http:www.cardiocirugia.sld.cu

Open Heart. 2025 Sep 17;12(2):e003453. doi: 10.1136/openhrt-2025-003453.

ABSTRACT

INTRODUCTION: An evidence-based selection between fractional flow reserve (FFR) and optical coherence tomography (OCT) to drive percutaneous coronary intervention is still lacking.

METHODS: Patients enrolled in the Fractional Flow Reserve vs. Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses (FORZA) trial and in the OCT-Features Of moRphology, coMposItion anD instABility of culprit and not culprit coronary pLaquE in ACS patient (OCT-FORMIDABLE) registry were included. Target vessel revascularisation (TVR) and major adverse cardiac events (MACE), a composite endpoint of cardiac death, myocardial infarction (MI) and TVR were considered as coprimary endpoints. Phenomapping with clustering was performed: incidence of outcomes according to FFR and OCT was explored.

RESULTS: 405 patients were treated according to OCT and 405 to FFR. Three different clusters were identified. 48% of the patients were included in the first cluster, presenting mainly with stable angina and a relevant burden of risk factors (cardiovascular risk factors, CVRFs). 21% of the patients were included in the second cluster, presenting with ST segment elevation MI (STEMI) and with low rates of CVRFs. 31% of the patients, being admitted mostly for non-STEMI (NSTEMI) and with high rates of CVRFs, were included in the third cluster. FFR and OCT performed similarly in terms of MACE and TVR in the first cluster. In the second cluster, rates of MACE were lower in the OCT arm (3% vs 12%, p 0.04), mainly driven by TVR (2% vs 6%, p 0.18). In the third cluster, rates of TVR were significantly reduced in the OCT arm (6% vs 14%, p 0.037) with a neutral impact on MACE (12% vs 15%, p 0.71).

CONCLUSIONS: Compared with a functional assessment, an OCT-based approach reduces revascularisation in patients with STEMI/NSTEMI, while FFR proved non-inferior for patients with stable angina.

PMID:40967674 | PMC:PMC12458727 | DOI:10.1136/openhrt-2025-003453

BMJ Open. 2025 Sep 17;15(9):e092482. doi: 10.1136/bmjopen-2024-092482.

ABSTRACT

INTRODUCTION: Treatment expectations are a key mechanism of placebo effects in clinical trials. In a previous study (PSY-HEART-I), preoperative expectation optimisation improved quality of life 6 months postcardiac surgery. However, barriers such as travel distance, staffing shortages and COVID-19 limited participation. This study evaluates the feasibility and acceptability of iEXPECT, a brief internet-based intervention designed to optimise expectations before heart surgery.

METHODS AND ANALYSIS: In this three-arm, multicentre randomised controlled trial, 160 patients undergoing elective coronary artery bypass graft surgery are randomised to: (a) standard of care (SOC); (b) SOC plus iEXPECT with phone-based guidance (iEXPECT enhanced) or (c) SOC plus iEXPECT with email-based guidance (iEXPECT limited). The intervention includes four 20 min online modules addressing surgical benefits, side effects and coping strategies. Modules are accompanied by personalised guidance provided through feedback on each module via email or telephone (three before surgery, three booster sessions at 6, 12 and 18 weeks postsurgery). Assessments occur at baseline (5-21 days before surgery), preoperatively (day before surgery), 7 days postsurgery and 6 months later. Primary feasibility outcomes include recruitment (≥1 participant/week/centre), retention (≥49% completing 6-month follow-up including biomarkers) and engagement (≥75% completing ≥1 presurgery module). Acceptability is measured by self-reported enjoyment, usefulness and impact, with acceptance defined as mean scores >3.4 (5-point Likert scale) and CSQ-I ratings. Secondary outcomes include psychological measures, inflammatory markers and heart rate variability.

ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Committees of Philipps University Marburg (AZ 229/23 BO) and the University of Giessen (AZ 186/23). All participants provide written informed consent. Results will be shared via publications, conferences and public outreach with relevant consumer advocacy groups.

TRIAL REGISTRATION NUMBER: DRKS00033284.

PMID:40967648 | PMC:PMC12458749 | DOI:10.1136/bmjopen-2024-092482

Ann Vasc Surg. 2025 Sep 16:S0890-5096(25)00600-4. doi: 10.1016/j.avsg.2025.08.052. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid artery stenosis is a significant cause of ischemic stroke. Transcarotid artery revascularization (TCAR), a newer technique utilizing dynamic flow reversal, has emerged as a potentially safer alternative to transfemoral carotid artery stenting (TFCAS). This systematic review and meta-analysis aimed to compare TCAR and TFCAS in patients undergoing carotid revascularization.

