http:www.cardiocirugia.sld.cu

J Cardiothorac Surg. 2025 Jun 21;20(1):266. doi: 10.1186/s13019-025-03512-9.

ABSTRACT

BACKGROUND: Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.

METHODS: PubMed, Google Scholar, and Cochrane Library were searched until May 2024 for studies comparing the radial and femoral approaches in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, and hospital stay. Generic inverse variance (GIV) was used to pool the risk ratio for dichotomous outcomes and mean difference (MD) for the continuous outcomes, with corresponding 95% confidence intervals (CIs).

RESULTS: Twelve studies including 15,700 patients with a mean age of 77.77 years in the radial group and 74.04 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was a significantly lower risk (RR: 0.23; 95% CI [0.12, 0.41]; p < 0.00001) in the radial group as compared to the femoral group. From the secondary outcomes, radial access was found to have significantly lower MACE (RR:0.80; 95% CI [0.68, 0.93]; p = 0.004), shorter procedural time (MD: -6.95; 95% CI [-11.52, -2.38], p = 0.003) and hospital stay (MD: -2.8; 95% CI [-5.56, -0.04], p = 0.05) as compared to femoral group. In contrast, all the other secondary outcomes were found to be insignificant.

CONCLUSION: Rotational atherectomy using the radial approach has a significantly lower rate of major vascular site bleeding and MACE and is associated with significantly shorter procedural time and hospital stay.

PMID:40544305 | PMC:PMC12182652 | DOI:10.1186/s13019-025-03512-9

Cardiovasc Revasc Med. 2025 Jun 13:S1553-8389(25)00296-9. doi: 10.1016/j.carrev.2025.06.010. Online ahead of print.

ABSTRACT

Advancements in percutaneous coronary intervention (PCI) technology and post-PCI patient management have led to improvements in clinical outcomes in coronary artery disease patients. At the forefront of these advancements is intravascular imaging - reduced risks of death, myocardial infarction, repeat revascularization, and stent thrombosis have been demonstrated with intravascular imaging-guided PCI compared with angiography guidance alone. The latest 2024 European Society of Cardiology chronic coronary syndrome guidelines and the 2025 American College of Cardiology/American Heart Association acute coronary syndrome guidelines provide a Class I recommendation for use of intravascular imaging in complex PCI. At the recently concluded Cardiovascular Research Technologies 2025 Meeting, a dedicated session titled "Beyond the Guidelines - Intravascular Imaging Guidance of PCI, Diagnosis and Treatment" was conducted to address gaps in the existing guidelines. This review summarizes the scenarios not covered by the current guidelines, key takeaways from the discussion by the expert panel, and the audience's perspective on critical questions needed for future guideline developments.

PMID:40544127 | DOI:10.1016/j.carrev.2025.06.010

Can J Cardiol. 2025 Jun 19:S0828-282X(25)00391-5. doi: 10.1016/j.cjca.2025.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: A 2022 meta-analysis concluded colchicine reduced the cardiac risk in secondary prevention. Nevertheless, a large, randomized clinical trial (RCT) continued to randomize patients to colchicine or placebo and in 2025 published findings of no benefit. Bayesian sequential analyses and hierarchical meta-analysis can assist in understanding not only the interpretation of this latest trial but also the totality of the evidence.

METHODS: A systematic review and Bayesian meta-analysis including the recent CLEAR trial results was performed. The primary outcome was major adverse cardiovascular events (MACE), a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization. Bayesian sequential analyses were performed with vague (result dominated by CLEAR), fully informative (based on all previous studies), and "focused" (considering only the largest and most similar previous trial) priors and results compared with a hierarchical meta-analysis. The probabilities of clinically meaningful results were based on > absolute 15% MACE reduction.

RESULTS: While the 2022 meta-analysis suggested a statistically significant MACE decrease with colchicine, the Bayesian reanalysis showed a 95% credible interval (95% CrI 0.26, 1.70) for the next study, justifying CLEAR continuation. The Bayesian sequential analyses using vague, all-inclusive, and focused priors showed 58%, 100% and 92% probabilities respectively of MACE decrease with colchicine. Clinically meaningful probability decreases, based on > absolute 15% reduction, were smaller, ranging between 2% to 41%.

