Practice-Changing Interventional Cardiology — ACC.26 (Bullet Summary)
Practice-Changing Interventional Cardiology — ACC.26 (Bullet Summary)
• CHIP-BCIS3 (Impella in high-risk PCI):
→ No benefit in 1-year outcomes
→ ↑ vascular complications + possible ↑ CV death
Routine LV unloading not supported
• ALL-RISE (FFRangio – AI angiography-based FFR):
→ Noninferior to wire-based FFR (MACE ~6.9% vs 7.1%)
→ ↓ procedure & fluoroscopy time
Simpler, wire-free physiology
• FAST-III (vFFR):
→ Noninferior to wire-based FFR (MACE identical ~7.5%)
→ ↓ contrast, radiation, procedure time
Angio-derived physiology validated
• ORBITA-CTO (Sham-controlled CTO PCI):
→ ↓ angina + ↑ quality of life
→ No hard events (small study)
True symptomatic benefit confirmed
• Big Picture:
\ Move toward less invasive, physiology-guided, simplified PCI
Re-evaluation of routine mechanical support in stable high-risk PCI