http:www.cardiocirugia.sld.cu

Int J Mol Sci. 2025 Sep 21;26(18):9217. doi: 10.3390/ijms26189217.

ABSTRACT

Primary human endothelial cells represent an essential tool to model endothelial dysfunction and to screen interventions for its treatment. Here, we developed a protocol for the synchronous isolation of primary human saphenous vein endothelial cells (HSaVEC), human internal thoracic artery endothelial cells (HITAEC), and human microvascular endothelial cells (HMVEC) from SV and ITA utilized as conduits during coronary artery bypass graft surgery and from subcutaneous adipose tissue excised while providing an access to the heart. Treatment by collagenase type IV and magnetic separation with anti-CD31-antibody-coated beads ensured relatively high efficiency of the isolation (≈60% for HSaVEC, ≈50% for HITAEC, and ≈20% for HMVEC) and high purity (≥99%) of isolated ECs within ≈2 weeks (HSaVEC), ≈2-3 weeks (HITAEC), and ≈3-4 weeks (HMVEC). A colorimetric assay of cell viability and proliferation, as well as real-time bioimpedance monitoring using the xCELLigence instrument, demonstrated high proliferative activity in HSaVEC, HITAEC, and HMVEC, whilst the in vitro tube formation assay indicated their angiogenic potential. The isolation of HSaVEC, HITAEC, and HMVEC from patients undergoing coronary artery bypass graft surgery is a promising option to investigate endothelial heterogeneity, to interrogate endothelial responses to various stresses, and to pinpoint the optimal approaches for restoring endothelial homeostasis, thereby reproducing them within the bedside-to-bench-to-bedside concept.

PMID:41009779 | PMC:PMC12471049 | DOI:10.3390/ijms26189217

Biomedicines. 2025 Sep 15;13(9):2265. doi: 10.3390/biomedicines13092265.

ABSTRACT

Background/Objectives: Angiotensin receptor-neprilysin inhibitor (ARNI) has a well-established advantage over angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy in patients (pts) with heart failure with reduced ejection fraction (HFrEF), but in pts after acute myocardial infarction (AMI) with left ventricular (LV) systolic dysfunction, the advantage of ARNI has not been clearly proven. The efficacy of ARNI is compared with that of ACEI/ARB therapy in patients with their first AMI in terms of improvement of post-infarction LV systolic function. Methods: The study was conducted as a retrospective one-center cross-sectional analysis. Overall, 1473 pts (990 M, median age 71 [64; 77]) with AMI (their first AMI, complete coronary revascularization, no prior coronary revascularization or history of HF) hospitalized in 2022-2024 were enrolled in a retrospective cross-sectional analysis. The study population was categorized into pts receiving ARNI and ACEI/ARB. Then, based on the ARNI subgroup, matching that included age, sex, and LV ejection fraction (LVEF) was performed by using the 1:1 nearest neighbor method without returning. Finally, two groups (ARNI vs. ACEI/ARB) of 30 pts were obtained and analyzed at baseline and at a 6-week follow-up. The improvement of post-infarction LV systolic function was obtained in terms of LVEF, ΔLVEF, and relative ΔLVEF values (ΔLVEF/baseline LVEF). Results: The comparison of baseline characteristics revealed borderline lower initial LVEF (30 vs. 36%, p = 0.076) and a higher frequency of SGLT-2 inhibitor use (70% vs. 36.7%, p = 0.01) in the ARNI subgroup. At the 6-week follow-up, in both subgroups, a significant improvement in the median LVEF values was achieved-from a median LVEF value of 30% (27.3; 38) to 37% (30; 43; p = 0.0008) in the ARNI subgroup and from a median LVEF value of 36% (33; 39) to 45% (42; 52; p < 0.0001) in the ACEI/ARB subgroup. The median ΔLVEF in the ACEI/ARB subgroup was higher [10% (6; 12)] than in the ARNI subgroup [6% (2; 10.25), p = 0.018]. Similarly, the median relative ΔLVEF was higher in the ACEI/ARB subgroup [30% (15.4; 40)] than in the ARNI group [17.5% (7; 31.9), p = 0.047]. The vast majority of patients, particularly in the ARNI group (99.7%), were treated with the lowest available dose of the drug. Conclusions: Our current experience in ARNI therapy after AMI is promising; however, it is limited to a small group of patients with severe impairment of LV systolic function. Regardless of the significant improvement in the baseline LVEF observed in patients receiving both ACEI/ARB and ARNI at the 6-week follow-up, the absolute and relative increases in the LVEF were higher in subjects treated with ACEI/ARB. However, the clinical benefits of ARNI therapy may emerge more gradually, and its advantages could become more apparent over a longer follow-up period. The clinical efficacy of early use of ARNI in the setting of AMI needs further evaluation.

PMID:41007826 | PMC:PMC12467660 | DOI:10.3390/biomedicines13092265

Biomedicines. 2025 Sep 14;13(9):2264. doi: 10.3390/biomedicines13092264.

