http:www.cardiocirugia.sld.cu

Front Cardiovasc Med. 2025 Sep 22;12:1670164. doi: 10.3389/fcvm.2025.1670164. eCollection 2025.

ABSTRACT

Located sinus of Valsalva (SOV) dissection is a rare but critical condition that presents as inferior ST-segment elevation myocardial infarction (STEMI). We present two cases in which computed tomography angiography (CTA) was essential in identifying SOV dissection. In the first case, CTA confirmed a localized dissection of the right SOV. Surgical revascularization was delayed owing to initial diagnostic challenges and the family's hesitation, which ultimately led to a fatal outcome. In the second, intravascular ultrasound (IVUS) confirmed extrinsic compression of the right coronary artery (RCA), and following emergency stent implantation, coronary blood flow was restored, conservative treatment achieved a favorable clinical outcome. These cases highlight the pivotal role of early CTA when angiographic findings are incongruent with the clinical presentation, the utility of IVUS in determining the etiology of coronary artery occlusion, and the critical importance of timely revascularization.

PMID:41059440 | PMC:PMC12497843 | DOI:10.3389/fcvm.2025.1670164

Cardiovasc Diabetol. 2025 Oct 6;24(1):385. doi: 10.1186/s12933-025-02915-1.

ABSTRACT

BACKGROUND: Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.

AIM: This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.

METHODS: Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.

RESULTS: We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.

CONCLUSIONS: This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.

PMID:41053738 | PMC:PMC12502128 | DOI:10.1186/s12933-025-02915-1

Sci Rep. 2025 Oct 6;15(1):34719. doi: 10.1038/s41598-025-18313-2.

ABSTRACT

Vectorcardiography (VCG) enables measurement of voltages and directions of resultant spatial vectors in the heart that are altered by myocardial ischemia. To validate the ability of VCG to detect electrophysiological effects of regional myocardial ischemia and identify blood vessels that obstruct blood flow significantly, VCG records of 37 patients who presented with unstable symptoms of ischemia requiring coronary angiography (CA) were processed and analyzed. The difference in magnitude and direction of electrical vectors were measured before and after percutaneous coronary intervention (PCI) to study the significance of changes after revascularization. Bio amplifiers recorded 3 simultaneous orthogonal lead ECG signals with low-pass frequency of 150 Hz without electronic filtration. The analogue signals were digitized and recorded for analysis. The numerical output was processed by algorithms to calculate and display the state of vectors. 36 of 37 patients showed congruence between VCG and CA results: 34 of the 36 showed changes in electrical vectors and insufficient blood supply. 2 showed no changes in electrical vectors and non-obstructive arteries on CA. 1 patient had ischemia detected by VCG, but CA was negative. Blood vessels that were opened with PCI corresponded with regions of myocardial ischemia and expected coronary blood supply on VCG interpretation.

PMID:41053096 | PMC:PMC12500967 | DOI:10.1038/s41598-025-18313-2

JAMA Netw Open. 2025 Oct 1;8(10):e2535573. doi: 10.1001/jamanetworkopen.2025.35573.

ABSTRACT

IMPORTANCE: Associations of midlife cardiovascular health (CVH), measured once, with incident cardiovascular disease (CVD) are well described. Less is known about patterns of young adulthood CVH, including its changes and associations with later-life CVD outcomes.

OBJECTIVE: To model patterns of change in population-level and individual-level CVH through young adulthood and to assess whether they are associated with incident CVD in later life.

DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective longitudinal cohort study that enrolled Black and White participants at ages 18 to 30 years in 1985 and 1986 with subsequent follow-up examinations during the next 35 years at 4 urban US centers. Participants with at least 3 CVH measurements in young adulthood and subsequent follow-up with assessment of incident CVD events were included. Analyses were conducted from October 26, 2023, to May 15, 2024.

EXPOSURES: CVH was measured using the American Heart Association Life's Essential 8 score. Patterns of CVH change in young adulthood (from examinations at years 0 to 20) were modeled with population-level trajectories and assessed by individual-level CVH status changes.

MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, heart failure, stroke, coronary revascularization, and CVD death) after year 20.

