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AIMS: The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. METHODS AND RESULTS: In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physicians confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. CONCLUSION: The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.

The 2024 ESC/EACTS guidelines for chronic coronary syndrome focus on patient-centered care and integrate various documents into a unified framework for diagnosis and treatment. The guidelines emphasize the importance of the Heart Team in decision-making for invasive treatments like CABG and PCI. Recommendations are provided for different scenarios, such as left main disease, multivessel disease, and single or double-vessel disease, with a focus on improving outcomes and symptoms. The guidelines also address the challenges of word count limits and the need for ongoing research and collaboration in the field of cardiovascular care. [Extracted from the article]

Objectives • In the context of coronary artery disease (CAD) and percutaneous coronary intervention (PCI), it is essential to explore the variations in coronary endothelial diameter. Understanding these variations holds significance for the early diagnosis and treatment of CAD. This study aims to elucidate the relevance of coronary endothelial diameter in the broader landscape of CAD and PCI outcomes. Methods • This study is a retrospective cohort study. Consecutive patients with CAD who underwent PCI during hospitalization were included. IVUS measured the endothelial diameter of the coronary artery, and the patients were divided into the endothelial diameter constricted group, normal group and dilated group. The primary endpoint event was all-cause death, and the secondary endpoint events were cardiac death, non-fatal myocardial infarction, and elective revascularization. Follow-up was completed from August 2021 to February 2022. The follow-up period from August 2021 to February 2022 was selected to capture a comprehensive view of long-term postoperative outcomes in coronary artery disease patients undergoing PCI, ensuring a contemporary and relevant assessment of the study endpoints. Results • The study ultimately included 705 patients, which included 295 (41.8%) in the endothelial diameter constricted group, 410 (58.2%) in the endothelial diameter normal group and 221 (31.3%) in the endothelial diameter dilated group. Patients with dilated endothelial diameter experienced a reduction in 5-year all-cause mortality, cardiac mortality, non-fatal heart attack, and elective revascularization rates. Specifically, the 5-year all-cause mortality rate in the dilated group was 1.79 (95% CI: 1.07-3.00), cardiac mortality was 3.73 (95% CI: 1.27-10.95), non-fatal heart attack rate was 1.65 (95% CI: 0.99-2.75), and elective revascularization rate was 2.15 (95% CI: 1.30-3.60) (P < .05). The Cox proportional- hazards model indicated that age, AMI, and endothelial diameter expansion were identified as risk factors for 5-year all-cause mortality (P < .05). There was no statistically significant difference in the 5-year all-cause mortality, cardiogenic mortality, elective revascularization rate and non-fatal myocardial infarction rate. Conclusions • Patients with dilated endothelial diameter had decreased 5-year all-cause mortality, cardiac mortality, non-fatal heart attack, and elective revascularization rates. IVUS evaluation of the diameter of the coronary endothelium prior to PCI can aid in the classification and prevention of CAD risk. The retrospective design and potential biases associated with hospitalization data, along with the absence of certain clinical parameters, should be considered when interpreting the findings. The IVUS evaluation of coronary endothelial diameter not only aids in risk classification but also has the potential to inform personalized treatment strategies, enhancing patient care in coronary artery disease. [ABSTRACT FROM AUTHOR]

Background: This proof-of-concept study aimed to assess the diagnostic potential of gas chromatography–mass spectrometry (GC-MS) in profiling volatile organic compounds (VOCs) from exhaled breath as a diagnostic tool for the chronic coronary syndrome (CCS). Methods: Exhaled air was collected from patients undergoing invasive coronary angiography (ICA), with all samples obtained prior to ICA. Post hoc, patients were divided into groups based on coronary lesion severity and indications for revascularization. VOCs in the breath samples were analyzed using GC-MS. Results: This study included 23 patients, of whom 11 did not require myocardial revascularization and 12 did. GC-MS analysis successfully classified 10 of the 11 patients without the need for revascularization (sensitivity of 91%), and 7 of the 12 patients required revascularization (specificity 58%). In subgroup analysis, GC-MS demonstrated 100% sensitivity in identifying patients with significant coronary lesions requiring intervention when the cohort was divided into three groups. A total of 36 VOCs, including acetone, ethanol, and phenol, were identified as distinguishing markers between patient groups. Conclusions: Patients with CCS exhibited a unique fingerprint of exhaled breath, which was detectable with GC-MS. These findings suggest that GC-MS analysis could be a reliable and non-invasive diagnostic tool for CCS. Further studies with larger cohorts are necessary to validate these results and explore the potential integration of VOC analysis into clinical practice. [ABSTRACT FROM AUTHOR]

Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided percutaneous coronary interventions (PCI) are alternative techniques to angiography-guided (ANG-g) PCI in patients with coronary artery disease (CAD), especially for optimal stent deployment in coronary arteries. We conducted a network meta-analysis including studies comparing those three techniques. We searched databases for studies that compared IVUS, OCT, and ANG-g PCI in patients with CAD. Overall, 52 studies with 231,137 patients were included in this meta-analysis. ANG-g PCI had higher major adverse cardiovascular events (MACEs), all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) than IVUS-guided PCI. Of note, both OCT-guided and IVUS-guided PCI had similar outcomes. The frequency of MACEs, cardiac death, and MI were higher in ANG-g PCI than in OCT-guided PCI. The highest benefit was established with OCT for MACEs (P-score=.973), MI (P-score=.823), and cardiac death (P-score=.921) and with IVUS for all-cause death (P-score=.792), TLR (P -score=.865), and ST (P-score=.930). This network meta-analysis indicated that using OCT or IVUS for optimal stent implantation provides better outcomes in comparison with ANG-g in patients with CAD undergoing PCI. [ABSTRACT FROM AUTHOR]