ABSTRACT

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cardiac surgery, limiting patient access and altering care quality. This study evaluates changes in cardiovascular disease severity, types, and postoperative complications in patients qualifying for coronary artery bypass grafting (CABG) during the pandemic. Methods: We performed a retrospective analysis of 1499 CABG patients at our institution between March 2018 and February 2022. Patients were categorised into two groups: pre-pandemic (March 2018 to February 2020, N = 853) and pandemic (March 2020 to February 2022, N = 646). We analysed and detailed data across three major COVID-19 waves in Poland. Results: During the COVID-19 pandemic, 646 patients underwent CABG, a 24.3% decline from 853 pre-pandemic procedures. Urgent procedures increased from 37.6% to 44%, and life-saving procedures rose from 2.9% to 5.2% (p < 0.05). The use of cardiopulmonary bypass increased, along with longer procedure times (median of 279.7 min vs. 315 min; p < 0.001). The duration of mechanical ventilation increased during the pandemic period (median 12 h vs. 11 h; p < 0.05). No significant differences in postoperative complications were noted. Analysis during the three COVID-19 waves showed consistent baseline characteristics. In the second wave, life-saving CABG procedures reached 11.4%, with 17.5% of patients presenting acute coronary symptoms. Conclusions: The COVID-19 pandemic reduced CABG procedures, prioritising urgent cases. Short-term mortality odds rose, despite unchanged patient risk profiles. More multicentre research is needed to understand resource constraints on cardiac surgical outcomes and to establish guidelines for patient prioritisation in future pandemics.

PMID:41007825 | PMC:PMC12467769 | DOI:10.3390/biomedicines13092264

JACC Case Rep. 2025 Sep 24;30(29):105231. doi: 10.1016/j.jaccas.2025.105231.

ABSTRACT

BACKGROUND: Vasospastic angina is a condition determined by epicardial coronary artery spasm, which is usually diagnosed from resting angina.

CASE SUMMARY: A 62-year-old man was admitted for recurrent rest angina despite previous coronary artery bypass grafting and plain-old balloon angioplasty for multivessel disease. Coronary computed tomography angiography revealed occluded bypass grafts but nonsignificant coronary atherosclerosis, along with diffuse coronary ectasia and myocardial bridging. During invasive re-evaluation, intravascular ultrasound confirmed positive remodeling and intimal thickening, suggestive of vasospastic pathology. Critical, focal epicardial vasospasm during angiography triggered ventricular fibrillation, reversed by defibrillation. A transient right coronary artery occlusion with ST-elevation resolved with nitrates, highlighting the dynamic nature of the vasospasm.

DISCUSSION: The case emphasizes the importance of considering coronary vasospasm in patients with ambiguous angiographic findings, the diagnostic and therapeutic role of intracoronary nitroglycerin, and the value of imaging in avoiding unnecessary revascularization. Careful pharmacologic testing and physiologic assessment are essential to distinguish functional vasospasm from fixed coronary disease, especially in left main involvement.

PMID:41005853 | DOI:10.1016/j.jaccas.2025.105231

Am J Cardiol. 2025 Sep 24:S0002-9149(25)00574-0. doi: 10.1016/j.amjcard.2025.09.018. Online ahead of print.

ABSTRACT

The impact of optimal intravascular ultrasound (IVUS)-guided left main coronary artery (LMCA) percutaneous coronary intervention (PCI) on clinical outcomes has not been adequately evaluated yet. The OPTIVUS-Complex PCI study LMCA cohort was a prospective multicenter single-arm trial enrolling 902 patients undergoing LMCA PCI targeting the prespecified IVUS criteria (minimal stent area ≥5.0 mm2 for left circumflex artery ostium, ≥6 mm2 for left anterior descending coronary artery ostium, ≥7 mm2 for polygon of confluence, and ≥8.0 mm2 for proximal LMCA). The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. The predefined performance goals were based on the CREDO-Kyoto PCI/coronary artery bypass grafting (CABG) registry cohort-2 (PCI: 32.0%, and CABG: 13.9%). The OPTIVUS criteria were met in 73.7% of patients. The prevalence of true bifurcation LMCA lesion was 18.4%. The cumulative 1-year incidence of the primary endpoint was 13.2% (95%CI: 11.0-15.4%), which was significantly lower than the PCI performance goal (32.0%, P<0.0001), and numerically lower than the CABG performance goal (13.9%). The cumulative 1-year incidences of target-lesion revascularization and target-lesion revascularization for LMCA lesions were 4.2% and 3.0%. The cumulative 1-year incidence of the primary endpoint was not different regardless of meeting or not meeting the OPTIVUS criteria (13.4% versus 14.2%, log-rank P=0.79), while those of target-lesion revascularization and target-lesion revascularization for LMCA lesions were significantly lower in patients meeting the OPTIVUS criteria than in patients not meeting the OPTIVUS criteria (3.3% versus 7.7%, log-rank P=0.01, and 2.3% versus 5.5%, log-rank P=0.02). In conclusion, IVUS-guided LMCA PCI targeting the OPTIVUS criteria in the contemporary clinical practice was associated with a significantly lower rate of cardiovascular event than the predefined PCI performance goal, and with a numerically lower rate of cardiovascular event than the predefined CABG performance goal at 1 year.