METHODS: We searched PubMed, Cochrane CENTRAL, Scopus, and Web of Science through June 2025 for comparative studies evaluating TCAR vs TFCAS. Primary outcomes included 30-day and in-hospital mortality, stroke, and composite stroke/death. Secondary outcomes assessed myocardial infarction (MI), transient ischemic attack (TIA), procedural times, and periprocedural complications. Risk ratios (RRs) and mean differences (MDs) were pooled using random-effects models.

RESULTS: Thirteen studies involving 142,032 patients were included in the analysis. TCAR significantly reduced 30-day mortality (RR 0.45; p<0.001), in-hospital mortality (RR 0.45; p<0.001), 30-day stroke (RR 0.66; p<0.001), and composite 30-day stroke/death (RR 0.57; p<0.001). TIA (RR 0.72; p<0.001) and stroke/TIA (RR 0.66; p<0.001) were also lower with TCAR. MI rates were similar overall, though asymptomatic patients had a higher 30-day MI risk with TCAR. TCAR reduced reperfusion injury (RR 0.38; p<0.001) and hospital stay length (RR 0.76; p<0.001), but had slightly longer operative times. Long-term data from two large cohorts confirmed TCAR's durable stroke risk reduction up to 3 years.

CONCLUSION: This meta-analysis of current observational data demonstrates that TCAR is associated with superior perioperative outcomes compared to TFCAS, with significantly lower rates of stroke and death. These findings support TCAR as a preferred endovascular treatment for eligible patients with carotid artery stenosis.

PMID:40967268 | DOI:10.1016/j.avsg.2025.08.052

Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 May 20;56(3):840-845. doi: 10.12182/20250560104.

ABSTRACT

OBJECTIVE: To study the effect of the transbrachial artery approach on the success rate of puncture, revascularization time, and postprocedural complications in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI).

METHODS: The clinical data of 324 patients with STEMI who underwent PCI between September 2020 and May 2024 at our hospital were retrospectively analyzed. According to the different approaches, the patients were divided into a brachial artery group (127 cases) and a radial artery group (197 cases). Their procedural parameters (X-ray exposure time, contrast agent dosage, puncture time, puncture success rate, and revascularization time) and hospital length-of-stay, cardiac function indicators, including left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI), before surgery and 3 months after PCI, and the incidence of complications were compared between the two groups of patients. Furthermore, a difference-in-differences method was adopted for the logistic model to evaluate the effects of different approaches.

RESULTS: There were no statistical differences in the general data between the brachial artery group and the radial artery group. Compared with those of the radial artery group, the revascularization time and length-of-stay of the brachial artery group were shortened, and the success rate of puncture was increased (P < 0.05). There were no significant differences in X-ray exposure time or contrast agent dosage between the two groups. The changes in LVEF, LVFS, LVESVI, and LVEDVI from baseline to 3 months post-PCI were (10.97 ± 7.15)%, (3.29 ± 5.90)%, (22.11 ± 9.30) mL/m2, and (18.13 ± 6.68) mL/m2, respectively, in the brachial artery group, while those in the radial artery group were (10.61 ± 7.13)%, (4.38 ± 6.04)%, (23.13 ± 9.60) mL/m2, and (19.34 ± 7.27) mL/m2, respectively, without statistical differences. Difference-in-differences analysis revealed that there were no statistical differences in the effects of different approaches on LVEF, LVFS, LVESVI, and LVEDVI between the brachial artery group and the radial artery group. During follow-up, no complications, such as coronary perforation, coronary dissection, or stent thrombosis, were observed in either group, and there were no statistical differences in the complication incidence between the two groups.

CONCLUSION: The transbrachial artery approach can shorten the revascularization time and length-of-stay of patients with STEMI treated by PCI. It has a high success rate of puncture and can promote the recovery of postoperative cardiac function without increasing postoperative complications.

PMID:40964121 | PMC:PMC12439660 | DOI:10.12182/20250560104

Catheter Cardiovasc Interv. 2025 Sep 17. doi: 10.1002/ccd.70163. Online ahead of print.

