http:www.cardiocirugia.sld.cu

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00568-5. doi: 10.1016/j.amjcard.2025.09.020. Online ahead of print.

ABSTRACT

This study investigated whether cardiovascular magnetic resonance (CMR)-derived atrial strain parameters are associated with new-onset cerebrovascular events in patients with reperfused ST-segment elevation myocardial infarction (STEMI). In this retrospective analysis, CMR scans of 211 consecutive STEMI patients (77% male; mean age 64.5 ± 10.3 years) who underwent coronary revascularization were assessed. The primary endpoint was the occurrence of acute ischemic stroke or transient ischemic attack, collectively defined as cerebrovascular events. Atrial strain was analyzed offline from standard cine steady-state free precession sequences, focusing on left atrial (LA) reservoir, conduit, and booster strain. Over a median follow-up of 25 months (interquartile range 13-36), 23 patients (11%) experienced cerebrovascular events. In multivariable Cox regression analysis, LA reservoir and conduit strain were independent predictors of these events, irrespective of cardiovascular risk factors, LA volume, thrombus presence, and incident atrial fibrillation (HR: 0.84; 95% CI: 0.77-0.91; p = 0.001 and HR: 0.74; 95% CI: 0.63-0.87; p = 0.001, respectively). In conclusion, CMR-derived LA reservoir and conduit strain are independently associated with increased risk of cerebrovascular events, and their integration into the clinical assessment of STEMI patients may improve risk stratification.

PMID:40992528 | DOI:10.1016/j.amjcard.2025.09.020

Ann Vasc Surg. 2025 Sep 22:S0890-5096(25)00619-3. doi: 10.1016/j.avsg.2025.09.014. Online ahead of print.

ABSTRACT

OBJECTIVE: Postoperative stroke and myocardial infarction (MI) are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relationship between the severity of stroke and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year survival following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR).

METHODS: This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (2016-2023). Our primary outcome was one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate and multivariable Cox regression analysis were applied to calculate hazard ratios (HR) after adjusting for potential confounders. Additionally, we conducted sub-analyses based on patients' symptomatic status.

RESULTS: Our study included 125,513 (61.8%) CEA, 25,875 (12.8%) TFCAS, and 51,545 (25.4%) TCAR. Compared to patients who did not have a postoperative stroke, the hazard of 1-year mortality was higher for those who did have a stroke following CEA (adjusted hazards ratio [aHR] = 5.9[95%CI:5.1-6.8] P<0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P<0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P<0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1- 4.6] P<0.001), TFCAS (aHR=3.5[95%CI:2.3- 5.5] P<0.001), and TCAR (aHR=5.1[95%CI:3.6- 7.2] P<0.001). This trend persisted in sub-analysis based on symptomatic status. At one year, TFCAS showed the lowest survival following an in-hospital stroke or MI. There was no significant difference in one-year mortality among patients who developed in-hospital stroke between TCAR and CEA (aHR=0.93[95%CI:0.73- 1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher mortality hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003), and TCAR was associated with a 30% reduction in one-year mortality compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) among patients who developed in-hospital stroke.

CONCLUSION: This large multicenter study reveals critical insights into the impact of in-hospital major adverse events on one-year survival following carotid revascularization. The analysis indicates a significant increase in the hazard of one-year mortality following in-hospital stroke and MI. In patients who developed in-hospital stroke or MI, there was no significant difference in one-year survival between TCAR and CEA. On the contrary, among patients who developed in-hospital stroke or MI, TFCAS was associated with significantly higher mortality compared to CEA and TCAR. This study highlights the importance of selecting the appropriate revascularization method for each patient to improve one-year survival.

PMID:40992493 | DOI:10.1016/j.avsg.2025.09.014

Bioact Mater. 2025 Sep 7;54:648-665. doi: 10.1016/j.bioactmat.2025.08.041. eCollection 2025 Dec.