PMID:41005598 | DOI:10.1016/j.amjcard.2025.09.018

Herz. 2025 Sep 26. doi: 10.1007/s00059-025-05340-y. Online ahead of print.

ABSTRACT

BACKGROUND: Acute chest pain is a common emergency department (ED) presentation requiring rapid risk stratification for major adverse cardiovascular events (MACE; including death, myocardial infarction, and urgent revascularization). While the HEART (History, ECG, Age, Risk factors, Troponin) and GRACE scores are widely used, their comparative predictive accuracy for short-term MACE remains unclear. This study aimed to directly compare the diagnostic performance of HEART and GRACE (Global Registry of Acute Coronary Events) in predicting 30-day MACE among ED patients with acute chest pain.

METHODS: We systematically searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from inception to May 2025 for prospective cohort studies directly comparing HEART and GRACE scores. Included studies applied both scores at ED presentation, reported 30-day MACE (death, myocardial infarction, urgent revascularization), and provided data for 2 × 2 contingency tables. Pooled sensitivity, specificity, likelihood ratios (PLR/NLR), diagnostic odds ratio, and area under the curve (AUC) were calculated using a bivariate random-effects model. Heterogeneity was assessed via I2 statistics, and subgroup analyses explored sources of variation.

RESULTS: In total, 19 studies (14,862 patients) were included. The HEART score demonstrated significantly higher sensitivity (0.96, 95% CI: 0.94-0.98 vs. 0.88, 95% CI: 0.85-0.91; ratio: 1.09 [1.05-1.14]) and lower negative likelihood ratio (NLR: 0.08, 95% CI: 0.03-0.17 vs. 0.42, 95% CI: 0.39-0.46) than the GRACE score. Specificity was lower for HEART (0.50, 95% CI: 0.41-0.60) versus GRACE (0.61, 95% CI: 0.58-0.64), while GRACE showed higher specificity. HEART also had superior discriminative power (AUC: 0.80, 95% CI: 0.77-0.84 vs. 0.72, 95% CI: 0.69-0.75; ratio: 1.11 [1.07-1.15]). Subgroup analyses confirmed HEART's advantage in sensitivity across geographic regions and age groups, particularly in Eastern populations (sensitivity ratio: 1.57 [1.27-1.93]).

CONCLUSION: The HEART score outperforms GRACE in sensitivity and rule-out capability (lower NLR) for 30-day MACE in ED patients with acute chest pain, supporting its utility for safe discharge of low-risk individuals. GRACE's higher specificity may aid in identifying high-risk cases requiring intervention. Standardization of troponin assays and MACE definitions is critical for future implementation.

PMID:41003766 | DOI:10.1007/s00059-025-05340-y

J Cardiovasc Dev Dis. 2025 Sep 3;12(9):338. doi: 10.3390/jcdd12090338.

ABSTRACT

Imaging techniques such as positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MR) have emerged as powerful and versatile tools for the comprehensive assessment of coronary artery disease (CAD). By combining anatomical and functional information in a single examination, these modalities offer complementary insights that significantly enhance diagnostic accuracy and support clinical decision-making. This is particularly relevant in complex clinical scenarios, such as multivessel disease, balanced ischemia, or suspected microvascular dysfunction, where conventional imaging may be inconclusive. This review aims to provide clinicians with an up-to-date summary of the principles, technical considerations, and clinical applications of hybrid PET/CT and PET/MR in CAD. Here, we describe how these techniques can improve the evaluation of myocardial perfusion, coronary plaque characteristics, and ischemic burden. Advantages such as improved sensitivity, spatial resolution, and quantification capabilities are discussed alongside limitations including cost, radiation exposure, availability, and workflow challenges. A dedicated focus is given to the emerging role of artificial intelligence (AI), which is increasingly being integrated to optimize image acquisition, fusion processes, and interpretation. AI has the potential to streamline hybrid imaging and promote a more personalized and efficient management of CAD. Finally, we outline future directions in the field, including novel radiotracers, automated quantitative tools, and the expanding use of hybrid imaging to guide patient selection and therapeutic decisions, particularly in revascularization strategies.

PMID:41002617 | PMC:PMC12471169 | DOI:10.3390/jcdd12090338

Cureus. 2025 Aug 25;17(8):e90952. doi: 10.7759/cureus.90952. eCollection 2025 Aug.

ABSTRACT

INTRODUCTION: Non-ST elevation myocardial infarction (NSTEMI) carries a substantial risk of early major adverse cardiovascular events (MACE) despite advances in therapy. Easily obtainable biochemical and echocardiographic markers may improve early risk stratification, particularly in patients managed without revascularization. This prospective study assessed the prognostic significance of inferior vena cava (IVC) diameter, serum uric acid, homocysteine, and selected hematological indices in predicting 90-day MACE in NSTEMI patients treated with conservative medical therapy. Unlike prior studies that examined these biomarkers individually, our study integrates biochemical (uric acid, homocysteine), echocardiographic (IVC diameter), and hemogram-derived indices into a combined model for early risk stratification in conservatively treated NSTEMI patients.