ABSTRACT

Dual antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI), though the optimal duration is unclear. DAPT reduces stent thrombosis, repeat myocardial infarction, and cardiovascular death, though at the cost of increased bleeding events. Currently, both European and American guidelines recommend a 6-month duration of DAPT following PCI with drug-eluting stents (DES) for stable coronary disease and a 12-month regimen following PCI for acute coronary syndrome. Recent randomized clinical trials (RCTs) suggest a shorter duration of DAPT may be acceptable. PubMed, EMBASE, and Cochrane databases were queried from inception to June 2025 to identify RCTs comparing short ( ≤ 3 months) with traditional durations of DAPT following PCI with DES and reporting outcomes of interest at 1 year, including major adverse cardiovascular and cerebrovascular events (MACCE) and net adverse clinical events (NACE). Individual endpoints including mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, significant bleeding, and target vessel revascularization were analyzed. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals. Thirteen studies met the inclusion criteria, reporting results on 53,421 patients, of whom 26,712 patients were in the short DAPT cohort and 26,719 in the traditional DAPT cohort. Duration of DAPT ranged from 1 to 3 months. Ten studies used P2Y12 inhibitors as the single antiplatelet agent following DAPT, whereas three studies used aspirin. Patients were 76.0% male, mean age 64.0 years, and 64.9% with ACS on presentation. Shorter duration of DAPT significantly decreased NACE (RR: 0.80; [0.71, 0.91], p < 0.001) without impacting MACE (RR: 0.98; [0.89, 1.07], p = 0.64) at 1 year following PCI with DES. A 3-month duration of DAPT demonstrated favorable results over shorter durations, and monotherapy with a high-potency P2Y12 inhibitor was preferable over aspirin or a low-potency P2Y12 inhibitor. In patients who underwent a PCI with DES placement, a 3-month duration of DAPT decreased NACE without impacting other MACCE compared to guideline-directed DAPT durations.

PMID:40963197 | DOI:10.1002/ccd.70163

Cardiol Rev. 2025 Sep 18. doi: 10.1097/CRD.0000000000001046. Online ahead of print.

ABSTRACT

Assessing lesion severity and optimizing percutaneous coronary intervention (PCI) are crucial for improving long-term outcomes in patients with coronary artery disease. Both strategies offer advantages over angiography alone; however, direct comparisons for revascularization decision-making are limited. This study evaluates and compares outcomes of FFR versus intravascular ultrasound (IVUS)-guided PCI strategies. We searched PubMed, Cochrane Central, and ScienceDirect from inception till April 2025. Data for various outcomes were extracted after computing the random-effect model and risk ratio (RR) with a 95% confidence interval (CI). The quality assessment of the included randomized controlled trials and observational studies was conducted using the Cochrane Risk of Bias 2 (ROB-2) and the Newcastle-Ottawa Scale, respectively. Publication bias was assessed visually through funnel plots and statistically through Egger's regression test. We included 5 studies comparing FFR and IVUS in 4714 patients undergoing PCI. The FFR and IVUS groups demonstrated comparable results across all endpoints including major adverse cardiovascular events (RR: 1.05; 95% CI: 0.84-1.30; P = 0.68), all-cause mortality (RR: 0.84; 95% CI: 0.50-1.39; P = 0.49), cardiac death (RR: 1.05; 95% CI: 0.59-1.87; P = 0.87), nonfatal myocardial infarction (RR: 1.31; 95% CI: 0.70-2.44; P = 0.40), and target vessel revascularization (RR: 1.20; 95% CI: 0.78-1.84; P = 0.40). The FFR (either hyperemic or angiography-driven) and IVUS groups showed comparable clinical outcomes in PCI for intermediate coronary lesions. However, FFR adds value with enhanced cost-efficiency and a physiology-driven approach that avoids unnecessary interventions. Selection should depend on patient factors, operator expertise, and institutional resources.

PMID:40963157 | DOI:10.1097/CRD.0000000000001046

Eur J Pharmacol. 2025 Sep 15;1006:178158. doi: 10.1016/j.ejphar.2025.178158. Online ahead of print.

ABSTRACT

Myocardial ischemia-reperfusion (I/R) injury is a significant complication post-revascularization in acute myocardial infarction, with limited effective clinical interventions. Corilagin, a natural polyphenolic compound, exhibits antioxidant and anti-inflammatory properties in various disease models. However, its effects and mechanisms in myocardial I/R injury remain unclear. This study aims to elucidate the specific mechanism by which Corilagin regulates ferroptosis through the PI3K/AKT signaling pathway, thereby laying a theoretical groundwork for the development of innovative cardioprotective agents. A myocardial I/R model was established in mice through left anterior descending (LAD) artery ligation, and Corilagin's effectiveness was assessed using echocardiography, biochemical assays, and histopathological analysis. Additionally, an in vitro H/R model with neonatal rat cardiomyocytes was employed to examine ferroptosis-related markers, oxidative stress, and mitochondrial function. Utilizing network pharmacology and molecular docking analysis, potential targets were identified and subsequently validated through pharmacological inhibition of the PI3K pathway with LY294002. The findings demonstrate that Corilagin exhibited significant cardioprotective effects against I/R injury, as evidenced by reduced myocardial injury markers, decreased infarct size, and improved cardiac function. In vitro studies revealed that Corilagin treatment enhanced cell viability, reduced ROS levels and iron content, and restored mitochondrial membrane potential. Network pharmacology and molecular docking identified PI3K as a crucial target, with subsequent activation of the PI3K/AKT pathway. Notably, PI3K inhibition abolished Corilagin's suppression of ferroptosis, underscoring its pathway-dependent action. Corilagin alleviates myocardial I/R injury by activating the PI3K/AKT pathway to suppress ferroptosis, highlighting its potential as a therapeutic candidate for clinical translation.