CONCLUSIONS: Bayesian analyses offer advantages in trial design and interpretation, suggesting some benefit for colchicine in secondary cardiovascular prevention, but considerably less certainty of its clinical importance.

PMID:40543648 | DOI:10.1016/j.cjca.2025.06.008

J Endovasc Ther. 2025 Jun 21:15266028251325054. doi: 10.1177/15266028251325054. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, is superior for treating primary carotid restenosis, irrespective of the initial revascularization method used.

DESIGN: Systematic review and meta-analysis.

METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRALs) databases were searched for eligible studies on December 19th, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Primary endpoint was the occurrence of transient ischemic attack (TIA) or any stroke. Secondary endpoints were technical success, death within 30 days, myocardial infarction (MI), local complications, cerebral hyperperfusion syndrome (CHS), cranial nerve injury (CNI), dys-/arrythmia, secondary restenosis, repeat revascularization, and long-term survival. Results were adjusted for symptomatic status and primary treatment strategy.

RESULTS: Nineteen studies comprising 10,171 procedures in 10,041 patients were included. Baseline characteristics were comparable between groups. Main findings were (1) No difference in primary outcome; however, if adjusted for symptomatic status the rate of TIA/any stroke is higher (OR: 2.05, 95% CI: 1.29-3.27, p < 0.01) after CEA compared to CAS; (2) Significant higher rate of MI (OR: 1.85, 95% CI: 1.19-2.86, p < 0.01) after CEA; (3) Besides CNI, which appears to be commonly temporary and occurred only after CEA (7.56%, 95% CI: 4.21%-13.22%), no significant differences in other secondary endpoints were observed between groups. Long-term risk of secondary restenosis was similar between CEA compared to CAS (OR: 0.98, 95% CI: 0.39-2.49, p = 0.95); (4) Correction for the index procedure did not affect conclusions.

CONCLUSION: Based on limited-quality studies, mostly retrospective and nonrandomized in design, both CAS and CEA represent feasible treatment approaches for patients with primary restenosis, with comparable primary outcome between the two groups. However, based on the obtained results, CAS appears to be preferable. Patients should be critically evaluated in a multidisciplinary team and further research is desirable.Clinical ImpactThis review expands on previous studies by incorporating a larger patient cohort and more recent literature while offering new insights into restenosis. Unlike earlier research, this study uniquely evaluates first repeat revascularization outcomes (CAS and CEA) independently of the initial procedure, suggesting that patient and plaque characteristics might be more influential than the primary technique. Sensitivity analysis confirmed this, as stratification by index procedure did not alter conclusions. Although lower TIA/stroke and mortality rates were observed in CAS-treated patients, these findings were not statistically significant in the overall group. These results may help guide clinical decision-making for optimal restenosis management.

PMID:40542821 | DOI:10.1177/15266028251325054

Cardiovasc Revasc Med. 2025 Jun 4:S1553-8389(25)00288-X. doi: 10.1016/j.carrev.2025.06.003. Online ahead of print.

ABSTRACT

BACKGROUND: Impella is a catheter-based, continuous blood flow left ventricle assist device used in selected patients undergoing high-risk percutaneous coronary interventions (HR PCI). We aimed to evaluate outcomes in patients undergoing Impella-assisted HR-PCI and identify independent predictors of 12-month mortality.

METHODS: Consecutive HR-PCI patients enrolled in the national, multicentre, retrospective IMPELLA-PL registry (n = 253) in 20 Polish interventional cardiological centres from October 2014 until December 2021 were included in the analysis. The main endpoints were (i) procedural success defined as revascularization of all preplanned lesions, (ii) device-related complications, (iii) 12-month mortality and major adverse cardiovascular events (MACE).