RESULTS: There were 4241 participants in young adulthood (2354 [55.5%] female, 2042 [48.1%] self-identified as Black and 2199 [51.9%] self-identified as White) with a mean (SD) baseline age of 24.9 (3.6) years. In the trajectory analysis, 4 distinct CVH trajectory patterns were identified. Compared with the persistently high CVH trajectory, the moderate-to-low declining and moderate declining CVH trajectories had substantially higher risk for incident CVD. AHRs for incident CVD events ranged from 2.15 (95% CI, 1.04-4.47) in the persistently moderate pattern to 9.96 (95% CI, 4.75-20.86) in the moderate-to-low declining pattern. In the CVH status change analysis (n = 2857), compared with stable moderate CVH in young adulthood, stable high CVH had a lower risk (adjusted hazard ratio [AHR], 0.25 [95% CI, 0.09-0.69]), and stable low CVH had a higher risk (AHR, 5.91 [95% CI, 2.38-14.66]) for incident CVD. Each 10-point decrease in Life's Essential 8 score between years 0 and 20 was associated with a 53% increase in CVD risk (AHR, 1.53 [95% CI, 1.31-1.78]).

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of young adults, unfavorable patterns of CVH change through young adulthood were associated with marked elevations in risk for incident CVD. These data suggest that achieving and maintaining high CVH throughout young adulthood through strategies of primordial prevention are important for prevention of later-life CVD.

PMID:41051778 | PMC:PMC12501802 | DOI:10.1001/jamanetworkopen.2025.35573

Heart Vessels. 2025 Oct 6. doi: 10.1007/s00380-025-02604-9. Online ahead of print.

ABSTRACT

Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are the two major mechanisms of ACS; however, how the vascular endothelial function differs between these etiologies is not well understood. Flow-mediated dilation (FMD) is a method used to evaluate the endothelial function. We aimed to assess endothelial function using FMD in patients with PE and PR. ACS patients (N = 160) who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment were retrospectively enrolled. Culprit plaques were categorized as PE or PR based on OFDI. Based on the median value of FMD (4.1%) in our data, patients were classified into high-FMD (> 4.1%) and low-FMD (≤ 4.1%) groups. Based on the plaque type and FMD values, the patients were divided into PR-HighFMD (N = 48), PR-LowFMD (N = 47), PE-HighFMD (N = 33), and PE-LowFMD (N = 32) groups, and then the clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization, hospitalization for angina or heart failure. FMD was similarly impaired in the PE and PR groups (4.2% vs. 4.1%, P = 0.85). Most clinical characteristics did not differ between the groups. The PR-HighFMD group showed the highest MACE-free survival, followed by the PE-LowFMD (HR = 2.62, CI = 0.58-11.7, P = 0.21), PE-HighFMD (HR = 3.18, CI = 0.76-13.3, P = 0.11), and PR-LowFMD (HR = 5.44, CI = 1.55-19.1, P = 0.008) groups. FMD is likely to have a prognostic impact on patients with ACS, which might vary depending on the culprit lesion.

PMID:41051435 | DOI:10.1007/s00380-025-02604-9

Acta Clin Croat. 2024 Dec;63(3-4):611-618. doi: 10.20471/acc.2024.63.03-04.20.

ABSTRACT

The aim of the study was to determine major adverse cardiac events (MACE) related to the percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) with a second-generation drug eluting stents in patients with previous coronary artery bypass graft (CABG). The research was conducted as a unicenter retrospective observational study which analyzed consecutive patients of both genders who had PCI on SVG from January 1, 2016 until June 30, 2019. The aim was to investigate the occurrence of MACE defined as development of periprocedural myocardial infarction, acute heart failure in the first 24 hours after PCI, unstable angina after PCI, periprocedural stroke, contrast induced nephropathy, death, acute/subacute/late stent thrombosis, and target lesion revascularization. The study included 97 consecutive patients. MACE was recorded in 20.6% of patients, more often in patients with thrombolysis in myocardial infarction grade flow ≤2. High thrombus burden (HTB) was detected in 44.3% of patients and it significantly contributed to the development of MACE. In conclusion, PCI on SVG is a highly challenging procedure, especially in patients with an acute coronary syndrome. In patients who have HTB recorded in SVG, the usage of thrombus aspiration and distal protection device can reduce the frequency of no-reflow phenomenon and consequential MACE.

PMID:41050241 | PMC:PMC12490448 | DOI:10.20471/acc.2024.63.03-04.20

Am J Prev Cardiol. 2025 Aug 19;23:101080. doi: 10.1016/j.ajpc.2025.101080. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: : Smoking is a preventable risk factor for incident cardiovascular disease. The impact of smoking status and potential benefits of smoking cessation in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA) remain poorly understood.

