http:www.cardiocirugia.sld.cu

Catheter Cardiovasc Interv. 2025 Jun 16. doi: 10.1002/ccd.31679. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic impact of complete revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.

AIMS: This study aimed to compare clinical outcomes between complete and incomplete revascularization in NSTEMI patients with MVD, assessing the optimal timing and strategy for revascularization.

METHODS: We analyzed 2460 consecutive NSTEMI patients with MVD enrolled across five institutions between January 2021 and December 2022. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs: all-cause death, recurrent myocardial infarction, heart failure, stroke, and urgent revascularization) and major adverse cardiac events (MACEs: cardiovascular death, recurrent myocardial infarction, heart failure, and urgent revascularization). Multivariable Cox proportional hazards regression analysis was conducted to adjust for important clinical characteristics, and adjusted hazard ratio (aHR) with a 95% confidence interval (CI) was calculated to assess the risk of clinical outcomes. Inverse probability weighting analysis was performed to verify the robustness of the results.

RESULTS: Over a median 528-day follow-up, complete revascularization was associated with a significantly lower risk of MACCEs (aHR 0.48, 95% CI 0.36-0.64) and MACEs (aHR 0.45, 95% CI 0.33-0.60) compared to incomplete revascularization. Single-stage and multistage complete revascularization showed comparable outcomes (MACCEs: aHR 0.93, 95% CI 0.47-1.85; MACEs: aHR 0.89, 95% CI 0.44-1.82). However, compared to delayed multistage complete revascularization, early multistage complete revascularization significantly reduced the risk of MACCEs (aHR 0.05, 95% CI 0.01-0.28) and MACEs (aHR 0.03, 95% CI 0.01-0.27). These results were consistent after confounder adjustment by inverse probability weighting analysis.

CONCLUSION: Complete revascularization is an effective treatment strategy for reducing the risk of adverse clinical outcomes in NSTEMI patients with MVD. Moreover, an early multistage complete revascularization may be a better option.

PMID:40521697 | DOI:10.1002/ccd.31679

Front Cardiovasc Med. 2025 May 30;12:1578159. doi: 10.3389/fcvm.2025.1578159. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the quantitative flow ratio (QFR) outcomes in the left circumflex artery (LCX) following the placement of a crossover stent from the left main coronary artery (LM) to the left anterior descending artery (LAD) in LM bifurcation lesions. In addition, we sought to assess the relationship between these QFR results and clinical prognoses.

BACKGROUND: The treatment approach for LM bifurcation lesions remains a topic of debate, with the LM-LAD single-stent technique being one possible option. QFR, a fractional flow reserve calculation method derived from angiography that does not require pressure guide wires, could serve as an alternative functional assessment of the LCX. This study aims to evaluate the clinical outcomes of postoperative LCX by utilizing QFR measurements, addressing a current gap in the relevant literature on this topic.

METHODS: This study was a retrospective, single-center analysis of patients with LM bifurcation lesions who underwent percutaneous coronary intervention (PCI) guided by intravascular ultrasound. QFR values were derived from angiographies. The primary endpoint was the 1-year rate of major adverse cardiac events, defined as a composite of cardiovascular death, target bifurcation-related myocardial infarction (MI), or target bifurcation revascularization. The secondary clinical endpoint was defined as the persistence or recurrence of angina pectoris after PCI.

RESULTS: We analyzed 91 patients from a total of 180 who were screened for LM bifurcation lesions. All patients completed the 1-year follow-up. The pre- and post-PCI QFR values were 0.89 ± 0.09 and 0.86 ± 0.11, respectively. Subgroup analysis showed that 74 patients were in the postoperative QFR ≥0.80 group, whereas 17 patients were in the QFR <0.80 group. In addition, 32 patients had a ΔQFR ≥0, and 58 patients had a ΔQFR <0. Nine patients (9.9%) achieved the primary endpoint, including one patient with non-ST elevation myocardial infarction who received revascularization in both the LM-LAD and LCX arteries. In addition, nine patients (9.9%) reported no substantial improvement in their chest pain symptoms. Post-LCX-QFR <0.8 was associated with a higher 1-year incidence of cardiovascular death or MI (P = 0.036). ΔQFR proved to be a robust predictor of the 1-year incidence of the primary endpoint, with an incidence of 15.3% in the ΔQFR ≥0 group compared to 0% in the ΔQFR <0 group (area under the curve: 0.822; 95% CI: 0.728-0.895, P < 0.001), especially when ΔQFR ≤-0.03.