ABSTRACT

Heart failure resulting from myocardial infarction (MI) is a leading global health concern. Current revascularization therapies cannot fully restore the infarcted myocardium or prevent maladaptive ventricular remodeling. Traditional Chinese medicine with its multitarget regulation and favorable biosafety shows a promising therapeutic potential. Tanshinone IIA (TIIA) and formononetin (FM), two bioactive compounds derived from Salvia miltiorrhiza and Astragalus membranaceus, respectively, exhibit antioxidant, anti-inflammatory, and proangiogenic effects. Herein, a neutrophil-targeted nanomedicine (TF-5NP) was developed to deliver TIIA and FM to the infarcted myocardium for mitigating oxidative damage and promoting angiogenesis. TF-5NP was synthesized by coassembling bis-5-hydroxytryptamine-modified 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-polyethylene glycol-carboxylic acid with cholesterol and lipid 1,2-distearoyl-sn-glycero-3-phosphoglycerol, which binds to troponin in the infarcted myocardium. This nanomedicine reduces inflammation and cardiomyocyte damage and improves cardiac function in porcine MI models, with therapeutic effects lasting for ∼28 d. These findings suggest that TF-5NP use is a promising approach for treating post-MI maladaptive remodeling and heart failure.

PMID:40988940 | PMC:PMC12451291 | DOI:10.1016/j.bioactmat.2025.08.041

Catheter Cardiovasc Interv. 2025 Sep 23. doi: 10.1002/ccd.70189. Online ahead of print.

ABSTRACT

BACKGROUND: Target lesion calcification is known to influence the percutaneous coronary intervention (PCI) outcomes. This study aimed to assess the impact of calcium fractures after balloon angioplasty on the PCI results as well as the long-term clinical outcomes.

METHODS: We formed a prospective, multicenter registry that enrolled 268 patients who underwent PCI to lesions with moderate to severe calcification. Balloon dilatation and subsequent drug eluting stent implantation were performed with optical coherence tomography (OCT) guidance in every case. Serial OCT images just before and after balloon angioplasty, and after stent implantation were analyzed at 1-mm intervals by an independent core laboratory. The primary endpoint was the relationship between calcium fracture after balloon angioplasty and stent expansion. The secondary endpoint was target vessel failure (TVF) at 1 year, defined as a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization.

RESULTS: A total of 242 patients were analyzed. Of these, OCT analysis was performed in 147 patients with a complete OCT data set. Calcium fractures were observed in 28 patients (19%) at the minimal lumen area site. The percent stent expansion was greater in lesions with calcium fracture than those without (99 ± 26% vs. 91 ± 18%, p = 0.039). In 229 patients who underwent clinical follow-up at 1 year, TVF occurred in 23 patients (10.0%).

CONCLUSION: The OCT-guided PCI strategy demonstrated acceptable acute and 1-year clinical outcomes. The presence of calcium fractures after balloon angioplasty may have a potential impact on acute results after DES implantation in calcified lesions.

PMID:40988477 | DOI:10.1002/ccd.70189

Medicine (Baltimore). 2025 Sep 19;104(38):e44556. doi: 10.1097/MD.0000000000044556.

ABSTRACT

Heart valve disease is one of the important factors leading to heart failure and cardiovascular death. Double valve replacement (DVR) and tricuspid valve plasty (TVP) have become important surgical approaches for treating severe valve lesions. However, combining with other surgeries may increase perioperative risk and have an impact on the long-term prognosis of patients. To address the complexity of postoperative outcomes in cardiac surgery, this study employs a combination of traditional statistical methods and machine learning techniques to assess risk factors. The primary aim was to investigate the effects of DVR + TVP and combined surgery on postoperative survival and adverse outcomes. Patients who underwent DVR + TVP surgery, they were divided into 4 groups: DVR + TVP, MAZE + TVP, coronary artery bypass grafting (CABG) + TVP, or ascending aortic surgery (AAS) + TVP. Kaplan-Meier survival analysis was used to evaluate the impact of different surgical approaches on postoperative survival rate, Cox proportional hazards regression model was used to analyze contribution of postoperative complications and reoperation to the mortality risk. A neural network model was used to identify factors affecting postoperative mortality risk of patients, to evaluate role of perioperative biomarkers in predicting postoperative mortality risk. The survival rate of patients in AAS + TVP group was the lowest (2.5%), while that in TVP group was the highest (78.8%). Postoperative complications and reoperation were independent predictors of postoperative death. The mortality risk of patients with complications was 2.164 times that of patients without complications (hazard ratio (HR) = 2.164, 95% confidence interval (CI): 1.275-3.671, P = .004), underwent reoperation had a 2.6-fold increased risk of mortality (HR = 2.599, 95% CI: 1.221-5.532, P = .013). Postoperative biomarkers (lactate dehydrogenase (LDH), D-dimer) were significantly associated with postoperative mortality risk. When using neural network model to evaluate the postoperative mortality risk, age (2.0783) and length of stay in the intensive care unit (ICU) (2.0135) were the most important predictors, the area under the curve value of the model was 0.79. Different surgical approaches have a significant impact on postoperative survival rate and the incidence of complications in patients undergoing DVR + TVP. Complications and reoperation are independent factors for poor prognosis. Perioperative biomarkers (LDH, D-dimer) have important value in predicting postoperative mortality risk. The machine learning model based on neural networks can effectively predict postoperative adverse outcomes.

