Italy: Interventional cardiology in 2025 was shaped by a series of landmark randomized trials that refined procedural strategies, clarified long-term expectations, and accelerated the shift toward personalized, physiology-guided care. In a viewpoint published in the European Heart Journal, Emanuele Barbato, Professor of Cardiology at Sapienza University of Rome, Italy, and colleagues reviewed the 10 most influential interventional cardiology papers of the year, selected for their methodological robustness, clinical relevance, and potential to inform future guideline updates.
The year in interventional cardiology 2025: 10 key takeaways
1. Antiplatelet therapy after PCI is becoming shorter and safer
Evidence from contemporary trials confirmed that early aspirin withdrawal followed by potent P2Y12 inhibitor monotherapy significantly reduces bleeding risk without increasing ischemic events in selected post-MI patients.
2. Very early aspirin discontinuation is feasible in acute coronary syndromes
Stopping aspirin within days of ACS presentation proved non-inferior to standard 12-month dual antiplatelet therapy, reinforcing a move away from prolonged, uniform DAPT strategies.
3. Individualized bleeding risk assessment now drives post-PCI decisions
The balance between ischemic protection and bleeding avoidance has become central, with treatment duration increasingly tailored to patient-specific risk profiles.
4. Precision ischemia mapping is reshaping revascularization strategies
PET-based coronary flow capacity assessment enabled more accurate identification of patients who benefit from revascularization, supporting a shift toward mechanism-guided intervention.
5. Comprehensive care beyond PCI improves long-term outcomes
Integrating precision imaging with aggressive medical therapy and lifestyle modification significantly reduced all-cause mortality, myocardial infarction, and late revascularization.
6. CABG remains the benchmark for complex multivessel coronary disease
Long-term data showed similar survival between surgery and physiology-guided PCI, but CABG continued to reduce myocardial infarction and repeat revascularization.
7. Physiology-guided PCI supports informed shared decision-making
Fractional flow reserve-guided PCI remains a valid option in selected anatomical settings, allowing individualized discussions between clinicians and patients.
8. Intravascular imaging improves outcomes in complex PCI
Optical coherence tomography-guided PCI achieved larger minimal stent areas and lower target-vessel failure rates, reinforcing guideline recommendations for imaging guidance.
9. Immediate non-culprit intervention in STEMI offers no clear benefit
Trials evaluating immediate FFR- or iFR-guided non-culprit PCI failed to show superiority over staged or deferred strategies and highlighted potential safety concerns.
10. Transcatheter valve therapies continue to expand, especially in women
In women with severe aortic stenosis, transcatheter aortic valve implantation demonstrated superior outcomes compared with surgery, supporting broader adoption under updated ESC guidance.
Beyond coronary interventions, 2025 also delivered important advances in structural heart disease. Updated ESC guidelines reinforced the central role of coronary computed tomography in evaluating patients with severe aortic stenosis and expanded indications for transcatheter valve therapies. TAVI emerged as the default strategy in older patients with suitable anatomy, while surgery remains preferred in bicuspid valves unsuitable for transcatheter intervention.
Collectively, the evidence from 2025 reflects a decisive transition in interventional cardiology toward personalized, imaging-guided, and less invasive care. From simplified antiplatelet regimens and precision revascularization to expanded indications for drug-coated balloons and transcatheter valve interventions, these studies are poised to shape future clinical practice and guideline recommendations. As the field continues to evolve, the insights of 2025 mark a significant step toward optimizing outcomes across coronary and structural heart disease.
Reference:
Barbato, E., McEntegart, M., & Gori, T. (2026). The year in cardiovascular medicine 2025: The top 10 papers in interventional cardiology. European Heart Journal, 47(4), 405-407. https://doi.org/10.1093/eurheartj/ehaf1046
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