Background: Heart failure (HF) is still an important disease with high mortality rates worldwide. HF treatment is also difficult due to different phenotypes. Diuretic response (DR) is one of the main differences across these subgroups. Novel urinary parameters are used for DR prediction. We sought to determine whether the MELD score could be used as an additional parameter for predicting the DR. Methods: Eighty‐one consecutive patients diagnosed with decompensated HF between June and October 2020 were included. The second hour urine sodium (UNa) level after the first intravenous diuretic administration and serum parameters were recorded. All patients underwent a comprehensive echocardiographic examination. MELD score derivatives were tested to assess the DR. Results: A total of 81 patients (mean age: 66.4 ± 13.5; mean ejection fraction: 29.6 ± 12.7%) were divided into two groups according to UNa. 26 (32%) patients had poor DR. MELD Na score was independently associated with DR (OR = 0.88 [−0.21 to (−0.03)]; p = 0.008). Furthermore, MELD Na score was correlated with urinary sodium ( r = −0.354; p = 0.004). Daily furosemide dose was higher (237.9 ± 204.7 vs. 129.3 ± 83.5 mg; p = 0.001) and length of hospital stay was longer (15.6 ± 10.8 vs. 8.5 ± 6.1 days; p < 0.01) in the low UNa group. Conclusion: The MELD score derivative was associated with DR according to urinary sodium and may be used as an additional parameter to predict the DR.

Background: Recent advances in disease awareness and diagnostic strategies have led to earlier diagnosis and improved survival in patients with light-chain cardiac amyloidosis (AL-CA). However, currently used prognostic staging systems are based on older cohorts and rely mainly on cardiac biomarkers, without incorporating patient-related clinical parameters. Aims: We sought to evaluate contemporary survival outcomes in patients with AL cardiac amyloidosis and to identify clinically available predictors that may improve current risk stratification. Methods: This was a single-center ambispective cohort study including consecutive patients diagnosed with AL cardiac amyloidosis between 2014 and 2024. Results: Ninety-six consecutive patients with AL-CA diagnosed between 2014 and 2024 were included. The mean age was 59.6 ± 11.2 years, and 38 patients (39.6%) were women. During follow-up, 51 patients (53.1%) died. Multivariable Cox regression identified lower systolic blood pressure (SBP) (HR 1.30, 95% CI 1.10–1.54; p = 0.002), troponin levels >3× the upper reference limit (HR 2.67, 95% CI 1.29–5.55; p = 0.008), and advanced New York Heart Association (NYHA) functional class (HR 1.92, 95% CI 1.14–3.24; p = 0.014) as independent predictors of mortality. Adding SBP to the Mayo 2012 staging system was associated with a modest improvement in prognostic discrimination (C-index: 0.685 vs. 0.723; ΔC-index = 0.038) and a modest reduction in prediction error. Conclusions: Lower SBP, marked troponin elevation, and advanced NYHA functional class are independent predictors of mortality in AL-CA. SBP may provide modest incremental prognostic information beyond the Mayo 2012 staging system; however, its added predictive value requires validation in larger independent cohorts.

Background: Percutaneous coronary intervention (PCI) remains controversial for coronary bifurcation lesions (CBLs), and over the years, several stent techniques have been developed. Current guidelines on myocardial revascularization recommend an upfront two-stent strategy (U2SS) for complex CBLs. This study was aimed at comparing different upfront two-stenting techniques for true complex CBLs. Methods: We retrospectively analyzed 142 consecutive patients with true coronary bifurcation lesions who underwent percutaneous coronary intervention using an upfront two-stent strategy (DK-crush, mini-culotte, or T/TAP) between June 2019 and September 2022. Clinical, angiographic, and procedural characteristics, as well as 6-month clinical outcomes, were compared among the three groups. The primary endpoint was major adverse cardiovascular events (MACE), and independent predictors of MACE were evaluated using a multivariable Firth penalized logistic regression analysis. Results: Major adverse cardiac events (MACE) [a composite of death, stent thrombosis, myocardial infarction, and target vessel revascularization] occurred in 6.3% of the study population at a median follow-up period of 6 months. There were no significant differences in the primary clinical outcomes among the groups. Although the DK-crush group had the lowest observed incidence of MACE, this difference did not reach statistical significance (p = 0.137). A multivariable Firth penalized logistic regression analysis identified previous myocardial infarction as the only independent predictor of MACE (adjusted OR: 4.33; 95% CI: 1.10–23.61; p = 0.035). Conclusions: Within the limitations of this study, all upfront two-stent strategies appeared feasible and were associated with relatively low short-term MACE rates. No significant differences in clinical outcomes were observed among the evaluated techniques. Previous myocardial infarction was identified as an independent predictor of MACE in the multivariable analysis.