METHODS: : In this prospective single-center cohort study, 1179 patients with MINOCA were classified as non-, ex-, or current smokers based on smoking status at baseline. Current smokers were further categorized as persistent smokers or quitters due to their continued tobacco use or cessation within 1 year after MI. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure.

RESULTS: : At multivariate Cox analysis, current smoking was independently associated with an increased risk of MACE compared to non-smokers over the median follow-up of 41.7 months [adjusted hazard ratio (aHR) 1.53; 95 % confidence interval (CI): 1.22-1.89, p < 0.001], whereas ex-smokers had a similar risk of MACE to non-smokers. Current smokers with ≥10 pack-years of exposure had a higher risk of MACE, and a near-linear trend was noted between cumulative smoking and MACE risk. Individuals who continued smoking had a significantly higher risk of MACE compared to quitters (aHR 1.70; 95 % CI: 1.17-2.47, p = 0.005). The benefits of smoking cessation remained consistent in subgroup and sensitivity analyses. Smokers who had substantial cigarette reduction or switched to E-cigarettes might also have a lower risk of MACE.

CONCLUSIONS: : Current smokers had worse outcomes as compared to non-smokers after MINOCA. Smoking cessation was associated with a reduced risk of adverse events, indicating the necessity of sustained smoking cessation in MINOCA population.

PMID:41049512 | PMC:PMC12490529 | DOI:10.1016/j.ajpc.2025.101080

Am Heart J Plus. 2025 Sep 18;59:100621. doi: 10.1016/j.ahjo.2025.100621. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Postoperative atrial fibrillation (POAF) can occur in up to 53.1 % of patients undergoing cardiac surgery. This serious condition has been associated with increased risk of morbidity and mortality during the initial weeks after the procedure. In this updated meta-analysis, we aim to study the impact of POAF on outcomes in patients undergoing CABG surgery.

METHODS: We searched PubMed, Scopus, Cochrane Library, and WOS from inception till April 15, 2024. The pooled effect sizes were mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes and a 95 % confidence interval (CI).

RESULTS: A total of 247,270 patients from 50 studies were included. Mean age ranged between 56.5 and 76 years and mean follow-up time duration ranged from six months to 15 years. In-hospital, 30-days, and long-term mortality were significantly higher in patients with POAF compared to patients without POAF with (OR: 2.37; 95 % CI: 1.45-3.87; P = 0.0033), (OR: 2.33; 95 % CI: 1.74-3.13; P < 0.01), and (OR: 2.15; 95 % CI: 1.8-2.54; P < 0.01respectively. In terms of stroke, both short- and long-term strokes were significantly higher in patients with POAF with (OR: 2.54; 95 % CI: 2.05-3.15; P < 0.01) and (OR: 1.92; 95 % CI: 1.37-2.68; P < 0.0007), respectively. Although POAF has significant longer hospital and intensive care unit stay and higher risk for post-operative renal failure and myocardial infarction, there was no significant difference in revascularization and reintubation rates in patients with POAF with (OR: 1.11; 95 % CI: 0.48-2.54; P = 0.656) and (OR: 2.72; 95 % CI: 0.86-8.67; P = 0.0742), respectively. The need for intra-aortic balloon pump was higher in POAF group with (OR: 1.84; 95 % CI: 1.42-2.37; P < 0.01) as well as the risk of developing heart failure with OR: 1.8; 95 % CI: 1.43-2.26; P = 0.0012.

CONCLUSION: Our findings suggest that POAF group may be associated with higher short-term mortality, long-term mortality, and length of hospital and ICU stay in patients undergoing CABG. Furthermore, there was a higher association between POAF and some postoperative complications such as stroke, acute renal failure, acute heart failure, and pneumonia. However, POAF did not seem to significantly affect rates of acute MI and reintubation.

PMID:41049259 | PMC:PMC12494572 | DOI:10.1016/j.ahjo.2025.100621

Eur Heart J Open. 2025 Sep 17;5(5):oeaf118. doi: 10.1093/ehjopen/oeaf118. eCollection 2025 Sep.

ABSTRACT

AIMS: Over recent decades, numerous measures have been implemented to improve treatment and timely intervention for ST-elevation myocardial infarction (STEMI). For deeper insights into the current state of care, this study investigates whether patient outcomes differ based on the timing of presentation (on-hours vs. off-hours) for primary percutaneous coronary intervention (PCI) for STEMI.

