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We aimed to determine the usefulness and sex differences of assessment of coronary artery calcification (CAC) with cardiovascular risk factors and major adverse cardiovascular events (MACE) in Japanese patients. In a nationwide, multicenter, prospective cohort study, 1187 patients with suspected coronary artery disease who underwent coronary computed tomography were enrolled. MACE included cardiovascular death, myocardial infarction, stroke, revascularization, and hospitalization for unstable angina, heart failure, or aortic disease. The concordance (C)-statistics were used to assess the relationships among the Suita risk score, CAC score, and incident MACE, with emphasis on sex differences. The final analysis included 982 patients (mean age, 64.7 ± 6.6 years; male patients, 53.9 %). MACE developed in 65 male and 21 female patients during a median follow-up of 1480 days. The C-statistics calculated using Suita score for MACE were 0.650, 0.633, and 0.569 in overall, male, and female patients, respectively. In overall patients, the C-statistic significantly increased in combined models of Agatston CAC scores of ≥100, 200, 300, or 400 and the Suita score. In each sex, the C-statistics significantly increased in the model that added an Agatston CAC score of ≥100 and ≥200 (+0.049 and +0.057) in male patients, and ≥400 (+0.119) in females, respectively. Adding assessment of Agatston CAC scores to Suita score was useful to improve the predictive ability for future MACE in Japanese patients. Agatston CAC scores of ≥100 or 200 in male and ≥400 in female patients in addition to Suita score improved the MACE risk prediction. [Display omitted] • NADESICO study was performed in a cohort of 1187 Japanese patients with suspected coronary artery disease. • Coronary artery calcification (CAC) and long-term major adverse cardiovascular events (MACE) were evaluated. • CAC scores in addition to conventional risk factors were useful for predicting MACE. • Sex differences were observed in the performance of CAC of risk prediction models. [ABSTRACT FROM AUTHOR]

Major adverse cardiac events (MACE) are a leading cause of morbidity and mortality after orthotopic liver transplantation (OLT). Cirrhotic cardiomyopathy (CCM), initially described in 2005 and revised in 2019, is a source of MACE in patients after OLT. We sought to identify CCM-related predictors of MACE at one-year follow-up after OLT and assess for reversibility of CCM post-OLT. This is a retrospective study of adult patients who underwent OLT between 2009 and 2019. All patients had transthoracic echocardiography pre-and post-OLT. Patients with a left ventricular ejection fraction <50 % pre-OLT were excluded. MACE was defined as death, myocardial infarction, congestive heart failure hospitalization, or cardiac arrest. In total, 131 patients were included in this study, of whom 103 and 23 patients met the 2005 and 2019 criteria, respectively. During the follow-up period, 42 patients had MACE and these patients were more likely to have ascites (p = 0.003), hepatorenal syndrome (p = 0.019), and CCM per 2005 criteria (p = 0.023). There were no significant differences between pre-OLT CCM per 2019 criteria (19 % vs 17 %, p = 0.758) or MELD-Na score (21.24 vs 19.40, p = 0.166) for MACE post-OLT. Per the 2005 criteria, 35 of 103 patients recovered and these patients were less likely to have MACE post-OLT (p = 0.012). Per the 2019 criteria, 13 of 23 patients recovered post-OLT but this low number precluded further statistics. The 2005 Montreal criteria for CCM were an independent predictor of MACE at one-year follow-up post-OLT while the 2019 CCC criteria for CCM were not. In addition, the 2005 Montreal criteria were more prevalent when compared to 2019 CCC criteria. Finally, the 2005 Montreal criteria were reversible post-OLT 34 % of the time compared to the 2019 CCC criteria which were reversible 57 % of the time. [Display omitted] • Cirrhotic cardiomyopathy (CCM) predicts major adverse cardiac events (MACE). • CCM per 2005 criteria predicted MACE at 1 year, but CCM per 2019 criteria did not. • CCM is reversible in 34 % and 57 % of patients per 2005 and 2019 criteria respectively after orthotopic liver transplantation. • The 2005 criteria of CCM are more prevalent when compared to the 2019 criteria. [ABSTRACT FROM AUTHOR]

Purpose: Data are limited on the long-term efficacy and safety of drug-coated balloon (DCB) treatment in comparison to drugeluting stent (DES) for de novo coronary lesions. We investigated the long-term clinical outcomes of DCB treatment in percutaneous coronary intervention (PCI) for de novo coronary lesions. Materials and Methods: A total of 103 patients scheduled for elective PCI for de novo non-small coronary lesions (≥2.5 mm) who were successfully treated with DCB alone were retrospectively compared with 103 propensity-matched patients treated with second- generation DES from the PTRG-DES registry (n=13160). All patients were followed for 5 years. The primary endpoint was major adverse cardiac events [MACE; cardiac death, myocardial infarction, stroke, target lesion thrombosis, target vessel revascularization (TVR), and major bleeding] at 5 years. Results: At 5-year clinical follow-up, Kaplan-Meier estimates of the rate of MACE were significantly lower in the DCB group [2.9% vs. 10.7%; hazard ratio (HR): 0.26; 95% confidence interval (CI): 0.07-0.96; log-rank p=0.027]. There was a significantly lower incidence of TVR in the DCB group (1.0% vs. 7.8%; HR: 0.12; 95% CI: 0.01-0.98; long-rank p=0.015), and there was major bleeding only in the DES group (0.0% vs. 1.9%; log-rank p=0.156). Conclusion: At 5-year follow-up, DCB treatment was significantly associated with reduced incidences of MACE and TVR, compared with DES implantation, for de novo coronary lesions. [ABSTRACT FROM AUTHOR]

This head-to-head, multicenter, randomized trial investigated the safety and efficacy of Restore (Cardionovum, Bonn, Germany) drug-coated balloon (DCB) angioplasty in an Asian patient population with coronary drug-eluting stent in-stent restenosis (DES-ISR). A total of 240 patients with coronary DES-ISR were treated with Restore DCB or with SeQuent® Please (Braun, Melsungen, Germany) DCB. This trial used nine-month in-segment late lumen loss (LL) as the primary endpoint. Secondary endpoints included two-year clinical event rates. Patient, lesion, and procedural characteristics in both treatment groups were similar. Nine-month in-segment LL was 0.38 ± 0.50 mm with Restore vs. 0.35 ± 0.47 mm with SeQuent® Please (p for non-inferiority = 0.02). The two-year follow-up rates were 95.8 % (115/120) in the Restore group and 94.2 % (113/120) in the SeQuent® Please group. Both groups had similar one- and two-year target lesion failure (TLF) rates (13.3 % vs. 12.6 %; p = 0.87 at one year, 14.8 % vs. 15.0 %; p = 1.0 at two years). Moreover, the all-cause mortality and myocardial infarction rates were 0 and 3.5 % (4/120) in the Restore group and 0.9 % (1/120) and 3.5 % (4/120) in the SeQuent® Please group, respectively. Additional analyzing of vessel quantitative flow ratio (QFR) did also show noninferior outcomes for one explicit treatment bunch. The two-year follow-up indicated sustained long-term clinical safety and efficacy for both devices on the basis of QFR value. [Display omitted] • Drug-coated balloon (DCB) angioplasty is a promising treatment for in-stent restenosis. • Identification of SeQuent® Please DCB has sustained safety and efficacy. • Restore DCB has similar clinical outcomes comparing to the SeQuent® Please DCB. • The result of quantitative flow ratio did show non-inferior outcomes for one explicit treatment bunch. • Restore DCB sustained clinical safety and efficacy at 24-month follow up. [ABSTRACT FROM AUTHOR]

In-stent restenosis (ISR) remains a significant challenge in interventional cardiology despite advancements in stent technology. Drug-coated balloons (DCBs), which deliver antiproliferative agents directly to the vessel wall, have emerged as a promising alternative to plain balloon angioplasty for ISR treatment. This meta-analysis evaluates the efficacy of DCBs compared to plain balloon angioplasty in patients with coronary ISR. A comprehensive search of PubMed and Embase was conducted on June 27, 2024. The search identified randomized controlled trials comparing DCBs and plain balloon angioplasty for ISR treatment. Six trials involving 1,322 patients met the inclusion criteria. Quality was assessed with the Cochrane Risk of Bias tool. Data extraction and statistical analysis were performed using RevMan software, assessing heterogeneity with the I2 statistic and publication bias using funnel plots. The analysis showed that DCBs significantly reduced late in-stent and in-segment luminal loss (P < 0.001) and target lesion revascularization (P = 0.02) compared to plain balloon angioplasty. Major adverse cardiovascular events and the combined endpoint of target lesion revascularization, myocardial infarction, and death also showed highly significant improvements with DCB treatment (P < 0.00001 and P = 0.0002, respectively). However, no significant effect was observed on myocardial infarction and mortality rates. DCBs significantly reduce in-stent late luminal loss, target lesion revascularization, and major adverse cardiovascular events compared to plain balloon angioplasty. [ABSTRACT FROM AUTHOR]