• Identifying which patients with coronary artery disease (CAD) and acute heart failure (HF) or left ventricular systolic dysfunction will benefit from revascularization is challenging owing to population heterogeneity. • We propose a treatment algorithm that categorizes patients with CAD and HF/left ventricular systolic dysfunction into 2 frameworks: those exhibiting CAD-predominant symptoms (acute myocardial infarction, refractory angina, or positive stress test) vs those with HF-predominant symptoms (dyspnea, orthopnea, peripheral edema without angina or positive stress test). • Randomized controlled trials and observational data indicate that revascularization benefits patients with CAD-predominant symptoms, but does not confer symptomatic or mortality benefit in those with HF-predominant symptoms. Patients with heart failure (HF) and underlying coronary artery disease (CAD) have a substantially higher risk of mortality compared with those with HF from other causes. However, identifying individuals with HF for whom revascularization is likely to improve prognosis is a complex clinical decision. Revascularization is likely beneficial for patients with CAD-predominant symptoms, such as those with acute myocardial infarction or stable ischemic heart disease with refractory angina. However, for patients with HF-predominant symptoms, characterized by dyspnea without acute myocardial infarction or refractory angina, the benefits of revascularization are less clear. This state-of-the-art review summarizes the outcomes, clinical trials, and therapeutic approaches for patients with both CAD and HF, and proposes a therapeutic algorithm to guide the diagnosis and comprehensive workup of these complex patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Composite time-to-event endpoints are commonly used in cardiovascular outcome trials. For example, the IMPROVE-IT trial comparing ezetimibe+simvastatin to placebo+simvastatin in 18,144 patients with acute coronary syndrome used a primary composite endpoint with five component outcomes: (1) cardiovascular death, (2) non-fatal stroke, (3) non-fatal myocardial infarction, (4) coronary revascularization ≥30 days after randomization, and (5) unstable angina requiring hospitalization. In such settings, the traditional analysis compares treatments using the observed time to the occurrence of the first (i.e. earliest) component outcome for each patient. This approach ignores information for subsequent outcome(s), possibly leading to reduced power to demonstrate the benefit of the test versus the control treatment. We use real data examples and simulations to contrast the traditional approach with several alternative approaches that use data for all the intra-patient component outcomes, not just the first. [ABSTRACT FROM AUTHOR]

Coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) is recommended for physiological assessment in intermediate coronary stenosis for guiding referral to invasive coronary angiography (ICA). In this study, we report real-world data on the feasibility of implementing a CTA/FFRCT test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30–89%) by CTA. Evaluation of CTA datasets, interpretation of FFRCT analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFRCT 375 (81%) and perfusion imaging 88 (19%). FFRCT analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFRCT was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFRCT-guided versus CTA-guided referral to ICA: 30–69% stenosis, 28 (44%) versus 8 (21%); 70–89% stenosis, 39 (69%) versus 25 (46%), respectively, both p < 0.05. Implementation of FFRCT at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate. [ABSTRACT FROM AUTHOR]

The document titled "2024 ESC Guidelines for the management of chronic coronary syndromes" provides comprehensive guidelines for the diagnosis and management of chronic coronary syndromes. It covers various topics such as initial management, diagnostic testing, medical therapy, revascularization options, and treatment for specific patient groups. The guidelines emphasize shared decision-making, patient education, and adherence to healthy lifestyle behaviors. It also highlights the importance of long-term follow-up and care, including strategies to improve medication adherence. These resources can be useful for library patrons conducting research on chronic coronary syndrome and seeking evidence-based guidance on its diagnosis and treatment. [Extracted from the article]

The aim: to evaluate the incidence of obstructive lesions of the coronary arteries during routine coronary angiography (CAG) before carotid endarterectomy (CEA) and the incidence of perioperative complications. Materials and Methods: We examined a continuous sample of 498 patients before CEA who underwent an invasive evaluation of the coronary bed during CAG. Depending on the hemodynamic significance of coronary artery lesions, the patients were divided into three groups: group I—obstructive coronary artery disease (≥70%) (n = 309, 62.0%); group II—non-obstructive lesions of the coronary arteries (<70%) (n = 118, 23.7%); group III—intact coronary arteries (n = 71, 14.3%). The groups were compared with each other according to the data of the preoperative examination (clinical and anamnestic parameters, laboratory data and results of echocardiography), as well as according to the immediate results of the operation. In the hospital period, adverse cardiovascular events were assessed: death, myocardial infarction (MI), stroke, arrhythmias, atrial fibrillation or flutter (AF/AFL) and combined endpoint. Results: The groups differed significantly in the presence of symptoms of angina pectoris, myocardial infarction and myocardial revascularization procedures in their medical history and in the presence of chronic ischemia of the lower extremities. However, in the group of intact coronary arteries, the symptoms of angina were in 14.1% of patients, and a history of myocardial infarction was in 12.7%. Myocardial revascularization before CEA or simultaneously with it was performed in 43.0% of patients. As a result, it was possible to reduce the number of perioperative cardiac complications (mortality 0.7%, perioperative myocardial infarction 1.96%). Conclusions: The high incidence of obstructive lesions in the coronary arteries in our patients and the minimum number of perioperative complications favor routine CAG before CEA. [ABSTRACT FROM AUTHOR]

Despite the remarkable and progressive advances made in the prevention and management of cardiovascular diseases, the recurrence of cardiovascular events remains unacceptably elevated with a notable size of the residual risk. Indeed, in patients who suffered from myocardial infarction or who underwent percutaneous or surgical myocardial revascularization, life-style changes and optimized pharmacological therapy with antiplatelet drugs, lipid lowering agents, beta-blockers, renin angiotensin system inhibitors and antidiabetic drugs, when appropriate, are systematically prescribed but they might be insufficient to protect from further events. In such a context, an increasing body of evidence supports the benefits of cardiac rehabilitation (CR) in the setting of secondary cardiovascular prevention, consisting in the reduction of myocardial oxygen demands, in the inhibition of atherosclerotic plaque progression and in an improvement of exercise performance, quality of life and survival. However, prescription and implementation of CR programs is still not sufficiently considered. The aim of this position paper of the Italian Society of Cardiovascular Prevention (SIPREC) and of the Italian Heart Failure Association (ITAHFA) is to examine the reasons of the insufficient use of this strategy in clinical practice and to propose some feasible solutions to overcome this clinical gap. [ABSTRACT FROM AUTHOR]

Surgical revascularization is the gold standard in the management of patients with multi-vessel coronary artery disease (CAD). It is well known that increased oxidative stress during ischemia-reperfusion and post-revascularization procedures leads to the release of free radical in the circulation. This process can cause reversible or irreversible myocardial damage. The aim of this study was to assess the effect of trimetazidine on decreasing postoperative ischemia-reperfusion myocardial damage. This prospective single-blind randomized controlled trial included 90 patients with elective surgery, operated between March 2018 and October 2018. The patients were divided into two equal groups, a study group and a control group; those in the study group received trimetazidine 35 mg b.d., immediately after tracheal extubation, in addition to their regular therapy. Pre- and postoperative levels of specific blood biomarkers such as high-sensitivity troponin T (hs-TnT), creatine kinase-MB (CK-MB), and malondialdehyde (MDA) were evaluated. Patients were followed for a period of 6 months after surgery. MDA levels were lower in patients who received trimetazidine, leading to a reduction in oxidative stress and improved cardiomyocyte protection by augmentation of the antioxidant status. The quality-of-life assessment with the Minnesota Living with Heart Failure Questionnaire yielded excellent results. Improvement of myocardial cell metabolism and decreasing the level of postoperative ischemiareperfusion damage is alleviated by postoperative regular trimetazidine therapy. [ABSTRACT FROM AUTHOR]

