http:www.cardiocirugia.sld.cu

Curr Opin Cardiol. 2025 Nov 1;40(6):390-394. doi: 10.1097/HCO.0000000000001252. Epub 2025 Sep 24.

ABSTRACT

PURPOSE OF REVIEW: Minimally invasive coronary artery bypass grafting (MICS CABG) offers the benefits of surgical revascularization without sternotomy but remains underutilized due to technical demands and a lack of structured training. This review outlines a stepwise framework for safe adoption.

RECENT FINDINGS: Studies and real-world experience confirm that off-pump CAB (OPCAB) proficiency, systematic technical progression, and mentorship in high-volume centers are essential for safe learning. Recent training innovations and simulator-based techniques improve outcomes and reduce complications during the learning curve.

SUMMARY: Wider adoption of MICS CABG hinges on structured training rooted in OPCAB, technical sequencing, and surgical mentorship. Programs emphasizing patient safety, proper case selection, and skill development can expand access to minimally invasive coronary surgery.

PMID:41025333 | DOI:10.1097/HCO.0000000000001252

Circ Cardiovasc Imaging. 2025 Sep 30:e018368. doi: 10.1161/CIRCIMAGING.125.018368. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary computed tomography angiography (CCTA) could evaluate myocardial fibrosis as well by estimating extracellular volume fraction (ECV). While coronary microvascular dysfunction (CMD) has been increasingly recognized as an important pathophysiological mechanism underlying chest pain, the association between CMD in angina with nonobstructive coronary artery disease (ANOCA) and CCTA-derived ECV remains to be elucidated. We sought to evaluate the association between CCTA-derived ECV and CMD in patients with ANOCA.

METHODS: We retrospectively analyzed 57 patients with ANOCA from a single center who underwent CCTA on ECV protocol with subtraction method (including precontrast and 7-minute delayed postcontrast) and invasive functional testing using pressure-temperature sensor-tipped wire. Patients with significant epicardial stenosis (fractional flow reserve ≤0.80 or stenosis on computed tomography ≥50%), prior history of revascularization, known myocardial infarction, or heart failure were excluded. CMD was defined as a coronary flow reserve of <2.5 in any of the vessels evaluated. Standard transthoracic echocardiography assessed diastolic dysfunction (DD).

RESULTS: Among the 57 patients included, 26 (45.6%) were diagnosed with CMD. CMD was significantly associated with age, NT-proBNP (N-terminal pro-B-type natriuretic peptide) level, calcium score, DD, and higher ECV. In a multivariable logistic regression analysis, a CCTA-derived ECV >31.9% (the optimal cutoff value derived from receiver operating characteristic curve analysis) was independently associated with CMD (odds ratio, 10.50 [95% CI, 2.34-47.40]; P=0.002). DD also emerged as an independent predictor (odds ratio, 17.90 [95% CI, 2.53-127.00]; P=0.004). The addition of elevated ECV to a clinical model including DD significantly enhanced the discrimination efficacy for CMD (area under the receiver operating characteristic curve, 0.742 versus 0.854; P=0.019).

CONCLUSIONS: In patients with ANOCA with CMD, ECV was significantly elevated, alongside a higher prevalence of DD. These findings suggest that ECV and DD may serve as pivotal markers for personalized management strategies in patients with CMD with ANOCA disease.

PMID:41025226 | DOI:10.1161/CIRCIMAGING.125.018368

World J Cardiol. 2025 Sep 26;17(9):110061. doi: 10.4330/wjc.v17.i9.110061.

ABSTRACT

BACKGROUND: Stable angina pectoris, a clinical manifestation of coronary artery disease (CAD), is commonly evaluated using non-invasive diagnostic tools. Traditionally, stress testing modalities such as exercise electrocardiography (ECG), myocardial perfusion imaging (MPI), and stress echocardiography have been the first-line strategies. However, coronary computed tomography angiography (CCTA), an anatomic imaging modality, is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden. Despite growing adoption, the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy, prognostic value, and clinical outcomes in stable angina remains an area of active debate.

AIM: To compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.

METHODS: A comprehensive literature search was performed across PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines. Only randomized controlled trials (RCT) published in English within the last 15 years were included. Studies involving adult patients (≥ 18 years) with stable angina or low-risk chest pain were selected. The intervention was CCTA, and the comparators included ECG, MPI, and stress echocardiography. Data were extracted using a standardized process, and study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Due to heterogeneity in outcome measures and modalities, narrative synthesis was employed.

RESULTS: Five high-quality RCTs encompassing a total of 5551 patients were included. CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies. It was more effective in predicting major adverse cardiac events, including myocardial infarction and cardiac death, and was associated with fewer unnecessary invasive coronary angiographies and better event-free survival. Studies also reported improved revascularization rates in patients evaluated with CCTA, particularly within tiered diagnostic protocols. Stress testing, while useful, showed limitations in sensitivity and downstream clinical decision-making.