PMID:40988293 | PMC:PMC12459530 | DOI:10.1097/MD.0000000000044556

Medicine (Baltimore). 2025 Sep 19;104(38):e44625. doi: 10.1097/MD.0000000000044625.

ABSTRACT

RATIONALE: Very late stent thrombosis (VLST) is associated with high mortality rates. The use of endoluminal imaging to identify the causes of VLST is crucial. Here, we report a case of VLST occurring 7 times over 14 years, wherein both stent fracture and malapposition were confirmed by endoluminal imaging.

PATIENT CONCERNS: A 66-year-old male patient had experienced sudden, recurrent myocardial infarctions 7 times over a period of 14 years, receiving 5 stents and 2 drug-coated balloons. An Electrocardiogram showed stent thrombosis-segment elevation in the inferior wall leads. Emergency coronary angiography demonstrated total occlusion of the proximal right coronary artery. Anticoagulation, thrombus aspiration and intracoronary thrombolysis were performed to treat the coronary thrombosis.

DIAGNOSES: The etiology of VLST was confirmed as stent fracture and malapposition, based on endoluminal imaging.

INTERVENTIONS: Stent implantation was performed following balloon angioplasty using a non-compliant balloon.

OUTCOMES: The patient remained asymptomatic and free of adverse cardiovascular events during an 18-month follow-up.

LESSONS: "Three-step" strategy is suggested for VLST management. Therefore, endoluminal imaging is important.

PMID:40988234 | PMC:PMC12459456 | DOI:10.1097/MD.0000000000044625

Nephrology (Carlton). 2025 Sep;30(9):e70122. doi: 10.1111/nep.70122.

ABSTRACT

AIM: Contrast-associated acute kidney injury (CA-AKI) has higher mortality in coronary artery disease (CAD) with chronic kidney disease (CKD), undergoing coronary angiography ± revascularisation (CAG ± R). We conducted a clinical superiority trial with dichotomous outcomes to evaluate the impact of renal hypoxia mitigation with oxygen therapy (OT) on CA-AKI incidence.

METHODS: CKD stages 3-5 patients undergoing CAG ± R were assigned to the OT group (OTG) and the control therapy group (CTG). CTG received hydration only, whereas OTG received 2 L/min of pure oxygen in addition to hydration. The primary endpoint was the incidence of CA-AKI at 48 h. Secondary endpoints included patient and renal survival (doubling of serum creatinine or dialysis dependency) at 30 days, as well as intervention complications.

RESULTS: Of the 395 patients, 321 patients qualified for the per-protocol analysis (OTG: 160 and CTG: 161). CA-AKI incidence was 5.6%, and OTG observed an effective prevention (1.25% vs. 9.93%, CTG, p = 0.004). Renal and patient survival at 30 days was 100%. Three CTG patients required dialysis and were dialysis-independent at 30 days. The risk of CA-AKI incidence was high among ages > 65 years (p = 0.007), previous acute myocardial infarction (p = 0.02), CKD stage-3 (p = 0.01) and avoidance of OT use (p = 0.02). OTG had a favourable serum creatinine trend (p = 0.05). Absolute risk reduction of CA-AKI with OT was 8.7%, and the number needed to treat was 12. Interventional complications were zero.

