http:www.cardiocirugia.sld.cu

Ann Nucl Med. 2025 Jun 27. doi: 10.1007/s12149-025-02077-w. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to assess the prognostic value of non-perfusion parameters for gated myocardial perfusion imaging (MPI) performed using Cadmium-Zinc-Telluride (CZT) single-photon emission computed tomography (SPECT) for individuals with normal myocardial perfusion.

METHODS: We analyzed data from consecutive patients who underwent thallium-201 MPI SPECT with normal perfusion. Major adverse cardiovascular events (MACEs) were recorded during a 2-year follow-up. Non-perfusion parameters were evaluated as predictors of MACEs.

RESULTS: Among 1570 patients with normal SPECT perfusion, 80 (5.1%) experienced MACEs over a mean follow-up of 22.5 ± 10.8 months: 12 (0.8%) had cardiac death, and 68 (4.3%) underwent coronary revascularization due to significant coronary artery disease. Independent predictors of MACEs included worsening post-stress ejection fraction (HR: 1.971; p = 0.008), and increased lung-to-heart ratio (HR: 2.207; p = 0.001). Kaplan-Meier analysis showed the highest MACEs' incidence in patients with two of these factors (p < 0.001). Among patients with normal resting ejection fraction, EF worsening (OR: 2.16; p = 0.004) and increased lung-to-heart ratio (OR: 1.91; p = 0.0013) both remained strong predictors.

CONCLUSIONS: Although normal myocardial perfusion typically indicates low risk for obstructive coronary artery disease, worsening post-stress ejection fraction and increased lung-to-heart ratio are crucial prognostic indicators. Importantly, these non-perfusion parameters retain their prognostic value even in patients without clinical heart failure, highlighting their relevance in comprehensive risk stratification beyond perfusion assessment alone.

PMID:40576735 | DOI:10.1007/s12149-025-02077-w

J Am Heart Assoc. 2025 Jun 27:e038770. doi: 10.1161/JAHA.124.038770. Online ahead of print.

ABSTRACT

BACKGROUND: In patients presenting with acute coronary syndromes (ACS), impaired coronary blood flow (CBF) after percutaneous coronary interventions (PCI) is linked to mortality. We developed a novel angiography-based approach for blood flow quantification using automatic contrast bolus tracking. Therefore, this study aimed to investigate the clinical impact of angiography-based blood flow quantification on major adverse cardiovascular events (MACE) after PCI in patients with ACS.

METHODS: Prospective, multicenter, nested case-control study of patients presenting ACS. A propensity score was used to match patients with and without MACE at 1 year of follow-up. MACE was defined as cardiovascular death, myocardial infarction, hospitalization for heart failure, or ischemia-driven revascularization. CBF was measured automatically from angiograms after PCI.

RESULTS: One hundred sixty-two patients were included. The mean age was 68.3±13.0 years, 83% were male, and 33% had diabetes. Overall, 66% of patients presented with ST-segment-elevation myocardial infarction. CBF after PCI was lower after ST-segment-elevation myocardial infarction compared with other clinical presentations (74.1±47.0 mL/min ST-segment-elevation myocardial infarction, 89.1±45.8 mL/min, non-ST-segment-elevation myocardial infarction, 95.7±48.8 mL/min, unstable angina, P=0.046). Patients with low post-PCI CBF (<54.3 mL/min) had an increased risk of MACE (hazard ratio, 2.11 [95% CI, 1.35-3.28], P=0.001).

CONCLUSIONS: After PCI, automatic quantification of CBF using angiography was associated with MACE in patients with ACS. Risk stratification using post-PCI CBF-derived angiography may enable tailored management strategies for individuals with ACS.

PMID:40576041 | DOI:10.1161/JAHA.124.038770

Catheter Cardiovasc Interv. 2025 Jun 27. doi: 10.1002/ccd.31724. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary calcified nodules (CNs) are a challenging subset of calcific lesions associated with adverse procedural outcomes. While rotational atherectomy (RA) and balloon angioplasty (BA) have been traditionally used, orbital atherectomy (OA) offers a unique mechanism of plaque modification that may be advantageous in the treatment of CNs. Data on OA in CNs remains limited.