METHODS: A total of 170 consecutive NSTEMI patients admitted to the University Clinical Center Tuzla between February 2022 and January 2023 were included. All patients received guideline-directed medical therapy. Clinical, echocardiographic, and laboratory data were obtained within 24 hours of admission. The primary endpoint was MACE (cardiac death, reinfarction, or urgent coronary revascularization) within 90 days. Logistic regression identified independent predictors; discriminatory ability was assessed using receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves evaluated event-free survival.

RESULTS: MACE occurred in 87 patients (51.2%). Compared to event-free patients, those with MACE had larger IVC diameters (20.25 ± 2.52 mm vs. 18.36 ± 2.16 mm; p < 0.001), higher uric acid (432.8 ± 47.3 μmol/L vs. 358.9 ± 44.6 μmol/L; p < 0.001), and elevated homocysteine levels (18.42 ± 4.13 μmol/L vs. 13.39 ± 2.88 μmol/L; p < 0.001). In multivariate analysis, uric acid (OR per 10 μmol/L = 1.32; 95% CI: 1.05-1.65; p = 0.015) and homocysteine (OR per 1 μmol/L = 1.23; 95% CI: 1.06-1.42; p = 0.005) remained independent predictors. ROC analysis showed excellent discrimination for homocysteine (AUC: 0.844) and uric acid (AUC: 0.830). IVC diameter was associated with lower MACE-free survival (log-rank p = 0.036) but lost significance after adjustment.

CONCLUSION: Elevated homocysteine and uric acid independently predicted 90-day MACE in NSTEMI patients managed without revascularization. While IVC diameter was not independently predictive, its combination with biochemical markers may enhance risk stratification and guide early post-discharge management. These findings warrant validation in larger multicenter studies.

PMID:41001293 | PMC:PMC12459640 | DOI:10.7759/cureus.90952

Front Cardiovasc Med. 2025 Sep 10;12:1574829. doi: 10.3389/fcvm.2025.1574829. eCollection 2025.

ABSTRACT

BACKGROUND: Rapid diagnosis of patients with acute coronary syndrome (ACS) is crucial for saving their lives. The de Winter electrocardiogram (ECG) pattern is rare and is treated similarly to ST-segment elevation myocardial infarction (STEMI) and acute thrombotic occlusion of the coronary artery. The de Winter ECG pattern has been previously reported, but its dynamic evolution and characteristics have not been summarized.

METHODS: We reported two male patients who presented with de Winter ECG pattern at rest, and neither patient had a family history of hypertension, diabetes, or coronary heart disease. An urgent examination in our hospital showed elevated levels of cardiac troponin T. Both patients underwent emergency coronary angiography, which revealed subtotal proximal left anterior descending (LAD) stenosis. There was an improvement in chest tightness and pain after stent implantation. Serial ECGs before and after percutaneous coronary intervention showed dynamic evolution of ECG. A literature review was conducted to examine reported coronary angiography findings in patients with the de Winter pattern. The review focused on the dynamic evolution of the ECG and the accuracy of this pattern in diagnosing acute coronary artery occlusion (culprit vessel). It also highlighted the danger of the de Winter ECG pattern and the importance of emergency treatment.

RESULTS: Eighteen patients, including two of our patients, presented with the de Winter ECG pattern. Our two cases demonstrated two different forms of ST-segment dynamic evolution, with Case 2 being the only one among 18 cases that dynamically evolved into a life-threatening non-STEMI (NSTEMI). All cases were male patients with sudden chest pain. ECG examination showed an upward-sloping ST-segment depression with tall symmetrical T waves in the chest leads, and multiple follow-up ECGs revealed dynamic ST-segment evolution. Emergency coronary angiography showed occlusion of the LAD, left main artery (LMA), right coronary artery (RCA), first diagonal branch (D1), and left circumflex (LCX) artery as well as multiple vascular lesions. Most cases support subtotal stenosis or complete occlusion of the anterior descending artery. Timely identification of the de Winter ECG pattern and prompt transfer to the catheterization laboratory for emergency revascularization can be lifesaving and improve prognosis.

CONCLUSION: These two cases and the literature review indicated that the de Winter ECG pattern is dynamically evolving. Its ECG pattern evolution is variable, progressing to STEMI, NSTEMI, Wellens, or even a normal. In patients presenting with chest pain, a de Winter ECG pattern, regardless of the subsequent dynamic evolution of the ECG, indicates the presence of severe coronary artery stenosis. The de Winter ECG pattern may be an early manifestation of ACS and requires urgent coronary angiography to save the patient's life and improve prognosis.

PMID:41000532 | PMC:PMC12457363 | DOI:10.3389/fcvm.2025.1574829

Kidney Blood Press Res. 2025 Sep 18:1-25. doi: 10.1159/000548172. Online ahead of print.