Background: As surgical techniques continue to evolve, the optimal approach for revascularizing multi-vessel coronary artery disease (CAD) remains a matter of ongoing debate. Accordingly, our objective was to compare and contrast various surgical techniques utilized in the management of multi-vessel CAD. Methods: A systematic literature review was performed using PubMed, Embase, and Cochrane central register of controlled trials from inception to May 2022. Random-effects network meta-analysis was performed for the primary outcome; target vessel revascularization (TVR), and secondary outcomes; mortality, major adverse cardiac and cerebrovascular events, postoperative myocardial infarction, new-onset atrial fibrillation, stroke, new-onset dialysis, in patients undergoing percutaneous coronary intervention (PCI) with a stent, off-pump coronary bypass graft, on-pump coronary artery bypass graft (ONCABG), hybrid coronary revascularization, minimally-invasive coronary artery bypass, or robot-assisted coronary artery bypass (RCAB) surgeries. Results: A total of 8841 patients were included from 23 studies. The analysis showed that ONCABG had the highest freedom from TVR, with a mean (SD) absolute risk of 0.027 (0.029); although ONCABG was found to be superior to all other methods, it was only significantly better than first-generation stent PCI. While RCAB did not demonstrate significant superiority over other treatments, it showed a greater probability of preventing postoperative complications. Notably, no significant heterogeneity was calculated for any of the reported outcomes. Conclusions: ONCABG shows a better rank probability compared to all other techniques for preventing TVR, while RCAB offers greater freedom from most postoperative complications. However, given the absence of randomized controlled trials, these results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the leading cause of mortality which primarily occurs due to the blood vessel obstruction or narrowing. Surgical procedures such as, coronary artery and peripheral artery bypass grafting frequently require vascular grafts for long‐term revascularization. However, using autogenous vessels, such as the internal thoracic artery and saphenous vein, especially for vessels with diameters less than 6 mm, are associated with number of concerns due to limited availability, invasive retrieval procedures, and aptness. To overcome these limitations, the development of tissue‐engineered vascular grafts (TEVGs) is in continuous thrust. This review comprehensively provides the potentiality of a range of artificial and naturally occurring biopolymers and their fabrication techniques, cell sources and seeding techniques to realize the state‐of‐the‐art TEVGs. Moreover, this review article presents a synopsis of insights obtained from a variety of in vitro and in vivo studies, including human clinical trials. It underscores the need for further exploration into key areas such as optimal cell sources, seeding techniques, mechanical properties, hemodynamics, graft integration, the impact of patient conditions, optimum burst pressure, sufficient suture strength, hydrophilicity, biodegradability, and related factors. In summary, the review offers insights into the current strategies, challenges, and future perspectives of TEVG. [ABSTRACT FROM AUTHOR]

Background: Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. Methods: This is an epidemiological, retrospective, and analytical case–control study (90 cases and 360 controls). Results: Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Conclusions: Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period. [ABSTRACT FROM AUTHOR]

Background Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. Methods Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. Results A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac–cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan–Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. Conclusion CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material. [ABSTRACT FROM AUTHOR]

Background This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). Methods Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades—0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5–95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure. Results Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10–1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II. Conclusion The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP. [ABSTRACT FROM AUTHOR]

Background Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable coronary artery disease who underwent CABG. Methods In our retrospective study, CABG patients were divided in: CABG preceded by PCI: PCI-first (PCF), and CABG-only (CO) groups. The PCF group was further divided in guideline-conform (GCO) and guideline nonconform (GNC) subgroups, according to the SYNTAX score (2014 European Society of Cardiology [ESC]/European Association for Cardio-Thoracic Surgery [EACTS] guidelines). Thirty days mortality, major adverse cardiac events, and QoL using the European Quality-of-Life–5 Dimensions were evaluated. Results A total of 997 patients were analyzed, of which 784 underwent CABG without (CO), and 213 individuals with prior PCI (PCF). The latter group consisted of 67 patients being treated in accordance (GCO), and 24 in discordance (GNC) to the 2014 ESC/EACTS guidelines. Reinfarction (PCF: 3.8% vs. CO: 1.0%; p = 0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p = 0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p < 0.001) were observed more frequently in PCF patients. Also, patients reported better health status in the CO compared to PCF group (CO: 72.48 ± 19.31 vs. PCF: 68.20 ± 17.86; p = 0.01). Patients from the guideline nonconform subgroup reported poorer health status compared to the guideline-conform group (GNC: 64.23 ± 14.56 vs. GCO: 73.42 ± 17.66; p = 0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p = 0.03). Also, GNC patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p < 0.001) and showed higher preinterventional SYNTAX score (GCO: 18.63 ± 9.81 vs. GNC: 26.67 ± 5.07; p < 0.001). Conclusion PCI preceding CABG is associated with poorer outcomes such as reinfarction, re-angiography, and re-PCI, but also worse health status and higher rehospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart Team decision. [ABSTRACT FROM AUTHOR]

Aims The study aimed, firstly, to validate automatically and visually scored coronary artery calcium (CAC) on low-dose computed tomography (CT) (LDCT) scans with a dedicated calcium scoring CT (CSCT) scan and, secondly, to assess the added value of CAC scored from LDCT scans acquired during [15O]-water-positron emission tomography (PET) myocardial perfusion imaging (MPI) on prediction of major adverse cardiac events (MACE). Methods and results Five hundred seventy-two consecutive patients with suspected coronary artery disease, who underwent [15O]-water-PET MPI with LDCT and a dedicated CSCT scan were included. In the reference CSCT scans, manual CAC scoring was performed, while LDCT scans were scored visually and automatically using deep learning approach. Subsequently, based on CAC score results from CSCT and LDCT scans, each patient's scan was assigned to one out of five cardiovascular risk groups (0, 1–100, 101–400, 401–1000, >1000), and the agreement in risk group classification between CSCT and LDCT scans was investigated. MACE was defined as a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, and unstable angina. The agreement in risk group classification between reference CSCT manual scoring and visual/automatic LDCT scoring from LDCT was 0.66 [95% confidence interval (CI): 0.62–0.70] and 0.58 (95% CI: 0.53–0.62), respectively. Based on visual and automatic CAC scoring from LDCT scans, patients with CAC > 100 and CAC > 400, respectively, were at increased risk of MACE, independently of ischaemic information from the [15O]-water-PET scan. Conclusion There is a moderate agreement in risk classification between visual and automatic CAC scoring from LDCT and reference CSCT scans. Visual and automatic CAC scoring from LDCT scans improve identification of patients at higher risk of MACE. [ABSTRACT FROM AUTHOR]