PMID:40962010 | DOI:10.1016/j.ejphar.2025.178158

Braz J Cardiovasc Surg. 2025 Sep 1;40(5):e20240266. doi: 10.21470/1678-9741-2024-0266.

ABSTRACT

INTRODUCTION: Prolonged aortic cross-clamping may intensify systemic inflammation after cardiac surgery. This study aimed to evaluate the effect of cross-clamp duration on systemic inflammatory response index (SIRI) and systemic immune inflammation index (SIII) in isolated coronary artery bypass grafting (CABG).

METHOD: This retrospective study included 155 patients who underwent first-time isolated CABG between January 2021 and June 2024. Patients were divided into two groups based on median cross-clamping time: Group I (≤ 64 minutes, n = 83) and Group II (> 64 minutes, n = 72). Demographic, hematologic, and biochemical data were collected. SIII was calculated as platelet × neutrophil/lymphocyte; SIRI as neutrophil × monocyte/lymphocyte.

RESULTS: The mean aortic cross-clamping time of Group I was 53 minutes (interquartile range 44 - 60 minutes) and of Group II it was 78 minutes (interquartile range 71 - 87 minutes) (P < 0.001). An increase in systemic immune inflammation index and systemic inflammatory response index values was observed in both groups at the 24th postoperative hour. Postoperative systemic immune inflammation index and systemic inflammatory response index levels were significantly higher in Group II (P < 0.05). There was a weak but significant positive correlation between aortic cross-clamping time and postoperative systemic inflammation response index (r = 0.220; P = 0.006).

CONCLUSION: Prolonged aortic cross-clamping time is associated with an increased postoperative inflammatory response. These indices may serve as biomarkers for evaluating systemic inflammation following coronary artery bypass grafting.

PMID:40961274 | PMC:PMC12443441 | DOI:10.21470/1678-9741-2024-0266

J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251367580. doi: 10.1177/23247096251367580. Epub 2025 Sep 17.

ABSTRACT

Coronary-subclavian steal syndrome (CSSS) is a rare but important complication following coronary artery bypass grafting (CABG) involving the left internal mammary artery (LIMA), typically due to proximal subclavian artery stenosis. We present a 54-year-old male with prior triple-vessel CABG (LIMA to left anterior descending) who developed acute chest pain and elevated troponin levels. Electrocardiogram showed diffuse ST-segment changes. Emergent angiography revealed patent grafts but critical 90% stenosis of the left subclavian artery proximal to the LIMA origin. The lesion was successfully treated with percutaneous angioplasty and drug-eluting stent placement, resulting in the resolution of symptoms and preserved cardiac function. CSSS, though uncommon, should be considered in post-CABG patients with recurrent angina or myocardial injury despite patent grafts. Literature estimates subclavian stenosis in up to 5% of CABG candidates, yet routine screening remains inconsistent. This case highlights CSSS as a reversible cause of ischemia and underscores the value of targeted vascular imaging in selected patients.

PMID:40960285 | PMC:PMC12444056 | DOI:10.1177/23247096251367580

Front Cardiovasc Med. 2025 Sep 1;12:1633002. doi: 10.3389/fcvm.2025.1633002. eCollection 2025.

ABSTRACT

This study aimed to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults. A retrospective analysis was conducted using data obtained from the Korean National Health Insurance Service, focusing on patients aged ≥20 years diagnosed with ASD between 2004 and 2015. Participants were categorized into the observation, device closure, and surgery groups. Propensity score matching (PSM) was employed to mitigate imbalances among the groups. The Cox proportional hazards model was utilized to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), coronary revascularization, and all-cause death. In total, 20,643 patients with ASD were included in this study. After PSM, there were 6,636 in the observation group and 3,318 each in the device closure and surgery group. Over a 5-year follow-up period, the adjusted hazard ratios for MACE were significantly lower in the surgery (0.72; 95% CI: 0.66-0.79) and device closure groups (0.85; 95% CI: 0.78-0.92) than in the observation group. Beneficial effects on stroke and all-cause mortality were observed in both intervention groups. Additionally, a beneficial effect on coronary revascularization was observed in the surgery group, whereas the impact on MI was not significantly different between the groups. ASD closure, whether by surgery or using a device, is associated with a decreased incidence of cardiovascular outcomes in adults. The benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults.

PMID:40959496 | PMC:PMC12434082 | DOI:10.3389/fcvm.2025.1633002

EuroIntervention. 2025 Sep 15;21(18):e1051-e1068. doi: 10.4244/EIJ-D-24-00992.