CONCLUSION: CCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina, especially those with intermediate pretest probability of CAD. Compared to conventional stress testing, it enhances risk stratification, reduces unnecessary procedures, and may improve long-term outcomes. These findings support its broader integration into diagnostic pathways for stable angina.

PMID:41024970 | PMC:PMC12476583 | DOI:10.4330/wjc.v17.i9.110061

World J Cardiol. 2025 Sep 26;17(9):110220. doi: 10.4330/wjc.v17.i9.110220.

ABSTRACT

BACKGROUND: Peripheral endovascular intervention (PEVI) is performed using radiation. Radiation has deleterious health consequences for patients and operators.

AIM: To investigate the gender radiation disparities and procedural outcomes in PEVI.

METHODS: A prospective observational study was performed in 186 consecutive patients (65 ± 12 years) at an academic medical center from January 2019 to April 2020 (mean follow-up of 3.9 ± 3.6 months) comparing the gender radiation disparity and outcomes of PEVI (n = 147 underwent intervention, 79.0%). Groups were divided into women (n = 99, 53.2%) and men (n = 87, 48.4%). Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use. Secondary endpoints included all-cause mortality, acute myocardial infarction, acute kidney injury, stroke, repeat revascularization, major adverse limb event, and the composite of complications.

RESULTS: Men showed increased DAP compared with women (15221.2 ± 25858.5 µGy × m2 vs 9251.7 ± 9555.3 µGy × m2, P = 0.047), but no significant difference in air kerma or any other primary endpoints. In the secondary endpoints, no significant difference was found between gender.

CONCLUSION: Men had increased DAP indicating more radiation absorption in the exposed area. Gender outcomes showed no difference in complications. Thus, PEVI can be safely performed in men or women.

PMID:41024969 | PMC:PMC12476585 | DOI:10.4330/wjc.v17.i9.110220

World J Cardiol. 2025 Sep 26;17(9):111044. doi: 10.4330/wjc.v17.i9.111044.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are well-established treatments for multivessel coronary artery disease (CAD), a condition where multiple heart arteries are narrowed. A newer approach, fractional flow reserve (FFR)-guided PCI, uses a specialized measurement to select which artery blockages to treat, aiming to enhance patient outcomes. Despite its adoption, the comparative effectiveness of FFR-guided PCI vs CABG remains unclear, particularly regarding key health outcomes such as survival, heart-related complications, and the need for further procedures.

AIM: To evaluate the safety and effectiveness of FFR -guided PCI compared to CABG in patients with multivessel CAD.

METHODS: This meta-analysis followed standard reporting guidelines and included randomized controlled trials (RCTs) comparing FFR-guided PCI with CABG in patients with multivessel CAD. We searched medical databases, including PubMed, EMBASE, ScienceDirect, and ClinicalTrials.gov, from their start to May 2025. We calculated combined risk ratios (RRs) with 95% confidence intervals (95%CIs) to analyze the data.

RESULTS: Three RCTs were analyzed. There was no notable difference in all-cause mortality between FFR-guided PCI and CABG (RR = 1.01, 95%CI: 0.78-1.31, P = 0.93). However, FFR-guided PCI showed higher rates of major adverse cardiac events (MACEs; RR = 1.30, 95%CI: 1.11-1.52, P = 0.001), myocardial infarction (RR = 1.49, 95%CI: 1.11-2.01, P = 0.009), and repeat revascularization (RR = 2.25, 95%CI: 1.78-2.85, P < 0.00001). Stroke rates were comparable between the two treatments (RR = 0.80, 95%CI: 0.54-1.20, P = 0.28).

CONCLUSION: FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD. However, CABG results in fewer MACEs, myocardial infarctions, and repeat procedures.

PMID:41024968 | PMC:PMC12476596 | DOI:10.4330/wjc.v17.i9.111044

World J Cardiol. 2025 Sep 26;17(9):110403. doi: 10.4330/wjc.v17.i9.110403.

ABSTRACT

BACKGROUND: Optical coherence tomography (OCT) offers detailed cross-sectional imaging during percutaneous coronary intervention (PCI), aiding in anatomically complex coronary lesions. Despite its advantages, evidence on the clinical effectiveness of OCT-guided PCI remains limited.

AIM: To compare clinical outcomes of OCT-guided vs angiography-guided PCI in patients with complex lesions.

METHODS: Major databases were systematically searched for randomized controlled trials (RCTs) comparing OCT-guided and angiography-guided PCI in complex lesions. Primary outcomes included major adverse cardiovascular events (MACE) and target vessel failure (TVF); secondary outcomes included mortality, myocardial infarction (MI), and other procedural outcomes. A random-effects model was used to pool risk ratio (RR), with 95%CI. Statistical analysis was conducted in R software (v4.4.1), with significance set at P < 0.05.