ABSTRACT

Introduction Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease and mortality. However, data on the prediction of long-term adverse outcomes in advanced predialysis CKD patients is lacking. Methods We studied the factors associated with mortality and major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, myocardial infarction, stroke and coronary revascularization) in a cohort of 210 patients with non-dialysis CKD stage 4-5 during a five-year follow-up. The participants underwent stress ergometry testing to study maximal exercise capacity (Wmax%), a plain lateral abdominal radiograph to study abdominal aortic calcification score (AAC) and laboratory tests including cardiac troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (ProBNP). Furthermore, a dichotomous composite covariate was created and explored by combining ProBNP and Wmax% using the cut-offs determined with the Youden index. The associations between covariates of interest and study outcomes were explored using multivariable Cox proportional hazards models adjusted with age, sex, coronary artery disease (CAD) and incident kidney transplantation (KTx). Results Median age at baseline was 65 (52-73) years and eGFR 12 (10-15) ml/min/1.73 m2, 34.8 % were female and 44.8 % had diabetes. Altogether 67 (31.9 %) patients died during follow-up and 65 (31.0%) were observed with a MACCE. In separate multivariable Cox proportional hazards models adjusted for age, gender, CAD and KTx, Wmax% (HR 0.983 [95 % CI: 0.968-0.999], p=0.019), TnT (HR 1.004 [95 % CI: 1.002-1.005], p<0.001 and) and ProBNP (HR 1.036 per 1000 ng/l [95 % CI: 1.014-1.059], p=0.002 were independently associated with mortality. In similarly adjusted multivariable Cox models Wmax% (HR 0.977 [95 % CI: 0.962-0.992], p=0.003), TnT (HR 1.004 [95 % CI: 1.002-1.005], p<0.001) and ProBNP (HR 1.034 per 1000 ng/l [95 % CI: 1.010-1.058], p=0.006) were independently associated with the occurrence of MACCE during follow-up. AAC was associated with the risk of an incident MACCE (HR 1.080 [95% CI 1.028-1.135], p=0.002) but, surprisingly, not with mortality (HR 1.046 [95% CI 0.994-1.101], p=0.083). Finally, in participants with Wmax ≤50 % and ProBNP ≥1270 ng/l the risk of mortality (HR 8.760 [95 % CI: 4.730-16.222], p<0.001) and MACCE (HR 3.293 [95 % CI: 1.850-5.862], p<0.001) was significantly greater than those with Wmax>50% and/or ProBNP <1270 ng/L. Conclusion Wmax% and ProBNP separately and together as a composite risk factor may serve as important predictors of long-term all-cause mortality and MACCE in patients with CKD stage 4-5 not undergoing dialysis at baseline.

PMID:40999822 | DOI:10.1159/000548172

Ann Vasc Surg. 2025 Sep 23:S0890-5096(25)00636-3. doi: 10.1016/j.avsg.2025.09.031. Online ahead of print.

ABSTRACT

BACKGROUND: High cervical carotid lesions increase intraoperative complexity in carotid endarterectomy (CEA) due to the challenge in obtaining a clean distal clamp site. For these cases, transcarotid artery revascularization (TCAR) may offer an alternative. Our aim was to compare outcomes of CEA and TCAR in patients with high cervical lesions.

METHODS: Demographics and outcomes of CEA and TCAR procedures were retrospectively captured at two high-volume institutions between 2003 and 2023. Patients with high cervical lesions, defined as target clamp sites above the C2 vertebra, were included. Patients were dichotomized according to surgical procedure. Univariate analysis was performed comparing baseline characteristics and outcomes in both groups at an α < 0.05.

RESULTS: 2,250 patients were reviewed, of which 106 lesions (5%) were classified as above C2, of which 73 (69%) underwent TCAR and 33 (31%) underwent CEA. TCAR patients were more likely symptomatic, whereas CEA patients were more likely to have coronary artery disease. Perioperative (30-day) morbidity was similar (ipsilateral stroke was 2.7% vs. 6.1%, p=0.406, myocardial infarction was 1.4% vs. 0%, p=0.499, cranial nerve injury was 1.4% vs. 6.1%, p=0.406, and mortality was 1.4% vs. 0%, p=0.499). Operative time and estimated blood loss were higher with CEA (72.9 ± 31.8 minutes vs. 132.5 ± 53.2 minutes, p <0.001, and 47.1 ± 57.3 mL vs. 214.2 ± 285.7 mL, p < 0.001).

CONCLUSION: This retrospective study demonstrates similar outcomes between CEA and TCAR. However, TCAR was associated with a shorter operative time, suggesting that this may be an advantageous approach.

PMID:40998248 | DOI:10.1016/j.avsg.2025.09.031

Cardiovasc Interv Ther. 2025 Sep 25. doi: 10.1007/s12928-025-01199-2. Online ahead of print.

ABSTRACT

In-stent protrusion is sometimes observed after the stent implantation to the culprit lesion of ST-segment elevation myocardial infarction (STEMI). However, it remains unclear whether additional interventions are necessary for non-obstructive in-stent protrusions. The purpose of this retrospective study was to compare clinical outcomes of patients with STEMI between with and without angiographically visible in-stent protrusions, and to evaluate the association between angiographically visible in-stent protrusions and long-term clinical outcomes in patients with STEMI. We included 639 patients with STEMI who underwent stent implantation and divided them into the protrusion group (n = 59) and the clear stent group (n = 580). In-stent protrusion was defined as an angiographically visible in-stent contrast filling defect at final angiography. The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, non-fatal myocardial infarction, and ischemia-driven target vessel revascularization. During the median follow-up duration of 620 (213-1379) days, MACE were more frequently observed in the protrusion group than in the clear stent group (p = 0.002). The multivariate Cox hazard analysis revealed that in-stent protrusion was significantly associated with MACE after controlling for multiple confounding factors (HR 2.373, 95% CI 1.311-4.294, p = 0.004). In conclusion, angiographically visible in-stent contrast filling defect at final angiography is a marker for worse clinical outcomes in primary PCI. When interventional cardiologists recognize visible irregular protrusion after stent implantation for STEMI, additional intervention or careful clinical follow up may be needed.