CONCLUSIONS: After the LM-LAD single-stent strategy for LM bifurcation lesions, a ΔQFR of LCX ≤-0.03 was associated with a higher risk of 1-year main adverse cardiac events, indicating the superior prognostic value of the post-PCI physiological assessment.

PMID:40520934 | PMC:PMC12162905 | DOI:10.3389/fcvm.2025.1578159

Eur Heart J Open. 2025 Jun 2;5(3):oeaf065. doi: 10.1093/ehjopen/oeaf065. eCollection 2025 May.

ABSTRACT

AIMS: Stress echocardiography (SE), though widely accessible, has some limitations in its diagnostic test characteristics for predicting major adverse cardiovascular events (MACEs). Carotid plaque score provides direct detection of subclinical atherosclerosis and can be integrated into the stress protocol. The aim of our study was to assess the value of adding a carotid plaque score to SE to enhance the test diagnostics for predicting MACE in low-intermediate-risk patients.

METHODS AND RESULTS: Patients aged 40-75 years referred for SE received a carotid ultrasound and were followed for 5-year MACE. Hard MACE was defined as a composite of cardiovascular death, non-fatal stroke or myocardial infarction, and emergency coronary revascularization. Soft MACE included non-emergency coronary revascularization. Patients aged >75 years, on a statin, with previously known vascular disease, a history of stroke, myocardial infarction, vascular intervention, or a resting wall motion abnormality on a baseline echo were excluded. Administrative data holdings housed at the Institute of Clinical Evaluative Sciences, ICES, were used for event follow-up. Of the 2588 patients, there were 49 cumulative incidence hard MACE and 119 soft MACE. Carotid plaque score improved the sensitivity of SE for predicting 1- and 5-year MACE. A plaque score threshold value of ≥2 provided clear differentiation of patients who experienced MACE in both positive and non-positive (negative/inconclusive for ischaemia) SE results.

CONCLUSION: Plaque score enhances diagnostic test characteristics of SE. The combination of carotid ultrasound with SE is an important new tool for cardiovascular risk assessment. This simple tool may help differentiate risk in patients with non-positive SE results.

PMID:40520409 | PMC:PMC12166518 | DOI:10.1093/ehjopen/oeaf065

Transplant Direct. 2025 Jun 12;11(7):e1802. doi: 10.1097/TXD.0000000000001802. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Kidney transplant physicians believe that the cardiac status of kidney transplant recipients influences posttransplant outcomes. However, the Scientific Registry of Transplant Recipients (SRTR) does not include cardiac variables in its risk-adjustment model, raising the question of whether it fairly risk adjusts recipients.

METHODS: This study conducted a retrospective analysis of the prospectively collected National Surgical Quality Improvement Program Transplant database to assess the impacts of pretransplant cardiac revascularization and left ventricular ejection fraction (LVEF) <55% on posttransplant outcomes in deceased donor renal transplantation. Recipients from 2017 to 2019 were stratified into those with versus without prior revascularization and those with LVEF <55% versus LVEF ≥55%. Primary outcomes included differences in 1-y patient and graft survival. Secondary outcomes included postoperative complications. An a priori-specified multivariable Cox-proportional hazards model including existing SRTR variables assessed the independent effect of prior revascularization on patient and graft survival.