METHODS AND RESULTS: Data from STEMI PCIs performed from 2017 to October 2020, as registered within the Netherlands Heart Registration (NHR), were analysed. Off-hours presentation was defined as arrival at the catheterization laboratory (cath lab) on weekends, during working days between 17.00 and 08.00, or Monday between midnight and 08.00. Short-term outcomes included 30-day all-cause mortality and acute MI within 30 days. Long-term outcomes included all-cause mortality rates up till 5 years after PCI, target vessel revascularization within 1 year, and repeat revascularization with elective or non-STEMI PCI. The study included 19 090 STEMI patients from 17 centres, with 11 719 (61.4%) PCIs performed on-hours. No significant difference in 30-day mortality was observed between on-hours and off-hours patients (5.7% vs. 5.8%). On-hours patients had a longer time from symptom onset to cath lab arrival (≤6 h: 80.2% vs. 84.4%, P < 0.001) and were less likely to present with out-of-hospital cardiac arrest (7.6% vs. 9.5%, P < 0.001). No statistically significant differences in long-term outcomes were observed after adjusting for confounders.

CONCLUSION: Outcomes after primary PCI for STEMI are comparable between on-hours and off-hours presentations. The quality of care appears to be independent of time of arrival at the cath lab.

PMID:41048405 | PMC:PMC12492485 | DOI:10.1093/ehjopen/oeaf118

Am J Cardiol. 2025 Oct 3:S0002-9149(25)00556-9. doi: 10.1016/j.amjcard.2025.09.008. Online ahead of print.

ABSTRACT

Surgical revascularization is still considered the gold standard for patients with complex coronary artery disease and left ventricular dysfunction. The advent of Impella has sparked growing interest, yet current evidence on its efficacy remains inconclusive. All studies reporting outcomes beyond 30 days outcomes of pPCI with any Impella device were included. Pooled effect of estimated outcomes was calculated according to a random-effect model with generic inverse variance weighting. Primary endpoint was all-cause mortality. Secondary outcomes were myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. Six studies globally encompassing 1,581 patients were included in the quantitative analysis. Median age was 70 years old (IQR 69 to 72) with a median left ventricular ejection fraction (LVEF) of 27 % (SD ± 6) and a SYNTAX SCORE of 31 (IQR 29 to 35). Impella 2.5 was the most common micro axial flow pump used to support high-risk PCI. All-cause of death was observed in 13.4% (95% CI: 10.4 to 16.4) of patients at 6 months median follow-up. Myocardial infarction occurred in 5.8% (95% CI 3.4 to 8.1) of patients, repeat revascularization in 9.1% (95% CI: 4.8 to 13.3) of patients, stroke in 1.6% (IQR 1.2 to 2.1) of patients and, finally, heart failure rehospitalization in 8.4% (95% CI 3.3 to 13.6) of patients. In conclusion, for high-risk patients, PCI with the Impella device represented a viable strategy with an acceptable risk profile when surgical revascularization is not an option, and a poor prognosis is predicted.

PMID:41046995 | DOI:10.1016/j.amjcard.2025.09.008

Am Heart J. 2025 Oct 2:107284. doi: 10.1016/j.ahj.2025.107284. Online ahead of print.

ABSTRACT

Complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease reduces major adverse cardiac events (MACE) compared with incomplete revascularization, although whether survival is improved is uncertain. For this systematic review and meta-analysis, all randomized trials of complete vs. incomplete revascularization in patients with acute MI without cardiogenic shock were identified from PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to December 31, 2024. The primary and major secondary endpoints were MACE and all-cause mortality derived from reconstructed time-to-event individual-patient-data from published Kaplan-Meier curves. Additional outcomes included cardiovascular mortality, MI, and unplanned repeat revascularizations. Outcomes were expressed as hazard ratios with 95% confidence intervals. This study was registered with the PROSPERO (number, CRD42023415428). A total of nine randomized trials with 9,658 patients (86.8% with STEMI) were identified among whom 4,671 (48.4%) patients had complete revascularization. Patients with complete revascularization had a lower 5-year risk of MACE (HR: 0.59, 95% CI: 0.54 to 0.66, p<0.001) compared with incomplete revascularization. Complete revascularization was also associated with lower 5-year risks of all-cause mortality (HR: 0.64, 95% CI: 0.56 to 0.72, p<0.001), cardiovascular mortality (HR: 0.82, 95% CI: 0.71 to 0.95, p=0.008), MI (HR: 0.69, 95% CI: 0.55 to 0.87, p<0.001), and unplanned repeat revascularizations (HR: 0.62, 95% CI: 0.54 to 0.71, p<0.001). Complete revascularization results in lower risks of all-cause and cardiovascular mortality, MI, unplanned repeat revascularizations and MACE in patients with acute MI and multivessel disease. These results support current guidelines recommending CR in hemodynamically stable patients with STEMI, emphasizing that this approach may improve survival.