RESULTS: Five RCTs (5737 patients) showed OCT-guided PCI significantly reduced MACE (RR: 0.63, 95%CI: 0.52-0.77, P < 0.01), TVF (RR: 0.68, 95%CI: 0.56-0.83, P < 0.01), all-cause (RR: 0.58, 95%CI: 0.38-0.87, P < 0.01) and cardiac mortality (RR: 0.43, 95%CI: 0.24-0.76, P < 0.01), target-lesion revascularization (RR: 0.53, 95%CI: 0.33-0.84, P < 0.01), stent thrombosis (RR: 0.52, 95%CI: 0.31-0.86, P = 0.01), and target-vessel MI (RR: 0.64, 95%CI: 0.42-0.97, P = 0.04) vs angiography-guided PCI. Periprocedural MI, any revascularization, target-vessel revascularization, and contrast-associated kidney injury were similar between groups.

CONCLUSION: OCT-guided PCI improves outcomes in complex lesions by reducing MACE, TVF, mortality, stent thrombosis, and target-vessel MI. These findings highlight the need for further large-scale RCTs to confirm its benefits.

PMID:41024966 | PMC:PMC12476618 | DOI:10.4330/wjc.v17.i9.110403

BMC Cardiovasc Disord. 2025 Sep 29;25(1):700. doi: 10.1186/s12872-025-05186-6.

ABSTRACT

BACKGROUND: The European Society of Cardiology (ESC) recently endorsed low-dose colchicine for chronic coronary syndrome. However, its role in acute coronary syndrome (ACS) remains uncertain due to inconsistent trial outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of colchicine in patients with ACS.

METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted through April 2025 to identify randomized controlled trials (RCTs) evaluating colchicine in adults with ACS. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke, myocardial infarction (MI), major adverse cardiovascular events (MACE), coronary revascularization, and gastrointestinal (GI) adverse events. Data were pooled using a random-effects model to estimate relative risks (RRs) with 95% confidence intervals (CIs), using the longest available follow-up.

RESULTS: Eleven RCTs encompassing 12,730 patients were included. Among them, 6,844 received colchicine for at least one month, while 5,886 received placebo or no additional treatment. Colchicine did not significantly reduce all-cause mortality (RR 0.95, 95% CI: 0.79-1.14) or cardiovascular mortality (RR 1.03, 95% CI: 0.82-1.29). No significant reductions were observed in MACE, MI, stroke, or coronary revascularization. Colchicine was associated with a non-significant trend toward increased GI adverse events, particularly at higher doses.

CONCLUSION: This meta-analysis does not support the routine use of colchicine in ACS management. While generally safe, colchicine did not confer clear cardiovascular benefits in this setting. However, potential subgroup effects, such as in longer-term use or among specific high-risk populations, warrant further investigation in future large-scale, well-designed trials.

PMID:41023831 | PMC:PMC12482528 | DOI:10.1186/s12872-025-05186-6

Commun Med (Lond). 2025 Sep 29;5(1):402. doi: 10.1038/s43856-025-01098-w.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting(CABG) has long been the preferred treatment for left main coronary artery disease(LMCAD), although percutaneous coronary intervention(PCI) has been increasingly utilized. Despite numerous investigations seeking to identify the optimal revascularization strategy for LMCAD, limitations in sample size or follow-up duration have hindered definitive conclusions. Herein, we compare the long-term outcomes up to 14 years after CABG or PCI for patients with LMCAD.

METHODS: Data was retrospectively collected from a provincial database. The inclusion criteria is patients ≥18 years old, with LMCAD, and revascularization with CABG or PCI. The primary outcome is all-cause mortality. Secondary outcomes are any rehospitalization, myocardial infarction (MI), stroke, or repeat revascularization. Outcomes are adjusted for age, sex, and clinical comorbidities. The average age of the patients was 67 ± 9 years for the CABG patients and 71 ± 11 years for the PCI patients. 84.7% of the CABG patients and 71.5% of the PCI patients were male.

RESULTS: 5580 patients are identified with LMCAD between 2009 and 2018. 1706 patients (1180 CABG; 526 PCI) are included in the final analysis and followed until March 31, 2023. Rates of mortality at longest follow-up of 14 years are 40.0% for CABG and 58.4% for PCI (adjusted hazard ratio(aHR) 0.58, 95% confidence interval(CI) 0.48-0.70, p < 0.001). Rates of MI (10.7% vs 22.3%, aHR 0.40, 95% CI 0.29-0.55, p < 0.001) and repeat revascularization (5.4%vs16.3%, aHR 0.25, 95% CI 0.18-0.36, p < 0.001) favor CABG over PCI.

CONCLUSIONS: Patients with LMCAD undergoing CABG experience significant benefit over PCI in terms of long-term mortality, MI, and required repeat revascularization. These finding suggest CABG should remain the preferred revascularization strategy for patients with LMCAD and acceptable surgical risk. Future studies should explore evolving PCI techniques and their impact on long-term outcomes.