OBJECTIVES: To evaluate procedural success, periprocedural safety, in-hospital and long-term outcomes of retrograde OA in the treatment of CNs.

METHODS: We conducted a retrospective analysis of all patients who underwent OA for angiographically identified coronary calcification between January 1, 2022 and March 31, 2024. A total of 312 patient underwent OA during this period, of whom 57 had a CN identified. Baseline demographics, lesion characteristics, procedural details, and outcomes were assessed. CNs were defined by angiographic or intravascular ultrasound appearance.

RESULTS: The mean age was 71, 71.9% were male, 71.9% had diabetes, 40.3% had CKD and 15.8% had prior coronary artery bypass. The majority of lesions involved the left anterior descending artery (49.1%). Retrograde treatment using a 1.25 mm burr at 80,000 rpms was exclusively used. Angiographic success was achieved in 100% of cases. No perforations or flow-limiting dissections were observed. During an average follow-up of 325.57 ± 233.45 days, there were no cases of early or late stent thrombosis, with one case of very late stent thrombosis. Major adverse cardiac events (MACE) occurred in 5.26% (three patients), comprising myocardial infarction in 3.51% (two patients) and target vessel revascularization in 1.75% (one patient).

CONCLUSIONS: In this real-world, single-center, retrospective analysis, OA was safe and effective in treating coronary CNs, achieving high angiographic success with minimal periprocedural complications. These findings support the use of OA as a viable strategy for CNs, though further studies are warranted.

PMID:40576015 | DOI:10.1002/ccd.31724

Zhongguo Yi Liao Qi Xie Za Zhi. 2025 May 30;49(3):269-275. doi: 10.12455/j.issn.1671-7104.240595.

ABSTRACT

This study investigated a novel coronary knobby scoring balloon through finite element analysis (FEA) and in vitro anti-slippage testing, evaluating its dilation process under various vascular conditions and comparing it with other balloons. The FEA results indicated that in the cases of healthy artery and diseased artery with different stenosis rates, the stress on the vessels caused by the knobby scoring balloon was significantly smaller than that of the scoring balloon, and was close to that of the plain balloon. In vitro anti-slippage testing showed that the slippage distance of a plain balloon was 0.11±0.06 mm, and there was no slippage for knobby scoring balloon under nominal pressure. Knobby scoring balloon can effectively expand calcified lesion while providing anti-slippage function, and has a lower risk of vascular injury.

PMID:40574436 | DOI:10.12455/j.issn.1671-7104.240595

Medicina (Kaunas). 2025 May 26;61(6):984. doi: 10.3390/medicina61060984.

ABSTRACT

Background and Objectives: Postoperative atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG), and is particularly associated with poor outcomes. Heart rate variability (HRV), a non-invasive marker of autonomic function, has been proposed as a tool to predict AF risk, but its utility in off-pump CABG remains unclear. This study aimed to evaluate the predictive value of preoperative HRV parameters, including nonlinear metrics, for postoperative AF in patients undergoing off-pump CABG. Materials and Methods: We prospectively enrolled 67 patients undergoing elective off-pump CABG. HRV was assessed using 15 min high-resolution ECGs. Linear and nonlinear HRV parameters were analyzed. Postoperative AF was monitored through continuous ECG (days 0-4), daily 12-lead ECGs (days 5-7), and a 24 h Holter ECG on day 7. Statistical comparisons between AF and non-AF groups were performed, and the predictive accuracy was evaluated using ROC analysis. Results: Postoperative AF occurred in 40.3% (n = 27) of patients. Standard HRV measures (total power, frequency components, LF/HF ratio) did not differ significantly between groups. However, preoperative DFA Alpha 1 was significantly lower in patients who developed AF (p = 0.010) and showed the highest predictive value (AUC = 0.725, specificity = 80%). Alpha 1 also remained significantly reduced postoperatively in the AF group. Other nonlinear parameters, such as low and average fractal dimension, were also lower postoperatively in the AF group. Conclusions: Traditional HRV parameters showed limited predictive value for postoperative AF following off-pump CABG. The nonlinear DFA Alpha 1 index demonstrated a moderate predictive performance and may serve as a useful marker of autonomic dysregulation. Incorporating nonlinear HRV measures into preoperative assessment may improve AF risk stratification.

