Sex Differences Among Young Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis Giordano Maria Pugliesi, Paul Onyeji, Giuseppe Verolino, Sonise MomplaisirOnyeji, Luca Fazzini, et al. Journal of the American Heart Association, 2026 Background Female sex is associated with lower incidence of myocardial infarction, especially at younger ages. However, sex differences in mortality and coronary artery disease patterns among young patients with ST‐segment–elevation myocardial infarction are not well established. This study evaluated sex differences in in‐hospital and 1‐year all‐cause death and in the extent of coronary artery disease in patients aged ≤45 years with ST‐segment–elevation myocardial infarction. Methods A systematic review (December 9, 2025) was conducted using PubMed, Cochrane, Embase, major cardiology conference proceedings, and ClinicalTrials.gov . Studies comparing sexes for outcomes were included. Non‐English publications, abstracts without full text, and studies published before 2010 were excluded. A random‐effects meta‐analysis was performed, with results presented as relative risks (RR) and 95% CIs. Heterogeneity was assessed using τ and I 2 , risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. The study was registered on the International Prospective Register of Systematic Reviews. Results Eleven studies including 738 029 patients with ST‐segment–elevation myocardial infarction (22% women) were analyzed. Female sex was associated with higher unadjusted in‐hospital (RR, 1.56 [95% CI, 1.40–1.74]; τ=0.04; I 2 =0%) and 1‐year mortality rate (RR, 1.78 [95% CI, 1.50–2.12]; τ=0.00; I 2 =0%). Women more frequently had single‐vessel disease (73% versus 60%; RR, 1.13 [95% CI, 1.03–1.23]; τ=0.07; I 2 =67%), while men had 2‐vessel (23% versus 18%; RR, 0.76 [95% CI, 0.68–0.85]; τ=0.00; I 2 =0%;) and 3‐vessel disease (16% versus 9%; RR, 0.49 [95% CI, 0.27–0.86]; τ=0.41; I 2 =33%). Conclusions In young patients with ST‐segment–elevation myocardial infarction, female sex is associated with higher unadjusted in‐hospital and 1‐year death despite less extensive CAD. Further studies adjusting for comorbidities and standardizing CAD definitions are needed.
Bleeding and Thrombotic Trade-off in Dual-Risk Patients Undergoing Percutaneous Coronary Intervention Maria Sara Mauro, Simone Finocchiaro, Dario Calderone, Claudio Laudani, Antonio Greco, et al. Thrombosis and Haemostasis, 2026 Dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention (PCI). Current guidelines recommend 6 to 12 months of DAPT, but managing thrombotic and bleeding risks is challenging, especially in patients with both high bleeding risk (HBR) and high thrombotic risk (HTR). This study aimed to characterize a contemporary dual-risk PCI population (HBR and HTR) and used the Academic Research Consortium (ARC) trade-off model to determine the predominant risk (bleeding or thrombosis) to support personalized DAPT management. All patients who underwent PCI between November 2019 and December 2023 were screened. Dual-risk patients were identified using ARC-HBR criteria for bleeding and European Society of Cardiology (ESC) thrombotic criteria. The ARC trade-off model further stratified these patients into three groups: DRBRTR, based on whether the risk of death from bleeding was lower, similar, or higher than the risk of death from thrombosis. The primary outcome was net adverse clinical events (NACE), defined as a composite of all-cause death, myocardial infarction (MI), stent thrombosis (ST), or major bleeding. Secondary outcomes included individual components of NACE. Among 3,051 PCI patients, 12.4% were identified as dual-risk. The trade-off model stratified these patients into DRBRTR (14.3%) groups. At 18 months, the DRBR>TR group showed a significantly increased risk of NACE (HR 1.77, 95% CI, 1.04 to 3.03, p = 0.03) versus the DRBR=TR group, driven by higher rates of both major bleeding (HR 2.61, 95% CI, 1.08 to 6.67, p = 0.03) and MI/ST (HR 3.36, 95% CI, 1.21 to 9.30, p = 0.02). These findings were confirmed in competing risk analysis using Fine–Gray regression, both for bleeding (HR 3.0, 95% CI, 1.24 to 7.25; p = 0.015) and for thrombotic outcomes (HR 3.13, 95% CI, 1.14 to 8.64; p = 0.027). A contemporary trade-off model successfully stratified the dual-risk population, enabling personalized DAPT strategies for this complex population. Reducing bleeding risk in dual-risk patients may improve clinical outcomes.