CONCLUSION: Oxygen supplementation and saline hydration effectively prevented CA-AKI in CKD stages 3-5 patients undergoing elective CAG ± R. Hence, oxygen therapy should be a standard CA-AKI protective strategy during CAG ± R and radiocontrast-related procedures.

PMID:40984804 | DOI:10.1111/nep.70122

Diabetes Res Clin Pract. 2025 Sep 20:112910. doi: 10.1016/j.diabres.2025.112910. Online ahead of print.

ABSTRACT

AIM: To compare the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among adults with type 2 diabetes mellitus (T2D) at moderate cardiovascular risk.

METHODS: We emulated a target trial using claims data of adults with T2D at moderate cardiovascular risk who initiated dulaglutide, exenatide, liraglutide, or semaglutide between 01/01/2014-12/31/2021. Random treatment assignment was emulated by propensity scores and incorporated into inverse probability of treatment weighted (IPTW) Cox models. Outcomes were time to composite major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause mortality), expanded MACE (MACE, hospitalization for heart failure, and revascularization) and its components, and severe hypoglycemia.

RESULTS: After IPTW, 35,572 patients initiated dulaglutide, 4376 initiated exenatide, 8843 initiated liraglutide, and 33,063 initiated semaglutide. Compared to dulaglutide, semaglutide was associated with lower risk of MACE (HR 0.85, 95CI% 0.78-0.93), expanded MACE (HR 0.92, 95CI% 0.87-0.96), all-cause mortality (HR 0.81, 95CI% 0.71-0.92), stroke (HR 0.82, 95CI% 0.70-0.97), and revascularization (HR 0.93, 95CI% 0.88-0.99), while liraglutide was associated with lower risk of MACE (HR 0.84, 95CI% 0.72-0.97) and all-cause mortality (HR 0.79, 95CI% 0.64-0.99).

CONCLUSIONS: Among GLP-1RAs, semaglutide and liraglutide were associated with the greatest cardiovascular risk reduction in patients with T2D at moderate cardiovascular risk.

PMID:40983112 | DOI:10.1016/j.diabres.2025.112910

Cardiol J. 2025 Sep 22. doi: 10.5603/cj.103397. Online ahead of print.

ABSTRACT

BACKGROUND: As a result of increased life expectancy, the number of octa- and nonagenarians presenting with myocardial infarction is on the rise. These patients are often underrepresented in clinical trials. The aim of this study was to compare the presentation and outcomes of ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in patients older than 80 years.

METHODS: This retrospective study included 14758 patients above 80 years of age hospitalized with STEMI or NSTEMI who were selected from the Polish Registry of Acute Coronary Syndromes using propensity score matching (two equal size groups).

RESULTS: Patients with STEMI were more likely to undergo coronary angiography (87.80% vs. 77,03%) and revascularization (80.50% vs. 54.26%); in STEMI the culprit lesion was more likely to be located in left anterior descending artery (LAD) (31.76% vs. 44.43%) or right coronary artery (RCA) (18.41% vs. 35.29%), and NSTEMI more likely to be located in left main (4.59% vs. 1.76%) or other native artery (23.3% vs. 6.02%). Elderly patients with STEMI had higher all-cause mortality at 30-days (19.62% vs. 14.51%) and 1-year (32.00% vs. 29.54%). The difference was highly influenced by initial in-hospital mortality (17.96% vs. 12.48%). Among hospital survivors there was no difference in 30-days mortality and 1-year mortality was higher for NSTEMI hospital survivors (17.06% vs. 14.04%).

CONCLUSIONS: In patients older than 80 years of age with similar baseline characteristics, STEMI and NSTEMI had different presentation, outcomes and required different treatment strategy. ST-elevation patients had higher in-hospital mortality and NSTEMI patients had higher post-hospital mortality after 1 year.

PMID:40981748 | DOI:10.5603/cj.103397

Med Sci (Basel). 2025 Sep 5;13(3):179. doi: 10.3390/medsci13030179.

ABSTRACT

Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017-2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. Results: MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (p = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, p < 0.001), shorter hospital stay (10 d vs. 12 d, p = 0.002), reduced ventilation time (8 h vs. 12 h, p < 0.001), lower delirium (5.0% vs. 14.2%, p = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, p = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, p < 0.001). Conclusions: In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits.