ABSTRACT

Over the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularisation, and it is increasingly used in patients with advanced coronary artery disease. Antithrombotic therapy, including antiplatelet and anticoagulant drugs, plays a key role and should be part of the optimal revascularisation strategy in the early phase as well as in the long-term prevention of ischaemic events. An antithrombotic therapy regimen of increased intensity and/or duration may mitigate part of the ischaemic burden associated with complex PCI. However, patients undergoing complex PCI are often at increased bleeding risk, challenging, therefore, the decision-making process. In this setting, the optimal antithrombotic treatment is still a matter of debate and has become a field of intensive research. In this state-of-the-art review, we analyse the evidence related to the different approaches regarding the periprocedural and long-term antithrombotic management of patients undergoing complex PCI. Since a "one-size-fits-all" approach cannot be justified in this clinical setting, our aim is to tailor the antithrombotic strategy to each patient's profile and PCI complexity. We discuss the type and duration of antithrombotic regimens that can be selected for patients undergoing complex PCI, with a focus on prolonged dual antiplatelet therapy, P2Y12 receptor inhibitor monotherapy, and dual pathway inhibition. We also address antithrombotic management in specific scenarios (left main disease, coronary bifurcations, chronic total occlusion) and in patients undergoing complex PCI who require oral anticoagulant therapy.

PMID:40958619 | PMC:PMC12418109 | DOI:10.4244/EIJ-D-24-00992

Catheter Cardiovasc Interv. 2025 Sep 16. doi: 10.1002/ccd.70182. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction (CMD) can be phenotyped as endogenous or classical.

AIMS: This study investigated the prognostic significance of these CMD endotypes in patients with chronic coronary syndrome after elective percutaneous coronary intervention (PCI).

METHODS: This retrospective study included 205 patients who underwent elective PCI in the left anterior descending artery (LAD). Post-PCI, coronary flow was assessed using stress transthoracic Doppler echocardiography to measure diastolic peak flow velocity (DPV) and calculate coronary flow velocity reserve (CFVR). CMD was defined as CFVR ≤ 2.0 and further classified as endogenous (resting DPV > 33 cm/s) or classical (resting DPV ≤ 33 cm/s). This cutoff was determined by the 34.6th percentile of sorted DPV values, corresponding to reduced CFVR distribution. The primary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, heart failure hospitalization, and target vessel revascularization.

RESULTS: Over a median follow-up of 2.3 years, 30 patients (14.6%) experienced MACE. The cumulative incidence of MACE was significantly higher in patients with endogenous-type CMD compared to those with classical-type CMD or without CMD (p < 0.001). In multivariate Cox proportional hazard analysis, endogenous-type CMD remained an independent predictor of MACE (hazard ratio: 3.28; 95% confidence interval: 1.53-7.04; p = 0.002).

CONCLUSIONS: Endogenous-type CMD in the LAD territory following elective PCI is an independent predictor of MACE. Noninvasive phenotyping of CMD post-PCI using stress echocardiography may improve risk stratification and guide personalized management strategies for these high-risk patients.

PMID:40958560 | DOI:10.1002/ccd.70182

Medicine (Baltimore). 2025 Sep 12;104(37):e44458. doi: 10.1097/MD.0000000000044458.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) is associated with an elevated risk of cardiovascular disease and necessitates repeat revascularization procedures, including percutaneous coronary intervention (PCI). However, extensive data on outcomes following PCI in this cohort remain scarce. This systematic review and meta-analysis sought to evaluate the short- and long-term cardiovascular outcomes in RA patients following PCI.

METHODS: We conducted a search of PubMed, Embase, Google Scholar, and Cochrane Central for studies published until October 2024 that compared RA and non-RA cohorts' post-PCI. The primary outcomes encompassed major adverse cardiovascular events, myocardial infarction, repeat revascularization, and overall mortality. The pooled odds ratio (OR) with 95% confidence intervals was computed utilizing random-effects models. A sensitivity analysis was conducted using a leave-one-out meta-analysis.

RESULTS: Our search identified 9 qualifying studies, encompassing nearly 1 million patients (174,229 with RA and 9771,911 without RA). Individuals with RA exhibited a markedly elevated risk of short-term stroke compared to non-RA patients (OR: 0.81, 95% CI: 0.6-1.02). Long-term follow-up found an elevated risk of myocardial infarction (OR: 1.08, 95% CI: 1.01-1.16), stroke (OR: 1.09, 95% CI: 1.07-1.11), major adverse cardiovascular events (OR: 1.12, 95% CI: 0.99-1.24), and repeat revascularization (OR: 1.09, 95% CI: 1.07-1.11) among patients with RA. The sensitivity analysis revealed no significant difference, even after the exclusion of each study.

CONCLUSION: This comprehensive meta-analysis revealed that patients with RA have markedly poorer clinical outcomes post-PCI, particularly in the long term. The results underline the necessity for tailored peri-procedural approaches and ongoing monitoring in RA patients.