PMID:41023142 | PMC:PMC12480625 | DOI:10.1038/s43856-025-01098-w

BMJ Open. 2025 Sep 28;15(9):e104578. doi: 10.1136/bmjopen-2025-104578.

ABSTRACT

INTRODUCTION: Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease, particularly in patients with multivessel disease. Connecting the saphenous vein graft (SVG) to the right internal mammary artery (RIMA) instead of the aorta has been proposed as an alternative approach to minimise aortic manipulation and potentially improve graft patency. This study aims to determine whether the RIMA-SVG technique is non-inferior to the conventional Aorta (Ao)-SVG approach in terms of 1-year graft patency, while also comparing perioperative complications and short-term clinical outcomes.

METHODS AND ANALYSIS: This non-inferiority, single-centre, prospective, double-blind, randomised clinical trial will enrol 300 patients undergoing CABG. Participants will be randomised into two surgical groups (RIMA-SVG vs Ao-SVG). The primary outcome is the 1-year SVG patency rate, assessed using coronary CT angiography. Secondary outcomes include perioperative complications, all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and surgical site infections occurring during hospitalisation and up to 1 year postoperatively. Randomisation will be computer-generated, and all procedures will be performed by experienced surgeons. Patients will be followed up 12 months post-surgery. Non-inferiority will be established if the upper bound of the one-sided 97.5% CI for the difference in graft occlusion rates is less than the prespecified non-inferiority margin of 10%.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Second Hospital of Jilin University (No. 460) and registered at ClinicalTrials.gov (NCT06787651). All participants will provide written informed consent before enrolment. To ensure data integrity and minimise bias, randomisation details will be concealed from researchers until surgery, and data analysts will remain blinded to group assignments. The findings will be disseminated through academic journals and conference presentations to promote knowledge sharing and clinical application in the field of cardiovascular surgery.

TRIAL REGISTRATION NUMBER: NCT06787651.

PMID:41022447 | PMC:PMC12481333 | DOI:10.1136/bmjopen-2025-104578

Crit Care Nurs Q. 2025 Oct-Dec 01;48(4):389-400. doi: 10.1097/CNQ.0000000000000577. Epub 2025 Aug 22.

ABSTRACT

Respiratory complications are among the most common issues post coronary artery bypass grafting (CABG), with atelectasis being one of the most serious respiratory consequences. This study aims to evaluate the association between positive end-expiratory pressure (PEEP) levels and post-CABG atelectasis, investigate demographic risk factors associated with atelectasis, and determine the timing pattern of atelectasis development. A retrospective analysis was conducted on data from 268 CABG patients. Three PEEP levels-5, 8, and 10 cm H2O were considered. Demographic information and postoperative outcomes were collected using a self-developed data collection tool. The study took place at a tertiary care hospital in Nablus, West Bank. Higher PEEP levels, especially at 10 cm H2O, were associated with a reduction in pulmonary atelectasis. Smoking emerged as a significant factor influencing atelectasis, while interventions such as spirometry and early thoracic drainage showed positive effects in reducing the incidence of atelectasis. Furthermore, higher PEEP levels were associated with a shorter hospital stay after CABG. This study has highlighted the importance of optimal PEEP adjustment in improving respiratory outcomes and reducing recovery time post-CABG.

PMID:41021683 | DOI:10.1097/CNQ.0000000000000577

Am Heart J Plus. 2025 Sep 13;59:100610. doi: 10.1016/j.ahjo.2025.100610. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Inflammation is associated with an increased risk of adverse cardiovascular events in patients with coronary artery disease (CAD). Colchicine is an anti-inflammatory drug that can be used to improve clinical outcomes in patients with CAD.

METHODS: A systematic literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane CENTRAL up to August 2025 to identify randomized controlled trials (RCTs) that reported clinical outcomes with the use of colchicine in CAD. Data for outcomes was extracted and summary estimates were generated using a random effects model.

RESULTS: 16 RCTs were included reporting data for 20,601 patients. The pooled analysis demonstrated a non-significant difference between colchicine and control groups for reducing all-cause death (RR: 0.97; 95 % CI, 0.78-1.22), cardiovascular death (RR: 0.98; 95 % CI, 0.79-1.21), and stroke (RR: 0.67; 95 % CI, 0.39-1.15). However, colchicine significantly reduced the risk of myocardial infarction (RR: 0.74; 95 % CI, 0.59-0.93), and ischemia-driven revascularization (RR = 0.72; 95 % CI, 0.53-0.99) at the expense of an increased risk of gastrointestinal adverse events (RR = 1.83; 95 % CI, 1.38-2.43) as compared to control.

CONCLUSION: Colchicine does not reduce the relative risk of all-cause and cardiovascular death in patients with CAD. However, it can reduce the risk of myocardial infarction and ischemia drive revascularization. Additional trial data are required to confirm these findings.