PMID:40981176 | PMC:PMC12452580 | DOI:10.3390/medsci13030179

Eur Heart J Open. 2025 Aug 20;5(5):oeaf111. doi: 10.1093/ehjopen/oeaf111. eCollection 2025 Sep.

ABSTRACT

AIMS: Myocardial infarction size is associated with mortality in ST-elevation myocardial infarction (STEMI). With advances in primary percutaneous coronary intervention (PPCI) and medical therapy, whether this relationship has changed over time is unclear.

METHODS AND RESULTS: Patients with STEMI in the UK from 2005 to 2019 were included from the national AMI MINAP registry, with mortality linkage to 2021. Primary outcomes were all-cause mortality at 30 days and 1 year according to infarct size, using Cox regression models. Infarct size was stratified by Tertiles (T1-3) of peak troponin level (T1, smallest; T3, largest), across the early (2005-09), middle (2010-14), and late (2015-19) periods. Subgroup analyses assessed the relationship according to infarct location (anterior vs. non-anterior). A total of 177 214 STEMI patients were included. Adjusted 30-day mortality risk according to infarct size was highest in the early period (aHR: 1.32, 1.21-1.45, P < 0.001), compared to middle (1.12, 1.04-1.20, P = 0.002) and late study periods (1.05, 0.96-1.14, P = 0.299). The relationship between infarct size and 30-day mortality was significant for patients with anterior STEMI in early (1.39, 1.22-1.57, P < 0.001) but not middle or late periods, while remained significant for non-anterior infarction until the late period (early, 1.28, 1.13-1.45, P < 0.001; middle, 1.17, 1.06-1.29, P = 0.002; late, 1.09, 0.96-1.24, P = 0.180).

CONCLUSION: We observed an independent relationship between infarct size and STEMI mortality, strongest between 2005 and 2009, which reduced over time, becoming non-significant in the 2015-19 period. This association diminished more rapidly for patients with anterior STEMIs. These findings underscore the potential role of contemporary revascularization, systems of care, and guideline-directed medical therapy in reducing STEMI-related mortality.

PMID:40980717 | PMC:PMC12448480 | DOI:10.1093/ehjopen/oeaf111

Eur Heart J Imaging Methods Pract. 2025 Aug 20;3(2):qyaf112. doi: 10.1093/ehjimp/qyaf112. eCollection 2025 Jul.

ABSTRACT

The 2019 ESC guidelines redefined stable coronary artery disease as chronic coronary syndrome (CCS), highlighting the dynamic nature of this disease. This condition is characterized by the gradual accumulation of atherosclerotic plaques in the epicardial coronary arteries. CCS can result in myocardial ischaemia due to supply-demand mismatch, often triggered by physical or emotional stress. The clinical course may be abruptly interrupted by plaque rupture or erosion, leading to acute coronary syndromes. Revolutionary advances in non-invasive imaging have transformed the chronic coronary syndrome diagnosis algorithm and management. Coronary computed tomography angiography provides detailed anatomical insights, identifying high-risk plaques with features like low attenuation and positive remodelling, as evidenced by SCOT-HEART, which reported reduced coronary events (HR: 0.59, P = 0.004). Stress echocardiography may detect ischaemia-induced wall motion abnormalities (sensitivity, 85-95%), while cardiovascular magnetic resonance is paramount in functional assessment, offering 81-86% sensitivity/specificity and detecting microvascular dysfunction via perfusion and late gadolinium enhancement. Nuclear imaging (SPECT/PET) enhances ischaemia detection, with PET's myocardial flow reserve improving prognostic accuracy (sensitivity 90%, specificity 88%). AI-driven innovations, such as CT-derived fractional flow reserve, automate plaque quantification and may reduce in the future unnecessary invasive angiographies by 19-25% (P = 0.01), while dynamic CT myocardial perfusion integrates anatomical and hemodynamic data, boosting diagnostic accuracy (87%). These advancements enable precise risk stratification and a personalized multimodal imaging approach, based on pre-test likelihood. It also increases the risk of unsustainable costs for society, repeated radiation exposure throughout a patient's life, and raises the question of actual limited benefits from revascularization in low-risk patients.