PMID:41046115 | DOI:10.1016/j.ahj.2025.107284

J Vasc Surg. 2025 Oct 2:S0741-5214(25)01778-1. doi: 10.1016/j.jvs.2025.09.044. Online ahead of print.

ABSTRACT

BACKGROUND: Beyond patient factors, recent evidence has suggested that institutional characteristics may contribute to persistent racial disparities in carotid revascularization following acute ischemic stroke. Minority-serving hospitals (MSH) care for a disproportionately high number of historically underserved populations and thus may contribute to observed disparities.

METHODS: All adults (≥ 18 years) admitted for acute ischemic stroke due to carotid artery stenosis were identified in the 2016-2021 Nationwide Inpatient Sample. Patients with missing key data, elective status or admitted to hospitals performing ≤5 carotid revascularization procedures per year (≤5th percentile), were excluded. Carotid revascularization comprised of endarterectomy or stenting. The outcomes of interest were receipt of carotid revascularization, in-hospital mortality, myocardial infarction (MI), and a composite of both measures (death/MI), along with postoperative length of stay, hospitalization costs, and non-home discharge. Multivariable regression models were developed to evaluate the association of MSH with outcomes of interest.

RESULTS: Of the hospitals included in the analysis, 28.9% were classified as MSH. Revascularization rate for these patients significantly increased for both MSH (2016: 16.5%, 2021: 20.5%, nptrend = 0.02) and non-MSH (2016: 20.1%, 2021: 22.0%, nptrend < 0.01), over the study period. Following risk adjustment, treatment at MSH was associated with significantly reduced odds of receiving revascularization (AOR 0.80, CI 0.74-0.87), relative to others. MSH status was linked with similar in-hospital mortality (AOR 1.15, CI 0.96-1.22), but increased odds of MI (AOR 1.17, CI 1.02-1.34) and death/MI (AOR 1.14, CI 1.04 - 1.25). Treatment at these centers was associated with prolonged LOS (β +0.45 days, CI 0.14-0.76) and hospitalization expenditures (β +$5,800, CI 4,510-7,080), along with increased relative risk of non-home discharge (AOR 1.10, CI 1.05 - 1.18) compared to non-MSH. Despite decreased revascularization use for Black and Asian patients across all centers, Hispanic race was linked with reduced odds of revascularization solely at MSH.

CONCLUSION: Providing increased resources to support MSH may be an effective strategy to ensure equal health access to racial/ethnic minority patients. Future studies incorporating hospital quality initiatives targeted for MSH are warranted.

PMID:41046049 | DOI:10.1016/j.jvs.2025.09.044

Am J Cardiol. 2025 Oct 2:S0002-9149(25)00601-0. doi: 10.1016/j.amjcard.2025.09.048. Online ahead of print.

ABSTRACT

OBJECTIVES: Diabetes mellitus (DM) is a known risk factor for cardiac events in patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether specific stent types improve long-term outcomes in this population. This substudy of the Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) IX trial compared long-term outcomes in patients with DM with either the polymer-free biolimus A9-coated BioFreedom stent (BF-BES) or the ultra-thin strut, biodegradable polymer sirolimus-eluting Orsiro stent (O-SES).

METHODS: SORTOUT IX was a randomized, non-inferiority trial allocating patients to BF-BES or O-SES. The primary endpoints was target lesion failure (TLF), consisting of cardiac death, target lesion-related myocardial infarction (MI), and target lesion revascularization (TLR), and stent thrombosis within 5 years in patients with DM.