PMID:41019029 | PMC:PMC12465056 | DOI:10.1016/j.ahjo.2025.100610

Open Forum Infect Dis. 2025 Sep 15;12(9):ofaf561. doi: 10.1093/ofid/ofaf561. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: It is unknown whether delayed antiretroviral therapy (ART) initiation worsens CVD outcomes in people with HIV (PHIV). This study compared CVD event rates between PHIV who were randomized to receive immediate versus deferred ART.

METHODS: ART-naïve adult PHIV with CD4+ counts > 500 cells/µL were randomized to immediate versus deferred ART initiation. Event rates for the main composite CVD outcome (myocardial infarction, coronary artery disease requiring revascularization, stroke and CVD-related death) were estimated for: (i) pre-2016 (treatment arms as designed); (ii) post-1Jan2016 (ART use similar across arms); and (iii) entire study follow-up period. Subgroup analyses were performed according to baseline characteristics.

RESULTS: Among 4684 participants (median age 36 years, 27% female, 30% Black race), 32% were smokers and 17% had a BMI ≥ 30 kg/m2. Comorbidities included hypertension (19%), dyslipidemia (8%), diabetes (3%); 0.8% had a history of CVD. The median time to ART initiation was 2.5 years (interquartile range [IQR] 1.6-3.5 years) in the deferred arm and 7 days (IQR 2-17 days) in the immediate arm. Over the entire study follow-up period (median follow-up of 9.3 years), 71 participants (35 immediate, 36 deferred) experienced a CVD event with no difference in CVD event rates between the immediate and deferred arms (0.17 vs 0.17 per 100 person-years, respectively); these findings were consistent across the pre-2016 and post-1Jan2016 periods. There were 58 CVD events among males (33 immediate; 25 deferred) and 13 among females (2 immediate; 11 deferred). A possible benefit of immediate ART was seen in females but not males (Hazard Ratio = 0.19 [95% confidence interval: 0.04-0.86] vs 1.33 [0.79-2.24]; interaction P-value = .014), though numbers of events were low.

CONCLUSIONS: Early versus deferred ART initiation was not associated with reduced CVD events. The potential benefit associated with immediate ART in female participants warrants further evaluation.

PMID:41018697 | PMC:PMC12461870 | DOI:10.1093/ofid/ofaf561

Cureus. 2025 Aug 28;17(8):e91175. doi: 10.7759/cureus.91175. eCollection 2025 Aug.

ABSTRACT

Background Acute coronary syndrome (ACS) is a common emergency presentation. The C-reactive protein-to-albumin ratio (CAR) serves as a composite marker reflecting both systemic inflammation and nutritional status and may enhance prognostic accuracy in myocardial infarction (MI). Objective To assess the prognostic utility of the CAR in predicting disease severity and major adverse cardiac events (MACE) among patients with ST-elevation myocardial infarction (STEMI). Methodology A cross-sectional, observational, prospective study was conducted on 203 patients with STEMI who presented to the outpatient and emergency departments between November 2023 and May 2025. Demographic and clinical data were collected. Thrombolysis in myocardial infarction (TIMI) scores were calculated, and serum C-reactive protein and albumin levels were measured within 24 hours of admission. The primary outcome was in-hospital mortality, while MACE, including reinfarction, revascularization, heart failure, and death, was assessed at 28 days through follow-up. Results Among the participants, the in-hospital mortality rate was 14 (6.9%), and the 28-day incidence of MACE was 38 (18.7%). Notably, MACE occurred more frequently in patients with elevated CAR, even among those with lower TIMI scores, suggesting that CAR may be a more sensitive early predictor of adverse outcomes. CAR demonstrated superior prognostic performance, with an area under the curve (AUC) of 0.726 compared with 0.668 for the TIMI score. Conclusions A CAR threshold greater than 0.568 was identified as clinically useful for early risk stratification in patients with STEMI. These findings support the integration of CAR into routine assessments to improve early prognostic evaluation and guide clinical decision-making.

PMID:41018414 | PMC:PMC12476131 | DOI:10.7759/cureus.91175

Cureus. 2025 Aug 27;17(8):e91092. doi: 10.7759/cureus.91092. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction (CMD) is increasingly recognized as a contributor to adverse cardiovascular outcomes in patients with diabetes mellitus (DM), yet it remains underdiagnosed. This is largely because routine evaluation is limited by the need for complex, time-consuming, and not routinely performed diagnostic methods, which primarily focus on macrovascular disease.

OBJECTIVE: To prospectively evaluate the association between CMD and major adverse cardiovascular events (MACE) - defined as myocardial infarction, hospitalization for heart failure, and cardiovascular death - in patients with type 2 diabetes without obstructive coronary artery disease (CAD).