Guidelines for evaluating patients with suspected coronary artery disease (CAD) recommend pretest probability (PTP) estimation but provide no clear recommendations regarding diagnostic testing in patients with >5% to 15% risk of obstructive CAD. The diagnostic and prognostic value of PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) minimal risk score (PMRS) calculation in this patient group is unknown. This work aims to improve the evaluation of stable patients with suspected CAD by using the PMRS, which identifies patients at minimal risk of CAD and events in patients with >5% to 15% PTP of obstructive CAD. Greater than 5% to 15% PTP patients from 2 large clinical trials were used for subcohort derivation: PROMISE (N = 10,003) and Dan-NICAD (Danish study of Non-Invasive Testing in Coronary Artery Disease) (N = 3,252). First, the PMRS cutoff associated with a prevalence of obstructive CAD ≤5% was determined in the >5% to 15% PTP PROMISE core lab computed tomographic angiography patients (discovery cohort: n = 2,191). This cutoff was validated for obstructive CAD in >5% to 15% PTP Dan-NICAD patients (CAD validation cohort: n = 1,386) and for prognostic impact on death and myocardial infarction in >5% to 15% PTP PROMISE non–core lab computed tomographic angiography patients (prognosis validation cohort: n = 2,753). In the discovery cohort, a CAD prevalence of ≤5% was found at a PMRS of ≥34%. In the CAD validation cohort, this cutoff down-classified 442 (31.9%) of >5% to 15% PTP patients into the low PTP group (CAD ≤5%); the prevalence of obstructive CAD in down-classified patients was 3.2% compared to 7.1% in non–down-classified patients. A PMRS ≥34% was nonsignificantly associated with a lower risk of myocardial infarction and death in the prognosis validation cohort (HR: 0.58 [95% CI: 0.29-1.18]; P = 0.13). For evaluating patients with suspected CAD, a combined use of traditional PTP and the PMRS correctly down-classified one-third of >5% to 15% PTP patients into a group with very low prevalence of obstructive CAD and adverse events. The proposed strategy may improve risk stratification and help reduce unneeded diagnostic testing. [Display omitted] [ABSTRACT FROM AUTHOR]

Background and Aim: Alterations of glucose homeostasis can increase advanced glycation end products (AGEs) that exacerbate vascular inflammatory disease and may increase vascular senescence and aging. This study examined the relationships between carboxymethyl-lysine (CML) and soluble receptor for AGEs (sRAGE) with leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn), as cell aging biomarkers, in patients with established coronary artery disease (CAD).Methods and Results: We studied 459 patients with CAD further categorized as having normal glucose homeostasis (NG, n = 253), pre-diabetes (preT2D, n = 85), or diabetes (T2D, n = 121). All patients were followed up for the occurrence of major adverse cardiovascular events (MACEs). Plasma concentrations of sRAGE and CML were measured by ELISA. mtDNAcn and LTL were measured by qRT-PCR. CML levels were significantly higher in patients with preT2D (p < 0.007) or T2D (p < 0.003) compared with those with NG. mtDNAcn resulted lower in T2D vs preT2D (p = 0.04). At multivariate Cox proportional hazard analysis, short LTL (HR: 2.89; 95% CI: 1.11-10.1; p = 0.04) and high levels of sRAGE (HR: 2.20; 95% CI: 1.01-5.14; p = 0.04) were associated with an increased risk for MACEs in patients with preT2D and T2D, respectively. T2D patients with both short LTL and high sRAGE levels had the highest risk of MACEs (HR: 3.11; 95% CI: 1.11-9.92; p = 0.04).Conclusions: High levels of sRAGE and short LTL were associated with an increased risk of MACEs, especially in patients with diabetes, supporting the usefulness of both biomarkers of glycemic impairment and aging in predicting cardiovascular outcomes in patients with CAD. [ABSTRACT FROM AUTHOR]

Patients with diabetes mellitus (DM) are at increased risk for peripheral artery disease (PAD) and its complications. Arterial calcification and non-compressibility may limit test interpretation in this population. Developing tools capable of identifying PAD and predicting major adverse cardiac event (MACE) and limb event (MALE) outcomes among patients with DM would be clinically useful. Deep neural network analysis of resting Doppler arterial waveforms was used to detect PAD among patients with DM and to identify those at greatest risk for major adverse outcome events. Consecutive patients with DM undergoing lower limb arterial testing (April 1, 2015-December 30, 2020) were randomly allocated to training, validation, and testing subsets (60%, 20%, and 20%). Deep neural networks were trained on resting posterior tibial arterial Doppler waveforms to predict all-cause mortality, MACE, and MALE at 5 years using quartiles based on the distribution of the prediction score. Among 11,384 total patients, 4211 patients with DM met study criteria (mean age, 68.6 ± 11.9 years; 32.0% female). After allocating the training and validation subsets, the final test subset included 856 patients. During follow-up, there were 262 deaths, 319 MACE, and 99 MALE. Patients in the upper quartile of prediction based on deep neural network analysis of the posterior tibial artery waveform provided independent prediction of death (hazard ratio [HR], 3.58; 95% confidence interval [CI], 2.31-5.56), MACE (HR, 2.06; 95% CI, 1.49-2.91), and MALE (HR, 13.50; 95% CI, 5.83-31.27). An artificial intelligence enabled analysis of a resting Doppler arterial waveform permits identification of major adverse outcomes including all-cause mortality, MACE, and MALE among patients with DM. [ABSTRACT FROM AUTHOR]

Objectives: Osteoarthritis (OA) is a common degenerative joint disease, and total knee replacement (TKR) is a successful surgical intervention for knee OA treatment. However, the risks of mortality and major cardiovascular events (MACEs) in patients receiving TKR remain unclear. This study investigated the risks of mortality and MACEs in knee OA patients who received TKR.Methods: For this population-based cohort study, the Longitudinal Health Insurance Database 2000 was used. Two million individuals with knee OA defined by ICD-9-CM codes who received physical therapy between 1999 and 2017 were selected. For propensity score matching (PSM), we considered the year of knee OA diagnosis, demographics, comorbidities, co-medications, and knee OA-related hyaluronic acid or physical therapy at baseline. After PSM, regression analyses were performed to assess the association of mortality or MACEs with TKR and non-TKR individuals.Results: We identified patients (n = 189,708) with a new diagnosis of knee OA between 2000 and 2017. In total, 10,314 propensity-score-paired TKR and non-TKR individuals were selected. The PSM cohort algorithm revealed that the risk of mortality or MACEs was lower in the TKR group (adjusted hazard ratio: 0.791; 95% confidence interval: 0.755-0.830) than in the non-TKR group.Conclusions: Patients with knee OA who received TKR had decreased risks of mortality and MACEs than those who did not receive TKR. Moreover, the TKR group received a reduced dosage of nonsteroidal anti-inflammatory drugs at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction (AMI) is major cardiovascular disease that causes high morbidity and mortality. In AMI, ischemia and necrosis affected some cardiomyocytes leading to a decrease in myocardial contractility which is followed by an acute proinflammation reaction and increased sympathetic tone. Meanwhile, high blood pressure variability (BPV) causing an increased left ventricular workload, heart rate, myocardial oxygen demand and induces proinflamations and endothelial dysfunction. Therefore a high BPV and its associated pathological effects are likely to aggravate the physiological function of the heart and affect the emergence of acute cardiac complications in AMI patients. This study aims to investigate the association's between short-term BPV and major adverse cardiac events (MACE) in AMI patients. This retrospective cohort study used simple random sampling to identify AMI patients who were hospitalized at Cipto Mangunkusumo National Hospital between January 2018 and December 2019. Mann Withney was performed to investigate the association between BPV and MACE. Results: The average systolic BPV value which was calculated as standard deviation (SD) and average real variability (ARV) was higher in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 13.28 ± 5.41 mmHg and 9.88 ± 3.81 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.76 (4.59–26.17) mmHg and 8.65 (3.22–19.35) mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic SD and systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE. Conclusions: The BPV of AMI patients who experience MACE was higher than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI. [ABSTRACT FROM AUTHOR]