RESULTS: Among 3,151 patients enrolled, 607 (19.3%) had DM (BF-BES: 304; O-SES: 303). At 5-year, TLF was higher for patients with DM than those without DM (19.9% vs. 11.4%, rate ratio (RR) 1.48; 95% confidence interval (CI) 1.15-1.91). In patients with DM, TLF was similar between BF-BES and O-SES (21.7% vs. 18.2%; RR 1.11; 95% CI; 0.76-1.62). Rates of cardiac death, TLR and stent thrombosis did not differ significantly. In-stent restenosis was higher for BF-BES within 1 year (4.6% vs. 1.0%; RR 4.20; 95% CI 1.20-14.7), but not after 5 years (5.9% vs. 10.2%; RR 1.56; 95 % CI 0.85-2.85).

CONCLUSION: In patient with DM undergoing PCI, rates of TLF, cardiac death, target MI, TLR and stent thrombosis did not differ between BF-BES and O-SES after 5 years.

PMID:41045957 | DOI:10.1016/j.amjcard.2025.09.048

Korean Circ J. 2025 Jul 14. doi: 10.4070/kcj.2024.0400. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: CENTUM is a biodegradable everolimus-eluting stent comprising a cobalt-chromium open-cell stent platform. In this prospective trial, we aimed to evaluate the effectiveness and safety of CENTUM™ in a clinical setting.

METHODS: A prospective, single-arm, multi-center observational registry was designed to assess the clinical outcomes after CENTUM implantation in all-comers who underwent percutaneous coronary intervention. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization at 12 months. The secondary endpoints included stent thrombosis and other clinical events (all-cause death, myocardial infarction, stroke, target vessel revascularization, and bleeding).

RESULTS: Total 490 patients were enrolled, and 451 completed the study. The mean age was 67.1 years, and 52.8% of the patients presented with acute coronary syndrome. The primary endpoint was observed in 1.11% of the patients. Definite/probable stent thrombosis was observed in 0.44% of the patients, whereas total clinical events recorded was 4.43%.

CONCLUSIONS: CENTUM was effective and safe at 12 months in all patients who underwent percutaneous coronary intervention. Our findings support the broader application of CENTUM in patients with coronary artery disease.

TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0009898.

PMID:41044739 | DOI:10.4070/kcj.2024.0400

Korean Circ J. 2025 Aug 21. doi: 10.4070/kcj.2025.0103. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The optimal grafting strategy for ischemic cardiomyopathy (ICMP) remains uncertain despite the growing heart failure population undergoing coronary artery bypass grafting (CABG). This study sought to explore the outcomes of CABG in ICMP patients according to the number of inflow sources.

METHODS: A total of 447 patients with an ejection fraction (EF) of ≤35% who underwent isolated CABG from 2009 to 2020 were analyzed. Patients were categorized into either a single inflow source group (single group, n=203), in which unilateral in situ internal thoracic artery (ITA) served as the sole inflow, or a multiple inflow source group (multiple group, n=244), utilizing additional inflow sources from the aorta or contralateral ITA. The primary outcome was all-cause mortality, analyzed after adjustment using the inverse-probability-of-treatment-weighting method.

RESULTS: There were no differences in the early outcomes between 2 groups. After adjustment, the single group exhibited significantly worse survival compared to the multiple group during a median follow-up of 5.3-years (adjusted hazard ratio, 1.88; 95% confidence interval, 1.26-2.80; p=0.001), particularly in the subgroup of patients without a recent myocardial infarction within 1 month (p=0.005) and those with an EF of ≥25% (p=0.007). At the last follow-up echocardiography (>6 months), the multiple group showed a significantly higher postoperative EF (p=0.009) and a smaller left ventricular end-systolic dimension (p=0.027) compared to the single group, which had not shown significant differences preoperatively.

CONCLUSIONS: In ICMP patients, CABG using multiple inflow sources was associated with improved outcomes, particularly in those without recent or profound myocardial injury.

PMID:41044726 | DOI:10.4070/kcj.2025.0103

Int J Cardiovasc Imaging. 2025 Oct 3. doi: 10.1007/s10554-025-03529-0. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the predictive value of hibernating myocardium (HM) proportion in total perfusion deficit (TPD) for reverse left ventricular (LV) remodeling and its prognostic significance in heart failure with reduced ejection fraction (HFrEF) patients after revascularization.