PMID:40958238 | PMC:PMC12440515 | DOI:10.1097/MD.0000000000044458

Radiology. 2025 Sep;316(3):e250078. doi: 10.1148/radiol.250078.

ABSTRACT

Background Left atrial (LA) structural and functional parameters are associated with prognosis after acute myocardial infarction (AMI). Purpose To explore the prognostic value of LA minimum volume index (LAVImin) as measured at cardiac MRI and its incremental predictive value beyond LA functional parameters for predicting major adverse cardiovascular events (MACE) after AMI in a large population. Materials and Methods This prospective study enrolled patients with AMI who underwent percutaneous coronary intervention and subsequent cardiac MRI between February 2014 and January 2024. MACE included all-cause death, reinfarction, unplanned revascularization, and heart failure hospitalization. Univariable and multivariable Cox regression analyses were used to evaluate the association between LAVImin and MACE. Receiver operating characteristic analysis and Kaplan-Meier analysis were used to evaluate the prognostic value of LAVImin in participants with AMI. Results A total of 1191 participants (mean age, 58 years ± 11 [SD]; 1007 male participants) were included. Among them, 183 individuals experienced MACE over a median follow-up of 38 months (IQR, 20-57 months). After adjusting for clinical risk factors and cardiac MRI parameters, a larger LAVImin was independently associated with MACE (hazard ratio, 1.06 [95% CI: 1.05, 1.08]; P < .001). Receiver operating characteristic analysis revealed that LAVImin (area under the receiver operating characteristic curve [AUC], 0.74) had better discriminative ability for MACE than LA maximum volume index (LAVImax) (AUC, 0.65; P < .001) and LA conduit strain (AUC, 0.64; P < .001). Traditional risk predictors plus LAVImin had greater prognostic value for MACE (C index, 0.75) than traditional risk factors alone (C index, 0.69; P < .001) or traditional risk predictors plus LAVImax (C index, 0.72; P = .03). Conclusion LAVImin was an independent predictor of MACE after AMI, with incremental prognostic value and improved discriminative ability over traditional risk factors including cardiac MRI parameters. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Weir-McCall and Hua in this issue.

PMID:40956159 | DOI:10.1148/radiol.250078

Ann Ital Chir. 2025 Aug 7;96(9):1218-1225. doi: 10.62713/aic.4017.

ABSTRACT

AIM: We aim to investigate the relationship between the synergy between percutaneous coronary intervention and cardiac surgery (SYNTAX) scoring system created with coronary angiographic and clinical parameters and the Visceral Adiposity Index (VAI), which includes anthropometric parameters and blood lipid values and is to evaluate their predictive power complications after coronary artery bypass grafting (CABG).

METHODS: This prospective observational clinical study was conducted between 15 August 2023 to 1 December 2023. A total of 173 patients who underwent isolated CABG were included. SYNTAX 2 scores, VAI results, and complications occurring in the postoperative period were recorded. All patients were divided into two separate groups, low and high, according to the median value of the SYNTAX 2 score and VAI. Postoperative complications were compared between groups, and correlation and predictive analyses were performed.

RESULTS: Intra-Aortic balloon pump (IABP) use and low cardiac output were more frequent in the group with a high SYNTAX 2 score. However, this difference was significant for IABP use but not for low cardiac output (LCO) (p = 0.011 and p = 0.109). A positive correlation was observed between VAI and intensive care unit stay and postoperative respiratory complications (p = 0.018 and p = 0.035). There was no statistically significant correlation between SYNTAX 2 score and VAI value (p = 0.540). In Receiver Operating Characteristic (ROC) analysis, it was determined that VAI could predict respiratory complications and SYNTAX 2 score could predict IABP requirement [area under the curve (AUC): 0.639, 95% CI: 0.531-0.746, p = 0.036 and, AUC: 0.799, 95% CI: 0.678-0.920, p = 0.001].

CONCLUSIONS: In our study, no correlation was found between SYNTAX 2 score and VAI. However, we found that high VAI can predict postoperative respiratory complications and that a high SYNTAX 2 score is associated with postoperative IABP requirement. These parameters can be taken into account in risk assessments.

PMID:40955196 | DOI:10.62713/aic.4017

Quant Imaging Med Surg. 2025 Jun 6;15(6):5739-5751. doi: 10.21037/qims-24-2238. Epub 2025 May 30.

ABSTRACT

BACKGROUND: Angiography-derived fractional flow reserve (AccuFFRangio) has emerged as a reliable tool for coronary functional assessment, demonstrating high concordance with invasive fractional flow reserve (FFR). This study aimed to determine the previously uninvestigated predictive value of combining AccuFFRangio with translesion gradient (TLG) following drug-coated balloon (DCB) angioplasty.