Contemporary Use of Coils During Percutaneous Coronary Intervention: Insights From the Multicenter COILSEAL Registry Enrico Cerrato, Giulio Piedimonte, Marco Franzino, Giorgio Marengo, Mario Bollati, et al. Catheterization and Cardiovascular Interventions, 2025 Background Use of coils during percutaneous coronary interventions (PCI) is often life‐saving and useful, although their off‐label use according to the instructions for use. Aims Evaluation of in‐hospital and long‐term outcomes of patients undergoing PCI with coil implantation for treating coronary perforation or closing coronary artery aneurysms/fistulas. Methods Among 245,652 PCIs performed in 17 high‐volume European centers, 143 patients (0.06%) undergoing coil implantation during PCI were finally included in the analysis. PCI strategy (coiling performed during coronary perforation vs. closing aneurysm/fistulas) and procedural devices used were collected. The primary outcome was technical success, defined as the successful sealing of coronary perforation or aneurysm/fistulas, and procedural success defined as technical success without in‐hospital major cardiovascular events (MACE). Long‐term MACE and mortality were also reported. Results The primary outcome occurred in 95.7% of cases, with no significant differences observed between the perforation and aneurysm/fistulas groups (94.5% vs. 100%, p = 0.19). Patients in the perforation group had a significantly lower rate of procedural success (83.5% vs. 96.6%, p = 0.01). Target lesion failure occurred in 11.4% of cases without differences between groups at a median follow‐up of 2 years. Conclusions Coils implantation during PCI is safe and feasible among patients treated for coronary perforations or closing aneurysms/fistulas.
Complete Revascularization Versus Culprit-Only PCI in Acute Coronary Syndrome and Multivessel Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis of 10,150 Subjects From 11 Randomized Studies Dario Calderone, Giuseppe Verolino, Alessandro Cianca, Giuseppe Migliario, Davide Sala, et al. Catheterization and Cardiovascular Interventions, 2025 BackgroundApproximately half of individuals with acute coronary syndrome (ACS) are affected by multivessel coronary artery disease (CAD), and recent studies in the field have presented conflicting data on effective benefit of complete revascularization. The aim of this study was to investigate the efficacy and safety of multivessel percutaneous coronary intervention (PCI) versus culprit‐only PCI in individuals presenting with acute coronary syndrome and multivessel CAD.Methods and ResultsRandomized trials on ACS comparing multivessel PCI versus culprit‐only PCI were included. The primary efficacy outcome was all‐cause death. The primary safety outcomes were major bleeding and contrast induced nephropathy. Secondary ischemic and safety outcomes were also investigated. Subgroup analyses were conducted to investigate the consistency of the effect sizes as a function of age (younger vs older individuals, using a cut‐off of 65 years) and of a higher or lower prevalence of diabetic patients (using a cut‐off of 20% for each study). A total of 11 randomized trials including 10,150 individuals with a mean follow‐up of 21.7 months were included. Compared with cluprit‐only PCI, multivessel PCI significantly reduced the risk of all‐cause death (risk ratio 0.86, [0.74–1.00], p = 0.047), mainly due to a significant reduction in cardiovascular mortality by 26%. Similarly, the rates of new myocardial infarction and unplanned revascularization were significantly reduced. No increases in major bleeding, contrast induced nephropathy or stroke were observed, with a significantly higher rate of stent thrombosis in complete revascularization group, even if with a low absolute risk (risk ratio 1.69 [1.10, 2.59], p = 0.027). Subgroup analyses revealed a significant interaction for death in studies with higher prevalence of diabetics (p for interaction = 0.029), but no interaction for death with regards of age.ConclusionIn individuals presenting with ACS and multivessel CAD, complete revascularization was associated with a significant reduction in all‐cause mortality, with a lower rate of major ischemic events and no significant increase in major complications. The benefit was particularly evident in diabetic patients.
Acurate Neo2 for valve-in-valve treatment of degenerated 3F Enable sutureless bioprosthetic valve in nonagenarian patient: a case report Andres Agustin Vecchia, Giuseppe Migliaro, Paolo Cioffi, Dario Calderone, Giuseppe Verolino European Heart Journal Case Reports, 2025 Background Sutureless bioprosthetic valves (SBVs) are engineered to enable a less invasive surgical valve replacement procedure in patients at high surgical risk. Valve degeneration is a relatively common occurrence across all types of surgical valves, including SBVs. Valve-in-valve (ViV) procedures are increasingly becoming the preferred treatment for many cases of valve degeneration due to their minimally invasive nature and favourable long-term outcomes. However, the specific structural characteristics of SBVs present challenges for ViV procedures, and the evidence on this subject remains limited. Case summary A 91-year-old man was admitted to our hospital presenting with dyspnoea due to severe aortic regurgitation in a degenerated 3F Enable sutureless valve. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) was successfully performed using a self-expanding Acurate Neo2 valve, yielding good haemodynamic results without overt interaction between the prosthesis. A 6-month follow-up echocardiogram confirmed excellent valve performance. Discussion ViV-TAVI is a well-established treatment for bioprosthetic valve failure in high-risk patients. However, sutureless valve degeneration presents a challenging scenario for ViV procedures, with only a limited number of cases performed using the Acurate platform. In this case, we demonstrated the technical feasibility of ViV using the Acurate system in a less explored surgical sutureless bioprosthesis.