METHODS: A retrospective analysis of 201 HFrEF patients (178 males, 60.6 ± 9.3 years) who underwent gated myocardial perfusion imaging, 18F-FDG cardiac PET/CT, and echocardiography was performed. Patients were followed for a median of 13.0(7.0) months and received follow-up echocardiography 6 months post-revascularization. Reverse remodeling (RR) was defined as ≥ 10% reduction in LV end-systolic diameter (LVESD). Logistic regression identified predictors of RR, with the predictive value of HM/TPD validated in a prospective cohort (n = 30). Changes were expressed as Δ(post-pre).

RESULTS: HM/TPD independently predicted RR (OR = 1.042, 95%CI: 1.019-1.065, P < 0.001). A HM/TPD cutoff of 38.5% demonstrated significant associations with reversed LV remodeling and improved cardiac function post-revascularization, along with a favorable prognosis. The prospective cohort validated these findings. ΔTPD positively correlated with ΔHM (r = 0.825, P < 0.001).

CONCLUSIONS: Higher HM/TPD proportion in HFrEF patients was associated with an increased likelihood of RR, improved cardiac function, and favorable outcomes post-revascularization. These findings warrant further prospective investigations.

PMID:41044300 | DOI:10.1007/s10554-025-03529-0

JACC Case Rep. 2025 Oct 1;30(30):105279. doi: 10.1016/j.jaccas.2025.105279.

ABSTRACT

BACKGROUND: F-18 flurpiridaz is a novel radiotracer approved for positron emission tmography (PET) myocardial perfusion imaging. Its long half-life supports exercise stress testing, and its short positron range and high myocardial extraction fraction provide superior image resolution.

EARLY REPORTS SUMMARY: A 70-year-old man with known coronary artery disease and prior coronary revascularization underwent exercise cardiac PET with F-18 flurpiridaz for chest discomfort. PET showed ischemia in the left anterior descending and right coronary artery territories. Coronary angiography revealed a severe mid-left anterior descending lesion and a severe proximal lesion in a small-caliber right posterior descending artery.

DISCUSSION: Ischemia on PET correlated with coronary angiography and optical coherence tomography, guiding revascularization and altering clinical management.

NOVELTY: This case represents the first post-approval clinical experience of F-18 flurpiridaz with exercise cardiac PET imaging in the United States.

TAKE-HOME MESSAGE: F-18 flurpiridaz has made exercise cardiac PET feasible in the clinical setting.

PMID:41043909 | DOI:10.1016/j.jaccas.2025.105279

Cureus. 2025 Aug 31;17(8):e91368. doi: 10.7759/cureus.91368. eCollection 2025 Aug.

ABSTRACT

BACKGROUND AND OBJECTIVE: Acute coronary syndromes (ACS), particularly those affecting the left main coronary artery (LMCA), are associated with high morbidity and mortality. The objective of the present study was to investigate long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for ACS affecting the LMCA compared to those with non-LMCA involvement.

METHODS: This interventional study was conducted at the Department of Cardiology of MH Shamorita Medical College Hospital in Dhaka, Bangladesh, from January 2023 to June 2024. A total of 101 patients with ACS who underwent PCI participated in the study. Of whom, 51 were in the LMCA group and 50 were in the non-LMCA group. Follow-up assessment was done at the third, sixth, and 12th months, focusing on major adverse cardiovascular events (MACE) as the primary endpoint and persistent symptoms, repeat revascularization, and stent thrombosis as secondary endpoints.

RESULTS: The mean age of the LMCA and non-LMCA groups was 56 and 54 years, respectively, with a higher female proportion in the LMCA group. The patients in the LMCA group presented with more complex lesions, with a mean synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score of 23.6. The MACE rate was notably higher in the LMCA group at 6%, compared to 2% in the non-LMCA group (p=0.013). Myocardial infarction (MI) occurred in 4% of the LMCA group, with no events in the non-LMCA group. Persistent symptoms and repeat revascularization were also more prevalent in the LMCA group (6% and 4%, respectively, p-value <0.05).

CONCLUSIONS: Patients with ACS involving the LMCA experienced higher rates of adverse outcomes, particularly MI and repeat revascularization, following PCI compared to non-LMCA cases.

PMID:41041103 | PMC:PMC12485219 | DOI:10.7759/cureus.91368

Front Endocrinol (Lausanne). 2025 Sep 17;16:1665292. doi: 10.3389/fendo.2025.1665292. eCollection 2025.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index is a reliable surrogate marker for insulin resistance, and is associated with cardiovascular diseases. However, the specific impact of TyG index on coronary plaque vulnerability and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study aimed to investigate the association of the TyG index with coronary plaque characteristics and clinical outcomes.