METHODS: This retrospective study included 232 patients treated with DCB angioplasty. Post-DCB AccuFFRangio and TLG were successfully measured in 218 patients. The vessels were classified according to dichotomous post-DCB AccuFFRangio and TLG. The primary endpoint was 2-year risk of target vessel failure (TVF), which is a composite of target vessel revascularization, target vessel myocardial infarction (MI), and cardiac death.

RESULTS: The optimal cutoff for post-DCB AccuFFRangio was 0.89. A post-DCB AccuFFRangio ≤0.89 was strongly associated with higher rates of TVF (14.3% vs. 2.8%; P=0.002), and a TLG of >0.03 was associated with increased rates of TVF (13.5% vs. 4.9%; P=0.046). Key predictors of adverse outcomes included male gender, smoking status, higher residual diameter stenosis, and post-DCB AccuFFRangio and TLG. In multivariate analysis, AccuFFRangio was independently predictive of TVF. The patient subgroup with high TLG and low AccuFFRangio had significantly higher rates of TVF (15.2%) as compared to the other groups (P=0.005).

CONCLUSIONS: Immediate post-DCB AccuFFRangio and TLG can be effectively used for stratifying risk and predicting long-term outcomes in patients undergoing DCB angioplasty. Post-DCB AccuFFRangio, in particular, offers significant prognostic insights beyond traditional clinical and imaging parameters, suggesting its potential as a critical tool in postangioplasty patient management.

PMID:40606399 | PMC:PMC12209666 | DOI:10.21037/qims-24-2238

Acta Inform Med. 2025;33(2):135-139. doi: 10.5455/aim.2025.33.135-139.

ABSTRACT

BACKGROUND: Minimally invasive coronary artery bypass grafting (MICS CABG) via left anterior thoracotomy has emerged as a less invasive alternative to conventional open sternotomy (OPEN CABG), offering potential benefits in perioperative outcomes and complication rates.

OBJECTIVE: The aim of this study was to compare procedural characteristics, ventilation duration, drainage volumes, and postoperative complications between MICS CABG and OPEN CABG in a single-center cohort in Bosnia and Herzegovina.

METHODS: This retrospective cross-sectional study included 262 patients who underwent surgical revascularization between January 2019 and June 2023.

RESULTS: MICS CABG was associated with a shorter median procedure time (2.5 vs. 3.5 hours, p<0.001) and reduced mechanical ventilation duration (11.0 vs. 14.0 hours, p<0.001). Although ICU stay was similar (3.0 days, p=0.001), total hospitalization was shorter for MICS CABG (6.0 vs. 7.0 days, p<0.001). Postoperative drainage was significantly lower at all measured time points (p<0.05), and transfusion requirements were reduced for red blood cells (0 vs. 2 units, p<0.001), fresh frozen plasma (0 vs. 2.5 units, p<0.001), and platelets (p=0.035). Use of inotropic agents was less frequent in MICS CABG, both at low (50.4% vs. 62.8%, p=0.043) and medium doses (4.0% vs. 16.0%, p=0.001). Wound infections were numerically lower in the MICS group (p=0.437).

CONCLUSIONS: Compared to open sternotomy, MICS CABG demonstrated significant advantages in operative time, ventilation duration, blood loss, and complication rates, supporting its role as a safe and effective alternative for coronary revascularization.

PMID:40606238 | PMC:PMC12212263 | DOI:10.5455/aim.2025.33.135-139

Circ Genom Precis Med. 2025 Jul 3:e004937. doi: 10.1161/CIRCGEN.124.004937. Online ahead of print.

ABSTRACT

BACKGROUND: Prior work suggests modifiable cardiovascular risk factors (CRFs) account for 80% to 90% of the risk for incident myocardial infarction. The contributions of genetic and other novel CRFs have not been simultaneously assessed in contemporary data sets.

METHODS: In the United Kingdom Biobank, CRFs were identified and Cox proportional hazards models with traditional CRFs (hypertension, diabetes, dyslipidemia, waist-to-hip ratio, diet, exercise, alcohol, and socioeconomic deprivation) and contemporary/genetic CRFs (Lp(a) [lipoprotein(a)], hsCRP [high-sensitivity C-reactive protein], familial hypercholesterolemia variants, and polygenic risk score for coronary artery disease) were constructed for coronary artery disease. Coronary artery disease was defined as a first-time myocardial infarction diagnosis or coronary revascularization. R2 was calculated for each model, and the percent contribution of each individual CRF was calculated by the R2 percent decrease after its removal.