RESULTS: A total of 2377 recipients were included: 13.3% had prior cardiac revascularization and 11.2% had LVEF <55%. Previous revascularization was significantly associated with an increased risk of deep surgical site infection (3.8% versus 1.1%, P = 0.001), delayed graft function (39.2% versus 28.3%, P < 0.001), myocardial infarction (4.4% versus 0.8%, P < 0.001), longer length of stay (6.57 versus 5.54 d, P = 0.001), and more readmissions (32.9% versus 23.1%, P < 0.001). In univariable analysis, previous revascularization was associated with death (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.11-5.1; P = 0.03) but not graft loss (HR, 1.3; 95% CI, 0.54-3.1; P = 0.55). LVEF <55% was only associated with a higher rate of sepsis (4.3% versus 1.7%, P = 0.011). After adjusting for SRTR variables (age, diabetes, peripheral vascular disease), previous revascularization was not independently associated with death (HR, 1.33; 95% CI, 0.57-3.1; P = 0.50).

CONCLUSIONS: Previous cardiac revascularization is associated with patient survival and complications, more than LVEF <55%. However, we show that existing variables of the SRTR risk model largely capture the impact of previous cardiac revascularization on patient survival.

PMID:40519671 | PMC:PMC12165656 | DOI:10.1097/TXD.0000000000001802

J Inflamm Res. 2025 Jun 9;18:7515-7527. doi: 10.2147/JIR.S515437. eCollection 2025.

ABSTRACT

PURPOSE: This study aimed to investigate the effects of the systemic inflammatory response index (SIRI) on the long-term prognosis of patients with acute coronary syndrome (ACS) and obstructive sleep apnea (OSA).

PATIENTS AND METHODS: This prospective cohort study enrolled patients with ACS and OSA at the Beijing Anzhen Hospital between June 2015 and January 2020. The SIRI was calculated at admission for all patients. Patients with SIRI ≥ 1.16 × 109/L were classified into the high SIRI group based on the optimal cutoff value for predicting major adverse cardiovascular and cerebrovascular events (MACCE) determined by the receiver operating characteristic (ROC) curve of our cohort study. The other patients were categorized into the low SIRI group. The primary endpoint was a composite of MACCE, including cardiovascular death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization.

RESULTS: A total of 1011 patients with ACS and OSA were enrolled, 435 of whom (43%) were in the high SIRI group. Over a median follow-up of 2.8 (1.4-3.6) years, 179 patients experienced MACCE. Kaplan-Meier survival analysis showed a higher cumulative incidence of MACCE in the high-SIRI group (log-rank P < 0.001). A restricted cubic spline analysis also showed a monotonic increase with a greater SIRI value for MACCE (P = 0.011). After adjusting for clinically relevant confounders, a high SIRI was independently associated with elevated MACCE risk (adjusted HR = 1.44, 95% CI 1.02-2.05, P = 0.039).

CONCLUSION: A high SIRI was associated with poorer clinical outcomes during long-term follow-up in patients with ACS and OSA.

PMID:40519655 | PMC:PMC12164839 | DOI:10.2147/JIR.S515437

Int J Cardiol. 2025 Jun 16;437:133496. doi: 10.1016/j.ijcard.2025.133496. Online ahead of print.

ABSTRACT

BACKGROUND: Recent randomized trials have suggested that immediate complete revascularization (ICR) is a viable alternative to staged complete revascularization (SCR) in patients with acute coronary syndrome (ACS) and multivessel disease. However, long-term outcomes comparing ICR with SCR in ST-segment elevation (STE) and non-ST-segment elevation (NSTE) ACS remain unclear.

METHODS: This study analyzes 2-year follow-up data from the BIOVASC trial, randomizing ACS patients to ICR or SCR. The primary composite endpoint includes all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events. Secondary endpoints evaluate these outcomes individually. Cox regression assessed if STE/NSTE-ACS diagnosis influences treatment effect.

