Contributing factors to the short-term progression of carotid plaque and its relation to cardiovascular outcomes
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
Extracellular Vesicle-Enhanced Stem Cell Therapy in Acute Myocardial Infarction: A Case Report of Cardiac Regeneration from a Bypass Surgery
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
Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial
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
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With 3-Vessel Coronary Artery Disease and Diabetes
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
Inpatient Outcomes for Patients With Peripheral Artery Disease Hospitalized for Acute Myocardial Infarction
J Am Heart Assoc. 2025 Jun 17;14(12):e040526. doi: 10.1161/JAHA.124.040526. Epub 2025 Jun 11.
ABSTRACT
BACKGROUND: Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.
METHODS: We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023. Primary outcomes were in-hospital mortality and major bleeding; secondary end points included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis initiation. Subgroup analyses were conducted by age, sex, race, AMI type, revascularization status, and extent of coronary disease. We used the NCDR validated risk model for multivariable adjustment.
RESULTS: PAD was present in 36 274 patients with AMI (7.4%). In-hospital mortality was significantly higher in patients with PAD compared with those without (8.23% versus 4.87%; adjusted odds ratio [aOR], 1.25 [95% CI, 1.19-1.31]). Increased mortality persisted across age groups (<65 years: aOR, 1.42; ≥65 years: aOR, 1.18) and AMI type (non-ST-segment-elevation MI: aOR, 1.14; ST-segment-elevation MI: aOR, 1.46), with significant interactions by both age and AMI type. Among revascularized patients, mortality was elevated in those with PAD (aOR, 1.49). PAD was associated with increased rates of major bleeding (aOR, 1.23), particularly among revascularized patients (aOR, 1.31), as well as cardiac arrest, shock, heart failure, stroke, and new dialysis.
CONCLUSIONS: PAD was independently associated with markedly worse in-hospital outcomes in AMI, highlighting the need for risk mitigation strategies in this high-risk population.
PMID:40497502 | DOI:10.1161/JAHA.124.040526
Prognostic Value of Plaque Radial Wall Strain Analysis in Patients With Acute Myocardial Infarction After Complete Revascularization
Catheter Cardiovasc Interv. 2025 Jun 11. doi: 10.1002/ccd.31680. Online ahead of print.
ABSTRACT
BACKGROUND: Even after complete revascularization (CR), patients with acute myocardial infarction (AMI) still face significant risks of adverse events, frequently linked to vulnerable plaque progression in nonsignificant stenosis.
AIMS: To investigate the relationship between the radial wall strain (RWS) of nonsignificant stenosis lesions and major adverse cardiac events (MACE) in patients with AMI following CR.
METHODS: This cohort study included patients with AMI who received CR of all culprit and non-culprit lesions with diameter stenosis (DS%) > 70% during index or staged percutaneous coronary intervention within 45 days, with at least one de novo native lesion (DS% of 30%-70%) for RWS analysis. The primary outcome was MACE comprising cardiovascular death, nonfatal myocardial infarction, unstable angina, and heart failure.
RESULTS: During a median follow-up of 3.6 years, 55 among 225 patients (24.4%) experienced MACE, mainly driven by unstable angina. Maximum RWS (RWSmax) was predictive of MACE with an area under the curve of 0.84 (95% CI: 0.78-0.90; p < 0.001) and an optimal cutoff > 14.5%. In the multivariable Cox regression model, RWSmax > 14.5% was an independent predictor for MACE among patients with AMI after CR (HR: 8.06; 95% CI: 3.98-16.35; p < 0.001). In patients with Murray law-based quantitative flow ratio (μQFR) > 0.8, the prognostic impact of RWSmax on MACE was comparable to that observed in patients with μQFR < 0.8 (P for interaction = 0.236).
CONCLUSIONS: Among patients with AMI who received CR, a high-strain pattern detected by RWS analysis in nonsignificant stenosis lesions was associated with a worse clinical outcome.
PMID:40495557 | DOI:10.1002/ccd.31680
Low-Density Lipoprotein Cholesterol Level, the Lower the Better? Analysis of Korean Patients in the Treat Stroke to Target Trial
J Stroke. 2025 May;27(2):228-236. doi: 10.5853/jos.2025.00409. Epub 2025 May 31.
ABSTRACT
BACKGROUND AND PURPOSE: The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90-110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear.
METHODS: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death.
RESULTS: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45-1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09-0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60-2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis.
CONCLUSION: In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.
PMID:40494581 | PMC:PMC12152449 | DOI:10.5853/jos.2025.00409
Cardiovascular burden of individuals diagnosed with idiopathic hypersomnia: Real-World Idiopathic Hypersomnia Total Health Model (CV-RHYTHM)
Sleep Med. 2025 May 19;133:106587. doi: 10.1016/j.sleep.2025.106587. Online ahead of print.
ABSTRACT
OBJECTIVE/BACKGROUND: Limited research assesses cardiovascular risk in people with idiopathic hypersomnia. This study compared cardiovascular conditions or events among individuals with idiopathic hypersomnia with those among matched non-idiopathic hypersomnia controls.
PATIENTS/METHODS: Claims from Merative™ MarketScan® Research Databases (12/2013-2/2020) were analyzed. Eligible individuals with idiopathic hypersomnia were ≥18 years of age upon cohort entry, continuously enrolled for 365 days before and after cohort entry (gaps ≤30 days allowed), and without cataplexy. Individuals with idiopathic hypersomnia entered the cohort upon their earliest medical claim with an idiopathic hypersomnia diagnosis code. Controls were matched 5:1, without replacement, to individuals with idiopathic hypersomnia using demographic characteristics. Odds of prevalent cardiovascular conditions or events during the 2-year assessment period (365 days before and after cohort entry date) were compared using unconditional logistic regression. Results were reported as odds ratios (ORs) with 95 % confidence intervals (CIs).
RESULTS: Final cohorts included 11,412 individuals with idiopathic hypersomnia and 57,058 matched controls. Odds (OR, 95 % CI) of cardiovascular disease (2.26, 2.14-2.38), major adverse cardiovascular event (2.08, 1.89-2.30), stroke (2.07, 1.87-2.29), hypertension diagnosis or antihypertensive use (2.02, 1.93-2.12), heart failure (1.97, 1.76-2.20), atrial fibrillation (1.91, 1.66-2.20), myocardial infarction (1.74, 1.42-2.12), and coronary revascularization (1.58, 1.12-2.17) were higher in individuals with idiopathic hypersomnia than matched controls.
CONCLUSIONS: Individuals with idiopathic hypersomnia had higher odds of prevalent cardiovascular conditions or events than matched controls. These results reinforce that clinicians should be aware of patients' cardiovascular risk profiles when selecting idiopathic hypersomnia treatments.
PMID:40494110 | DOI:10.1016/j.sleep.2025.106587