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Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI.

Bioresorbable scaffolds/stents offer new and exciting perspectives in the treatment of patients with acute coronary syndromes, especially after the recent development of invasive imaging techniques, such as optical coherence tomography, which allow complete assessment of vascu-lar segments. A particular advantage of bioresorbable scaffolds is that once the biosorption of the scaffold is complete, the vascular segment regains its normal physiological functions, thus eliminating the risk of late complications. New studies show the importance of shear stress in the progression of vascular atherosclerosis or in accelerating endothelial turnover. Based on the current knowledge in this field, a future standardized determination of shear stress may help in the long-term follow-up of patients that have suffered or are at risk of developing an acute coronary syndrome.

Kawasaki disease, also known as Kawasaki syndrome or mucocutaneous lymph node syndrome, is a pathology that causes inflammation in the walls of medium-sized arteries, with symptoms such as fever, lymphadenopathy, rash, and erythema of the eyes, lips, nose, palms, and feet. The cause is unknown, although clinical features strongly suggest an infectious etiology. We present the case of a 53-year-old woman, known with Kawasaki disease since childhood, with different associated pathologies, who presented with acute inferior ST elevation myocardial infarction.

Background: The evaluation of site-specific phenotype according to the topographic location of atherosclerotic lesions within the coronary tree has not been studied so far. The present study is based on the premise that the location of coronary plaques can influence their composition and degree of vulnerability. Aim: To evaluate different phenotypes of vulnerable coronary plaques across the three major coronary arteries in terms of composition, morphology, and degree of vulnerability, in patients with chest pain and low-to-intermediate probability of coronary artery disease, using coronary computed tomography angiography (CCTA) and a complex plaque analysis. Material and methods: This was a cross-sectional study on 75 subjects undergoing CCTA for chest pain, who presented at least one vulnerable coronary plaque (VP), defined as the presence of ≥1 CT vulnerability marker (low attenuation plaque, napkin-ring sign, spotty calcifications, positive remodeling). The study included per plaque analysis of 90 vulnerable coronary lesions identified in various locations within the coronary tree as follows: n = 30 VPs in the left anterior descending artery (LAD), n = 30 VPs in the circumflex artery (CXA), and n = 30 VPs in the right coronary artery (RCA). Results: The RCA exhibited significantly longer VPs (p = 0.001), with the largest volume (p = 0.0007) compared to those arising from the LAD and CXA. Vulnerable plaques located in the LAD exhibited a significantly more calcified phenotype (calcified volume: LAD – 44.07 ± 63.90 mm3 vs. CXA – 12.40 ± 19.65 mm3 vs. RCA – 33.69 ± 34.38 mm3, p = 0.002). Plaques from the RCA presented a more non-calcified phenotype, with the largest non-calcified (p = 0.002), lipid rich (p = 0.0005), and fibrotic volumes (p = 0.003). Low-attenuation plaques were most frequent in the RCA (p = 0.0009), while the highest vulnerability degree was present in lesions located in the LAD, which presented the highest number of vulnerability markers per plaque (p = 0.01). Conclusions: Vulnerable plaques arising from the right coronary artery are longer, more vo-luminous and with larger lipid and non-calcified content, whereas those located in the left anterior descending artery present a higher volume of calcium, but also a higher degree of vulnerability. The least vulnerable lesions were present in the circumflex artery.

Background and Objectives: Atherosclerotic disease is a major contributor to heart failure, stroke, and myocardial infarction, significantly lowering the quality of life and life expectancy and placing a significant burden on healthcare. Not all lesions deemed non-significant are benign, and conversely, not all significant lesions are causative of ischemia. Fractional flow reserve (FFR) provides a functional assessment of coronary lesions, while optical coherence tomography (OCT) offers detailed imaging of plaque morphology, aiding in therapeutic decision-making. The objective of this study was to evaluate the utility of OCT and FFR as adjunctive tools in the catheterization laboratory for guiding therapeutic decisions in patients with multivessel disease for non-culprit vessels. Specifically, we aimed to assess how OCT and FFR influence therapeutic decision-making in patients with multivessel coronary artery disease. Materials and Methods: A total of 36 patients with acute coronary syndrome (ACS) and multivessel disease were randomized 1:1 into two groups: one guided by FFR alone and the other by a combination of FFR and OCT. For the FFR group, revascularization decisions for non-culprit lesions were based solely on FFR measurements. If the FFR was >0.8, the procedure was concluded, and the patient received maximal medical treatment. If the FFR was ≤0.8, a stent was placed. For the FFR + OCT group, if the FFR was >0.8, the revascularization decision was based on OCT findings. If there were no vulnerable plaques (VP), the procedure was concluded, and the patient received maximal medical treatment. If OCT imaging indicated VP, then the patient underwent revascularization. If the FFR was ≤0.8, the patient underwent revascularization regardless of OCT findings. Results: OCT imaging altered the therapeutic decision in 11 cases where FFR measurements were above 0.8, but the lesions were characterized as VP. Analyzing the total change in the decision to stent, 4 cases in the FFR group and 15 cases in the FFR and OCT groups (4 based on FFR and 11 on OCT) revealed a statistically significant difference (p = 0.0006; Relative Risk = 0.2556; 95% CI: 0.1013 to 0.5603). When analyzing the change in the total decision both to stent and not to stent, we observed a statistically significant difference, with Group 1 having 7 cases and Group 2 having 15 cases (p = 0.0153; Relative Risk = 0.4050; 95% CI: 0.2004 to 0.7698. Conclusions: Based on the findings of this study, OCT significantly increases the percentage of stenting procedures by identifying vulnerable lesions. The use of intracoronary imaging facilitates the timely identification and treatment of these vulnerable lesions. This underscores the crucial role of OCT in enhancing the precision of coronary interventions by ensuring timely intervention for vulnerable lesions, thereby potentially improving patient outcomes. [ABSTRACT FROM AUTHOR]

The pericoronary fat attenuation index (FAI) is an emerging computed tomography-derived marker for measuring vascular inflammation at coronary vessels. It holds prognostic significance for major cardiovascular events and enhances cardiac risk assessment, complementing traditional risk factors and coronary artery calcium scores. However, the impact of local coronary circulation factors on pericoronary inflammation development in right versus left coronary arteries has not been clearly understood.

Electrical storm is defined by at least three episodes of sustained ventricular tachyarrhythmias or appropriate shocks given by implantable cardiac defibrillator devices (ICD), occurring within a period of 24 hours. In the present manuscript, we present the case of a 69-year-old female patient with previous aortocoronary bypass, who was admitted from the Emergency Department after presenting several episodes of syncope in prehospital settings and presented 4 episodes of sustained ventricular tachycardia which required electrical cardioversion. The arrhythmia disappeared after percutaneous revascularization of a chronic occlusion in the right coronary artery. In this case, the implantation of an ICD was avoided, as a reversible cause of ES has been identified and treated.