RESULTS: In 608 STE-ACS patients, the 2-year cumulative incidence of the primary composite endpoint was 10.9 % (ICR) and 11.7 % (SCR) (risk difference [RD] 0.8 %, 95 % confidence interval [CI] -4.3 % to 5.9 %; P = 0.71). In NSTE-ACS, cumulative incidence was 13.5 % (ICR) and 12.8 % (SCR) (RD -0.7 %, 95 % CI -5.1 % to 3.7 %; P = 0.90). No differential effect was observed comparing ICR with SCR between STE- and NSTE-ACS.

CONCLUSIONS: ICR did not sustain a significant benefit in terms of the primary and secondary outcomes at 2 years follow-up. In addition, no differential effect of ICR versus SCR was observed between STE-ACS and NSTE-ACS after 2 years follow-up. However, there seems to be a late catch-up in the cumulative event rate in patients randomized to ICR.

PMID:40516659 | DOI:10.1016/j.ijcard.2025.133496

J Anesth. 2025 Jun 13. doi: 10.1007/s00540-025-03526-6. Online ahead of print.

ABSTRACT

PURPOSE: Phase angle (PA), derived from bioelectrical impedance-analysis (BIA) has emerged as a reliable marker predicting clinical outcomes. This prospective observational study investigated the association between PA and a composite in-hospital outcome in major abdominal surgery.

METHODS: Each patient underwent BIA before surgery (PApre), immediately postoperatively (PApost), and 1 day postoperatively (PAPOD1). Specific assessment for frailty and nutrition status was performed before surgery. Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, stroke, hemodynamic instability, acute kidney injury, pulmonary complications, delirium, ileus, and surgical complications during hospitalization. One-year complication, including all-cause mortality, myocardial infarction, stroke, surgical complications, and readmission after discharge within the year were also assessed.

RESULTS: A total of 122 adults who underwent major abdominal surgery were enrolled from July 2019 and April 2021. Twenty-three patients (53.5%) in the lower PA group (PA < 5) experienced in-hospital complications compared to 38 patients (34.2%) in the higher PA group (PA ≥ 5) (relative risk, 1.6; 95% confidence interval [CI], 1.0 to 2.4; p = 0.038). PApre was significantly associated with in-hospital complications (odds ratio, 0.491; 95% CI, 0.279 to 0.862; p < 0.001). Patients with lower PApre had a higher degree of frailty, and poor nutritional status. However, PApre was not significantly associated with 1-year composite complications.

CONCLUSION: Low PApre was associated with adverse postoperative outcomes after major abdominal surgery. PA can be a reliable prognostic factor to predict in-hospital complications in patients undergoing major abdominal surgery, serving as an alternative surrogate to frailty indices and nutritional markers.

TRIAL REGISTRATION: Clinical Research Information Services of the Republic of Korea (CRIS identifier: KCT0004160).

PMID:40514407 | DOI:10.1007/s00540-025-03526-6

Sci Rep. 2025 Jun 13;15(1):20068. doi: 10.1038/s41598-025-87667-4.

ABSTRACT

This study reports the 15th year follow-up of a previously reported monocentric, randomized controlled trial comparing the effectiveness of yoga vs. conventional exercise-based cardiac rehabilitation (CR) on mortality and major adverse cardiovascular outcomes in middle-aged, male patients who underwent coronary artery bypass graft surgery (CABG). Three hundred male patients, aged 53.32 (SD, 6.72) years, were recruited for CABG at Narayana Institute of Cardiac Sciences, India, in 2005, followed by random assignment into a yoga-based cardiac rehabilitation program (YCRP) or conventional exercise-based cardiac rehabilitation program (CCRP). This legacy study reports the extended follow-up outcomes for all-cause mortality and cardiovascular events for a median of 14·14 years (IQR 13.82-14.47) since randomisation in 2005. The YCRP group received lectures on yoga philosophy combined with sequential phase-wise administration of yoga modules suited for their pre-and post-operative health status with gradual phase-wise addition of physical postures to initially administered relaxation-based techniques, under continued home-based practice model monitored telephonically until 12 months post-surgery related discharge from the hospital. The CCRP group received conventional exercise-based cardiac rehabilitation with similar phase-wise administration. Both study groups were under continued outpatient department-based care with 6 monthly review sessions until 2020. The exploratory follow-up outcomes [the all-cause mortality, and the major adverse cardiac events (MACE)] were analyzed using an intention-to-treat approach comparing the initially randomized study groups. MACE was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke. The study staff determined the occurrence of death from the medical records or telephonic calls and ascertained it by matching and identifying information reported by participants/or their family members. The Cox proportional hazard estimates and Kaplan-Meier Curve with Log-rank test estimates were used to compare the mortality and MACE outcomes between the study groups. Participants of the YCRP group exhibited significantly reduced risk of all-cause mortality [HR = 0.41 (95% CI = 0.16-0.91, P = 0.02)] and trends of reduction in MACE outcomes [HR = 0.57 (95% CI = 0·30-1.04, P = 0.065)] compared to the CCRP. No significant interaction effects were observed between the intervention and the baseline covariates, such as age, ejection fraction values, or presence of comorbidities. This first-ever long-term follow-up established the survival advantage of the YCRP over CCRP for patients who underwent coronary artery bypass graft surgery (CABG). The results support the utility of yoga-based CR as an alternative to CCRP in low-resource settings.