PMID:40996679 | DOI:10.1007/s12928-025-01199-2

Circulation. 2025 Sep 25. doi: 10.1161/CIRCULATIONAHA.125.074198. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical significance and outcome predictors of anomalous aortic origin of a coronary artery (AAOCA) in adults remains unclear. Therefore, the aim of this study was to analyze the clinical and prognostic implications of AAOCA in a large cohort of patients undergoing coronary computed tomography angiography (CCTA) in an Italian tertiary referral center.

METHODS: Consecutive adults with AAOCA identified through CCTA from September 2004 to September 2024 were included. Data on clinical indications of CCTA, AAOCA subtypes, evidence of inducible myocardial ischemia, and concomitant coronary atherosclerotic disease were collected. Patients were followed up for the end points of all-cause mortality and major adverse cardiac events (nonfatal acute coronary syndromes, revascularization procedures, and heart failure hospitalization). Outcomes were compared with matched controls with normal coronary artery anatomy.

RESULTS: Among 17 454 CCTAs performed over a span of 20 years, AAOCA was detected in 173 patients (62±15 years of age, n=58 women [34%]). Chest pain (34%) was the most common indication of CCTA. Obstructive coronary atherosclerotic disease was present in 36 patients (21%), and myocardial ischemia was detected in 60% of those (n=62) who underwent functional imaging testing. AAOCA repair was performed in 10 patients (6%), whereas the majority of patients were treated conservatively. After a median 37-month follow-up (17 to 69 months), mortality (P=0.321) and major adverse cardiac events (P=0.392) were similar between patients with AAOCA and controls. Only obstructive coronary atherosclerotic disease was associated with a higher event rate during follow-up, whereas AAOCA subtype and ischemia were not.

CONCLUSIONS: In adults with AAOCA, concomitant obstructive coronary atherosclerotic disease is the primary determinant of adverse events. Given the low prevalence of AAOCA and event rates, multicenter registries are needed to refine risk stratification and management of these patients.

PMID:40995628 | DOI:10.1161/CIRCULATIONAHA.125.074198

Res Pract Thromb Haemost. 2025 Aug 13;9(6):103005. doi: 10.1016/j.rpth.2025.103005. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare hematologic disorder with improved survival due to advancements in treatment. However, long-term cardiovascular morbidity and mortality remain significant. Established cardiovascular risk calculators, such as the 2008 Framingham Heart Study (FHS) global cardiovascular disease (CVD) and the American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic CVD (ASCVD) risk estimators, may not adequately account for the elevated and unique cardiovascular risks in iTTP survivors.

OBJECTIVES: To evaluate the discrimination and calibration of the ACC/AHA ASCVD and FHS global CVD models in predicting major adverse cardiovascular events (MACEs) among iTTP survivors.

METHODS: This retrospective study analyzed 135 iTTP survivors from Johns Hopkins University (1994-2024). Presence of MACEs, including myocardial infarction, stroke, and cardiac revascularization, was the primary outcome and was assessed during clinical remission. Discriminatory ability of the model was assessed using c-statistics, while calibration was evaluated with Hosmer-Lemeshow tests and calibration plots. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated.

RESULTS: MACEs occurred in 37.8% of the cohort over a median follow-up of 3.8 years. The ASCVD and FHS models demonstrated poor discrimination (c-statistics, 0.54 and 0.52, respectively) and poor calibration, with observed MACE rates exceeding predicted probabilities (Hosmer-Lemeshow P < .05). The ASCVD model showed sensitivity of 56.5%, specificity of 49.4%, PPV of 36.6%, and NPV of 64.9%, while the FHS model showed sensitivity of 69.6%, specificity of 39.3%, PPV of 37.2%, and NPV of 67.9%.

CONCLUSION: Standard cardiovascular risk models inadequately predict MACE risk in iTTP survivors, underscoring the need for tailored tools that incorporate iTTP-specific factors to improve cardiovascular risk stratification and management.

PMID:40994890 | PMC:PMC12454890 | DOI:10.1016/j.rpth.2025.103005

Health Sci Rep. 2025 Sep 22;8(9):e71254. doi: 10.1002/hsr2.71254. eCollection 2025 Sep.

ABSTRACT

BACKGROUND AND AIMS: COVID-19 is an independent risk factor for cardiovascular disease. We investigated undiagnosed COVID-19 and its effect on recurrent adverse cardiovascular events among patients with acute myocardial infarction (AMI).