Objectives: The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 h (same-day) of the primary PCI procedure were included. Patients were stratified as high- and lowrisk based on ZRS score; low-risk (≤3) and high-risk (≥4). All patients were followed during 30-days post-procedure period for major adverse cardiac events (MACE). Results: Out of 487 patients, 83.2% (405) were male and mean age was 54.6 ± 10.87 years. Mean ZRS was 2.34 ± 1.64 with 16.0% (78) patients in high-risk (≥4) group. 30-days MACE rate was observed to be 5.3% (26) with significantly higher rate among high-risk patients as compared to low-risk patients 12.8% (10) vs. 3.9% (16); p ¼ 0.004 respectively with OR of 3.61 [1.57e8.29]. The area under the curve (AUC) of ZRS for prediction of 30-day MACE was 0.67 [95% CI: 0.58-0.77], ZRS ≥4 had sensitivity of 38.5% and specificity of 85.2% with AUC of 0.62 [95% CI: 0.50-0.74] for prediction of 30-day MACE. Conclusion: ZRS showed moderate discriminating potential in identifying patients with high-risk of MACE at 30-day after same-day discharge after primary PCI. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Coronary CT angiography (CCTA) is a noninvasive reliable cardiovascular imaging technology to assess coronary atherosclerosis progression. However, there is limited data available to investigate the relationship between the atherosclerosis progression and cardiovascular events in patients with nonobstructive coronary artery disease (CAD).Materials and Methods: A total of 757 patients (53.4 ± 9.5 years, 61.2% male) with nonobstructive CAD (1%-49% diameter stenosis) who underwent baseline and follow-up CCTA were retrospectively included in this study. Coronary atherosclerosis and its changing were analyzed by these following semi-quantitative scores: (1) obstructive plaque scores (three-vessel plaque score and severe proximal plaque score); (2) scores exhibiting plaque distribution and extent (segment stenosis score and segment involvement score); (3) coronary artery calcium score. The end points of this study were the major adverse cardiac events (MACE), which included cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina.Results: The average time between scans was 2.0 years. After their second scan, 82 (10.8%) patients experienced MACE during 4.9 ± 1.0 years follow-up. Combined baseline and follow-up CCTA together, we found that the progression of coronary atherosclerosis was significantly higher in patients with MACE than those without (all p < 0.05). Diabetes mellitus (hazard ratio [HR] = 3.17, p < 0.001), dyslipidemia (HR = 1.69, p = 0.046), and family history of CAD (HR = 1.79, p = 0.005) were independently associated with MACE. Three vessel plaque progression (HR = 2.37, p = 0.026) and severe proximal plaque progression (HR = 3.65, p = 0.003) were strong predictors of MACE.Conclusion: Coronary atherosclerosis progression had a predictive value of MACE in patients with nonobstructive CAD. [ABSTRACT FROM AUTHOR]

Background: Approximately half of all women with anginal symptoms and/or signs of ischemia and no obstructive coronary artery disease (INOCA) referred for coronary angiography have elevated risk for major adverse cardiac events (MACE), poor quality of life and resource consumption. Yet, guidelines focus on symptom management while clinical practice typically advocates only reassurance. Pilot studies of INOCA subjects suggest benefit with intensive medical therapy (IMT) that includes high-intensity statins and angiotensin converting enzyme inhibitors (ACE-I) or receptor blockers (ARB) to provide the rationale for a randomized pragmatic trial to limit MACE.Methods: The Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD is a multicenter, prospective, randomized, blinded outcome evaluation (PROBE design) of a pragmatic strategy of IMT vs usual care (UC) in 4,422 symptomatic women with INOCA (NCT03417388) in approximately 70 United States sites. The hypothesis is that IMT will reduce the primary outcome of first occurrence of MACE by 20% vs. UC at ∼2.5 year followup. Secondary outcomes include quality of life, time to return to "duty"/work, healthcare utilization, angina, cardiovascular death and individual primary outcome components over 3 years follow-up. The study utilizes web-based data capture, e-consents, single IRB and centralized pharmacy distribution of strategy medications directly to patients' homes to reduce site and patient burden. A biorepository will collect blood samples to assess potential mechanisms.Conclusions: The results of this trial will provide important data necessary to inform guidelines regarding how best to manage this growing and challenging population of women with INOCA. [ABSTRACT FROM AUTHOR]

• Optimal medical therapy (OMT) at discharge was associated with decreased all-cause mortality after acute coronary syndrome. • OMT prescription remains suboptimal in routine clinical practice. • OMT with high-intensity statin maximizes substantial benefits. Optimal medical therapy (OMT) is recommended for patients with acute coronary syndrome (ACS) at discharge. This study aimed to assess temporal trends of OMT prescription as a five-drug regimen at discharge and its association with clinical outcomes in patients with ACS in Thailand. A retrospective cohort study was conducted in a tertiary-care medical center in Thailand. Data were collected from an electronic medical database. Patients were categorized into OMT or non-OMT groups based on their discharge medications. OMT was defined as a combination of aspirin and P2Y12 inhibitors, statins, beta-blockers, and angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers. The primary outcome was 1-year all-cause mortality. The secondary outcome was major adverse cardiac events (MACE) which was defined as a composite of non-fatal myocardial infarction, non-fatal stroke, and all-cause mortality. The prescription trends were also estimated. A multivariate Cox's proportional hazard model was used to assess the association of OMT prescriptions at discharge with all-cause mortality and MACE. A total of 3531 patients discharged with ACS [mean age, 69.5 (SD 12.4) years; 58.3% male] were identified. Only 42.6% were discharged with OMT. The rates of OMT prescriptions did not change over time. However, the prescription of OMT with high-intensity statin was significantly increased from 5.0% in 2013 to 38.3% in 2018 (p for trend <0.001). Multivariable analyses indicated that OMT significantly reduced all-cause mortality (adjusted HR: 0.77; 95%CI: 0.63-0.95; p =0.012) and MACE (adjusted HR 0.84; 95%CI: 0.71-0.99; p = 0.044). Subgroup analysis indicated that patients receiving OMT with high-intensity statins exhibited survival benefits (adjusted HR: 0.72; 95%CI: 0.56-0.92; p =0.008). The five-drugs comprising OMT were associated with a reduction in all-cause mortality and MACE in patients with ACS. Nevertheless, OMT prescribing remains underused and could be enhanced in the real-world setting. [ABSTRACT FROM AUTHOR]

The association between long-term systolic blood pressure variability (SBPV) and cardiovascular (CV) outcomes after being adjusted with mean blood pressure (BP) is questionable. This systematic review aims to evaluate the associations between mean BP adjusted long-term SBPV and CV outcomes. A systematic search was conducted on PubMed, Scopus, and Science Direct on January 4, 2023. A total of 9,944,254 subjects from 43 studies were included in this meta-analysis. Long-term SBPV increased the risk of all-cause mortality (HR 1.21 [95%CI 1.16-1.25], I2=100%), CV mortality (HR 1.10 [95%CI 1.07-11.4], I2 = 90%), MACE (HR 1.10 [1.07-1.13], I2 = 91%), cerebrovascular stroke (HR 1.22 [1.16-1.29], I2=100%), and myocardial infarction (HR 1.13 [95%CI (1.07-1.19)], I2=91%). European populations generally had higher risk compared to other continents. In conclusion, long-term SBPV is associated with all-cause mortality, CV mortality, MACE, MI, and stroke. Poor outcomes related to long-term SBPV seem more dominated by cerebrovascular than coronary events. [ABSTRACT FROM AUTHOR]

This study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women. To our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women. Prospective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition. The propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation. Among pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217) [ABSTRACT FROM AUTHOR]

Background: The strategy for early discharge after primary percutaneous coronary intervention (PCI) could have substantial financial benefits, especially in low-middle income countries. However, there is a lack of local evidence on feasibility and safety of the strategy for early discharge. Therefore, the aim of this study was to assess the safety of early discharge after primary PCI in selected low-risk patients in the population of Karachi, Pakistan. Methods: In this study 600 consecutive low-risk patients who were discharged within 48 hours of primary PCI were put under observation for major adverse cardiac events (MACE) after 7 and 30 days of discharge respectively. Patients were further stratified into discharge groups of very early (= 24 hours) and early (24 to 48 hours). Results: The sample consisted of 81.8% (491) male patients with mean age of 54.89 ± 11.08 years. Killip class was I in 90% (540) of the patients. The majority of patients (84%) were discharged within 24 hours of the procedure. Loss to follow-up after rate at 7 and 30 days was 4% (24) and 4.3% (26) respectively. Cumulative MACE rate after 7 and 30 days was observed in 3.5% and 4.9%, all-cause mortality in 1.4% and 2.3%, cerebrovascular events in 0.9% and 1.4%, unplanned revascularization in 0.9% and 1.2%, re-infarction in 0.3% and 0.5%, unplanned re-hospitalization in 0.5% and 0.5%, and bleeding events in 0.5% and 0.5% of the patients respectively. Conclusion: It was observed that very early (= 24 hours) discharge after primary PCI for lowrisk patients is a safe strategy subjected to careful pre-discharge risk assessment with minimal rate of MACE after 7-days as well as 30-days. [ABSTRACT FROM AUTHOR]