PMID:40514390 | PMC:PMC12166042 | DOI:10.1038/s41598-025-87667-4

Cardiovasc Revasc Med. 2025 Jun 6:S1553-8389(25)00292-1. doi: 10.1016/j.carrev.2025.06.007. Online ahead of print.

NO ABSTRACT

PMID:40514315 | DOI:10.1016/j.carrev.2025.06.007

JACC Case Rep. 2025 Jun 11;30(14):103632. doi: 10.1016/j.jaccas.2025.103632.

ABSTRACT

Two patients presented with chronic coronary syndrome and type B Wellens electrocardiography with preserved left ventricular ejection fraction according to transthoracic echocardiography. Further myocardial systolic function assessment by means of left ventricular global longitudinal strain (LVGLS) and myocardial work index (MWI) showed reduced peak systolic strain and MWI value in the left anterior descending (LAD) coronary territory. Invasive coronary angiography found significant proximal LAD stenosis in both patients, and revascularization with stent placement was performed with good result (TIMI flow grade III). In the follow-up, improvement in LVGLS and MWI after LAD revascularization was observed in both cases.

PMID:40514128 | DOI:10.1016/j.jaccas.2025.103632

JACC Case Rep. 2025 Jun 11;30(14):103684. doi: 10.1016/j.jaccas.2025.103684.

ABSTRACT

BACKGROUND: Dynamic coronary obstruction is a rare and potentially lethal condition, which may cause an acute coronary syndrome (ACS).

CASE SUMMARY: A young patient with metastatic rhabdomyosarcoma was transferred to our center's cardiac intensive care unit with a ventricular tachycardia (VT) storm. A cardiac mass was demonstrated on transthoracic echocardiography and computed tomography. Coronary angiography was performed owing to suspected compression of the coronary arteries. Dynamic obstruction in the left anterior descending artery (LAD) was demonstrated with the use of angiography and intravascular ultrasound. After successful ostial to mid-LAD stenting, there was no recurrence of VT episodes.

DISCUSSION: VT storm is a lethal condition that requires rapid diagnosis and treatment. Rarely, it can be caused by dynamic coronary obstruction.

PMID:40514127 | DOI:10.1016/j.jaccas.2025.103684

Curr Cardiol Rev. 2025 Jun 10. doi: 10.2174/011573403X357542250526072430. Online ahead of print.

ABSTRACT

INTRODUCTION: The PCSK9 enzyme is present mainly in the liver and is responsible for the degradation of LDL-C receptors. Currently, there are some drugs that inhibit this enzyme, such as alirocumab and evolocumab. Consequently, these drugs reduce serum LDL-C levels. Therefore, a systematic review and a meta-analysis were carried out in order to compare alirocumab against evolocumab in reducing cardiovascular outcomes.

