November 2025 | Issue 79
Featured in this issue:
4 SELECT trial
More data on cardiovascular benefits
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6 Artificial intelligence
Smartwatch detects structural heart disease
18 Profile
Patrick Myers
XXXXX TAVI
T
he latest results from the trial, which are among the longest follow-up data for TAVI in low risk patients, were shared in a late-breaking trial session at the 2025 Transcatheter Cardiovascular Therapeutics (TCT) meeting (25–28 October, San Francisco, USA), presented by Michael Mack (Baylor Scott & White Research Institute, Dallas, USA), and published simultaneously in the New England Journal of Medicine (NEJM). “As TAVI is increasingly performed in younger patients with longer life expectancy, understanding long-term transcatheter and surgical valve durability is essential to inform patientcentred decision-making,” Mack said in his presentation of the results at TCT. The trial enrolled 1,000 patients with severe symptomatic aortic stenosis between March 2016 and October 2017 who underwent either TAVI using the Sapien 3 (Edwards Lifesciences) balloon-expandable valve or surgery for severe aortic stenosis. At the time of randomisation, the mean age was 73.3 years, 69.3% of patients were male, and the mean Society of Thoracic Surgeons (STS) predicted risk of mortality score was 1.9%, Mack detailed. The as-treated population included 496 TAVR and 454 surgery patients. Of those, 495 TAVR and 453 surgery patients received the intended valve. Results at one and two years demonstrated superior or similar results for TAVI for the primary endpoints of death, stroke or rehospitalisation, though data from the trial at five
Tendyne shows promise in MAC
ARTIFICIAL INTELLIGENCE
AI model improves STEMI triage accuracy
PARTNER 3 shows similar outcomes for SAVR and TAVI at seven years in low-risk patients Seven-year outcome data from the PARTNER 3 trial of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in low surgical risk patients with severe, symptomatic aortic stenosis have shown similar rates of death, stroke or rehospitalisation for both therapies, though TAVI’s early advantage has narrowed over time.
22 TMVR
years, presented at TCT in 2023, showed an attenuation of the differences between the two groups in the primary endpoint. From baseline to seven years, the first primary endpoint, consisting of a non-hierarchical composite of death, stroke, or rehospitalisation—defined as being related to the procedure, valve or heart failure—occurred in 37.2% of surgery patients compared with 34.6% of TAVI patients. Death from any cause was 19.5% for TAVI versus 16.8% for surgery, stroke was 8.5% for TAVI versus 8.1% for surgery, and rehospitalisation occurred in 20.6% of TAVI patients compared with 23.5% for surgery. No significant differences were noted in rates of cardiovascular or non-cardiovascular death between TAVI and surgery at seven years.
Understanding longterm transcatheter and surgical valve durability is essential to inform patientcentred decision-making.” The win ratio for the second primary endpoint consisting of a hierarchical composite of death, disabling stroke, non-disabling stroke, and rehospitalisation days was 1.04. Other key assessments including all-cause bioprosthetic valve failure (BVF) per VARC-3 criteria, which stood at 6.9% in the TAVI group and 7.3% in the surgery group, the report of the findings in NEJM detailed. At seven years, 73.4% of the patients in the TAVI group and 75% of the patients in the surgery group were alive without BVF. Aortic valve reintervention was required in 6.7% of TAVI patients and 6% of surgery patients. On functional and health-status endpoints, the investigators
THE USE OF AN ARTIFICIAL intelligence (AI) algorithm to analyse electrocardiograms (ECG) may significantly improve the detection of ST-elevation myocardial infarction (STEMI) and STEMI equivalents, potentially shortening time to treatment and reducing false positive readings. At the 2025 Transcatheter Cardiovascular Therapeutics (TCT) conference (25–28 October, San Francisco, USA) conference, Timothy Henry (The Christ Hospital Medical Center, Cincinnati, USA) presented the results of a retrospective analysis of the STEMI AI ECG model—Queen of Hearts (PMcardio)—using data from over 1,032 patients from three US primary PCI centres. Findings of the analysis were published simultaneously in JACC: Cardiovascular Interventions. Rapid restoration of blood flow using percutaneous coronary intervention (PCI) is the standard of care in STEMI treatment; however, delays in achieving the guidelinerecommended time to reperfusion still persist, especially at centres not specialising in PCI and in rural areas. Time to reperfusion longer than 90 minutes is associated with threefold higher rates of mortality. “We’ve made tremendous progress in the treatment of STEMI over the last 20 years with primary PCI, and we can expect mortality of less than 4%. But there are still challenges,” Henry said, pointing out that in the region of 15–30% of STEMI activations have been shown to be false positives. Added to this, a high proportion may be STEMI equivalents, indicating a coronary occlusion without meeting the specific ST-elevation criteria. The Queen of Hearts AI model has been trained on more than 2.5 million ECGs to identify both typical and atypical occlusions, and to distinguish them from benign patterns like early repolarisation or left ventricular hypertrophy. Continued on page 3
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