METHODS: Between January 2017 to December 2019, 1,831 STEMI patients who underwent optical coherence tomography imaging were retrospectively enrolled. Patients were divided into three groups based on TyG index tertiles (Group T1: <8.82, Group T2: 8.82-9.41, Group T3: ≥9.41). Major adverse cardiovascular and cerebrovascular events (MACCE) included cardiac death, non-fatal stroke, non-fatal myocardial infarction, ischemia-driven revascularization, and rehospitalization.

RESULTS: The average age was 58.7 years, and 72.1% were male. The incidence of plaque rupture, thin-cap fibroatheromas, macrophages, and the size of lipid core, increased with increasing TyG index tertiles (all P<0.05). Multivariate logistic regression analysis showed that TyG index independently predicted culprit plaque rupture (T2: OR 1.39, 95%CI 1.06-1.82; T3: OR 1.51, 95%CI 1.05-2.16; T1 as reference). During a median follow-up of 4.2 years, 541 (29.9%) patients developed MACCE. Patients in the highest TyG index tertile had a significantly higher cumulative incidence of MACCE (43.5% vs. 37.3% vs. 31.1%, P = 0.007) than the other two groups. After adjusting for clinical risk factors and coronary plaque features, the increased TyG index independently predicted MACCE (HR 1.18, 95%CI 1.00-1.38, per unit increased). This association was notable in patients without diabetes but was not demonstrable in diabetes (interaction P-value <0.05).

CONCLUSIONS: In patients with STEMI, elevated TyG index increased atherosclerotic plaque vulnerability, and independently predicted plaque rupture. A higher TyG index was an independent predictor of MACCE, especially for patients without diabetes.

PMID:41040860 | PMC:PMC12483882 | DOI:10.3389/fendo.2025.1665292

medRxiv [Preprint]. 2025 Sep 27:2025.09.22.25336403. doi: 10.1101/2025.09.22.25336403.

ABSTRACT

BACKGROUND: Revascularization for Chronic Limb-Threatening Ischemia (CLTI) may be performed with an endovascular (Endo) or open surgical (Bypass) approach.

OBJECTIVE: To evaluate the cost-effectiveness of Endo versus Bypass surgery for CLTI using data from the Best Endovascular versus Best Surgical Therapy for Patients with CLTI (BEST-CLI) trial.

METHODS: We developed an individual-level continuous time Markov model that included health states representing the occurrence of adjudicated clinical events from BEST-CLI. Rates of clinical outcomes and health utilities were derived directly from trial data. Costs came from Medicare insurance claims data and physician fee schedule. We calculated the incremental cost per life years gained, incremental quality-adjusted life years (QALYs) gained, incremental net monetary benefit (INMB) and cost per major events of amputation, revascularization, and myocardial infarction (MI) or stroke avoided over a 5- and 10-year time horizon. Sensitivity analyses were performed using a Monte Carlo simulation.

RESULTS: In base case analyses conducted over a 5-year time horizon, the mean per person direct medical costs were $227,341 (95% Credible Interval [CrI]: $173,075, $291,443) for Bypass and $243,614 (95% CrI: $190,112, $305,605) for Endo. The mean survival per person was 3.91 years (95% CrI: 3.78, 4.03) for Bypass and 3.88 years (95% CrI: 3.68, 4.06) for Endo. This resulted in Endo being dominated by Bypass surgery with respect to costs per life year gained. The mean QALYs per person were 2.48 (95% CrI: 1.11, 3.49) for Bypass and 2.54 (95% CrI: 1.39, 3.40) for Endo, resulting in an incremental costs per QALY gained of $263,973/QALY and an INMB of -$10,109 (95% CrI: -$168,908, $157,433) at a $100,000/QALY willingness-to-pay threshold for Endo vs. Bypass. The results over 10 years were consistent with those of the 5-year follow-up. In the Monte Carlo simulation, there was only a 55% chance that Bypass was more cost-effective than Endo.

CONCLUSION: In the base case analysis, Bypass was the preferred strategy with respect to survival and QALYs, at conventional willingness to pay thresholds. There was substantial uncertainty around these estimates in probabilistic sensitivity analysis, justifying future research to identify subgroups for whom each of these approaches may definitively be cost-effective.

PMID:41040676 | PMC:PMC12485972 | DOI:10.1101/2025.09.22.25336403