This study sought to develop a clinical model that identifies a lower-risk population for coronary artery disease that could benefit from stress-first myocardial perfusion imaging (MPI) protocols and that can be used at point of care to risk stratify patients. There is an increasing interest in stress-first and stress-only imaging to reduce patient radiation exposure and improve patient workflow and experience. A secondary analysis was conducted on a single-center cohort of patients undergoing single-photon emission computed tomography (SPECT) and positron emission tomography (PET) studies. Normal MPI was defined by the absence of perfusion abnormalities and other ischemic markers and the presence of normal left ventricular wall motion and left ventricular ejection fraction. A model was derived using a cohort of 18,389 consecutive patients who underwent SPECT and was validated in a separate cohort of patients who underwent SPECT (n = 5,819), 1 internal cohort of patients who underwent PET (n=4,631), and 1 external PET cohort (n = 7,028). Final models were made for men and women and consisted of 9 variables including age, smoking, hypertension, diabetes, dyslipidemia, typical angina, prior percutaneous coronary intervention, prior coronary artery bypass graft, and prior myocardial infarction. Patients with a score ≤1 were stratified as low risk. The model was robust with areas under the curve of 0.684 (95% confidence interval [CI]: 0.674 to 0.694) and 0.681 (95% CI: 0.666 to 0.696) in the derivation cohort, 0.745 (95% CI: 0.728 to 0.762) and 0.701 (95% CI: 0.673 to 0.728) in the SPECT validation cohort, 0.672 (95% CI: 0.649 to 0.696) and 0.686 (95% CI: 0.663 to 0.710) in the internal PET validation cohort, and 0.756 (95% CI: 0.740 to 0.772) and 0.737 (95% CI: 0.716 to 0.757) in the external PET validation cohort in men and women, respectively. Men and women who scored ≤1 had negative likelihood ratios of 0.48 and 0.52, respectively. A novel model, based on easily obtained clinical variables, is proposed to identify patients with low probability of having abnormal MPI results. This point-of-care tool may be used to identify a population that might qualify for stress-first MPI protocols. [ABSTRACT FROM AUTHOR]

• Reduced staffing affects poor outcomes of patients with acute myocardial infarction (AMI) during off-hours. • On-duty cardiologists' presence is not a prognostic factor for patients with AMI. • Our medical system prevents delaying treatment of AMI without on-duty cardiologists. Owing to reduced staffing, patients hospitalized for acute myocardial infarction (AMI) during off-hours (nights, weekends, and holidays) have poorer outcomes than those admitted during regular hours. Whether the presence of an on-duty cardiologist in a hospital during off-hours is related to better outcomes for patients with AMI remains unclear. The Miyazaki Prefectural Nobeoka Hospital had a unique medical care system in that cardiologists were on call for half of the week and on duty for the other half during off-hours, thus providing an opportunity to assess the relationship between the presence of an on-duty cardiologist and patient outcomes. We examined clinical outcomes of patients admitted for AMI during off-hours according to the presence of an on-duty cardiologist. We recruited 225 consecutive patients with AMI hospitalized during off-hours, who underwent stent implantation at Miyazaki Prefecture Nobeoka Hospital from 2013 to 2017. The endpoints were in-hospital death or long-term major adverse cardiac events (MACE) including cardiovascular death, non-fatal MI, non-fatal stroke, stent thrombosis, ischemia-driven target-lesion revascularization, admission owing to unstable angina, or admission owing to heart failure. Based on the presence of an on-call cardiologist at admission, we divided patients into the cardiologist on-call group (n = 112) or cardiologist on-duty group (n = 113). The presence of an on-duty cardiologist did not affect door-to-reperfusion time (p = 0.776), level of peak creatine kinase (p = 0.971), or in-hospital death (p = 0.776). The Kaplan–Meier curve analysis showed similar prognosis for the cardiologist on-duty and cardiologist on-call groups (p = 0.843), and multivariable Cox regression analysis showed that the presence of an on-duty cardiologist was not associated with MACE. The presence of an on-duty cardiologist is not a prognostic factor for patients hospitalized for AMI during off-hours in our medical system. Further prospective multicenter studies should confirm our results. [ABSTRACT FROM AUTHOR]

The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFR CT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFR CT) with downstream care and clinical outcomes. Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFR CT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFR CT ≤0.80 and in 89 (5.60%) with an FFR CT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFR CT ≤0.80 and 12 occurred in those with an FFR CT >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFR CT ≤0.80 compared with 10 (0.60%) patients with an FFR CT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFR CT ≤0.80 compared with patients with an FFR CT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). The 1-year outcomes from the ADVANCE FFR CT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFR CT compared with patients with abnormal FFR CT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679) [ABSTRACT FROM AUTHOR]

Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery. [ABSTRACT FROM AUTHOR]

• At 5 years, target lesion revascularization was significantly lower in the everolimus-eluting stent (EES) group than in the sirolimus-eluting stent (SES) group. • The rate of stent thrombosis was significantly less in the EES group than in the SES group. • Hemodialysis and the type of stent were independent risk factors for primary outcome. • EES offers a safe and effective treatment throughout 5 years. Use of the everolimus-eluting stent (EES) instead of the sirolimus-eluting stent (SES) has been shown to improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) out to 3 years. However, it is not known whether the differences in efficacy and safety outcomes remain constant throughout 5 years. This was a retrospective, non-randomized, observational study. We followed 1460 consecutive patients undergoing PCI in our institutions from April 2005 to March 2012. There were 718 cases in patients with SES (SES group) and 742 with EES (EES group). Ten-month angiographic follow-up results and 5-year clinical follow-up outcomes were compared between the EES and SES groups. The primary outcome of this study was major adverse cardiac events (MACE), defined as the composite of cardiac death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST). At 5 years, the rates of target lesion revascularization (TLR), TVR, recurrent MI and ST were significantly lower in the EES group compared to the SES group (TLR: 4.6% vs. 8.2%, p < 0.05; TVR: 5.0% vs. 9.0%, p < 0.05; recurrent MI: 1.5% vs. 4.4%, p < 0.05; ST: 1.2% vs. 3.9%, p < 0.05). Thus, MACE were significantly lesser in the EES group compared to the SES group (8.8% vs. 12.8%, p = 0.006). EES improved clinical outcomes compared to SES, and specifically, was associated with reductions in TVR, ST, and recurrent MI out to 5 years. [ABSTRACT FROM AUTHOR]

This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure. Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis. In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year. At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p < 0.001). Rates of normal ICA were 24.6% in the selective referral arm compared with 61.1% in the direct referral arm of the trial (p < 0.001). In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198) [ABSTRACT FROM AUTHOR]

Background: The endothelial dysfunction was greater by glucose fluctuation than by chronic hyperglycemia. The glycemic variability (GV) may be an independent risk factor for atherosclerotic coronary artery disease in diabetic patients. The cardiovascular complications are higher following myocardial infarction in diabetic patients than nondiabetic individuals. Aim of the Work: Our aim is to prove that good controlling of acute shooting of blood glucose level up and down will improve the outcome in patient undergoing percutaneous coronary intervention (PCI). Subjects and Methods: GV is evaluated using intraday variability by fasting, preprandial, and postprandial blood glucose levels in 120 patients. Hemoglobin A1c was used to evaluate glycemic control. The relationship between GV and development of major adverse cardiac events (MACE) in patients undergoing PCI is studied. Results: There is a statistically significant difference between the relation of GV and MACE within 1 month after PCI in uncontrolled diabetes compared to controlled group. There is no statistically significant difference found between the two groups regarding age, gender, risk factors (hypertension, smoking and dyslipidemia), and laboratory parameters including triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusions: Uncontrolled GV is associated with poor short-term outcome after PCI in controlled diabetic patients compared to nondiabetic individuals undergoing PCI. Greater GV is associated with composite MACE, especially for uncontrolled diabetic patients. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE after 3 months in patients undergoing PCI. [ABSTRACT FROM AUTHOR]