Antithrombotic strategies for preventing graft failure in coronary artery bypass graft Maria Sara Mauro, Simone Finocchiaro, Dario Calderone, Carla Rochira, Federica Agnello, et al. Journal of Thrombosis and Thrombolysis, 2024 Coronary artery bypass graft (CABG) procedures face challenges related to graft failure, driven by factors such as acute thrombosis, neointimal hyperplasia, and atherosclerotic plaque formation. Despite extensive efforts over four decades, the optimal antithrombotic strategy to prevent graft occlusion while minimizing bleeding risks remains uncertain, relying heavily on expert opinions rather than definitive guidelines. To address this uncertainty, we conducted a review of randomized clinical trials and meta-analyses of antithrombotic therapy for patients with CABG. These studies examined various antithrombotic regimens in CABG such as single antiplatelet therapy (aspirin or P2Y12 inhibitors), dual antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes including the patency of grafts, major adverse cardiovascular events, and bleeding complications and also explored future perspectives to enhance long-term outcomes for CABG patients. Early studies established aspirin as a key component of antithrombotic pharmacotherapy after CABG. Subsequent randomized controlled trials focused on adding a P2Y12 inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin, yielding mixed results. This article aims to inform clinical decision-making and guide the selection of antithrombotic strategies after CABG.
Clinical Performance of the Gore Septal Occluder in Patent Foramen Ovale Closure in Different Septal Anatomies: 1-Year Results from a Single-Center Experience Giuseppe Verolino, Dario Calderone, Mara Gavazzoni, Davide Sala, Paolo Sganzerla Journal of Clinical Medicine, 2023 Background: PFO (Patent foramen ovale) is a common defect that affects about 25% of the population. Although its presence is asymptomatic in the majority of the cases, the remaining part becomes overt with different symptoms, including cryptogenic stroke. PFO closure is currently a widely available procedure in complex anatomy, with Amplatzer PFO Occluder (APO) being the most commonly used tool. However, the performance of another device, the GORE Septal Occluder (GSO), has not been completely explored with regard to different septal anatomies. Methods: From March 2012 to June 2020, 118 consecutive patients with an indication of PFO closure were treated using the GSO system, included in a prospective analysis, and followed. After 12 months, every patient underwent transcranial Doppler ultrasound to evaluate the effectiveness of treatment. Results: Of 111 patients evaluated, 107 showed effective PFO closure (96.4%), and 4 showed a residual shunt (3.6%). To better evaluate the device performance, the overall population was sorted into two clusters based on the echocardiographic characteristics. The main difference between groups was for PFO width (4.85 ± 1.8 vs. 2.9 ± 1 mm, p < 0.001) and PFO tunnel length (12.6 ± 3.8 vs. 7.2 ± 2, p < 0.001), allowing complex and simple anatomies to be identified, respectively. Regardless of the aforementioned cluster, the GSO performance required to reach an effective closure was independent of anatomy type and the chosen device size. Conclusion: The GSO device showed a high closure rate at 1-year follow-up in patients, with at least one anatomical factor of complexity of PFO irrespective of the level of complexity itself.
Efficacy and Safety of Aspirin for Primary Cardiovascular Risk Prevention in Younger and Older Age: An Updated Systematic Review and Meta-analysis of 173,810 Subjects from 21 Randomized Studies Dario Calderone, Antonio Greco, Salvatore Ingala, Federica Agnello, Gabriele Franchina, et al. Thrombosis and Haemostasis, 2022 Aims The efficacy and safety of aspirin for primary cardiovascular disease (CVD) prevention is controversial. The aim of this study was to investigate the efficacy and safety of aspirin in subjects with no overt CVD, with a focus on age as a treatment modifier. Methods and Results Randomized trials comparing aspirin use versus no aspirin use or placebo were included. The primary efficacy outcome was all-cause death. The primary safety outcome was major bleeding. Secondary ischemic and bleeding outcomes were explored. Subgroup analyses were conducted to investigate the consistency of the effect sizes in studies including younger and older individuals, using a cut-off of 65 years. A total of 21 randomized trials including 173,810 individuals at a mean follow-up of 5.3 years were included. Compared with control, aspirin did not reduce significantly the risk of all-cause death (risk ratio: 0.96; 95% confidence interval: 0.92–1.00, p = 0.057). Major adverse cardiovascular events were significantly reduced by 11%, paralleled by significant reductions in myocardial infarction and transient ischemic attack. Major bleeding, intracranial hemorrhage, and gastrointestinal bleeding were significantly increased by aspirin. There was a significant age interaction for death (p for interaction = 0.007), with aspirin showing a statistically significant 7% relative benefit on all-cause death in studies including younger patients. Conclusion The use of aspirin in subjects with no overt CVD was associated with a neutral effect on all-cause death and a modest lower risk of major cardiovascular events at the price of an increased risk in major bleeding. The benefit of aspirin might be more pronounced in younger individuals.