PMID:40978762 | PMC:PMC12448739 | DOI:10.1093/ehjimp/qyaf112

Circ J. 2025 Sep 20. doi: 10.1253/circj.CJ-25-0130. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend early revascularization in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI). However, guideline-recommended first medical contact-to-device times is reportedly achieved in only 40% of patients.

METHODS AND RESULTS: We retrospectively analyzed 369 patients with AMI complicated by CS from the Kanagawa-Acute Cardiovascular Registry to evaluate factors influencing delays in treatment and their effect on in-hospital mortality. Patients were stratified into 2 groups based on the median door-to-cardiac catheterization laboratory (D2C) time (≤39 or >39 min). In the group with D2C time ≤39 min, the first-contact physician was more frequently a cardiologist (71.9% vs. 47.0%; P<0.001) and significantly more patients had chest pain as the chief complaint (70.3% vs. 47.4%; P<0.001). Although pre- and post-percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was similar between the 2 groups, in-hospital mortality was significantly lower in the D2C time ≤39 min group (18.8% vs. 37.6%; P<0.001). Multivariate logistic regression analysis revealed that D2C time >39 min was independently associated with a non-cardiologist being the first-contact physician, the absence of chest pain, a higher heart rate, and elevated creatinine levels.

CONCLUSIONS: D2C time ≤39 min is correlated with reduced mortality in AMI patients with CS. Implementing systems to ensure cardiologists are the initial responders and optimizing in-hospital workflows could reduce the D2C time and improve outcomes.

PMID:40976693 | DOI:10.1253/circj.CJ-25-0130

J Vasc Surg. 2025 Sep 19:S0741-5214(25)01765-3. doi: 10.1016/j.jvs.2025.09.033. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty is increasingly recognized as a key driver of postoperative risk in vascular surgery. Yet the relative accuracy of the major frailty indices in a purely vascular cohort remains unclear.

OBJECTIVE: To compare the predictive accuracy of the Modified Frailty Index (mFI), Risk Analysis Index (RAI), Vascular Quality Initiative Frailty Index (VQI-FI), and VQI Procedure-Based Index (VQI-PBI) in predicting adverse postoperative outcomes in patients undergoing lower extremity revascularization.

METHODS: In this retrospective single-center cohort study, 193 patients who underwent open or endovascular lower extremity revascularization between January 1 and December 31, 2023, were included. Frailty scores were retrospectively calculated based on data available at the time of the preoperative evaluation. Primary outcomes were 30-day and one-year mortality and 30- and 60-day hospital readmission. Secondary outcomes included new dialysis within 30 days, and myocardial infarction. Statistical associations were evaluated using logistic regression models.

RESULTS: The cohort's mean age was 69.4 years, 32 % were female, and 74 % presented with critical limb ischemia. All four indices predicted 1-year mortality and initiation of dialysis within 30 days. The mFI, VQI-FI, and VQI-PBI also predicted 30-day readmission, but only the VQI scores were associated with 60-day readmission. The RAI was the only score associated with in-hospital mortality. The VQI-FI demonstrated the greatest number of statistical associations with good discriminatory ability.

CONCLUSIONS: Vascular specific frailty indices (VQI-FI and VQI-PBI) provide superior risk stratification compared to generic measures. Incorporating these tools into preoperative evaluation may improve patient selection and shared decision-making.

PMID:40976447 | DOI:10.1016/j.jvs.2025.09.033

Clin Transl Sci. 2025 Sep;18(9):e70357. doi: 10.1111/cts.70357.