Noncardiac surgery early after coronary stenting has been associated with a high rate of stent thrombosis and catastrophic outcomes. However, those outcomes were mostly seen when dual antiplatelet therapy (DAPT) was discontinued before surgery. This observational study sought to estimate the risk of major adverse cardiac events (MACEs) after femoral artery repair following recent stent-percutaneous coronary intervention under continued DAPT and to explore potential risk factors. We suspect that in this setting, the risk of MACEs is lower than previously reported. This retrospective cohort study included all consecutive patients who underwent femoral artery repair because of puncture site complications (bleeding or occlusion) within 28 days after coronary stenting at a tertiary referral center in Switzerland from 2005 to 2015. The primary end point consisted of the MACEs death, cardiac arrest, stent thrombosis, and myocardial infarction. There were 12,960 patients who underwent coronary stenting. Seventy patients (0.5%) required repair of the femoral vessels, which was performed under continued DAPT in all cases. Eight patients (11.4%; 95% confidence interval [CI], 5.4-21.8) experienced a total of 17 MACEs within 30 days after surgery, including 5 deaths (7.1%; 95% CI, 2.7-16.6). Factors significantly associated with postoperative MACEs were cardiogenic shock on admission before coronary stenting (hazard ratio, 6.9; 95% CI, 1.8-29.6; P =.035) and limb ischemia as an indication for surgery compared with bleeding (hazard ratio, 10.5; 95% CI, 2.7-40.7; P =.008). In our series, femoral artery repair under DAPT for access site complications early after stent-percutaneous coronary intervention is associated with only a modest MACE rate and therefore a much better outcome than previously reported. [ABSTRACT FROM AUTHOR]

Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P =.48). There was no significant difference in the rates of myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a composite of these cardiovascular end points (P =.68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P =.03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P >.10). Conclusions In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery. [ABSTRACT FROM AUTHOR]

Background Even though longer stented lengths may increase the risk of restenosis, full coverage of diffuse long lesions with longer stents seems to be the optimal strategy for percutaneous coronary intervention (PCI) in the new drug-eluting stent (DES) era. However, it remains unclear whether this strategy will indicate favorable outcome or not. This study evaluated the impact of stent length on two-year clinical outcomes after PCI with the XIENCE Alpine everolimus-eluting stent. Methods This was a retrospective, non-randomized, observational study. Four patient groups were classified according to implanted overall total stent length (short, <15 mm; middle, 15–23 mm; long, 24–32 mm; and ultra-long, >32 mm). The primary outcome of this study was major adverse cardiac events (MACE), defined as the composite of cardiac death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST). Angiographic restenosis by quantitative coronary angiography was defined as >50% diameter stenosis at 10 months after PCI. Results A total of 730 patients who received intravascular ultrasound (IVUS)-guided PCI were enrolled. The short, middle, long, and ultra-long stent groups included 138 patients (149 lesions), 210 patients (235 lesions), 190 patients (209 lesions), and 192 patients (208 lesions), respectively. The primary outcome at two years did not differ among the four groups (MACE: 4.4% in short, 3.3% in middle, 4.7% in long, and 4.7% in ultra-long groups, p = 0.402); TVR, ST, MI, and cardiac mortality also did not differ among groups. Conclusions Long stenting using the XIENCE stent which was guided by IVUS for diffuse, long lesions was associated with favorable clinical outcomes at two years in daily clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the mechanism of exogenous adiponectin in the prevention of no-reflow phenomenon in type 2 diabetic (T2DM) patients with acute myocardial infarction (AMI) during percutaneous coronary intervention (PCI) treatment. PATIENTS AND METHODS: 66 patients were randomly divided into control group and observation group, 33 cases in each group. According to the percutaneous coronary intervention (PCI) emergency treatment principle, patients from the control group were treated with an intracoronary injection of adenosine combined with a micro-pump intravenous infusion of tirofiban. Patients from the observation group were injected with exogenous adiponectin in addition to the adenosine and tirofiban treatments. RESULTS: There were no significant differences in gender, age, location of the target lesion, degree of stenosis, stent implantation number, length and the inner diameter between control and observation group (p > 0.05). Lower frequent of slow blood flow and no-reflow and shorter interventional procedures were observed in observation group compared with those of control group (p < 0.05). Moreover, the increase of plasma creatine kinase (CK-MB) in patients of observation group was lower than that of the patients in control group (p < 0.05). In addition, the levels of troponin-I (cTnI), IL-6, TNF-α, endothelin-1 (ET-1), vascular endothelial adhesion molecular I (VCAM-1) and bax/Bcl-2 were significantly lower in observation group than those in control (p < 0.05). Furthermore, the occurrence of major adverse cardiac events (MACE) during a 12-month follow-up was significantly lower in the observation group than that of control (p < 0.05). CONCLUSIONS: Exogenous adiponectin further reduced the no-reflow phenomenon during PCI treatment of the patients with T2DM combined with AMI. The function of exogenous adiponectin is associated with the reduced myocardial and endothelial cell injury and the inhibited inflammation and apoptosis. The application of exogenous adiponectin can significantly improve the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Little is known about the influence of coronary atherosclerosis progression on the risk of major adverse cardiac events (MACE). Similarly, differences between men and women regarding atherosclerosis progression are poorly understood. The purpose of this study was to investigate the progression of coronary atherosclerosis by coronary CT angiography (coronary CTA) in men and women, and to evaluate its prognostic value regarding MACE. Methods This study included 1046 patients with suspected coronary artery disease (CAD) who underwent serial coronary CTA because of new or worsening symptoms or because follow-up coronary CTA had been recommended by attending physicians. Coronary atherosclerosis was semi-quantitatively assessed as follows: three-vessel plaque score (TVPS), severe proximal plaque score (SPPS), segment stenosis score (SSS), segment involvement score (SIS), and coronary artery calcium score (CACS). Patients were followed-up regarding the occurrence of MACE, defined as cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina. Follow-up information was gathered by clinical visits or telephone contacts. Results Follow-up was achieved in 953 (91.1%) patients (63.8% male; mean age, 53.9 ± 9.7 years) with a mean interval of 4.9 ± 1.1 years. MACE occurred in 132 (13.9%) patients. The average interscan time was 2.1 years. Compared with women, men had significantly higher progression of SPPS, SSS and SIS (6.6% vs. 3.5%, 28.0% vs. 18.3%, 26.6% vs. 16.8%, respectively, all P < 0.005). There was a strong association between the progression of SPPS as well as SSS and MACE, both for men (SPPS, HR:2.17, P < 0.001; SSS, HR:1.28, P = 0.023) and women (SPPS, HR:2.75, P < 0.001; SSS, HR:1.19, P = 0.027). Conclusions Progression of coronary atherosclerosis as determined by coronary CTA is higher in men than women, it is associated with the risk of future MACE. [ABSTRACT FROM AUTHOR]

Background Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular events. Previous studies using 2-dimensional echocardiography show that left atrial end-diastolic volume (LAEDV) predicts cardiovascular outcomes and mortality in patients with CKD. However, contrast-enhanced cardiac CT may offers a more precise measure of atrial dimensions and function than 2-dimensional echocardiography and may provide improved predictionof patient outcome. Aim The aim of the present study was to examine the association of LAEDV and left atrial ejection fraction (LAEF) assessed by CT with left ventricle end-diastolic volume (LVEDV), left ventricular mass, left ventricular ejection fraction and N-terminal plasma-pro-brain natriuretic peptide (NT-PRO-BNP). Furthermore, we examined LAEDV and LAEF as predictors of major adverse cardiac events (MACE) and mortality. Methods Kidney transplant candidates (n = 117) underwent contrast-enhanced CT screening for coronary artery disease as part of the work-up prior to kidney transplantation before being accepted on the transplantation waiting list. Left atrial (LA) and left ventricular (LV) volume and function were determined by cardiac CT. MACE and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. Results Baseline patient characteristics did not differ between LAEDV tertiles. LAEDV was positively associated with measures of LV function – both LVEDV (β = 0.36, p < 0.05) and LV mass (β = 0.30, p < 0.05). LAEF was not associated with measures of LV function. LAEDV was positively and LAEF negatively associated with NT-PRO-BNP (LAEDV: β = 10.28, p < 0.05. LAEF: β = −0.06, p < 0.05). During a median follow-up of 3.7-years, 19 (16.2%) patients died and 19 (16.2%) patients suffered MACE. MACE and survival analysis showed no relation to LAEDV or LAEF. Conclusions Using contrast-enhanced CT, we demonstrated a correlation between atrial and ventricular functional parameters. However, we found no association with either LAEF or LAEDV or MACE and mortality in this cohort of kidney transplant candidates. [ABSTRACT FROM AUTHOR]