Background and Objectives: The saphenous vein graft (SVG) remains the most frequently used conduit worldwide, despite its common disadvantage of early graft failure. To solve the problem and reduce the SVG damage, Souza implemented a new technique where a vein is harvested with surrounding fascia and fat tissue (the so-called no-touch technique). Materials and Methods. A prospective study conducted from February 2019 to June 2024 included 23 patients who underwent myocardial revascularization using a no-touch vein, with follow-up control examinations using computed tomographic angiography to detect graft stenosis or occlusion. Results. Of the entire patient group, 17 (73.9%) were male, with a mean age of 67.39 ± 7.71 years. The mean follow-up period was 25 months. There were no major adverse cardiovascular or cerebrovascular events (MACCEs) during hospitalization, although one patient died in the hospital. Another patient died due to malignancy, but no MACCEs occurred during the follow-up period. According to multi-slice CT coronary angiography, the results were impeccable, with an astonishing 100% patency observed in all 20 IMA grafts and 58 no-touch SVGs examined. Conclusions. The excellent patency rate during the early follow-up period confirmed that the no-touch technique is a good option for surgical revascularization. [ABSTRACT FROM AUTHOR]

Background. Acquired aortic valve disease and coronary heart disease often occur together, and almost two thirds of patients with aortic valve stenosis have severe coronary heart disease. Given the presence of both pathologies, this cohort of patients requires an individual diagnostic and therapeutic approach. The aim of the study was to analyze risk factors for the development of major adverse cardiovascular and cerebrovascular events (MACCE) in patients after aortic valve replacement with myocardial revascularization. Materials and methods. For this study, a selection of disease histories of adult patients (over 18 years old) who underwent surgical aortic valve replacement (SAVR) together with myocardial revascularization at the State Institution “Heart Institute of the Ministry of Health of Ukraine” from 2018 to 2022 was carried out. Results. We selected 130 case histories of patients who underwent SAVR together with myocardial revascularization: the first group (n = 51) — a combination of SAVR and percutaneous coronary interventions; the second group (n = 79) — a combination of SAVR and coronary artery bypass grafting. The analysis of intraoperative data showed that the duration of cardiopulmonary bypass and aortic cross-clamping in patients of the first group was significantly lower, by 1.5 times (p = 0.0001) and 1.4 times (p = 0.0001), compared to the second group. There was no significant difference between the study groups regarding the frequency of MACCE (p = 0.589). Reliable risk factors for the development of MAССE in the early postoperative period were the evaluation of the operative risk according to the EuroSCORE II scale (odds ratio (OR) 2.13, confidence interval (CI) 1.54–4.48, p = 0.012), the history of myocardial infarction (OR 1.43, CI 1.13–2.45, p = 0.002) and right coronary artery damage (OR 1.79, CI 1.44–3.78, p = 0.021). Conclusions. Patients who underwent percutaneous coronary interventions before SAVR were characterized by a shorter duration of cardiopulmonary bypass and aortic cross-clamping, however, no significant difference in major early postoperative complications was observed between the study groups. In particular, there were no significant differences regarding the frequency of MACCE in the early postoperative period.

Objective: To develop and test an algorithm for no-reflow phenomenon (NRP) prevention during endovascular treatment of patients with ST-elevation myocardial infarction (STEMI) Methods: A prospective single-center randomized study included 100 patients diagnosed with STEMI who underwent coronary artery stenting. Group 1 included 50 patients who were operated using an algorithm for the NRP prevention, while Group 2 included 50 patients who underwent routine transluminal balloon angioplasty and stenting of the coronary arteries. The NRP risk was assessed using the predictive model by Wang JW et al Results: Both groups were comparable in terms of anamnestic and clinical data, biochemical and instrumental examination results. High NRP risk was determined in 36% of Group 1 patients and 40% of Group 2 patients. NRP developed significantly less often in Group 1 patients compared to Group 2 (14% vs. 36%, p=0.01). Worsening of Killip class of acute heart failure was found significantly less common in Group 1 patients compared to Group 2 (2% versus 16%, p=0.03) Conclusion: The proposed algorithm for NRP prevention increased the effectiveness of treatment for STEMI

We discuss main challenges of much-debated endovascular treatment in patients with “false” bifurcation stenoses of the left main coronary artery. There are no convincing literature data on the rationale of planning complete bifurcation stenting using 2 stents and clear indications for this procedure. We highlight the importance of studying the effectiveness and safety of the complex routine use of various intravascular imaging during the left main coronary artery percutaneous coronary intervention. We analyzed observations in which a “false” bifurcation lesion can only be considered an ostial stenosis, which will affect the stenting strategy. We focus on the development of universal algorithms for performing endovascular interventions, including those using intravascular imaging which role at each stage of surgery should be additionally studied.