RESULTS: The majority of patients presented with multivessel disease including left main (63.6 %). The median Syntax Score II was 43.0 (32.4-55.0). The procedural success was achieved in 83.0 % of patients. Device-related complications included access site bleeding (14.6 %), limb ischemia (2.4 %) and hemolysis (1.6 %). The in-hospital MACE included 1 cardiosurgical intervention (0.4 %), 12 exacerbations of heart failure (4.7 %), 11 myocardial infarctions (4.3 %), 32 cases of acute kidney injury (12.6 %), 35 inflammatory complications (13.8 %) and 32 major bleeding complications (13.4 %). In-hospital mortality rate was 8.3 %, 12-month mortality rate was 18.2 % and MACE rate post-discharge was 22.5 %. The 12-month-mortality was increased by pre-existing, atrial fibrillation (OR 3.50, 95 % CI 1.38-8.95) and chronic kidney disease (OR 2.77, 95 % CI 1.06-7.26) and decreased by Impella removal in the cath-lab (OR 0.11, 95 % CI 0.02-0.76) and RAAS inhibitor use (OR 0.26, 95 % CI 0.08-0.89).

CONCLUSIONS: Despite high anatomical complexity of coronary artery disease of patients included in the IMPELLA-PL registry, the procedural success rate was relatively high and the mortality relatively low.

PMID:40541478 | DOI:10.1016/j.carrev.2025.06.003

Cardiovasc Drugs Ther. 2025 Jun 20. doi: 10.1007/s10557-025-07735-9. Online ahead of print.

ABSTRACT

PURPOSE: The association between the intra-procedure quantitative flow ratio (QFR) and clinical outcomes after drug-coated balloon (DCB) angioplasty has not been investigated. This study aimed to investigate the clinical predictive value of pre-DCB QFR, a functional assessment of lesion preparation, for clinical outcomes in de novo coronary lesions after DCB angioplasty.

METHODS: This retrospective study included 170 consecutive patients undergoing DCB angioplasty for 177 de novo coronary lesions between January 2021 and December 2022. The QFR was computed at baseline, pre-DCB, and post-DCB. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, cardiac death, target vessel myocardial infarction, and target lesion revascularization.

RESULTS: During 2-year follow-up, 37 patients with 38 lesions have experienced MACE. The pre-DCB QFR, measured after pre-dilation, was significantly lower in the MACE group. Receiver operator characteristic curve analysis showed the optimal pre-DCB QFR cut-off value for predicting MACE was 0.925 (area under curve = 0.782, 95% confidence interval [CI] 0.702-0.861, sensitivity = 78.9%, specificity = 74.8%, p < 0.001). A pre-DCB QFR < 0.925 was associated with a significantly higher risk of MACE compared with a value > 0.925 (46.1% vs. 7.1%, p < 0.001). In multivariable Cox regression analyses, pre-DCB QFR < 0.925 was associated with an over sixfold increased risk of MACE (hazard ratio = 7.483, 95% CI 3.363-16.653, p < 0.001).

CONCLUSION: The pre-DCB QFR was a promising predictor of unfavorable clinical outcomes in de novo coronary lesions after DCB angioplasty.

PMID:40540079 | DOI:10.1007/s10557-025-07735-9

Cardiol Rev. 2025 Jun 20. doi: 10.1097/CRD.0000000000000971. Online ahead of print.

ABSTRACT

Dual antiplatelet therapy is a standard treatment after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), but the optimal monotherapy agent post-dual antiplatelet therapy remains unclear. Clopidogrel and aspirin are widely used, yet their comparative effectiveness and safety in this patient population have not been fully established. This systematic review and meta-analysis compared the efficacy and safety of clopidogrel and aspirin monotherapy following PCI in patients with ACS. A comprehensive search of PubMed, Embase, and Web of Science was conducted from inception to March 31, 2025. Randomized controlled trials (RCTs) comparing clopidogrel and aspirin monotherapy in adult ACS patients post-PCI were included. Primary outcomes were all-cause death, myocardial infarction (MI), and ischemic stroke. Secondary outcomes included target-vessel and target-lesion revascularization, cardiovascular and noncardiovascular death, and stent thrombosis. The risk of bias was assessed using the Cochrane RoB 2 tool, and the GRADE methodology was applied to evaluate the certainty of evidence. Three RCTs involving 16,056 patients (clopidogrel: 8103; aspirin: 7953) were included. Clopidogrel significantly reduced MI (risk ratio = 0.71; 95% confidence interval: 0.55-0.92; P = 0.01) and target-vessel revascularization (risk ratio = 0.77; 95% confidence interval: 0.60-0.97; P = 0.03). No significant differences were found in all-cause death, ischemic stroke, or other secondary outcomes. Sensitivity analysis suggested a potential reduction in noncardiovascular death favoring clopidogrel. Clopidogrel monotherapy after PCI may offer superior protection against MI and target-vessel revascularization compared with aspirin, with no increased risk of death or stroke.