There have been no published recommendations for management of Low Risk Chest Pain in Emergency Departments across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in Emergency Departments. Risk stratification of patients utilizing an Accelerated Diagnostic Protocol has been shown to decrease hospitalizations by approximately 40% with a low 30 day risk of Major Adverse Cardiac Events. The Experts Group of Academic Leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with Academic Experts in Emergency Medicine and Cardiology from leading Institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in Emergency Departments across India. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Intervention and prospective long-term follow-up was performed to observe the presence of the “J-curve effect” in patients with Coronary Artery Disease (CAD) who underwent intensive anti-hypertensive therapy after (PCI or CABG). PATIENTS AND METHODS: Four hundred and thirty-six successive CAD patients were included in this study, 67 patients with CAD only (Group A) and the 369 patients with both CAD and hypertension who were randomly assigned to Group B (no control of blood pressure (BP), n=72), Group C (n=83, target BP 130-140/80-90 mmHg), Group D (n=78, target BP 120-130/75-80 mmHg), Group E (n=74, target BP 110-120/70-75 mmHg) and Group F (n=62, target BP <110/70 mmHg). All patients had undergone revascularization and anti-hypertensive therapy. The composite endpoint was the end of the follow-up, i.e. major adverse cardiac events (MACE) (cardiac death, nonfatal myocardial infarction and target vessel revascularization) and stroke. RESULTS: 1) Results showed that smoking, total cholesterol (Tc), low density lipoprotein-C (LDL-C), high-sensitivity C-reactive protein (hs-CRP), β-blockers, ACEI or ARB (except for Group A and Group B), diuretics and follow-up duration among the 6 groups were not significantly different, However significantly lower than those results on admission (p<0.05). The difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significant, p<0.05, both BP achieved target values. 2) The “J-curve effect” was present in the actual occurrence of composite endpoint and MACE for SBP and DBP, with a reasonable BP-lowering range of 120-130/75-80 mmHg, while the “J-curve effect” was absent in the occurrence of stroke. CONCLUSIONS: For the patients who had CAD and hypertension, intensive anti-hypertensive therapy could produce the “J-curve effect” after revascularization with the optimal blood pressure (BP) range being 120-130/75-80 mmHg. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the differences of the B-type natriuretic peptide (BNP) levels in serum or plasma of the STEMI patients with different infarction sites. To explore the relationship between the BNP level and the short-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS: A total of 216 STEMI patients were enrolled in this study from June 2012 to June 2014. All patients received coronary angiography (CAG). Based on electrocardiography (ECG) and CAG results, patients were divided into three groups. Group A included 80 patients with anterior/lateral wall myocardial infarction, group B included 76 patients with inferior/posterior wall myocardial infarction and group C included 60 patients with right ventricular myocardial infarction. We enrolled 53 patients with normal CAG results as Group D. BNP levels were compared among these groups. and according to BNP levels, all patients were subdivided into normal BNP group (<100 ng/mL, n=53), mild-higher BNP group (100-400 ng/mL, n=105) and marked-higher BNP group (≥400 ng/mL, n=58). The occurrence of major adverse cardiovascular events (MACE) including secondary heart failure, severe arrhythmia, post-infarction angina, recurrent myocardial infarction, and cardiac death within 6 months after disease onset were assessed. RESULTS: BNP levels showed a gradually decreasing trend in groups A, B, C and D (p<0.05). Significant differences in left ventricular ejection fraction (LVEF) were found among normal BNP group, mild-high BNP group and markedhigher BNP group (p<0.05). The MACE occurrence presented no statistical differences between normal BNP group and mild-higher BNP group (p>0.05) . The MACE prevalence in marked-higher BNP group was significantly higher than normal BNP group and mild-higher BNP group (p<0.05). CONCLUSIONS: BNP levels can be used as a clinical indicator to predict short-term prognosis in STEMI patients. [ABSTRACT FROM AUTHOR]

It is still debatable whether metabolic status in normal weight population increases the risk of mortality (all-cause mortality (ACM), cardiovascular mortality (CVM)) and major adverse cardiac events (MACE) as compared to the obese population. Therefore, this meta-analysis aims to evaluate the association of the metabolically unhealthy normal weight (MUH-NW) phenotype with all-cause mortality, cardiovascular mortality, and MACE in comparison to metabolically healthy obesity (MH-O), along with the association of metabolically unhealthy obesity (MUH-O) phenotype regarding the same outcomes compared to MUH-NW. A systematic literature search was conducted using online databases from inception to June 20, 2022, to comprehensively search all prospective cohort studies comprising three variables including adults aged ≥18 years, obesity and four metabolic phenotypes, and interest outcomes (ACM, CVM, and MACE). Forty-one prospective cohort studies with a total of 4,028,750 participants was included in this study. Compared to MH-O, MUH-NW had a substantially higher risk of ACM (RR = 1.47 (95%CI = 1.32–1.64); P < 0.001; I2 = 89.8%,P-heterogeneity<0.001), CVM (RR = 2.37 (95%CI = 1.97–2.86); P < 0.001; I2 = 83.7%,P-heterogeneity<0.001), and MACE (RR = 1.73 (95%CI = 1.49–2.00); P < 0.001; I2 = 74.3%,P-heterogeneity<0.001). Moreover, MUH-O did not have a significantly elevated risk of ACM (RR = 0.97 (95%CI = 0.82–1.15); P = 0.736; I2 = 98.3%,P-heterogeneity<0.001), CVM (RR = 0.96 (95%CI = 0.88–1.05); P = 0.394; I2 = 77.0%,P-heterogeneity<0.001), and MACE (RR = 0.95 (95%CI = 0.80–1.13); P = 0.570; I2 = 92.2%,P-heterogeneity<0.001) compared to MUH-NW. In conclusion, MUH-NW was superior but not inferior to MH-O and MUH-O in terms of increased risk of interest outcomes, refuting the notion that normal weight population is a benign condition. Hence, in normal weight population, metabolic screening is highly suggested to measure the baseline of obesity and metabolic phenotypes, thus preventing the risk of CVD and mortality in the future. • Various novel phenotypes reflecting metabolic health have been discovered including MUH-NW, MH-NW, MUH-O, and MH-O. • It is still being argued if the metabolic phenotype of normal weight is truly innocuous as compared to those in the obese population. • MUH-NW was superior but not inferior to MH-O and MUH-O, respectively with reference to increased risk of poor outcomes. • Our meta-analysis refutes the notion that normal weight is a benign condition. [ABSTRACT FROM AUTHOR]

Objectives This study sought to compare the outcomes of fractional flow reserve (FFR)–guided and angiography (Angio)–guided provisional side-branch (SB) stenting for true coronary bifurcation lesions. Background Angio-guided provisional SB stenting after stenting of the main vessel provides favorable outcomes for the majority of coronary bifurcation lesions. Whether an FFR-guided provisional stenting approach is superior has not been studied. Methods A total of 320 patients with single Medina 1,1,1 and 0,1,1 coronary bifurcation lesions undergoing stenting with a provisional SB approach were randomly assigned 1:1 to Angio-guided and FFR-guided groups. SB stenting was performed for Thrombolysis In Myocardial Infarction flow grade <3, ostial SB stenosis >70%, or greater than type A dissection after main vessel stenting in the Angio-guided group and for SB-FFR <0.80 in the FFR-guided group. The primary endpoint was the 1-year composite rate of major adverse cardiac events (cardiac death, myocardial infarction, and clinically driven target vessel revascularization). Results Comparing the Angio-guided and FFR-guided groups, treatment of the SB (balloon or stenting) was performed in 63.1% and 56.3% of lesions respectively (p = 0.07); stenting of the SB was attempted in 38.1% and 25.9%, respectively (p = 0.01); and, when attempted, stenting was successful in 83.6% and 73.3% of SBs, respectively (p = 0.01). The 1-year composite major adverse cardiac event rate was 18.1% in both groups (hazard ratio: 0.91, 95% confidence interval: 0.48 to 1.88; p = 1.00). The 1-year target vessel revascularization and stent thrombosis rates were 6.9% and 5.6% (p = 0.82) and 1.3% and 0.6% (p = 0.56) in the Angio-guided and FFR-guided groups, respectively. Conclusions In this multicenter, randomized trial, angiographic and FFR guidance of provisional SB stenting of true coronary bifurcation lesions provided similar 1-year clinical outcomes. (Randomized Study on DK Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions; ChiCTR-TRC-07000015 ) [ABSTRACT FROM AUTHOR]