RESULTS: Among 299 707 individuals, the mean (SD) age was 56.2 (8.1) years, and 166 533 (55.6%) were women. Over a median (interquartile range) follow-up of 11.0 (9.6-12.5) years, 17 409 (5.8%) of participants developed myocardial infarction. R2 increased from the base model (R2, 0.021 [0.020-0.022]), to the clinical model (R2, 0.045 [0.043-0.046]), to the contemporary/genetic model (R2, 0.053 [0.052-0.055]). The most powerful individual CRFs were hypertension (R2 loss, 15.2% [14.5-17.1]) and polygenic risk score for coronary artery disease (R2 loss, 12.4% [10.8-13.3]), followed by dyslipidemia (R2 loss, 3.4% [2.6-3.5]), diabetes (R2 loss, 2.2% [1.5-2.0]), hsCRP (R2 loss, 1.8% [1.5-2.0]), and Lp(a) (R2 loss, 1.5% [1.2-1.8]).

CONCLUSIONS: Novel CRFs like polygenic risk score for coronary artery disease, hsCRP, and Lp(a) have similar importance, comparable to traditional CRFs such as hypertension, dyslipidemia, and diabetes, for incident myocardial infarction, highlighting important identifiable residual risk factors.

PMID:40605734 | DOI:10.1161/CIRCGEN.124.004937

Circ J. 2025 Jul 1. doi: 10.1253/circj.CJ-25-0028. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of the location of calcification in the left main coronary artery (LMCA) bifurcation on cardiovascular events remains unclear.

METHODS AND RESULTS: This retrospective study included 498 patients who underwent LMCA stenting at a single center between 2014 and 2018. Moderate or severe calcification was visually assessed by coronary angiography. The primary endpoint was 3-year target lesion failure (TLF), defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Most patients (n=314; 63.1%) had no calcification in the LMCA bifurcation. One-segment calcification was observed in 45 (9.0%) patients, primarily in the left anterior descending artery (LAD; n=43 [8.6%]). Two-segment calcification was observed in 81 (16.3%) patients, most commonly involving the LMCA and LAD (n=70; 14.1%). Three-segment calcification was observed in 58 (11.6%) patients. Overall, 58 (11.6%) patients developed TLF within 3 years. Multivariable Cox regression analysis revealed a significant association between calcification in the left circumflex artery (LCX) and 3-year TLF (adjusted hazard ratio [aHR] 4.46; 95% confidence interval [CI] 1.81-10.99; P=0.001). In contrast, there was no significant association between calcification at the LMCA (aHR 1.29; 95% CI 0.47-3.55; P=0.623) or LAD (aHR 0.49; 95% CI 0.17-1.45; P=0.199) and the primary endpoint.

CONCLUSIONS: Moderate or severe calcification in the LCX is significantly associated with 3-year TLF in patients who have undergone LMCA stenting.

PMID:40603065 | DOI:10.1253/circj.CJ-25-0028

J Gen Intern Med. 2025 Jul 2. doi: 10.1007/s11606-025-09701-5. Online ahead of print.

ABSTRACT

BACKGROUND: Transgender and gender diverse (trans) populations are at elevated risk for atherosclerotic cardiovascular disease (ASCVD).

OBJECTIVE: Measure the association of gender identity and gender-affirming hormone therapy (GAHT) with ASCVD outcomes.

DESIGN: Cohort study.

PARTICIPANTS: Over 1 million veterans receiving care in the Veterans Health Administration.

MAIN MEASURES: Gender identity was identified via a validated natural language processing (NLP) algorithm. Incident ASCVD (acute myocardial infarction, ischemic stroke, or revascularization after the baseline date) was identified via International Classification of Diseases diagnosis codes among veterans without prevalent ASCVD. We calculated sample statistics stratified by gender identity and used Cox proportional hazard regression to assess associations of gender identity and GAHT with incident ASCVD.

KEY RESULTS: Among 1,105,082 veterans, 42,149 were classified as trans (8013 transfeminine, 7127 transmasculine, and 27,009 uncategorized trans) while 918,843 were cisgender men and 144,090 were cisgender women. During a median follow-up of 9.39 years, 92,910 veterans had incident ASCVD (2806 among trans veterans). Adjusting for age, race, Hispanic ethnicity, and sexual orientation, trans veterans had 1.52 [1.45, 1.59] and 0.92 [0.89, 0.96] times the hazard of ASCVD compared to cisgender women and cisgender men, respectively. Compared to trans veterans not receiving GAHT, GAHT among trans veterans assigned female at birth was significantly associated a reduced hazard of ASCVD (0.89 [0.80, 0.98]); GAHT was not associated with ASCVD among trans veterans assigned male at birth (0.99 [0.89, 1.09]).

LIMITATIONS: With NLP, there is potential for selection bias as clinicians may preferentially document the gender identity for trans more than cisgender veterans.

CONCLUSIONS: This is one of the first studies to examine the association of both gender identity and GAHT with incident ASCVD in veterans. Future research must comprehensively evaluate ASCVD outcomes and the effects of gender-affirming care (including hormone therapy) in trans populations.

PMID:40601199 | DOI:10.1007/s11606-025-09701-5