ABSTRACT

This study investigated the relationship between trimethylamine N-oxide (TMAO) levels and plaque instability in Chinese patients with ST-elevation myocardial infarction (STEMI) using optical coherence tomography (OCT), with a 7 -year follow-up. Between January 1, 2017, and December 31, 2018, 188 Chinese patients with STEMI who underwent OCT at the Second Affiliated Hospital of Harbin Medical University were enrolled. Patients were stratified into low TMAO (≤ 2.54 μM) and high TMAO (> 2.54 μM) groups. The primary endpoint was major adverse cardiovascular events (MACE: all-cause mortality, reinfarction, target vessel revascularization, and stroke). Compared with the low TMAO group, the high TMAO group showed a higher incidence of plaque rupture and a lower incidence of plaque erosion. Laboratory findings revealed significantly elevated NT-proBNP levels in the high TMAO group. OCT analyzes demonstrated greater plaque length and more frequent microchannels in the high TMAO group. During follow-up, both TMAO and NT-proBNP were independently associated with 7-year MACE. Receiver operating characteristic analysis identified TMAO as a predictor of MACE, with a sensitivity of 59.5% and a specificity of 65.8%. In conclusion, elevated TMAO levels were associated with adverse plaque characteristics and independently predicted long-term cardiovascular events in Chinese STEMI patients. These findings suggest that TMAO may serve as a valuable biomarker for assessing plaque instability and improving risk stratification in this population.

PMID:40973984 | PMC:PMC12449236 | DOI:10.1111/cts.70357

Int J Stroke. 2025 Sep 19:17474930251383626. doi: 10.1177/17474930251383626. Online ahead of print.

ABSTRACT

BACKGROUND: An in-hospital double-dose influenza vaccination strategy's effect on preventing major cardiovascular events (MACE) in patients with previous stroke is still uncertain. This study is a prespecified analysis of the vaccine against influenza to avoid cardiovascular events after the Acute Coronary Syndrome (VIP-ACS) trial.

METHODS: The VIP-ACS trial was a randomized, pragmatic, multicenter, open-label trial with blinded-adjudication endpoints. Adult patients with acute coronary syndrome (ACS) ≤ seven days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine or a standard-dose vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of all-cause death, myocardial infarction (MI), stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analyzed by the win ratio (WR) method. The secondary endpoint was a hierarchical composite consisting of CV death, MI and stroke (MACE). Patients were followed for 12 months each influenza season.

RESULTS: The trial enrolled 1,801 patients (31% female). A total of 67 patients had a history of stroke. There were no significant differences between groups on the primary hierarchical endpoint: 11.4% wins in the double-dose vaccine group vs 12.1% wins in the standard-dose vaccination group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke. However, in-hospital double-dose vaccination favored individuals with previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8% wins). Results were consistent for hierarchical MACE (WR:3.01; 95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital double-dose vaccination.

CONCLUSIONS: After an ACS, in-hospital double-dose influenza vaccination prevents hospitalizations and death compared with standard-dose vaccination at 12 months in individuals with previous strokes.

PMID:40973981 | DOI:10.1177/17474930251383626

Eur J Prev Cardiol. 2025 Sep 18:zwaf475. doi: 10.1093/eurjpc/zwaf475. Online ahead of print.

ABSTRACT

AIMS: Both lipoprotein(a) [Lp(a)] and peripheral artery disease (PAD) are associated with ischaemic events. We sought to assess the association between Lp(a) and major adverse cardiovascular events (MACE) and major lower extremity events (MALE) among patients with baseline PAD.

METHODS AND RESULTS: The Mass General Brigham (MGB) Lp(a) registry includes all individuals with Lp(a) measured at two tertiary care centres from 2000 to 2019. Those with PAD were grouped according to Lp(a) percentile: 1st-25th [Q1, Lp(a) ≤ 14 nmol/L], 26th-50th (Q2, 14-<42 nmol/L), 51st-75th (Q3, 42-<132 nmol/L), and 76th-100th (Q4, 132-855 nmol/L). Outcomes were MACE [composite of cardiovascular (CV) death, myocardial infarction, or coronary revascularization] and MALE (composite of peripheral revascularization, acute limb ischaemia, or major lower extremity amputation). Cox proportional hazard modelling was used to assess the association between Lp(a) and the outcomes of interest after adjusting for traditional risk factors. Among 3757 individuals with PAD [39% female, median age 68 (IQR: 58-77)], individuals with Lp(a) levels in the third and fourth quartiles had a 24 and 30% increased hazard of MACE, respectively [adj. hazard ratio (HR): 1.24, P = 0.005; adj. HR: 1.30, P = 0.001] when compared with those in the first quartile. Individuals in the fourth quartile had a 19% greater hazard of MALE (adj. HR: 1.19, P = 0.043).