METHODS: This systematic review was carried out in accordance with PRISMA and was registered in PROSPERO (CRD42024573217). The following databases were searched on July, 9, 2024: Pubmed, Web of Science and Scopus. Randomized clinical trials with a control group were included and meta-analyses were performed to assess relative risk (RR). The random effects model was used in heterogeneous samples. The articles were distributed into 2 subgroups: use of alirocumab and evolocumab.

RESULTS: Initially, 2,213 articles were found, of which 6 were included. In total, 62,119 patients participated. The RR values were significant for alirocumab in the following outcomes: myocardial infarction (MI) 0.85 (95% CI 0.77-0.93), stroke 0.75 (95% CI 0.60-0.94) and hospitalization for unstable angina 0.58 (95% CI 0.39-0.86), while for evolocumab they were significant for MI 0.75 (95% CI 0.68-0.83) and coronary revascularization 0.81 (95 CI % 0.75-0.88). There was a statistically significant difference between the drugs for hospitalization for unstable angina (p=0.02).

DISCUSSION: This study highlights the benefits of PCSK9 inhibitors, especially alirocumab, in reducing major cardiovascular events. Alirocumab significantly lowered hospitalizations for unstable angina, with a 42% reduction, and showed favorable outcomes in reducing myocardial infarction, coronary revascularization, and stroke. These reductions are clinically meaningful, as they lower morbidity, improve patient quality of life, and reduce healthcare costs. Both alirocumab and evolocumab are effective and safe, offering important therapeutic options for high-risk cardiovascular patients.

CONCLUSION: The use of alirocumab is preferable if the focus is to avoid hospitalizations for unstable angina or stroke, while evolocumab may be an option if one wants to avoid coronary revascularization. Both drugs are effective in reducing cardiovascular outcomes, but alirocumab was superior to evolocumab.

PMID:40511660 | DOI:10.2174/011573403X357542250526072430

Int J Cardiol Heart Vasc. 2025 May 27;59:101708. doi: 10.1016/j.ijcha.2025.101708. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Nicorandil is used to induce hyperemia when measuring fractional flow reserve (FFR). However, it is unknown whether the clinical outcome of patients assessed using nicorandil is similar to that of patients assessed using adenosine triphosphatase (ATP). We aimed to compare the clinical outcomes of nicorandil and ATP in the PCI and deferred groups.

METHODS: This retrospective study examined 492 patients with chronic coronary syndrome who underwent FFR assessment between February 2016 and December 2021. The patients received either nicorandil or ATP to induce hyperemia. The primary endpoints were all-cause death, myocardial infarction, and urgent revascularization. These clinical outcomes were followed up for three years and compared between the groups.

RESULTS: In the PCI group (161 patients), primary endpoint events occurred in 9 % of the nicorandil group and 11 % of the ATP group (Adjusted HR 1.10, 95 % CI 0.35-3.40, P = 0.87). In the deferred group (331 patients), primary events occurred in 7 % of the patients in both groups (Adjusted HR 1.39, 95 % CI 0.55-3.49, P = 0.49). Kaplan-Meier curves showed no significant differences in event rates between nicorandil and ATP in either group.

CONCLUSIONS: In the evaluation of FFR, nicorandil is a safe and simple alternative that shows similar clinical outcomes to ATP.

PMID:40510821 | PMC:PMC12159487 | DOI:10.1016/j.ijcha.2025.101708

Eur Stroke J. 2025 Jun 12:23969873251343828. doi: 10.1177/23969873251343828. Online ahead of print.

ABSTRACT

INTRODUCTION: We examined the prevalence and the characteristics of vessel wall (VW) lesions in young stroke patients and their relation to recurrent vascular events. We hypothesize that having VW lesions is associated with an increased risk on recurrent vascular events.