METHODOLOGY: We conducted a prospective observational study at Shifa College of Medicine, Islamabad, from August 2022 to July 2024. A total of 264 adults with type 2 DM of five or more years' duration and non-obstructive CAD (<50% stenosis on angiography/CT) were consecutively enrolled. Exclusion criteria included type 1 diabetes, left ventricular ejection fraction <50%, significant structural or valvular heart disease, prior revascularization, acute coronary syndrome at baseline, and incomplete data. CMD was diagnosed using transthoracic Doppler echocardiography, with coronary flow reserve (CFR) <2.0 considered abnormal in accordance with current consensus. CFR was measured in the left anterior descending artery by two independent operators blinded to outcomes, with reproducibility assessed in a subset. Patients were followed for 24 months; loss to follow-up (7.95%) was excluded from survival analyses. Multivariate Cox regression adjusting for age, sex, hypertension, dyslipidemia, BMI, and diabetes duration was performed, with hazard ratios (HR) and 95% confidence intervals (CI) reported.

RESULTS: Among 264 patients (mean age 58.0 ± 8.1 years, 56.8% male), 142 (53.8%) had CMD. Follow-up was completed in 243 patients (CMD: 128, non-CMD: 115). CMD patients experienced significantly more MACE (29.7% vs. 10.4%, p<0.001). On multivariate analysis, CMD remained an independent predictor of MACE (HR 2.41, 95% CI 1.39-4.16, p=0.002), myocardial infarction (HR 2.28, 95% CI 1.01-5.16, p=0.047), and heart failure hospitalization (HR 2.85, 95% CI 1.19-6.80, p=0.018). Cardiovascular mortality was higher in CMD (7.8% vs. 2.6%), while non-cardiovascular mortality was similar between groups. Event-free survival was significantly shorter in CMD patients on Kaplan-Meier analysis.

CONCLUSION: CMD strongly and independently predicts long-term adverse cardiovascular outcomes in patients with type 2 diabetes without obstructive CAD, even after adjusting for conventional risk factors such as hypertension and smoking. Early detection of CMD using CFR assessment may improve risk stratification and guide preventive management in this high-risk population.

PMID:41018312 | PMC:PMC12465086 | DOI:10.7759/cureus.91092

J Clin Epidemiol. 2025 Sep 26:112001. doi: 10.1016/j.jclinepi.2025.112001. Online ahead of print.

ABSTRACT

OBJECTIVES: To address the limitations of existing models for research and population health applications in older adults with type 2 diabetes, we developed and validated cardiovascular disease (CVD) and heart failure risk models using linked Medicare claims and electronic health records (2013-2020).

STUDY DESIGN AND SETTING: The study included adults >65 years with type 2 diabetes and ≥1 HbA1c measurement before cohort entry (defined as the date of a physician/outpatient visit). Using LASSO and XG-boost machine learning algorithms, we predicted 1-year risks of a composite cardiovascular event (myocardial infarction, stroke, coronary artery revascularization, or hospitalization for heart failure). Separate models were developed for patients with and without baseline CVD using claims-only and claims-EHR predictors. Models were trained on 70% of the data and validated on 30%. Model performance was evaluated using c-statistics for discrimination, scaled Brier scores, and calibration curves. We externally validated the models in Clinformatics commercial and Medicare Advantage claims data.

RESULTS: There were 14,776 patients with baseline CVD [mean (SD) age: 77(8) years] and 10,679 without baseline CVD [mean (SD) age: 74 (7) years]. Claims-only models achieved a c-statistic of 0.75 and a Brier score of 0.09 in patients with baseline CVD, while in those without baseline CVD, the c-statistic was 0.73 and the Brier score was 0.01. For both subgroups, calibration intercepts were ∼0, with slopes ∼1. Claims-EHR models provided similar performance.

CONCLUSION: In older adults with diabetes, our models predicted one-year cardiovascular outcomes with good discrimination and accuracy, independently of CVD history.

PLAIN LANGUAGE SUMMARY: Older adults with type 2 diabetes have a high risk of heart disease, heart failure, and death, yet it is difficult to predict who is most at risk. Most existing prediction tools are designed for use during a single clinic visit, not for large healthcare databases that researchers use to study treatment safety and effectiveness. In this study, we developed computer-based models using Medicare claims data and, for some models, additional information from electronic health records (EHR). These models predicted the chance of having a major heart event or dying within one year. We created separate models for people with and without existing heart disease, because their risk factors differ. Our models accurately predicted risk in both groups. Adding EHR data did not improve performance compared to using claims data alone. This means that claims-only models can still be useful for researchers studying treatments in large healthcare databases. These models can help identify people at higher risk, guide research on diabetes medications, and support better planning for healthcare resources.

PMID:41016516 | DOI:10.1016/j.jclinepi.2025.112001

Interdiscip Cardiovasc Thorac Surg. 2025 Sep 27:ivaf237. doi: 10.1093/icvts/ivaf237. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to determine whether the anatomical burden of prior percutaneous coronary intervention(PCI) influences long-term outcomes after coronary artery bypass grafting, beyond the impact of intervention presence alone.