PMID:40572672 | PMC:PMC12195077 | DOI:10.3390/medicina61060984

Medicina (Kaunas). 2025 May 25;61(6):975. doi: 10.3390/medicina61060975.

ABSTRACT

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB.

PMID:40572662 | PMC:PMC12195263 | DOI:10.3390/medicina61060975

Circ J. 2025 Jun 24. doi: 10.1253/circj.CJ-24-0644. Online ahead of print.

ABSTRACT

BACKGROUND: Nodular calcification (NC) detected via intracoronary imaging is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). However, the impact of NC detected on pre-PCI non-contrast computed tomography (CT) on clinical outcomes has not been fully investigated.

METHODS AND RESULTS: We retrospectively included 267 consecutive patients with chronic coronary syndrome who underwent electrocardiography-gated non-contrast CT before PCI for severely calcified lesions. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, stroke, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-eight patients had NC detected on non-contrast CT in target lesions. The MACCE-free survival rate was significantly lower in patients with than without NC (P<0.001). All-cause death, cardiac death, and TLR-free survival rates were significantly lower among patients with than without NC. Multivariate Cox regression analysis revealed that hemodialysis (hazard ratio [HR] 3.00; P=0.003), peripheral artery disease (HR 2.65; P=0.01), and the presence of NC (HR 5.25; P<0.001) were independently associated with MACCE. Adding NC to traditional cardiovascular risk factors, peripheral artery disease, and hemodialysis can provide discriminatory and reclassification abilities in predicting MACCE.

CONCLUSIONS: NC detected on non-contrast CT was independently associated with MACCE. Therefore, evaluating NC using preprocedural non-contrast CT may be useful in predicting future clinical outcomes after PCI.

PMID:40571597 | DOI:10.1253/circj.CJ-24-0644

J Nippon Med Sch. 2025 Jun 26. doi: 10.1272/jnms.JNMS.2025_92-609. Online ahead of print.

ABSTRACT

The combination of initial Impella therapy, Impella-supported coronary artery bypass grafting (ISCAB), and postoperative Impella therapy providing antegrade perfusion in myocardial infarction can prove effective. We investigated strategies for Impella stabilization in ISCAB, particularly during peripheral circumflex branch anastomosis. Case 1 was a 70-year-old man treated with an Impella 2.5, followed by urgent ISCAB on the day of hospitalization, for a left main trunk lesion. Use of an apical suction device to position the heart to expose an obtuse marginal branch caused Impella obstruction by applying suction to the left ventricular wall, interrupting revascularization; however, one revascularization was achieved. Case 2 was a 79-year-old man treated with an Impella CP for a three-vessel lesion until ISCAB 4 days later. The Impella was stabilized with appropriate positioning by adjusting the bed angle, minimal heart compression with a deep pericardial stitch without pulling on the cardiac apex, and sufficient preload, even during posterolateral branch anastomosis. Four revascularizations were eventually achieved. Multiple innovations to prevent Impella contact with the left ventricle as described herein improve ISCAB safety, particularly during peripheral circumflex branch anastomosis.

PMID:40571582 | DOI:10.1272/jnms.JNMS.2025_92-609

Int J Cardiol. 2025 Jun 24:133542. doi: 10.1016/j.ijcard.2025.133542. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Shorter DAPT regimens may reduce bleeding but could compromise ischemic protection.

METHODS: This study analyzed data from the ULTRA and BIFURCAT registries, including patients treated with PCI for bifurcation lesions. Patients requiring oral anticoagulation were excluded. DAPT duration was categorized as ≤6 months, 6-12 months and > 12 months. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis. Cox regression analysis was used to assess the association between DAPT duration and MACE.