Background: Despite advancements in percutaneous and surgical revascularization techniques, nearly 20% of patients who undergo myocardial revascularization need repeat revascularization. Recently, identified as a prognostication factor for adverse cardiovascular events, the uric acid/albumin ratio (UAR) serves as a new marker for assessing inflammation and oxidative stress. Our objective was to investigate the association between UAR levels and repeat revascularization in young patients with acute coronary syndrome (ACS). Methods: We enrolled 371 patients with ACS who were under the age of 55 years and who had previously undergone primary percutaneous coronary intervention. Due to their recurrent symptoms, these patients underwent subsequent coronary angiographic examination. The study cohort was splitted into two groups based on whether repeat revascularization was needed. Results: The study and control groups consisted of 99 and 272 patients, respectively. The mean age of the patients in the study cohort was 41.99±4.99 years. Patients who needed repeat revascularization, in comparison to those who did not, exhibited significantly greater levels of the UAR and uric acid, along with lower levels of neutrophils, stent diameter and high density lipoprotein-cholesterol. Additionally, they had more complex disease, as described by the SYNTAX score. To identify the influential factors associated with repeat revascularization, multivariate logistic regression was performed. SYNTAX score, stent diameter, uric acid levels and the UAR were predictive of the need for repeat revascularization. Conclusions: UAR was found to be an inexpensive, easily accessible marker for identifying young patients with ACS requiring repeat revascularization. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Myocardial ischaemia following coronary artery bypass grafting (CABG) is a potentially devastating complication. Nevertheless, the incidence, aetiology and prognostic relevance of unplanned coronary angiography (uCAG) remain understudied. We aimed to investigate the prevalence and outcome of patients undergoing urgent, uCAG in the postoperative period following CABG. METHODS We screened all patients undergoing isolated elective CABG in an academic referral centre between 2016 and 2021 and identified patients undergoing uCAG within 30 days of surgery. For uCAG patients, a distinction was made between patients undergoing re-revascularization (REV) and patients receiving conservative management (CON). The primary outcomes were 30-day mortality and unadjusted and adjusted long-term survival. Secondary outcomes were the indication for and prevalence of uCAG and urgent revascularization. RESULTS Of the 1918 patients undergoing isolated CABG, 78 individuals needed uCAG (4.1%), of whom 45 underwent immediate revascularization (REV group; 2.3% overall, 57% within the uCAG group, median age 69.9 years) and 33 were treated conservatively (CONS group; 1.7% overall, 42% within the uCAG group, median age 69.1 years). Patients undergoing uCAG (n  = 78) had a higher 30-day mortality than patients not undergoing uCAG (n  = 1840, 30-day mortality: 9.0% vs 0.4%, P  < 0.001). Long-term survival was significantly decreased in patients undergoing uCAG in both unadjusted (hazard ratio 2.20, 95% confidence interval 1.30–3.73) and EuroSCORE-, age- and sex-adjusted models (hazard ratio uCAG 2.03, 95% confidence interval 1.16–3.56). CONCLUSIONS Unplanned postoperative coronary angiography is performed in 4.1% of isolated CABG procedures, and patients in need of such urgent invasive evaluation are subjected to decreased short- and long-term survival. [ABSTRACT FROM AUTHOR]

Myocardial revascularization in coronary artery disease via percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery effectively relieves symptoms, significantly improves prognosis and quality of life when combined with guideline-directed medical therapy. Hybrid coronary revascularization is a promising alternative to percutaneous coronary intervention or CABG in selected patients and is defined as a planned and/or intended combination of consecutive CABG surgery using at least 1 internal mammary artery to the left anterior descending (LAD), and catheter-based coronary intervention to the non-LAD vessels for the treatment of multivessel disease. The main indications for hybrid coronary revascularization are (i) to achieve complete revascularization in patients who cannot undergo conventional CABG, (ii) to treat patients with acute coronary syndromes and multivessel disease with a non-LAD vessel as the culprit lesion that needs revascularization and (iii) in highly select patients with multivessel disease with complex LAD lesions and simple percutaneous coronary intervention targets for all other vessels. Hybrid coronary revascularization patients receive a left internal mammary artery graft to the LAD artery through a minimal incision along with percutaneous coronary intervention to the remaining diseased coronary vessels using latest generation drug-eluting stents. A collaborative environment with a dedicated heart team is the optimal platform to perform such interventions, which aim to improve the quality and outcome of myocardial revascularization. This position paper analyses the rationale of hybrid coronary revascularization and the currently available evidence on the various techniques and delves into the sequence of the interventions and pharmacological management during and after the procedure. [ABSTRACT FROM AUTHOR]

Objectives: Manual compression (MC) or vascular closure devices (VCDs) are used to achieve hemostasis after percutaneous transluminal angioplasty (PTA). However, limited data on the comparative safety and effectiveness of VCDs vs MC in patients with end-stage renal disease (ESRD) undergoing PTA are available. Accordingly, this study compared the safety and effectiveness of VCD and MC in patients with ESRD undergoing PTA. Methods: This single-center retrospective cohort study included the data of patients with ESRD undergoing peripheral intervention at Chang Gung Memorial Hospital, Taiwan, from January 1, 2019, to June 30, 2022. The patients were divided into VCD and MC groups. The primary endpoint was a composite of puncture site complications, including acute limb ischemia, marked hematoma, pseudoaneurysm, and puncture site bleeding requiring blood transfusion. Results: We included 264 patients with ESRD undergoing PTA, of whom 60 received a VCD and 204 received MC. The incidence of puncture site complications was 3.3% in the VCD group and 4.4% in the MC group (hazard ratio:.75; 95% confidence interval:.16-3.56 L P = 1.000), indicating no significant between-group difference. Conclusion: VCDs and MC had comparable safety and effectiveness for hemostasis in patients with ESRD undergoing peripheral intervention. [ABSTRACT FROM AUTHOR]

Myocardial revascularization in patients presenting with an anterior mediastinal mass poses considerable challenges. In this report, we outline two cases involving patients with anterior mediastinal masses who underwent surgical resection alongside concurrent myocardial revascularization. One patient underwent coronary artery bypass graft surgery, while the other was treated by percutaneous coronary intervention with drug‐eluting stent placement. Both patients fully recovered from the relative procedures and were discharged within two weeks post‐surgery, ultimately diagnosed with thymoma. The concomitant intervention offered the advantage of promptly addressing both conditions, and it was performed safely through a collaborative multidisciplinary effort. [ABSTRACT FROM AUTHOR]

Introduction: Acute myocardial infarction (AMI) is a major global health concern. However, the optimum timing of coronary artery bypass grafting (CABG) in AMI patients remains controversial. This study investigated the optimal timing of CABG and its impact on postoperative outcomes. We hypothesized that determining the optimal timing of CABG could positively impact postoperative outcomes. Methods: We conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications. Results: Of the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1–2 days post‐AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes. Conclusion: CABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1–2 days. These findings provide evidence‐based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Ischemic cardiomyopathy (ICM) accounts for more than 60% of congestive heart failure cases and is associated with high morbidity and mortality rates. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) ≤35% aims to improve survival and quality of life and reduce complications associated with heart failure and coronary artery disease. The majority of randomized clinical trials have consistently excluded those patients, resulting in evidence primarily derived from observational studies. Main body: We performed a scoping review using the Arksey and O'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review. Conclusion: The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization's benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions. [ABSTRACT FROM AUTHOR]