METHODS: This retrospective study analyzed consecutive patients undergoing coronary artery bypass grafting at a single institution between 2000 and 2024. The inclusion criteria comprised isolated, non-emergent surgery. Patient categorization was based on prior PCI-treated lesions: none, single, or multiple. The primary endpoint was long-term overall survival. The secondary endpoints included cardiac death, myocardial infarction, stroke, heart failure hospitalization, and repeat revascularization. Long-term outcomes were assessed using Kaplan-Meier analysis and Cox multivariable models, adjusting for 26 clinical factors.

RESULTS: Of 2,442 patients, 1,205 met the inclusion criteria (755 none, 227 single-lesion, 223 multiple-lesion intervention). Over a median follow-up of 12.0 (interquartile range, 11.3-12.9; maximum: 24.2) years, the multiple-lesion intervention group had higher rates of in-hospital acute kidney injury (34.1% vs. 21.1% vs. 24.2%, P = 0.003). Overall survival differed significantly between groups over the follow-up period (log-rank P = 0.004), with 15-year survival rates of 35.8%, 46.0%, and 48.0% for multiple-lesion, single-lesion, and no prior PCI groups, respectively. After adjustment, multiple-lesion intervention was associated with increased risks of cardiac death (adjusted subdistribution hazard ratio: 1.91), myocardial infarction (2.26), and repeat revascularization (1.92) compared with no prior intervention.

CONCLUSIONS: Multiple-lesion PCI was associated with higher long-term risks of cardiac death, myocardial infarction, and repeat revascularization, while stroke risk was similar. Single-lesion PCI showed outcomes comparable to no prior PCI except for higher heart failure hospitalization. These findings require confirmation in larger, multicenter comparative studies to address residual confounding.

PMID:41014500 | DOI:10.1093/icvts/ivaf237

Heart Vessels. 2025 Sep 27. doi: 10.1007/s00380-025-02605-8. Online ahead of print.

ABSTRACT

Fractional flow reserve (FFR) is an invasive standard, and resting full-cycle ratio (RFR), a non-hyperemic pressure ratio, is an alternative to FFR for evaluating the functional severity of coronary stenosis. However, the prognostic impact of coronary revascularization in vessels with discordant results of FFR and non-hyperemic pressure ratios remains unclear. This single-center study included 212 vessels in 191 patients with intermediate coronary stenosis and discordant results of FFR and RFR. FFR ≤ 0.80 and RFR ≤ 0.89 were considered physiologically positive. Vessels with discordant results of FFR and RFR were divided into two groups according to the revascularization strategies-the deferral and revascularization groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization. Of the 212 vessels, 145 (68.4%) and 67 (31.6%) were categorized as the deferral and revascularization groups, respectively. The deferral group was more likely to be older and women than the revascularization group. FFR values were higher, and the rate of positive FFR was lower in the deferral group than in the revascularization group. During the median follow-up of 406 days, 12 of 212 (5.7%) developed TVF. The Kaplan-Meier analysis demonstrated that the TVF rate was significantly lower in the revascularization group than the counterpart (7.6% vs. 1.5% at 3 years, P = 0.046). In conclusion, coronary revascularization in vessels with discordant results of FFR and RFR was associated with lower TVF rates as compared with the deferral strategy.

PMID:41014328 | DOI:10.1007/s00380-025-02605-8

BMC Cardiovasc Disord. 2025 Sep 26;25(1):671. doi: 10.1186/s12872-025-05155-z.

ABSTRACT

BACKGROUND: Contemporary practice in coronary and valve interventions continues to evolve with changing indications, technology, and systems of care. I characterized statewide procedure volumes and mortality for PCI, CABG, Valve ± CABG, and TAVR using a unified, internally consistent analytic framework.

METHODS: I analyzed New York State public-use registry data (2010-2019). All PCI and Non-Emergency PCI are reported annually. Emergency PCI was derived annually at the hospital-year level as All PCI - Non-Emergency PCI; deaths and expected deaths were derived by subtraction and aggregated statewide. CABG is reported annually. Valve ± CABG and TAVR are provided as overlapping 3-year windows; I produced annualized values by averaging the per-year contribution from the two windows that include each year (single window at edges; TAVR available 2013-2019). Statewide Observed %, Expected %, O/E, and Risk-Adjusted % were computed as case-weighted aggregates. No hypothesis testing was performed.