PATIENTS AND METHODS: Single-center prospective study of participants aged 18-50 years, with a transient ischemic attack (TIA) or ischemic stroke, who underwent high-resolution 3T magnetic resonance imaging (HR-MRI) with VW imaging. We included 10 controls with symptoms diagnosed as stroke mimics. The HR-MRI scans were reviewed by two neuroradiologists blinded for clinical information. Follow-up was conducted via telephone interviews. Recurrent vascular events were defined as TIA, cerebral stroke, myocardial infarctions, revascularization procedures, or vascular death.

RESULTS: We included 158 participants (median age: 41.5 years, IQR 33.0-46.4); 75 (47.5%) of whom were women. Of these, 44 (27.8%) participants had 81 VW lesions, primarily characterized by VW enhancement (74.1%). 86.4% of VW lesions were located in the corresponding ischemic territory, and 48.6% showed no MRA abnormalities. Almost half of the VW lesions were found in the rare causes subgroup, while 13.6% of the "cryptogenic" subgroup showed VW enhancement. VW lesions were not significantly associated with an increased risk of recurrent vascular events (HR 2.2, 95% CI: 0.7-6.6).

CONCLUSION: One in four young stroke patients have VW lesions, which were not related to an increased risk of recurrent vascular events. VW lesions were seen across all TOAST categories and were not specific to one stroke cause. Further research is needed to investigate the diagnostic and prognostic value of VW lesions in young stroke patients.

PMID:40509544 | PMC:PMC12165956 | DOI:10.1177/23969873251343828

J Clin Med. 2025 Jun 4;14(11):3969. doi: 10.3390/jcm14113969.

ABSTRACT

Background/Objectives: Previous research has established that beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patients with preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted a systematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with AMI and preserved LVEF. Methods: A comprehensive literature search was conducted across PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: "preserved", "myocardial infarction", and "beta-blocker". Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account for the study's heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of p < 0.05. Results: Beta-blocker therapy was significantly associated with a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61-0.88, p = 0.001) and an HR of 0.78 (95% CI: 0.67-0.91, p = 0.002). Similarly, beta-blocker administration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95% CI: 0.68-0.84, p < 0.00001) and an HR of 0.76 (95% CI: 0.59-0.99, p = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of major adverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75-0.95, p = 0.004) and an HR of 0.84 (95% CI: 0.71-0.99, p = 0.04). Conclusions: The current meta-analysis suggests a potential beneficial association between beta-blocker use and outcomes in patients with AMI and preserved LVEF, including lower rates of all-cause mortality, cardiovascular mortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm these findings, particularly in distinguishing outcomes among patients with and without heart failure.

PMID:40507730 | PMC:PMC12156146 | DOI:10.3390/jcm14113969

J Clin Med. 2025 May 27;14(11):3753. doi: 10.3390/jcm14113753.

ABSTRACT

Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes-specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization-at 36 months of follow-up. Results: A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m2 (IQR: 50.8-84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m2, 29.0% an eGFR of 30-<60 mL/min/1.73 m2, and 7.3% an eGFR of <30 mL/min/1.73 m2. Compared to patients with an eGFR ≥ 60 mL/min/1.73 m2, those with an eGFR 30-<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; p = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; p = 0.001). At 36 months of follow-up, patients with an eGFR 30-<60 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739-2.157, p = 0.001 and HR = 3.223, 95% CI: 2.743-3.787, p = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m2 (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. Conclusions: Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months-even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m2 was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30-<60 mL/min/1.73 m2, presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization.

PMID:40507513 | PMC:PMC12155580 | DOI:10.3390/jcm14113753

J Clin Lipidol. 2025 Apr 10:S1933-2874(25)00269-7. doi: 10.1016/j.jacl.2025.04.191. Online ahead of print.

ABSTRACT

BACKGROUND: The temporal changes in carotid plaque progression (PP) and its association with cardiovascular events are not well understood.

OBJECTIVE: This study aimed to evaluate the factors affecting short-term carotid PP and its relation to cardiovascular events.

METHODS: A total of 650 patients who underwent serial carotid ultrasonography over a period of at least 12 months were enrolled and analyzed. The study population was stratified into 2 groups: those with carotid PP (n = 304) and those without PP (n = 346). PP was defined as an increase of plaque number or a ≥20% increase in total plaque thickness compared to previous ultrasonography. The primary endpoint was a 4-year incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, coronary revascularization, or stroke.