CONCLUSION: Elevated Lp(a) in patients with PAD was associated with an increased risk of both MACE and MALE. Accordingly, measurement of Lp(a) may convey important prognostic value and allow for further risk stratification within this high-risk population.

PMID:40973195 | DOI:10.1093/eurjpc/zwaf475

Catheter Cardiovasc Interv. 2025 Sep 18. doi: 10.1002/ccd.70185. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately half of individuals with acute coronary syndrome (ACS) are affected by multivessel coronary artery disease (CAD), and recent studies in the field have presented conflicting data on effective benefit of complete revascularization. The aim of this study was to investigate the efficacy and safety of multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI in individuals presenting with acute coronary syndrome and multivessel CAD.

METHODS AND RESULTS: Randomized trials on ACS comparing multivessel PCI versus culprit-only PCI were included. The primary efficacy outcome was all-cause death. The primary safety outcomes were major bleeding and contrast induced nephropathy. Secondary ischemic and safety outcomes were also investigated. Subgroup analyses were conducted to investigate the consistency of the effect sizes as a function of age (younger vs older individuals, using a cut-off of 65 years) and of a higher or lower prevalence of diabetic patients (using a cut-off of 20% for each study). A total of 11 randomized trials including 10,150 individuals with a mean follow-up of 21.7 months were included. Compared with cluprit-only PCI, multivessel PCI significantly reduced the risk of all-cause death (risk ratio 0.86, [0.74-1.00], p = 0.047), mainly due to a significant reduction in cardiovascular mortality by 26%. Similarly, the rates of new myocardial infarction and unplanned revascularization were significantly reduced. No increases in major bleeding, contrast induced nephropathy or stroke were observed, with a significantly higher rate of stent thrombosis in complete revascularization group, even if with a low absolute risk (risk ratio 1.69 [1.10, 2.59], p = 0.027). Subgroup analyses revealed a significant interaction for death in studies with higher prevalence of diabetics (p for interaction = 0.029), but no interaction for death with regards of age.

CONCLUSION: In individuals presenting with ACS and multivessel CAD, complete revascularization was associated with a significant reduction in all-cause mortality, with a lower rate of major ischemic events and no significant increase in major complications. The benefit was particularly evident in diabetic patients.

PMID:40968459 | DOI:10.1002/ccd.70185

Curr Cardiol Rev. 2025 Sep 17. doi: 10.2174/011573403X396917250910215747. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVE: This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).

METHODS: A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.

RESULTS: Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,475 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75; 95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI 2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI 0.35-2.41).

DISCUSSION: While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, myocardial infarction, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.

CONCLUSION: CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.

PMID:40968418 | DOI:10.2174/011573403X396917250910215747

Cardiol Rev. 2025 Sep 19. doi: 10.1097/CRD.0000000000001057. Online ahead of print.

ABSTRACT

Cardiovascular complications remain the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), despite substantial advances in pharmacologic management. Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown potential in reducing cardiovascular events through its multifaceted metabolic and anti-inflammatory effects. This systematic review and meta-analysis aimed to assess the efficacy and safety of semaglutide in improving cardiovascular outcomes among patients with T2DM. A comprehensive literature search was conducted across multiple databases up to March 30, 2025. Randomized controlled trials comparing semaglutide with placebo in adults with T2DM were included. Five randomized controlled trials with a total of 19,717 participants were included. Semaglutide was associated with a significant reduction in major adverse cardiovascular events [risk ratios (RR), 0.82; P < 0.00001], cardiovascular death (RR, 0.81; P = 0.05), and need for coronary revascularization (RR, 0.74; P < 0.0001). A significant reduction in cardiac disorder-related adverse events was also observed (RR = 0.80; P = 0.03). No significant difference was noted in all-cause mortality (RR = 0.83; P = 0.16), hospitalization for heart failure (RR = 0.86; P = 0.10) or unstable angina (RR = 0.94; P = 0.63), nonfatal myocardial infarction (RR = 0.82; P = 0.10) or stroke (RR = 0.83; P = 0.06), and vascular disorders (RR = 1.03; P = 0.73). These findings highlight semaglutide's role as a cardioprotective agent, supporting its integration into standard care for high-risk T2DM patients.

PMID:40968407 | DOI:10.1097/CRD.0000000000001057