RESULTS: From 2010 to 2019, there were 1,005,980 PCI and 171,182 CABG procedures statewide. Overall PCI volume was stable (2010: 108,070; 2019: 108,552). Within PCI, Non-Emergency comprised 835,480 (83.1%) and Emergency 170,500 (16.9%); non-emergency PCI declined modestly (2010: 93,498 → 2019: 89,654), while emergency PCI increased (2010: 14,572 → 2019: 18,898). CABG volumes were broadly stable (2010: 18,842 → 2019: 17,876). Annualized Valve ± CABG volumes declined (≈ 14,822 in 2010 → 11,893 in 2019), whereas TAVR expanded after introduction (2013: 3,703 → 2019: 9,963). Pooled risk-adjusted mortality: All PCI 1.11%, Non-Emergency PCI 0.72%, Emergency PCI 3.07%, CABG 1.53%, Valve ± CABG 3.27% (2010-2019), and TAVR 2.93% (2013-2019). Across procedures and years, O/E ≈ 1.00, indicating good model calibration.

CONCLUSIONS: Between 2010 and 2019, statewide PCI volume was stable; non-emergency PCI declined modestly, emergency PCI rose modestly, CABG volumes were broadly stable, Valve ± CABG decreased, and TAVR increased substantially with improving mortality. Overall PCI mortality remained low and largely stable, consistent with higher-risk case mix over time. These contemporary benchmarks can inform quality improvement, capacity planning, and policy while highlighting the need for continued monitoring of high-risk PCI pathways and long-term TAVR durability in younger patients.

PMID:41013313 | PMC:PMC12465987 | DOI:10.1186/s12872-025-05155-z

Medicina (Kaunas). 2025 Aug 27;61(9):1545. doi: 10.3390/medicina61091545.

ABSTRACT

Background and Objectives: Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) commonly occur after coronary artery bypass grafting (CABG) surgery, with frequent ectopics linked to atrial fibrillation risk and reduced heart function. While CABG-induced inflammation causes arrhythmogenic changes, the connection between preoperative inflammatory markers and postoperative ectopic burden has not been studied. Therefore, the aim of the present study is to evaluate the association between preoperative inflammatory biomarkers and postoperative atrial and ventricular ectopic burden, and to determine their influence on clinical outcomes following elective CABG procedures. Materials and methods: This study assessed preoperative plasma levels of highly sensitive C-reactive protein (hs-CRP), von Willebrand factor (vWF), transforming growth factor-β (TGF-β), interleukin (IL)-2, IL-1β, IL-6, IL-8, and vascular endothelial growth factor (VEGF) using the Multiplex technique in patients undergoing elective CABG. A continuous 24-h ECG Holter monitoring was performed one day before CABG, as well as on days 2, 3, and 4 post-CABG. The PACs and PVCs burdens were quantified, and correlations with clinical parameters were analyzed. Results: Preoperative plasma concentrations of vWF, TGF-β, and IL-8 exhibited significant positive correlations with postoperative PACs (p < 0.001, p = 0.03, and p < 0.001, respectively). Preprocedural hs-CRP, TGF-β, IL-6, and IL-8 levels showed significant positive associations with PVCs (p < 0.0001, p < 0.0001, p = 0.02, and p < 0.0001, respectively). However, none of the tested biomarkers could predict other postoperative outcomes, such as acute kidney injury, acute liver failure, duration of inotropic support, and days of hospitalization. Conclusions: Preoperative inflammatory biomarkers may serve as predictive tools for postoperative ectopic activity following CABG. Early identification of high-risk patients could enable prophylactic strategies and improve post-CABG outcomes.

PMID:41010936 | PMC:PMC12471965 | DOI:10.3390/medicina61091545

J Clin Med. 2025 Sep 19;14(18):6607. doi: 10.3390/jcm14186607.

ABSTRACT

Background: Kidney function is critical for cardiovascular health, and its appropriate assessment entails proper determination of prognosis in patients with chronic coronary syndromes (CCSs). However, assessment of the urinary spot albumin to creatinine ratio (uACR) is often overlooked, whereas it is crucial for determination of chronic kidney disease (CKD). This study assesses the prevalence of impaired kidney function in patients with CCS based on their eGFR and albuminuria. Methods and results: This study comprised a total of 1957 patients from seven regions in Poland, aged ≤ 80 years, who, 6-18 months earlier, were hospitalized for acute coronary syndrome or elective myocardial revascularization. Complete uACR and eGFR data were obtained from 1152 patients (median age was 67 years, and 71.23% of participants were male). The finding of albuminuria reclassified the CKD in 17% (200) patients, suggesting that a patient's risk cannot be ascertained only based on their eGFR result. CKD reclassification by albuminuria was observed in older (p < 0.001) patients with higher BPs (p = 0.008), BPd (p = 0.038), HR (p < 0.001), fasting glucose (p < 0.001), and HbA1c (p < 0.001) and decreased HDL concentration (p = 0.001); hence, this is the population where uACR assessment is particularly valuable. Conclusions: In a notable percentage of patients with CCS, their kidney function classification is changed based on their albuminuria. Therefore, it is important to include albuminuria in the routine assessment of patients with cardiovascular disease.

PMID:41010810 | PMC:PMC12470754 | DOI:10.3390/jcm14186607