RESULTS: Among 6729 patients, 425 (6 %) received DAPT ≤6 months, 3446 (51 %) for 6-12 months and 2858 (42 %) for >12 months. At 800-day follow-up, MACE rates were higher with shorter DAPT (19.5 % vs. 10 % vs. 5.9 %, p < 0.001). Adjusted hazard ratios for MACE were significantly higher for DAPT ≤6 months (HR 4.8, 95 % CI 1.8-12.7) and 6-12 months (HR 2.7, 95 % CI:1.5-4.7) compared to >12 months. This trend was consistent in acute coronary syndrome (ACS) patients but not in stable patients.

CONCLUSION: In PCI-treated bifurcation lesions, particularly in ACS patients, shorter DAPT duration (≤6 months) is associated with a higher risk of adverse events. These findings, albeit hypothesis generating, highlight the need to consider bifurcation lesions as a key factor in tailoring DAPT duration and may warrant confirmation in dedicated trials.

PMID:40571129 | DOI:10.1016/j.ijcard.2025.133542

Cureus. 2025 May 26;17(5):e84818. doi: 10.7759/cureus.84818. eCollection 2025 May.

ABSTRACT

ST-elevation criteria miss a substantial number of acute coronary occlusions, resulting in treatment delays and worse prognosis. The Aslanger pattern has been proposed as a new pattern that, despite not meeting the definition of ST-elevation myocardial infarction, represents an acute coronary occlusion. Therefore, patients with this pattern could benefit from early revascularization. The case of a man with acute chest pain is presented, whose initial electrocardiogram showed an Aslanger pattern. Due to the misdiagnosis at the primary care center and the emergency room, the patient did not receive timely optimal management. This case remarks the importance of recognition of this new pattern and its impact on decision-making in patients with acute coronary syndrome.

PMID:40568275 | PMC:PMC12188695 | DOI:10.7759/cureus.84818

Med Sci Monit. 2025 Jun 15;31:e948085. doi: 10.12659/MSM.948085.

ABSTRACT

BACKGROUND Quantitative flow ratio (QFR) is a non-invasive angiographic tool that provides functional assessment of coronary stenosis without the need for pressure wires or hyperemia. This prospective study aimed to evaluate the procedural and inpatient treatment outcomes of QFR-guided percutaneous coronary intervention (PCI) compared with that of angiography-guided PCI in patients with ST-elevation myocardial infarction (STEMI) undergoing staged revascularization of non-culprit lesions. MATERIAL AND METHODS This randomized prospective single-center study was conducted at the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (July 2020-June 2021). After successful culprit-lesion PCI for STEMI, 124 participants with residual angiographically significant non-culprit stenosis (50-75%) were randomized to QFR-guided (n=62) or angiography-guided PCI (n=62). Procedural characteristics, fluoroscopy time, contrast usage, stent number/length, and inpatient treatment outcomes were compared between groups using SPSS 28.0 software. RESULTS Compared with PCI guided by visual estimation alone, the QFR-guided PCI group showed significant reductions in fluoroscopy time (median 6.2 vs 8.0 min, P=0.009), contrast volume (median 100 vs 120 mL, P=0.038), number of stents implanted (median 1.5 vs 2.0, P=0.002), and stent length (median 28 vs 45 mm, P<0.001). No significant differences were found between the groups in terms of periprocedural complications or length of inpatient stay. CONCLUSIONS QFR-guided PCI of the non-culprit lesion resulted in shorter fluoroscopy time, lower contrast volume, and a smaller number and average length of implanted stents. These findings highlight the potential of QFR to enhance procedural efficiency and reduce unnecessary stenting in clinical practice without compromising patient outcomes.

PMID:40566730 | PMC:PMC12178142 | DOI:10.12659/MSM.948085

Med Sci Monit. 2025 Jun 26;31:e948348. doi: 10.12659/MSM.948348.