METHODS: We enrolled patients with either ST-segment elevation (STEMI) or non ST-segment elevation myocardial infarction (NSTEMI) presenting at the National Institute of Cardiovascular Disease, Dhaka, from June 28 to August 11, 2020. Nasopharyngeal swabs were collected for SARS-CoV-2 testing by rRT-PCR at enrolment. We followed all patients from admission until February 7, 2021, before the COVID-19 vaccination in Bangladesh, to register clinical endpoints (all-cause death, new AMI, heart failure, or new revascularization). Demographic information, cardiovascular risk factors, and clinical data were registered. Incidence rate (IR) per 100 person-years follow-up was calculated for clinical endpoints. Poisson regression was employed to estimate the incidence rate ratio (IRR) for SARS-COV-2 infection, adjusting for age.

RESULTS: We enrolled 280 patients with a mean age of 54.5 ( ± SD,11.8) years, and 78.6% were males. Of them, 12.9% had undiagnosed SARS-CoV-2 infection and were diagnosed with STEMI (n = 140, 50.0%) and NSTEMI (n = 140, 50.0%). We found that the IR per 100 person-years of all cause death was 35.2, 95% CI: 25.6 to 48.5; recurrent AMI was 18.5, 95% CI: 12.1 to 28.2; heart failure was 6.7, 95% CI: 3.3 to 13.5; and revascularization was 23.5, 95% CI: 16.1 to 34.3. Patients with COVID-19 had numerically higher IRRs for heart failure (2.40, 95% CI: 0.47 to 12.09, p = 0.290) and revascularization (1.11, 95% CI: 0.37 to 3.3, p = 0.853) compared to those without COVID-19, though these differences were not statistically significant.

CONCLUSION: This study provides updated data on undiagnosed cases among AMI patients during the first wave of the COVID-19 pandemic. Our findings emphasize the need for further research to explore the impact of COVID-19 on AMI patients in resource-limited settings like Bangladesh.

PMID:40994781 | PMC:PMC12453963 | DOI:10.1002/hsr2.71254

JACC Cardiovasc Interv. 2025 Sep 22;18(18):2209-2221. doi: 10.1016/j.jcin.2025.07.036.

ABSTRACT

BACKGROUND: Drug-coated balloons (DCBs) are increasingly used in percutaneous coronary intervention (PCI). Their application for chronic total occlusions (CTOs) is a promising option to limit stent length in diffuse disease and avoid stent underexpansion and malapposition in negatively remodeled distal vessel segments.

OBJECTIVES: The aim of this study was to analyze CTO PCI procedures recorded in ERCTO (European Registry of Chronic Total Occlusion) to investigate frequency of use, patient and lesion characteristics, and in-hospital outcomes of DCBs.

METHODS: CTO cases entered into the database from 2016 to 2023 were examined and categorized according to DCB use. DCB-treated patients were further divided into 2 groups: DCBs only and DCBs in association with drug-eluting stents. To minimize the potential impact of confounding factors, 1:1 propensity score matching was applied.

RESULTS: Of 40,449 CTO PCIs performed at 184 centers, DCBs were used in 2,506 (6.2%), increasing from 3.4% (n = 185 of 5,498) in 2016 to 14.9% (n = 705 of 4,722) in 2023. In-hospital complications were infrequent, but DCB-treated CTOs had significantly lower rates of pericardial tamponade (0.1% [n = 2 of 2,506] vs 0.4% [n = 169 of 37,943]; P = 0.006). After propensity score matching, DCB use led to reduced drug-eluting stent length (44.2 ± 36.9 mm [95% CI: 42.7-45.7 mm] vs 58.1 ± 35.9 mm [95% CI: 56.7-59.5] mm; P < 0.001). Contrast volume was lower in the DCB-treated patients (202.4 ± 109.8 mL [95% CI: 198.1-206.7 mL] vs 211.6 ± 123 mL [95% CI: 206.8-216.4 mL]; P = 0.005).

CONCLUSIONS: The use of DCBs in CTO recanalization is increasing and is associated with a reduction in the length of stents implanted, as well as a decrease in contrast volume and a lower rate of pericardial tamponade.

PMID:40992801 | DOI:10.1016/j.jcin.2025.07.036

JACC Cardiovasc Interv. 2025 Sep 22;18(18):2197-2205. doi: 10.1016/j.jcin.2025.07.024.

ABSTRACT

BACKGROUND: Robust evidence on optimal stent expansion using intravascular ultrasound (IVUS) is still lacking.

OBJECTIVES: The aim of this study was to validate the impact of different criteria for IVUS-defined optimal stent expansion on 1-year clinical outcomes after percutaneous coronary intervention (PCI).

METHODS: Individual patient data from 3 randomized trials were aggregated for this analysis. Patients (n = 6,290) were classified into 3 groups: optimized PCI by IVUS, nonoptimized PCI by IVUS, and angiography-guided PCI. The primary endpoint was target vessel failure (TVF) at 1 year, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.