A randomized, controlled trial of rivaroxaban vs. warfarin in patients with atrial fibrillation and a bioprosthetic valve revealed rivaroxaban is noninferior to warfarin for the prevention of major cardiovascular events and the avoidance of major bleeding events over 12 months. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Metabolic syndrome (MetS) is an independent risk factor for chronic kidney and cardiovascular diseases. However, few studies have examined the combined effects of MetS and renal insufficiency after acute myocardial infarction (AMI). We examined the effect of MetS on clinical outcomes in patients with AMI in the presence or absence of renal insufficiency. Methods: From November 2005 to September 2008, 11,462 patients with AMI were enrolled in the prospective Korean Acute Myocardial Infarction Registry. Participants were analyzed according to the presence or absence of MetS and renal insufficiency, defined by a low estimated glomerular filtration rate (eGFR). The primary endpoints were major adverse cardiac events (MACE), including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft during the 1-year follow-up period. Results: The prevalence of MetS was higher in AMI patients with low eGFR. In-hospital death and composite MACE were significantly higher in patients with MetS than in those without MetS in the presence of renal insufficiency. Multivariate analysis showed that old age, multi-vessel involvement, high levels of inflammation, diabetes and MetS were associated with 1-year composite MACE in patients with renal insufficiency. After adjusting for multiple covariates, the 1-year mortality rate was higher in patients with both MetS and renal insufficiency than in those with MetS without renal insufficiency or in individuals without MetS. Conclusion: MetS is associated with poor clinical outcomes and it increases the mortality in patients with AMI, especially in association with renal insufficiency. [Copyright &y& Elsevier]

Abstract: Introduction: Terminal T wave inversions (TTWI) indicate advanced stages of ST-elevation myocardial infarction (STEMI). The present study investigated whether TTWI predict unfavorable in-hospital outcomes in STEMI patients treated with urgent percutaneous coronary intervention (PCI). Methods: A retrospective cohort study was performed with consecutive 188 STEMI cases undergoing urgent PCI. The primary endpoint was in-hospital major adverse cardiac event (MACE), and the secondary endpoints were ST resolution (STR) after PCI and length of stay (LOS). Results: TTWI on presentation were independently associated with higher incidence of in-hospital MACE (adjusted OR 2.8; 95% CI 1.1–7.0; p=0.03), inadequate STR (adjusted OR 5.5; 95% CI 2.1–14.3; p=0.01), and longer LOS (adjusted mean increase 4.1days; 95% CI 0.3–7.9; p=0.03). TTWI predicted these outcomes better than patient-reported ischemic time or pathologic Q waves. Conclusions: TTWI on presentation are an independent risk factor for poor inpatient prognosis among patients presenting with STEMI undergoing urgent PCI. [Copyright &y& Elsevier]

Rationale and Objectives: To document the prevalence of coronary artery disease (CAD) and major adverse cardiac events (MACE) in patients younger than 45 years of age with intermediate pretest likelihood of CAD, and to determine whether coronary computed tomography angiography (cCTA) is useful for risk stratification of this cohort. Materials and Methods: We followed 452 intermediate pretest likelihood (according to Diamond and Forrester) outpatients who were suspected of CAD and underwent cCTA. They were all younger than 45 years old. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 427 patients (94.5%) with a median follow-up period of 1081 days. No plaque was noted in 357 (83.6%) patients. Nonsignificant CAD was noted in 33 (7.7%) individuals and 37 (8.7%) patients with significant CAD. At the end of the follow-up period, 12 (2.8%) patients experienced MACE. The annualized event rate was 0.2% in patients with no plaque, 2.0% in patients with nonsignificant CAD, and 7.3% in patients with significant CAD. Hypertension, smoking, and significant CAD in cCTA were significant predictors of MACE in univariate analysis. Moreover, cCTA remained a predictor (P < .001) of events after multivariate correction (hazard ratio: 8.345, 95% CI: 3.438–17.823, P < .001). Conclusion: The prevalence of CAD and MACE in young adults with an intermediate pretest likelihood of CAD was considerable. cCTA is effective in restratifying patients into either a low or high posttest risk group. These results further emphasize the usefulness of cCTA in this cohort. [ABSTRACT FROM AUTHOR]

The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-KB (RANK)/RANI< ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels dis-played higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarc-tion (TIMI) risk score, TIM1 risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed ves-sels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of car-diovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE). Background: The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA. Methods: We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001). Conclusions: The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value. [Copyright &y& Elsevier]

Abstract: Cystatin-C (CYS-C) has emerged as a highly sensitive marker of even a mildly impaired glomerular filtration rate. Experimental studies have suggested that its inhibitory effects on cysteine protease may help to prevent plaque destabilisation. We aimed to evaluate the predictive value of CYS-C level for major adverse cardiac events (MACE) including mortality and morbidity during the hospital stay and 3-month follow-up period. Methods: Seventy-five patients were hospitalised for acute coronary syndrome (ACS). Another control group consisted of patients who were presented with chest pain but no evidence of ischaemic heart disease documented by laboratory markers and angiography. Serum CYS-C levels were measured during the first 24h of admission. Patients with an abnormal creatinine-derived glomerular filtration rate (GFR) were excluded. Coronary angiography was performed for the entire study population. Results: In group I, the mean CYS-C was 1.836±0.782mg/l vs. 0.991±0.163mg/l in the control group (P <0.000). Cystatin-C showed a moderate correlation with total cholesterol in group I (r =0.5) and with LDL (r =0.367, P <0.01). CYS-C showed a moderate positive correlation with the number of diseased vessels (r =0.419, P <0.01) and a moderate significant positive correlation with Killip classification (r =0.349). Smoking was the only predictor associated with a high CYS-C level in the multivariate regression analysis (P =0.033). CYS-C was an independent predictor of MACE and heart failure complications either in-hospital or during follow-up (P <0.05). Conclusions: CYS-C could be a useful marker for diagnosing coronary arteriosclerosis. An elevated CYS-C in patients with ACS is an independent predictor of MACE either in-hospital or during follow-up. [Copyright &y& Elsevier]

Abstract: Background: This study was designed to evaluate the value of plasma cystatin C in predicting adverse cardiac events after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods: A total of 605 patients (404 male, mean age 60.4 ± 10.6 years) with ACS underwent successful PCI. Patients were divided into 4 groups according to the level of cystatin C, which was measured before the PCI: Q1 (<1.02 mg/L), Q2 (1.02-1.16 mg/L), Q3 (1.17-1.34 mg/L), and Q4 (≥1.35 mg/L). Results: After a follow-up of 14.3 ± 1.7 months, the incidence of mortality, nonfatal myocardial infarction, and target lesion revascularization in the Q2, Q3, and Q4 groups was higher than in the Q1 group (P < .001). The incidence of heart failure in the Q3 and Q4 groups was higher than in the Q1 group (P < .05). Multivariate Cox regression analysis showed that cystatin C elevation was an independent predictor of major adverse cardiac events. The cumulative survival rate of the Q3 and Q4 groups was lower than in the Q1 group (P < .001). Conclusion: High plasma cystatin C concentration is an independent predictor of major adverse cardiac events in patients with ACS treated with PCI. [Copyright &y& Elsevier]

Rationale and Objectives: To determine the accuracy of 64-section coronary computed tomography angiography (CCTA) in predicting 30 day major adverse cardiac events (MACE) for patients presenting with symptoms concerning for acute coronary syndrome (ACS). Materials and Methods: Electronic databases between January 1, 2005, and May, 1, 2011, and reference lists from relevant published research articles were searched. We included studies on adult patients who presented with active symptoms suggestive of ACS, had immediate 64-section CCTA performed and were assessed for MACE at a minimum of 30 days past their initial presentation. Studies had to report or provide sufficient detail to determine sensitivity, specificity, positive predictive value, and negative predictive value in relation to MACE using a 50% diameter stenosis as cutoff criterion for coronary artery disease. Results: Nine studies were included for a total of 1559 patients studied (42.3% women, mean age 51.9 ± 10.6). Patients ranged from low to intermediate risk for ACS. All had initial inconclusive electrocardiograms and negative cardiac biomarker results. A total of 14.8% of patients had a positive CCTA result. The pooled sensitivity was 93.3% (95% CI 88.3%–96.6%), specificity was 89.9% (95% CI 88.3%–91.3%), positive predictive value was 48.1% (95% CI 42.5%–53.8%), and negative predictive value was 99.3% (95% CI 98.7%–99.6%). Conclusion: Sixty-four section CCTA had a 99.3% negative predictive value in excluding MACE for 30 days after initial symptom presentation in 85.2% of our study population. Although the value of 64-section CCTA is best for identifying patients who can safely be discharged home, it is less useful for patients who have positive results. [ABSTRACT FROM AUTHOR]