PMID:40539811 | DOI:10.1097/CRD.0000000000000971

Cureus. 2025 May 20;17(5):e84471. doi: 10.7759/cureus.84471. eCollection 2025 May.

ABSTRACT

Background The healthcare landscape is notably divided between investor-owned and nonprofit hospitals, raising questions about the impact of hospital ownership on patient outcomes, especially for high-stakes conditions such as cardiogenic shock resulting from ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). This study analyzed whether differences in hospital ownership are associated with variations in mortality, length of stay (LOS), and healthcare costs. Methodology We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2021, identifying 95,260 adult patients with STEMI-induced cardiogenic shock treated with PCI. Identification was based on validated International Classification of Diseases, Tenth Revision, Clinical Modification coding algorithms. The primary outcome was in-hospital mortality, with LOS and total hospital charges (inflation-adjusted via the Consumer Price Index) as secondary outcomes. All outcomes were assessed using multivariable regression models adjusting for patient demographics (age, sex, race/ethnicity), comorbidities, insurance type, and hospital-level factors (region, teaching status, and bed size). Regional cost variation and case mix were also accounted for. Propensity score matching was additionally performed to validate results. Results The analysis revealed no significant difference in mortality rates between investor-owned (27.22%) and nonprofit hospitals (26.93%, adjusted odds ratio (aOR) = 1.03, p = 0.60; 95% confidence interval (CI) = 0.91-1.16). Propensity score-matched analysis confirmed similar findings (aOR = 0.98, p = 0.696). Investor-owned hospitals, however, incurred significantly higher healthcare costs (average charges = $325,543 vs. $222,528; p < 0.001). The average cost difference of $103,015.50 remained statistically and systemically significant after adjustment and may reflect differences in resource utilization and/or billing practices. LOS was slightly shorter in investor-owned hospitals (6.51 vs. 7.27 days); while statistically significant (p < 0.001), this difference was not clinically meaningful after adjustment (coefficient = 0.19, p = 0.334). Key demographic and clinical predictors included age, insurance status, comorbidity index, hospital bed size, and teaching status. Racial and insurance-based disparities, particularly among Hispanic patients and Medicaid enrollees, were associated with higher costs, though not fully explained by hospital ownership. Conclusions In this national analysis, hospital ownership was not associated with differences in mortality for STEMI-induced cardiogenic shock treated with PCI, but was independently associated with substantially higher hospital charges in investor-owned hospitals. These findings demonstrate association, not causation, and highlight the need for future research into cost drivers and initiatives to promote high-value, standardized care across all hospital types.

PMID:40539141 | PMC:PMC12178224 | DOI:10.7759/cureus.84471

Front Cardiovasc Med. 2025 Jun 5;12:1611019. doi: 10.3389/fcvm.2025.1611019. eCollection 2025.

ABSTRACT

This study delineates the diagnostic and therapeutic strategies for acute myocardial infarction occurring years after stent implantation for Stanford type A aortic dissection. Emergency coronary angiography presented substantial technical challenges attributable to the lack of recent aortic imaging data and marked tortuosity of the brachiocephalic trunk resulting from postoperative anatomical changes. Consequently, while selective left coronary angiography was successfully completed, visualization of the right coronary artery necessitated non-selective contrast administration via a pigtail catheter. This case underscores the pivotal role of preoperative aortic computed tomography angiography (CTA) in hemodynamically stable patients, as it provides essential vascular anatomical information that may circumvent procedural complexities during coronary angiography. Building upon these observations, we advocate an "aorto-coronary combined assessment" strategy for post-aortic surgery patients, integrating systematic imaging surveillance to facilitate early identification of coronary lesions. Such an approach permits the timely implementation of intensive medical therapy or elective revascularization, thereby mitigating the risk of acute cardiovascular events.