RESULTS: Angiography-guided PCI was performed in 3,208 patients. Optimal stent expansion was evaluated in 3,082 patients with IVUS-guided PCI. For the absolute criterion of minimal stent area (MSA) >5.5 mm2 indicating optimal stent expansion, the optimized PCI group had a lower incidence of TVF (1.45% vs 3.86% vs 5.07%) compared with the nonoptimized PCI group (adjusted HR: 0.45; 95% CI: 0.26-0.75; P = 0.002) and the angiography-guided PCI group (adjusted HR: 0.35; 95% CI: 0.22-0.54; P < 0.001). Relative criteria did not show a significantly different TVF incidence between the optimized and nonoptimized PCI groups. In particular, the absolute criterion of MSA >5.5 mm2 was associated with a significant reduction of the composite of cardiac death or target vessel myocardial infarction (0.54% in the optimized PCI group vs 1.59% in the nonoptimized PCI group; adjusted HR: 0.39; 95% CI: 0.17-0.91; P = 0.028).

CONCLUSIONS: Post-PCI stent expansion meeting an absolute criterion of MSA >5.5 mm2 was associated with the most favorable clinical outcomes. (Effect of Intravascular Ultrasound in Patients Receiving Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: An Individual Patient Data Meta-Analysis of IVUS-XPL, ULTIMATE and IVUS-ACS Randomized Trials; CRD42024559794).

PMID:40992799 | DOI:10.1016/j.jcin.2025.07.024

Open Heart. 2025 Sep 23;12(2):e003673. doi: 10.1136/openhrt-2025-003673.

ABSTRACT

BACKGROUND: Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).

METHODS: This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.

RESULTS: A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).

CONCLUSIONS: IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.

TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry: Chictr2400085741.

PMID:40992796 | PMC:PMC12458668 | DOI:10.1136/openhrt-2025-003673

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00567-3. doi: 10.1016/j.amjcard.2025.09.013. Online ahead of print.

ABSTRACT

This study sought to assess sex differences in timely diagnosis (time-to-ECG) and treatment (time-to-percutaneous coronary intervention (PCI)) of ST-elevation myocardial infarction (STEMI) and Non-STEMI (NSTEMI) patients utilizing a retrospective cross-sectional analysis of 1098 STEMI (306 females and 792 males) and 2,179 NSTEMI (747 females, 1432 males) patients that presented to 2 urban EDs between January 2022 and December 2024 was performed. Sex differences in time-to-ECG were assessed in both STEMI and NSTEMI patients, whereas differences in time-to-PCI were assessed in STEMI patients only. Time-to-ECG and time-to-PCI were compared continuously, as well as categorically (ECG delay = time-to-ECG > 10 min and PCI delay = time-to-PCI > 90 min or >120 min when a transfer occurred). Median time-to-ECG was 3.0 min shorter for male STEMI and NSTEMI patients. Males also had a reduced likelihood of an ECG delay (OR: 0.64 [95% CI: 0.51 - 0.82]). Sex disparities remained when assessing only patients with a chief complaint of chest pain (OR:0.74 [95% CI: 0.56 - 0.97]). Male STEMI patients also had a shorter wait time for PCI compared to females (walk-in: 1:26:00 vs. 1:41:00, transfer: 2:19:30 vs. 2:44:30, respectively). However, sex was not a significant predictor of PCI delay after controlling for time-to-ECG. In conclusion, sex disparities were found in time-to-ECG for STEMI and NSTEMI patents, as well as time-to-PCI for STEMI patients. However, sex was not significantly associated with PCI delay after controlling for time-to-ECG. This highlights the importance of timely diagnosis to ensure timely revascularization in acute myocardial infarction patients.

PMID:40992532 | DOI:10.1016/j.amjcard.2025.09.013

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00563-6. doi: 10.1016/j.amjcard.2025.09.016. Online ahead of print.

ABSTRACT

There is limited data on the incidence and outcomes of ST-segment elevation myocardial infarction (STEMI) due to the left main coronary artery (LMCA) lesions. We aimed to examine the trends and outcomes of STEMI due to LMCA lesions. The Nationwide Readmissions Database was utilized to identify hospitalizations with LMCA STEMI between January 2016 and December 2022. The primary outcome was all-cause in-hospital mortality during index admission. Among 1,528,764 weighted hospitalizations with STEMI from 2016 to 2022, 4,885 (0.3%) were due to LMCA lesions, of which 2,156 (44.1%) had cardiogenic shock (CS). The number of LMCA STEMI hospitalizations and the incidence of CS increased over time. Mechanical circulatory support was used in 78.8% of the patients with LMCA STEMI and CS, with intra-aortic balloon pump being the most common modality (63%). Impella utilization increased from 4.5% in Q1 2016 to 34% in Q4 2022. Revascularization was performed in 78.2% of cases, with percutaneous coronary intervention (PCI) being the most common revascularization modality (62.1%). Among those who had PCI, intravascular imaging (IVI) was used in 18.3%, with a significant increase from 9.6% in Q1 2016 to 26.3% in Q4 2022. All-cause in-hospital mortality was 25.5% and was significantly higher among CS patients (43.4% vs. 11.4%, P<0.001). In conclusion, the incidence of LMCA STEMI increased from 2016 to 2022 with nearly half of the patients developing CS. IVI use in LMCA PCI was low (18.3%) but increased over time. More than 1 in 4 patients with LMCA STEMI died during the index hospitalization.

PMID:40992531 | DOI:10.1016/j.amjcard.2025.09.016