2 (15%) Type B dissections, and 1 (8%) Ellis Grade I perforation. 9 (70%) patients were treated with drug‐coated balloons (DCBs), 1 (8%) of which had crossover to stenting and 2 (15%) had hybrid strategy with DCB and stenting combined. At a median follow‐up of 13 months, 4 (31%) patients had MACE, comprising 1 (8%) TV‐MI by TLR, 2 (15%) clinically driven TLR, and 1 (8%) TVR. Secondary outcomes included 1 (8%) case of hospitalization for heart failure (HF) and 1 (8%) COVID‐19–related death. Conclusions: RA combined with super high‐pressure NC balloons for the treatment of severe ISR or Re‐ISR is associated with a significant risk of periprocedural complications. However, the midterm outcomes suggest this strategy might be effective in managing severe or Re‐ISR. Trail Registration: ClinicalTrials.gov identifier: NCT06075602