PMID:40538917 | PMC:PMC12176840 | DOI:10.3389/fcvm.2025.1611019

Korean Circ J. 2025 May 14. doi: 10.4070/kcj.2024.0318. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Rotational atherectomy (RA) is a technique used to ablate calcified plaques. There is speculation that operators' experience with RA could play a role in the outcomes.

METHODS: From December 2015 to April 2020, patients with calcified coronary lesions requiring percutaneous coronary intervention (PCI) with RA were enrolled in a prospective, multicenter, observational registry. The patients were divided into two groups based on the number of RAs performed by their operator in the past. A propensity score matching was done for a sensitivity analysis. The primary outcome was a composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year.

RESULTS: A total of 497 patients were enrolled in the study. The calculated cutoff number of RA-PCI between the two groups was 82 cases. The more experienced group underwent PCI with less fluoroscopy time (less experienced vs. more experienced, 38.8 vs. 30.0 minutes, p<0.001), and more frequent intravascular imaging (54.6% vs. 69.0%, p=0.012). The primary outcome did not differ significantly between the groups (5.2% vs. 7.3%, hazard ratio, 1.46; 95% confidence interval [CI], 0.57-3.74; p=0.433). No significant difference in the incidence of complications was observed between the groups (5.5% vs. 7.0%, odds ratio, 1.38; 95% CI, 0.57-3.04; p=0.526). Similar results were observed in the propensity-score matched population.

CONCLUSIONS: In PCI using RA for calcified lesions, the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization at 1 year was not significantly different according to RA experience among operators.

PMID:40537426 | DOI:10.4070/kcj.2024.0318

Cardiovasc Revasc Med. 2025 Jun 8:S1553-8389(25)00291-X. doi: 10.1016/j.carrev.2025.06.006. Online ahead of print.

ABSTRACT

Current guidelines recommend 6-12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention(PCI) followed by aspirinin monotherapy indefinitely. We aimed to assess efficacy and safety of Clopidogrel as compared to aspirin in patients undrgoing PCI after completing DAPT. We systematically searched 3 electronic databases and identified studies comparing clopidogrel to aspirin in post PCI population after completing DAPT. We included 7 studies with 20,360 patients. We pooled outcomes for major adverse cardiac events (MACE), typically comprising a composite of death, myocardial infarction (MI), or stroke; all-cause mortality; cardiac death; major bleeding; any stroke; ischemic stroke; hemorrhagic stroke; repeat revascularization; target-vessel revascularization (TVR); and definite stent thrombosis. Mean follow up was 12-36 months. Duration of DAPT was 1-18 months. Clopidogrel was associated with reductions in MACE than aspirin (RR: 0.82; 95 % CI: 0.69-0.98; p = 0.03), showed reduced risk of MI (RR 0.93 CI 0.60-1.44; p 0.74, I2 63%) indicating a relative reduction of 7 %, reduced strokes numerically but non-significantly (RR: 0.72; 95 % CI: 0.48-1.07; p = 0.11), RRR 28 %, all cause mortality did not exhibit a significant difference between clopidogrel and aspirin (RR: 0.99; 95 % CI: 0.67-1.44; p = 0.94). Cardiac death (RR: 0.81; 95 % CI: 0.56-1.17; p = 0.26), major bleeding (RR: 0.90; 95 % CI: 0.61-1.33; p = 0.61), reflecting a 10 % non-significant relative reduction, repeat revascularization showed no significant difference (RR: 0.95; 95 % CI: 0.74-1.23; p = 0.72) representing a slight 5 % relative reduction, target vessel revascularization did not reveal any significant differences (RR: 0.89; 95 % CI: 0.69-1.16; p = 0.40) corresponding to a non-significant relative risk reduction of 11 %, stent thrombosis demonstrated no statistically significant difference (RR: 0.78; 95 % CI: 0.27-2.31; p = 0.66) RRR of 22 %. Compared to aspirin Clopidogrel was associated with reduction in MACE with no significant differences in Mortality, Major bleeding, MI, and repeat revascularization between groups. PROSPERO REGISTRATION NUMBER: CRD420251042349.

PMID:40537309 | DOI:10.1016/j.carrev.2025.06.006

Curr Cardiol Rep. 2025 Jun 19;27(1):96. doi: 10.1007/s11886-025-02249-0.