ABSTRACT

BACKGROUND Many randomized controlled trials have explored the optimal revascularization strategy for patients with diabetes, but real-life outcomes are still poorly investigated. We assessed the complete 6-year outcomes of diabetic individuals with multivessel coronary artery disease (MVD) treated either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). MATERIAL AND METHODS We reviewed data of all patients from 176 local Heart Team meetings and their treatment recommendations and assessed primary and secondary endpoints of 317 MVD patients with diabetes qualified either for CABG or PCI (98 and 219 patients, respectively) with subsequent optimal medical therapy. RESULTS At 6 years, no significant difference in overall mortality was observed (16.3% vs 20.5% for PCI, P=0.38). The incidence of myocardial infarction (MI) was higher in patients treated percutaneously (4.1% vs 12.3% for PCI, P=0.02), while those undergoing CABG had significantly longer postprocedural hospital stay (10.7 vs 4.4 days for PCI, P<0.01). The occurrence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by the increased rate of repeat revascularization (RR), was higher in the PCI group (83.6% vs 44.9%, P<0.01 and 47.0% vs 17.3%, P<0.01, respectively). The rates of stroke and in-hospital mortality were similar between the 2 groups. CONCLUSIONS For MVD patients with diabetes, CABG was superior in real-life clinical practice in terms of rates of MI, RR, and MACCE, while postprocedural hospital stays were shorted with PCI. The rates of all-cause death, stroke, and in-hospital mortality were comparable between groups.

PMID:40566650 | DOI:10.12659/MSM.948348

Life (Basel). 2025 Jun 4;15(6):908. doi: 10.3390/life15060908.

ABSTRACT

BACKGROUND: Matrix metalloproteinase 9 (MMP9) has recently emerged as a risk predictor in patients with cardiovascular diseases (CVD). However, little is known regarding the significance of elevated plasma MMP9 levels in patients during the long-term period following myocardial revascularisation. We aimed to investigate the role of MMP9 in relation to myocardial status before and after myocardial revascularisation and to assess its long-term prognostic value.

METHODS: This prospective observational study included 200 male patients with ischaemic heart disease. All patients underwent direct myocardial revascularisation on a beating heart (off-pump surgery). Plasma MMP9 levels were analysed preoperatively, at 48 h postoperatively, and during the long-term follow-up period (one year postoperatively). Key echocardiographic parameters, specifically left ventricular ejection fraction (LVEF) and Left Ventricular End-Diastolic Volume (LVEDV), were also assessed.

RESULTS: MMP9 levels decreased significantly at 48 h postoperatively (p < 0.0001). During the long-term postoperative period, a clear relationship was demonstrated: higher 1-year MMP9 levels were associated with lower 1-year LVEF, whilst lower 1-year MMP9 levels were associated with higher 1-year LVEF. No significant correlation was observed between preoperative MMP9 levels and age or most other baseline laboratory parameters.

CONCLUSIONS: Our study established an association between 1-year postoperative MMP9 levels and key parameters of left ventricular function during the long-term follow-up period. This suggests that MMP9 may serve as a novel biomarker for predicting outcomes following myocardial revascularisation.

PMID:40566560 | PMC:PMC12194191 | DOI:10.3390/life15060908

J Clin Med. 2025 Jun 17;14(12):4304. doi: 10.3390/jcm14124304.

ABSTRACT

Multiple sclerosis (MS) is a chronic progressive neurodegenerative disease that leads to disabilities such as difficulty moving and slowed cognitive processing. It is the leading non-traumatic cause of disability worldwide. MS also has a high potential to become a model for neurodegenerative diseases with a progression like Alzheimer's or Parkinson's. Cardiovascular diseases (CVDs) remain the leading cause of global deaths and have a considerable economic impact. The higher incidence of cardiovascular comorbidities in patients with MS compared to healthy individuals of the same age worsens the prognosis of neurological pathology, leading to a higher level of disability, poorer physical outcomes, higher depression scores, cognitive aging, and diminished quality of life. Classical observational studies often have questionable elements that can represent a source of error, making it difficult to establish a causal relationship between MS and CVD. Genetic studies, including genome-wide evaluation, may resolve this issue and may represent a topic for future research. We report the case of a 31-year-old male patient with a history of multiple sclerosis (MS) diagnosed seven years prior, who presented with acute chest pain upon returning from vacation. Despite the previous recommendation for disease-modifying therapy, the patient had discontinued treatment by personal choice. Electrocardiography (ECG) revealed ST-segment elevation in inferior leads, and emergent coronary angiography identified severe multi-vessel coronary artery disease (CAD), requiring immediate revascularization. This case highlights the potential cardiovascular risks in young patients with MS and the importance of continuous medical supervision.