Background: Severe diffuse coronary artery disease with anatomy that is not amenable to revascularization represents a poorly studied entity, with a poorly defined prognosis and prevalence, associated with high morbidity and mortality, poor quality of life and high hospitalization rates. Objective: Due to the limited evidence in this clinical field and the absence of contemporary studies, we decided to explore this line of research, determining epidemiological, clinical and prognostic aspects. Material and methods: Analytical, retrospective observational cohort study, carried out in a National Medical Center. Results: The prevalence of three-vessel coronary artery disease not susceptible to revascularization was 12.2%, the majority were men (66%), over 65 years of age, with a high burden of comorbidities: pharmacological management consisted of beta blockers (91.5 %), antiplatelet aggregation (95.3%) and statins (95.3%): cardiovascular mortality was 9.4%, with myocardial infarction occurring in 10.4%: the predictor variables of mortality were chronic kidney disease, age over 70 years, insufficiency mitral valve. Conclusion: Coronary artery disease of three vessels not susceptible to revascularization continues to be a frequent entity, with a high-risk clinical and anatomical profile, with a better contemporary prognosis despite the multiple gaps in knowledge that limit its understanding and treatment. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long‐term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non‐invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non‐invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy. [ABSTRACT FROM AUTHOR]

The transition from the second to the third millennium happened to be a turning point in the history of myocardial revascularization on a beating heart, which moved from technical development to critical evaluation. This article describes how the initial acceptance and spread of off-pump coronary artery bypass grafting (OPCABG) was followed by the general perception that the technique could not fulfill the expectations placed in it and provides some insight on what should we do with the know-how of OPCABG in the present and the future of coronary surgical revascularization. [ABSTRACT FROM AUTHOR]

Background The optimal statin treatment strategy that is balanced for both efficacy and safety has not been clearly determined in older adults with coronary artery disease (CAD). Methods In the post hoc analysis of the LODESTAR (low-density lipoprotein cholesterol-targeting statin therapy versus intensity-based statin therapy in patients with coronary artery disease) trial, the impact between a treat-to-target strategy versus a high-intensity statin therapy strategy was compared in older adults (aged 75 years or older). The goal of treat-to-target low-density lipoprotein cholesterol (LDL-C) level was 50–70 mg/dl. The primary endpoint comprised the three-year composite of all-cause death, myocardial infarction, stroke or coronary revascularisation. Results Among 4,400 patients with CAD enrolled in the LODESTAR trial, 822 (18.7%) were aged 75 years or older. Poor clinical outcomes and risk factors for atherosclerosis were more frequently observed in older adults than in younger population (<75 years old). Among these older adults with CAD, the prescription rate of high-intensity statin was significantly lower in the treat-to-target strategy group throughout the study period (P  < 0.001). The mean LDL-C level for three years was 65 ± 16 mg/dl in the treat-to-target strategy group and 64 ± 18 mg/dl in the high-intensity statin group (P  = 0.34). The incidence of primary endpoint occurrence was 10.9% in the treat-to-target strategy group and 12.0% in the high-intensity statin group (hazard ratio 0.92, 95% confidence interval 0.61–1.38, P  = 0.69). Conclusions High-intensity statin therapy is theoretically more necessary in older adults because of worse clinical outcomes and greater number of risk factors for atherosclerosis. However, the primary endpoint occurrence with a treat-to-target strategy with an LDL-C goal of 50–70 mg/dl was comparable to that of high-intensity statin therapy and reduced utilisation of a high-intensity statin. Taking efficacy as well as safety into account, adopting a tailored approach may be considered for this high-risk population. Trial Registration ClinicalTrials.gov , NCT02579499. [ABSTRACT FROM AUTHOR]

Autoimmune blistering disorders (ABDs) might elevate cardiovascular risk, but studies are lacking. The objective of this study was to examine if ABDs elevate the risk of atherosclerotic cardiovascular disease, heart failure, arrhythmia, venous thromboembolism, and cardiovascular death. A population-based cohort of Danish patients with ABD (≥18 years of age) diagnosed during 1996–2021 (n = 3322) was compared with an age- and sex-matched comparison cohort from the general population (n = 33,195). Compared with the general population, patients with ABDs had higher 1-year risks of atherosclerotic cardiovascular disease (3.4% vs 1.6%), heart failure (1.9% vs 0.7%), arrhythmia (3.8% vs 1.3%), venous thromboembolism (1.9% vs 0.3%), and cardiovascular death (3.3% vs 0.9%). The elevated risk persisted after 10 years for all outcomes but arrhythmia. The hazard ratios associating ABDs with the outcomes during the entire follow-up were 1.24 (1.09-1.40) for atherosclerotic cardiovascular disease, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for venous thromboembolism, and 2.01 (1.76-2.29) for cardiovascular death. The elevated cardiovascular risk was observed for both pemphigus and pemphigoid. Our findings might only generalize to patients with ABDs without prevalent cardiovascular diseases. Patients with ABDs had an elevated cardiovascular risk compared with age- and sex-matched controls. [ABSTRACT FROM AUTHOR]

Objective: Although the adverse effects of smoking are well-established, evidence shows a longer survival rate following an acute myocardial infarction (MI) among smokers or the so-called "smoker's paradox". This study aimed to determine the impact of smoking on the one-year clinical outcomes of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) in a large registry of the Iranian population. Methods: A total of 3087 patients diagnosed with acute STEMI who underwent PPCI between 2013 and 2018 were enrolled in the study. Patients' smoking status was determined based on self-reported history and categorized into two groups: current smokers and non-smokers. Clinical and angiographic data were collected from the Tehran Heart Center (THC) registry. The primary outcome was one-year of major adverse cardiac and cerebrovascular events (MACCE). The effect of smoking on MACCE was evaluated using a Cox model. Results: From the study population, 1967 (63.7%) were non-smokers, and 1120 (36.3%) were current smokers. Non-smokers had higher rates of prior CABG (5.3%) as well as a higher history of co-morbidities, including a history of diabetes mellitus (46.0%), hypertension (52.7%) and hyperlipidemia (55.4%) than smokers (2.3%, 30.4%, 35.7%, and 49.8% respectively). Smokers had a higher reference vessel diameter than non-smokers (P=0.005). The unadjusted hazard ratios (HRs) for MACCE within one year were significantly lower in smokers than nonsmokers (0.73, 95% CI: [0.58,0.92]; P=0.009); however, after adjustment for confounders, the HRs for MACCE in smokers were similar to non-smokers (HR: 1.00, 95% CI: [0.73,1.38]). Conclusion: The study found that smoking had no significant impact on the one-year clinical outcomes of STEMI patients after PPCI in the Iranian population. This study is the first of its kind to assess the effect of smoking on STEMI patients in Iran and highlights the need for further research in this area. [ABSTRACT FROM AUTHOR]