Background: Stent overlapping serves as a crucial strategy in achieving complete coverage of diffuse coronary artery lesions, plaque shifts, and edge dissections. Objectives: We aimed to evaluate the long-term clinical outcomes of overlapping heterogeneous drug-eluting stents (DES) in comparison to homogeneous DES. Methods: A total of 421 patients treated with overlapping DES were included in the study. The study patients were stratified into two groups according to the type of overlap: homogeneous (same antiproliferative drug and stent platform) and heterogeneous (different drug and/or platform). The primary endpoint was a device-oriented composite of cardiac death, target-vessel myocardial infarction and target lesion revascularization; a broader composite of all-cause death, any repeat revascularization, stent thrombosis, in-stent restenosis and cerebrovascular events (MACE) and its components were secondary endpoints. Propensity-score analysis with inverse probability of treatment weighting (IPTW) was used to account for treatment-selection bias. Results: The device-oriented composite endpoint occurred in 9.3% and 7.1% (p = 0.60), and MACE in 17.6% and 14.7% (p = 0.56) of patients with homogeneous and heterogeneous DES, respectively, with no significant difference in any individual component. After IPTW adjustment, heterogeneous overlap was not associated with an increased risk of MACE (odds ratio: 0.45, 95% confidence interval: 0.23–0.86) or of the device-oriented composite endpoint (0.52, 0.22–1.23). In a multivariable model with clinically prespecified covariates, lower left ventricular ejection fraction and greater total stent length, but not HbA1c, were independently associated with MACE. Conclusions: In this retrospective cohort, overlapping heterogeneous DES was not associated with an increased risk of adverse events compared with homogeneous DES, including in patients presenting with acute coronary syndromes; however, the modest sample size and the low number of events preclude conclusions of equivalence, and clinically relevant differences cannot be excluded.

Atrial fibrillation (AF) is a major cause of cardioembolic stroke, and oral anticoagulation (OAC) remains the standard of care for thromboembolic prophylaxis. Because the left atrial appendage (LAA) is the dominant source of thrombus in AF, percutaneous LAA occlusion (LAAO) has been developed as a mechanical alternative for patients in whom long-term anticoagulation is problematic. Randomized trials against warfarin established non-inferiority for the composite endpoint, though not consistently across coprimary endpoints, and more recent trials against direct oral anticoagulants (DOACs) have extended this comparison to post-ablation and lower-risk populations. Across these studies a consistent pattern emerges: the clinical advantage of LAAO derives largely from a reduction in non-procedural bleeding rather than from superior ischemic protection, and recent meta-analyses diverge mainly according to how the thromboembolic endpoint is composed. At the extreme of stroke and bleeding risk, LAAO failed to demonstrate non-inferiority to physician-directed medical care. This review synthesizes the randomized evidence, examines methodological differences in endpoint construction and patient selection that complicate cross-trial comparison, and discusses determinants of procedural success including peridevice leak, device endothelialization, and device-related thrombus. Remaining evidence gaps are outlined, particularly for patients who experience ischemic stroke despite adequate anticoagulation.

Drug-coated balloons (DCBs) are a percutaneous coronary intervention technology that enables rapid and homogeneous delivery of antiproliferative agents to the vessel wall without leaving a permanent metallic scaffold. With the accumulation of clinical evidence and the development of new-generation devices, the use of DCBs has expanded beyond the treatment of in-stent restenosis (ISR) to include a wide range of clinical settings such as small vessel disease, bifurcation lesions, acute coronary syndromes (ACS), and chronic total occlusions (CTO). Contemporary DCB platforms are primarily based on paclitaxel- or sirolimus-coated technologies, while advances in carrier systems and coating techniques have improved drug transfer efficiency, safety, and long-term outcomes. Appropriate lesion preparation, optimal device selection, and the integration of intravascular imaging techniques remain essential determinants of procedural success. Randomized trials support DCB use in ISR and in small-vessel coronary disease, although current European guidelines favor repeat drug-eluting stent (DES) implantation over DCB for restenosis of DES. Evidence in bifurcation lesions, ACS, and CTO is more limited and derives largely from trials powered for angiographic rather than clinical endpoints; in unrestricted de novo lesions, a DCB-based strategy did not meet non-inferiority against DES in the REC-CAGEFREE I trial. This review summarizes the fundamental principles of DCB technology, contemporary device characteristics, technical considerations, major clinical indications, and the most relevant evidence from current literature. DCB technology is an established component of the “leave nothing behind” strategy in selected indications, whereas its role in several de novo settings remains to be defined by adequately powered randomized trials with long-term clinical endpoints.