PMID:40566048 | PMC:PMC12194425 | DOI:10.3390/jcm14124304

J Clin Med. 2025 Jun 12;14(12):4191. doi: 10.3390/jcm14124191.

ABSTRACT

Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged 65 years and older who had cardiovascular disease and had undergone body composition analysis using dual-energy X-ray absorptiometry (DXA) between November 2021 and October 2022 and been followed through February 2024. Sarcopenia was defined using the 2019 Asian Working Group for Sarcopenia criteria, and visceral obesity was defined using Korean sex-specific visceral adipose tissue area. The primary outcome was a composite of all-cause mortality and major cardiovascular events, including myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: A total of 317 patients were included, of whom 118 patients (37.2%) had sarcopenia, 184 (58.0%) had visceral obesity, and 55 (17.4%) had sarcopenic obesity. The prevalence of sarcopenia or visceral obesity was 93.8% in patients with obesity and 69.3% in those without obesity. Sarcopenic obesity showed a mixture of characteristics of two metabolic conditions in terms of demographics and body mass index. Sarcopenia was associated with an increased risk of primary outcomes (hazard ratio [HR], 1.93; 95% CI, 1.02-3.66), with the highest risk observed in patients with sarcopenic obesity (HR, 6.74; 95% CI, 1.81-25.16). Conclusions: Sarcopenia was associated with 1.9-fold increased risk of cardiovascular events among older adults with CVD, with a greater than 6-fold increased risk when combined with visceral obesity.

PMID:40565935 | PMC:PMC12194000 | DOI:10.3390/jcm14124191

J Clin Med. 2025 Jun 11;14(12):4130. doi: 10.3390/jcm14124130.

ABSTRACT

The current management of patients with acute coronary syndrome (ACS) and bleeding disorders, such as hemophilia, is supported by small retrospective studies or expert consensus documents. Moreover, people with hemophilia are less likely to receive invasive treatments like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for ACS compared to those without hemophilia, which could affect their cardiovascular outcomes. A multidisciplinary team with an expert hematologist is essential to properly define the therapeutic strategy, which should balance both the thrombotic and bleeding risks. We report a clinical case that illustrates an alternative revascularization strategy for hemophilic patients presenting with ACS and with a pattern of diffuse coronary atherosclerotic disease (CAD), encompassing drug-coated balloons (DCBs) in combination with spot stenting. The proposed approach might avoid a full-length drug-eluting stent (DES) implantation and also allow a short dual antiplatelet therapy (DAPT) regimen that is desirable in patients at a very high bleeding risk (HBR) like hemophiliacs. Furthermore, we have provided a review of the available literature on this topic and a focus on the main recommendations for managing ACS, in response to the presented clinical case. Finally, this article aims to share information and develop more confidence in the current guidelines on the treatment of hemophiliacs who need myocardial revascularization.

PMID:40565875 | PMC:PMC12194593 | DOI:10.3390/jcm14124130

Int J Mol Sci. 2025 Jun 6;26(12):5453. doi: 10.3390/ijms26125453.

ABSTRACT

Surgical myocardial revascularization, regardless of the technique used, causes ischemia-reperfusion injury (IRI) in the myocardium mediated by inflammation and degradation of the endothelial glycocalyx (EG). We investigated the difference between on-pump and off-pump techniques in terms of the concentration of proinflammatory interleukin (IL)-18 and the EG degradation products syndecan-1 and hyaluronic acid measured by ELISA in the peripheral and cardiac circulation during open heart surgery and in the early postoperative period. The concentration of IL-18, C-reactive protein (CRP), and cardiac troponin T (cTnT) and the leukocyte count increased statistically significantly in revascularized patients at 24 and 72 h after revascularization compared to the beginning of the procedure and was always statistically significantly higher in on-pump patients. Syndecan-1 and hyaluronic acid only increased in on-pump patients 24 and 72 h after revascularization. IL-18 correlated positively with syndecan-1 and CRP only in the pump setting and with the number of leukocytes in both revascularization regimens 24 and 72 h after the surgery. cTnT and hyaluronic acid did not correlate with IL-18. Our results suggest that IL-18 plays an important role in the early inflammatory response in patients during open heart surgery and in the early postoperative period, leading to additional damage to the EG, while it is probably not responsible for myocardial necrosis. It could serve as a biomarker to identify high-risk patients and as a therapeutic target to reduce inflammation and EG degradation. In addition, measurement of IL-18 could help improve the treatment, recovery, and outcomes of patients after heart surgery.