Objectives: We sought the incremental prognostic value of coronary computed tomography angiography (CTA) in coronary artery bypass graft (CABG) patients. Background: Coronary CTA is a noninvasive and accurate tool for the detection of obstructive coronary artery disease, and coronary CTA appears to have prognostic value in patients without previous revascularization. However, the prognostic value of coronary CTA to predict major adverse cardiac events in CABG patients is unclear. Methods: Consecutive CABG patients were prospectively enrolled and cardiac risk was calculated using the National Cholesterol Evaluation Program/Adult Treatment Panel III. Using the severity of native coronary artery disease and graft disease, the number of unprotected coronary territories (UCTs) (0, 1, 2, or 3) was calculated. Patients were followed for cardiac death and nonfatal myocardial infarction. All events were confirmed with death certificates or medical records and reviewed by a clinical events committee. Results: Between February 2006 and March 2009, 250 consecutive patients were enrolled and followed for a mean of 20.8 ± 10.1 months. At follow-up, 23 patients (9.2%) had major adverse cardiac events (15 cardiac deaths and 8 nonfatal MI). The absence of UCTs conferred a good prognosis with an annual event rate of 2.4%. Conversely, patients with 1, 2, and 3 UCTs had annualized event rates of 5.8%, 11.1%, and 21.7%, respectively. Multivariable analysis showed that UCTs (hazard ratio: 2.08; 95% confidence interval: 1.40 to 3.10; p < 0.001) was a predictor of major adverse cardiac events when adjusted for clinical variables. Examining the receiver-operator characteristic curves, the area under the curve increased from 0.61 to 0.76 when UCTs was combined with clinical variables (p = 0.001). Conclusions: Assessing UCTs with coronary CTA appears to have prognostic value in CABG patients and is incremental to clinical variables. Coronary CTA appears to be a promising tool for risk stratification of CABG patients. Further multicenter studies using large CABG cohorts are needed to confirm our findings. [Copyright &y& Elsevier]

Objectives: The aim of this study was to determine the 2-year prognostic value of cardiac computed tomography (CT) for predicting major adverse cardiac events (MACE) in patients presenting to the emergency department (ED) with acute chest pain. Background: CT has high potential for early triage of acute chest pain patients. However, there is a paucity of data regarding the prognostic value of CT in this ED cohort. Methods: We followed 368 patients from the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial (age 53 ± 12 years; 61% male) who presented to the ED with acute chest pain, negative initial troponin, and a nonischemic electrocardiogram for 2 years. Contrast-enhanced 64-slice CT was obtained during index hospitalization, and caregivers and patients remained blinded to the results. CT was assessed for the presence of plaque, stenosis (>50% luminal narrowing), and left ventricular regional wall motion abnormalities (RWMA). The primary endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: Follow-up was completed in 333 patients (90.5%) with a median follow-up period of 23 months. At the end of the follow-up period, 25 patients (6.8%) experienced 35 MACE (no cardiac deaths, 12 myocardial infarctions, and 23 revascularizations). Cumulative probability of 2-year MACE increased across CT strata for coronary artery disease (CAD) (no CAD 0%; nonobstructive CAD 4.6%; obstructive CAD 30.3%; log-rank p < 0.0001) and across combined CT strata for CAD and RWMA (no stenosis or RWMA 0.9%; 1 feature—either RWMA [15.0%] or stenosis [10.1%], both stenosis and RWMA 62.4%; log-rank p < 0.0001). The c statistic for predicting MACE was 0.61 for clinical Thrombolysis In Myocardial Infarction risk score and improved to 0.84 by adding CT CAD data and improved further to 0.91 by adding RWMA (both p < 0.0001). Conclusions: CT coronary and functional features predict MACE and have incremental prognostic value beyond clinical risk score in ED patients with acute chest pain. The absence of CAD on CT provides a 2-year MACE-free warranty period, whereas coronary stenosis with RWMA is associated with the highest risk of MACE. [Copyright &y& Elsevier]

Objectives: This study sought to evaluate the impact of SYNTAX score (SXscore), and compare its performance in isolation and combination with the PAMI (The Primary Angioplasty in Myocardial Infarction Study) score, for the prediction of 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Background: Patients with STEMI were excluded from the original SYNTAX score (SXscore) algorithm. Therefore, the utility of using the SXscore in this patient group remains undefined. Methods: SXscore was calculated retrospectively in 807 patients with STEMI enrolled in the randomized STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) clinical trials. Clinical outcomes of all-cause death, reinfarction, and clinically driven target vessel revascularization were subsequently stratified according to SXscore tertiles: SXLOW ≤9 (n = 311), 9 < SXMID ≤16 (n = 234), SXHIGH >16 (n = 262). Results: At 1-year follow-up, all clinical outcomes including mortality, mortality/reinfarction, major adverse cardiac events (MACE) (a composite of all-cause death, reinfarction and target vessel revascularization), and definite, definite/probable, and any stent thrombosis were all significantly higher in patients in the highest SXscore tertile. SXscore was identified as an independent predictor of mortality, MACE, and stent thrombosis out to 1-year follow-up. The combination SYNTAX-PAMI score led to a net reclassification improvement of 15.7% and 4.6% for mortality and MACE, respectively. The C-statistics for the SXscore, PAMI score, and the combined SYNTAX-PAMI score were 0.65, 0.81, and 0.73 for 1-year mortality, and 0.68, 0.64, and 0.69 for 1-year MACE, respectively. Conclusions: SXscore does have a role in the risk stratification of patients with STEMI having primary percutaneous coronary intervention; however, this ability can be improved through a combination with clinical variables. (Multicentre 2×2 Factorial Randomised Study Comparing Tirofiban Versus Abciximab and SES Versus BMS in AMI; NCT00229515) [Copyright &y& Elsevier]

Objectives: We evaluated outcomes following XIENCE V everolimus-eluting stent (EES) compared with the Taxus Express2 paclitaxel-eluting stent (PES) in patients undergoing multilesion and multivessel intervention. Background: The optimal revascularization strategy for patients with multivessel disease is unknown. Methods: The SPIRIT III (A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With De Novo Native Coronary Artery Lesions) (n = 1,002) and SPIRIT IV (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With De Novo Native Coronary Artery Lesions) (n = 3,690) trials enrolled patients with de novo lesions ≤28 mm in length and reference vessel diameter of 2.5 to 3.75 mm. The SPIRIT III trial enrolled patients with a single lesion in 1 or 2 coronary arteries, and the SPIRIT IV trial enrolled patients with up to 2 lesions in 3 different vessels (maximum 2 lesions per vessel). In both trials, patients were randomized 2:1 to EES vs. PES. Clinical outcomes to 1 year were analyzed in patients with single (n = 3,823) versus multiple (n = 765) treated vessels, and in those with single (n = 3,536) versus multiple (n = 1,052) treated lesions. Results: Among patients with multivessel disease, EES compared with PES resulted in reduced rates of target vessel myocardial infarction (2.2% vs. 6.1%, p = 0.007) and ischemia-driven target lesion revascularization (4.2% vs. 8.0%, p = 0.04). Among patients undergoing multilesion stenting, EES compared with PES resulted in reduced rates of target vessel myocardial infarction (2.1% vs. 5.4%, p = 0.008) and ischemia-driven target lesion revascularization (3.7% vs. 7.4%, p = 0.01). The absolute benefits of EES versus PES in patients undergoing multivessel or multilesion intervention were greater than in those undergoing single-lesion, single-vessel intervention. Conclusions: The EES compared with PES provided significant improvements in clinical safety and efficacy outcomes. The absolute benefit provided by EES versus PES appears to be proportional to the complexity of coronary disease. (SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With De Novo Native Coronary Artery Lesions [SPIRIT III]; NCT00180479) (SPIRIT IV Clinical Trial: Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With De Novo Native Coronary Artery Lesions [SPIRIT IV]; NCT00307047) [Copyright &y& Elsevier]