Aims Myocardial perfusion imaging (MPI) using [15O]H2O positron emission tomography (PET) is used to guide the selection of patients with angina for invasive angiography and possible revascularization. Our study evaluated (i) whether atrial fibrillation (AF) reduces global hyperaemic myocardial blood flow (MBF) and (ii) whether [15O]H2O PET MPI effectively guides revascularization procedures for patients with ongoing AF. Methods and results We prospectively recruited 346 patients with angina and persistent or paroxysmal AF referred for baseline/hyperaemic [15O]H2O PET MPI. The primary outcome was revascularization within 3 months of MPI. In the analyses, patients were divided into four groups based on whether they had ongoing AF or sinus rhythm (SR) and whether they had previously documented coronary artery disease (CAD) or not. Thus, four groups were compared: SR-noCAD, AF-noCAD, SR-CAD, and AF-CAD. Hyperaemic MBF was affected by both ongoing AF and prior CAD [MBF (mL/min/g): 2.82 (SR-noCAD) vs. 2.12 (AF-noCAD) vs. 2.22 (SR-CAD) vs. 1.80 (AF-CAD), two-way analysis of variance P < 0.0001]. In multiple linear regression, ongoing AF was independently associated with reduced hyperaemic MBF. Every 0.1 mL/min/g decrease in hyperaemic MBF was associated with a 23% increase in odds of early revascularization. Receiver operating characteristic (ROC) analysis of vessel-specific hyperaemic MBF to predict early revascularization yielded the following areas under the ROC curve: SR-noCAD: 0.95 (P < 0.0001); AF-noCAD: 0.79 (P < 0.0001); SR-CAD: 0.78 (P < 0.0001); and AF-CAD: 0.88 (P < 0.0001). Conclusion Ongoing AF is associated with 19–25% reduced global hyperaemic MBF as measured by [15O]H2O MPI PET. Regardless, vessel-specific hyperaemic MBF still predicts early revascularization in patients with AF. [ABSTRACT FROM AUTHOR]

Background: The management of heart surgery waiting list is essential, particularly in ultraperipheral regions. We aimed to characterise a cohort of patients awaiting surgery in such a region, and to assess the occurrence of adverse events and causative factors. Methods: A retrospective, multicentre analysis from 2016 to 2020. Patients were divided into "Urgent group" vs "Priority group" based on surgical priority. A composite outcome of death or hospital admission was determined. Results: We included 329 patients, 18.2% in the Urgent group. Baseline characteristics were similar, except for a higher prevalence of smoking habits in the Urgent group (56.7% vs 38.7%, p = 0.016), as well as the CCS class (p = 0.014) and EuroScore surgical risk (p < 0.001). Disease acuity indicated highest priority for coronary artery bypass grafting patients. Myocardial revascularization and aortic valvular replacement were the main procedures. Overall, 15.2% of patients received treatment within recommended waiting time, with 50.8% being Urgent patients. Urgent patients had higher risk for composite outcome (HR 3.92, 95% CI 1.26-12.22; p = 0.019), with fewer events reported (5% vs 17.8%, p = 0.051). Chronic kidney disease and previous open-heart surgery were independent predictors of this outcome. Chronic kidney disease remained as independent predictor at 1-year follow-up, while surgical priority did not affect outcomes. Conclusions: Despite similar occurrences of adverse events on the waiting list, longer waiting times for patients in the Urgent group increase their risk of adverse events. The priority level had no impact on outcomes. Chronic kidney disease and open-heart surgery were independent predictors for events, highlighting their significance in the triage process. [ABSTRACT FROM AUTHOR]

Background and Objectives. Distinct pressure curve differences exist between akinetic (A-LVA) and dyskinetic (D-LVA) aneurysms. In D-LVA, left ventricular (LV) ejection pressure decreases relative to the aneurysm size, whereas A-LVA does not impact pressure curves, indicating that the decrease in stroke volume (SV) and cardiac output is proportional to the size of dyskinesia. This study aimed to assess the frequency of A-LVA and D-LVA, determine aneurysm size parameters (volume and surface area), and evaluate predictive parameters using echocardiography in A-LVA and D-LVA. Furthermore, it aimed to compare individual echocardiographic parameters, according to ejection fraction (EF) and SV, with hemodynamic events shown in experimental models of A-LVA and D-LVA and their significance in everyday clinical practice. Materials and Methods. This clinical study included patients with post-infarction left ventricular aneurysm (LVA) admitted to the cardiovascular institute ''Dedinje", Serbia. Echocardiographic volume and surface area of LV and LVA were determined (by the area–length method) along with EF (by Simpson's method). Results. A-LVA was present in 62.9% of patients, while D-LVA was present in 37.1%. Patients with D-LVA had significantly higher systolic aneurysm volume (LVAVs) (94.07 ± 74.66 vs. 51.54 ± 53.09, p = 0.009), systolic aneurysm surface area (LVAAs) (23.22 ± 11.73 vs. 16.41 ± 8.58, p = 0.018), and end-systolic left ventricular surface areas (LVESA) (50.79 ± 13.33 vs. 42.76 ± 14.11, p = 0.045) compared to patients with A-LVA. The ratio of LVA volume to LV volume was higher in the D-LVA in systole (LVAVs/LVESV). The end-diastolic volume of LV (LVEDV) and end-systolic volume of LV (LVESV) did not significantly differ between D-LVA and A-LVA. EF (21.25 ± 11.92 vs. 28.18 ± 11.91, p = 0.044) was significantly lower among patients with D-LVA. Conclusions. Differentiating between A-LVA and D-LVA using echocardiography is crucial since D-LVA causes greater hemodynamic disturbances in LV function, and thus surgical resection of the aneurysm or LV reconstruction must have a positive effect regardless of myocardial revascularization surgery. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass grafting (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG. Methods: This cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up. Results: Totally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, P = 0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77–3.17, P = 0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51–2.69, P = 0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65–1.92, P = 0.68). Conclusions: EVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up. [ABSTRACT FROM AUTHOR]

Background/Objectives: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. Methods: REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up. Results: A total of 2025 patients from 30 centers worldwide with complete follow-up were included in the registry. Most patients had single-vessel CAD (56.1%). An involvement of proximal coronary tracts was detected in 62.5% of cases, with 12.0% of patients having CAD in left main (LM). Most patients received percutaneous coronary intervention (PCI) (n = 1617, 79.9%), especially those with proximal CAD (90.4%). At 2 years, the rates of all-cause death [Kaplan–Meier (KM) estimates 20.1% vs. 18.8%, plog-rank = 0.86] and of the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure (KM estimates 29.7% vs. 27.5%, plog-rank = 0.82) did not differ between patients undergoing PCI and those who were not. Conclusions: Patients undergoing TAVI with obstructive CAD more commonly had a single-vessel disease and an involvement of proximal coronary tracts. They were commonly treated with PCI, with similar outcomes compared to those treated conservatively. [ABSTRACT FROM AUTHOR]

Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization. [ABSTRACT FROM AUTHOR]

Introduction: Ivabradine reduces heart rate (HR), episodes of angina, and nitrate consumption, and increases exercise capacity in patients with chronic angina (CA). In this exploratory study, myocardial perfusion scintigraphy (MPS) was used to evaluate changes in the percentage of myocardial ischemia after ivabradine therapy in patients with CA. Methods: This prospective, open-label, single-arm study included patients with CA receiving maximum tolerated doses of beta blockers, who had a resting HR ≥ 70 bpm and had experienced ischemia according to MPS during an exercise test at baseline. Participants received ivabradine 5 mg twice daily (titrated according to HR) concomitant with beta blockers. A second MPS was performed after 3 months, without interruption of treatment with beta blockers or ivabradine. The primary outcome was change in the percentage of myocardial ischemia from baseline to 3 months. Time to ischemia during the exercise test, the proportion of patients presenting angina during the exercise test, and health status, assessed using the seven-item Seattle Angina Questionnaire-7 (SAQ-7), were also evaluated. Results: Twenty patients (3 females) with a mean (± standard deviation [SD]) age of 62.2 ± 6.5 years were included in the study, of whom 55% had diabetes, 70% had previous myocardial revascularization, and 45% had previous myocardial infarction. The percentage of patients with myocardial ischemia significantly decreased from baseline to 3 months after initiation of treatment with ivabradine (− 2.9%; 95% confidence interval [CI] − 0.3 to − 5.5; p = 0.031). Mean time to appearance of ischemia increased from 403 ± 176 s at baseline to 466 ± 136 s at 3 months after initiation of ivabradine (Δ62 s; 95% CI 18–106 s; p = 0.008), and the proportion of patients experiencing angina during the exercise test decreased from 40% at baseline to 5% also at 3 months (p = 0.016). Mean resting HR decreased from 76 ± 7 bpm at baseline to 55 ± 8 bpm at 3 months (p < 0.001). The mean SAQ-7 summary score improved from 69 ± 21 at baseline to 83 ± 12 at 3 months (p = 0.001). No serious adverse effects were reported. Conclusion: Ivabradine added to beta blockers was associated with a reduction in detectable myocardial ischemia by MPS in patients with CA. Infographic available for this article. Trial Registration: The trial has been retrospectively registered with the Brazilian Registry of Clinical Trials (REBEC) under the following number RBR-5fysqrh (date of registration: 30 November 2023). [ABSTRACT FROM AUTHOR]

The Short Physical Performance Battery (SPPB) may be feasible for evaluating older adults undergoing myocardial revascularization surgery (MRS). However, it is necessary to verify its measurement properties and safety to use it for clinical practice. To investigate the reliability, hemodynamic responses, subjective perceived exertion (SPE), and adverse events during and after SPPB in older adults undergoing MRS. A cross-sectional and methodological study conducted with 85 older adults in the pre and postoperative periods of MRS. The hemodynamic responses [heart rate (HR) and systolic blood pressure (SBP)], SPE, and adverse events were evaluated before and after the SPPB. Two researchers performed the inter-rater reliability within a 30-minute interval, while the interval between measures for intra-rater reliability was 24 hours. The Friedman test was used to analyze hemodynamic and SPE responses. The intraclass correlation coefficient (ICC) and the coefficient variation of method error (CVME) were used for the reliability analysis. Increases in HR (p < 001), SBP (p < 0.01), and SPE (p < 0.01) were observed immediately after the SPPB. Only seven volunteers reported minor adverse events. Regarding reliability results, ICC(3,1) for intra-rater reliability varied from 0.66 to 0.87 and CVME from 4.80 to 8.82%. For inter-rater reliability, ICC(2,1) varied from 0.66 to 0.91 and CVME from 4.04 to 9.02%. The SPPB increased the HR, SBP, and SPE immediately after its execution. In addition, it showed light changes in SPE, few adverse events, and good reliability in older adults in the pre and postoperative MRS period. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to determine the predictive value of the leukocyte-glycemic index in the long-term evolution of diabetic patients with peripheral arterial disease following endovascular treatment. Methods: This retrospective observational study enrolled 127 diabetic patients diagnosed with peripheral arterial disease requiring endovascular treatment. Patients were categorized into two groups based on the severity of the infrapopliteal atherosclerotic lesions identified during the pre-operative Computer Tomography Angiography examination. Group 1 includes patients without severe damage to the infrapopliteal artery, while Group 2 includes patients with severe infrapopliteal artery damage, identified by stenosis greater than 70% on all infrapopliteal arteries. The primary outcome was to assess the association between leukocyte-glycemic index value at baseline and the severity of infrapopliteal atherosclerotic lesions and long-term major amputation after percutaneous transluminal angioplasty. Results: Patients in Group 2 had a higher incidence of cardiovascular events (p=0.009), stage IV Leriche-Fontaine (p=0.016), and incidence of major amputation (p<0.001), as well as an increased value of leukocyte-glycemic index (p=0.004). During the follow-up, patients with above-median leukocyte-glycemic index value have a higher risk of major amputation (p=0.034), as seen in the Kaplan-Meier analysis. Moreover, at cox-regression, elevated biomarker values were associated with long-term risk of major amputation, independent of age, sex, cardiovascular risk factors, and below-the-knee arterial occlusion (HR:2.69, p=0.001). Conclusions: Elevated values of leukocyte-glycemic index are associated with the severity of infrapopliteal atherosclerotic lesions and major amputation in the long term. [ABSTRACT FROM AUTHOR]

Aims The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. Methods and results In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. Conclusion The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) remains a leading cause of mortality among cancer patients, primarily due to shared risk factors and the impacts of chemotherapeutic drugs, immune checkpoint inhibitors, and radiotherapy. Determining the optimal treatment strategy remains a challenging issue for patients with concurrent CHD and malignant neoplasms. In high-risk patients, managing CHD frequently takes precedence over addressing the oncologic disease. Myocardial revascularization, coupled with optimal medical therapy for CHD, can significantly enhance patient survival by reducing the risks of myocardial infarction and sudden cardiac death. However, selecting a surgical treatment strategy requires careful consideration of the indications, the complexity of coronary lesions, the risk of bleeding and thrombosis, and the overall prognosis of the malignancy. This clinical case demonstrates the importance of risk-benefit assessment, multidisciplinary discussion of cure strategy, and application of novel technologies to provide the most personalized and effective treatment.