PMID:40564918 | PMC:PMC12193331 | DOI:10.3390/ijms26125453

Biomedicines. 2025 Jun 14;13(6):1470. doi: 10.3390/biomedicines13061470.

ABSTRACT

Background/Objectives: Polymer-free drug-eluting stents (PF-DESs) aim to mitigate long-term adverse effects associated with polymer-based platforms. However, clinical comparisons with biodegradable polymer DESs (BP-DESs) remain limited. The objective of this review is to assess the efficacy and safety of PF-DESs versus thin-struts (<100 μm) BP-DESs in patients undergoing percutaneous coronary intervention (PCI). Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PF-DESs and BP-DESs in adults undergoing PCI. PubMed, Embase, and CENTRAL were searched up to 1 February 2025. A random-effects model was used to calculate pooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Outcomes included myocardial infarction (MI), all-cause and cardiac death, target lesion revascularization (TLR), stent thrombosis, and angiographic/OCT parameters. Subgroup and sensitivity analyses were conducted for outcomes with high heterogeneity (I2 > 50%). Results: Nine RCTs (n = 9597) were included. At 12 months, no significant differences were found between PF-DESs and BP-DESs for TLR (RR 1.51; 95% CI: 0.83-2.75), MI, or stent thrombosis. At 24 months, MI and all-cause death were similar between groups. A subgroup analysis showed lower cardiac death with the BioFreedom stent (RR 0.57; 95% CI: 0.35-0.90), not observed in non-BioFreedom devices. No significant differences were detected in angiographic or OCT outcomes, though heterogeneity was high. Conclusions: PF-DESs and BP-DESs demonstrated comparable clinical performance. The observed benefit in cardiac death with BioFreedom may reflect device-specific effects and merits further investigation.

PMID:40564189 | PMC:PMC12190656 | DOI:10.3390/biomedicines13061470

Biomedicines. 2025 May 23;13(6):1289. doi: 10.3390/biomedicines13061289.

ABSTRACT

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD.

PMID:40564009 | PMC:PMC12189317 | DOI:10.3390/biomedicines13061289

Cardiovasc Revasc Med. 2025 Jun 21:S1553-8389(25)00312-4. doi: 10.1016/j.carrev.2025.06.027. Online ahead of print.

ABSTRACT

BACKGROUND: Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) of complex coronary lesions is currently recommended by international guidelines. Complex coronary anatomy is observed in up to one third of the patients undergoing coronary interventions and is associated with worse clinical outcomes. Data on lesion characteristics and outcomes are scarce in census-defined minority groups.

METHODS/DESIGN: The Intravascular Ultrasound Guidance for Complex High-Risk Indicated Procedures in Underrepresented Patient Populations (UPP) Registry is a prospective, observational, multicenter, single-arm study describing the safety and efficacy of IVUS-guided PCI in approximately 1010 subjects who self-identify within a demographic minority and undergo complex high-risk procedures. Criteria for optimal stenting include final minimal stent area (MSA) >5 mm2 or MSA >90 % of the distal reference lumen, plaque burden <50 % within 5 mm proximal or distal to stent edges, and absence of edge dissections involving the media and > 3 mm in length. The primary endpoint of target-vessel failure is a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target-vessel revascularization at 1 year. Secondary endpoints include the individual components of the primary end point as well as procedural and imaging endpoints.

SUMMARY: The IVUS CHIP UPP Registry is the first prospective investigation of procedural and clinical outcomes related to an IVUS-guided PCI for management of complex coronary lesions among minority patient populations in the United States.

PMID:40562607 | DOI:10.1016/j.carrev.2025.06.027