RESULTS: Among all patients, the initial mean plaque thickness and number were 6.0 ± 6.7 mm and 2.7 ± 2.7, respectively. Upon follow-up, the PP rate was 46.7%, plaque regression was 16.5%, and no change was observed in 36.8%. The incidence of MACE over 4 years was significantly higher in the PP group (26.6%) compared to the no-PP group (13.0%), with a hazard ratio (HR) of 2.19 (95% CI, 1.52-3.15; P < .001). Independent predictors of MACE included age, chronic kidney disease, coronary artery disease, previous stroke, and PP (HR, 2.05; 95% CI, 1.42-2.95; P < .001). Age (HR, 1.02; 95% CI, 1.00-1.03; P = .038) and coronary artery disease (HR, 1.42; 95% CI, 1.04-1.95; P =.030) were independent predictors of PP.

CONCLUSION: Older age and coronary artery disease tended to increase the likelihood of PP during short-term follow-up, which was significantly associated with cardiovascular events.

PMID:40506269 | DOI:10.1016/j.jacl.2025.04.191

Stem Cell Rev Rep. 2025 Jun 12. doi: 10.1007/s12015-025-10910-y. Online ahead of print.

ABSTRACT

Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.

PMID:40504481 | DOI:10.1007/s12015-025-10910-y

Eur Heart J Open. 2025 Jun 11;5(3):oeaf057. doi: 10.1093/ehjopen/oeaf057. eCollection 2025 May.

ABSTRACT

AIMS: In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.

OBJECTIVES: We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.

METHODS AND RESULTS: All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators' visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction P > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).

CONCLUSION: In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.

PMID:40503340 | PMC:PMC12152305 | DOI:10.1093/ehjopen/oeaf057

J Am Heart Assoc. 2025 Jun 17;14(12):e039663. doi: 10.1161/JAHA.124.039663. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting (CABG) has been associated with reduced mortality, myocardial infarction, and repeat revascularization compared with percutaneous coronary intervention (PCI) for patients with 3-vessel coronary artery disease (CAD) and diabetes. The majority of previous studies have been limited to follow-up of <10 years. Herein, we compared CABG and PCI in patients with 3-vessel coronary artery disease and diabetes with a maximum long-term follow-up of 14 years.

METHODS: Patients with diabetes and 3-vessel coronary artery disease but without ST-segment-elevation myocardial infarction who underwent coronary angiography followed by CABG or PCI from 2009 to 2018 were included in this study. The primary outcome was mortality, and the secondary outcomes included myocardial infarction, stroke, or repeat revascularization. Outcomes were adjusted for age, sex, and clinical comorbidities.

RESULTS: A total of 1210 patients underwent PCI (median follow-up, 9.1 years) while 477 underwent CABG (median follow-up, 8.1 years). Patients who underwent CABG were less likely to experience mortality (49.6% versus 57.6%, P=0.003, adjusted hazard ratio [aHR], 0.75 [95% CI, 0.61-0.91]), myocardial infarction (15.6% versus 28.1%, P<0.001, aHR, 0.45 [95% CI, 0.33-0.61]), or require repeat revascularization (7.7% versus 26.9%, P<0.001, aHR, 0.21 [95% CI, 0.14-0.30]) at longest follow-up. Risk of rehospitalization (82.6% versus 83.4%, P=0.656) and stroke (11.6% versus 12.2%, P=0.794) did not significantly differ between groups.

CONCLUSIONS: In this study, we describe one of the longest follow-up periods for patients with diabetes and 3-vessel coronary artery disease who underwent CABG or PCI and confirmed that the shorter-term benefits seen in randomized trials do translate into longer-term reductions in risk of death, myocardial infarction, or repeat revascularization.

PMID:40497515 | DOI:10.1161/JAHA.124.039663