ABSTRACT

PURPOSE OF REVIEW: To provide an overview of up-to-date treatment practices for in-stent restenosis (ISR).

RECENT FINDINGS: ISR is treated with similar effectiveness by paclitaxel drug coated balloons and second-generation drug eluting stents. Sirolimus coated balloons are an emerging technology that requires further investigation. The management of ISR remains challenging even with the newest generation of drug-eluting stents. The use of intravascular imaging is highly recommended to identify the mechanisms of stent failure and to tailor the method of treatment, whether it is plain old balloon angioplasty, plaque/calcium modifying tools such as intravascular lithotripsy or rotational atherectomy, additional drug eluting stents, or drug coated balloons. Paclitaxel drug coated balloons are the most recent technological advancement which has provided an option to treat ISR that doesn't require further layers of metal. Currently, other drug coatings are being studied but it is unclear whether these balloons are as effective as paclitaxel coated balloons, with ongoing trials designed to answer this question.

PMID:40536538 | DOI:10.1007/s11886-025-02249-0

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):955-957. doi: 10.1007/s12055-025-01973-0. Epub 2025 May 8.

ABSTRACT

In this review, we critically examine the 5-year outcomes of the Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease (FAME 3) trial. While the composite outcome of death, stroke, or myocardial infarction showed no significant difference between the two strategies at 5 years, percutaneous coronary intervention was associated with higher rates of myocardial infarction and repeat revascularization. Coronary artery bypass graft surgery demonstrated greater benefit in patients with more complex coronary lesions. These findings stress the need for cautious interpretation of the trial findings and emphasize the value of long-term follow-up in assessing meaningful differences in clinical outcomes.

PMID:40535222 | PMC:PMC12170967 | DOI:10.1007/s12055-025-01973-0

J Med Case Rep. 2025 Jun 18;19(1):282. doi: 10.1186/s13256-025-05341-9.

ABSTRACT

BACKGROUND: Calcified nodules within coronary stents are increasingly recognized as contributors to in-stent restenosis and stent thrombosis, which pose significant cardiovascular risks. Advanced imaging techniques, such as optical coherence tomography, have been crucial in detecting calcified nodules, which are more prevalent in patients undergoing hemodialysis and those with pre-existing calcified lesions.

CASE PRESENTATION: A 67-year-old British man with a history of diabetes, hypertension, and heart failure presented with chest pain, dyspnea, and diaphoresis, leading to a diagnosis of non-ST-elevation myocardial infarction based on elevated troponin and B-type natriuretic peptide levels. Imaging revealed significant coronary artery disease, including a patent left anterior descending stent with focal stenosis due to a calcified nodule, chronic total occlusion of the left circumflex artery, and right coronary artery occlusion. The patient was treated with intravenous lithotripsy and balloon angioplasty, along with medical therapy, including dual antiplatelet therapy, statins, beta-blockers, angiotensin-converting enzyme inhibitors, and diuretics. The discussion highlights the challenges of managing calcified coronary lesions, comparing rotational atherectomy, intravenous lithotripsy, and conventional stenting techniques. While rotational atherectomy is effective for superficial plaque modification, intravenous lithotripsy offers deeper calcium modification with fewer complications, though both modalities require careful patient selection for optimal outcomes.

CONCLUSION: Calcified nodules within coronary stents are a significant cause of in-stent restenosis and thrombosis, leading to adverse cardiovascular events. Advanced imaging techniques such as intravascular ultrasound and optical coherence tomography are crucial for early detection and accurate diagnosis. Effective management of calcified nodule-related lesions remains challenging, with rotational atherectomy and intravenous lithotripsy emerging as viable adjunctive therapies for optimal stent expansion. This case highlights the successful use of rotational atherectomy in treating a patient with severe in-stent calcification presenting with non-ST-elevation myocardial infarction. A tailored approach combining advanced imaging, lesion preparation, and optimal stent deployment is essential for improving outcomes in patients with complex calcified coronary disease.

PMID:40533839 | PMC:PMC12178041 | DOI:10.1186/s13256-025-05341-9

J Nucl Med. 2025 Jun 18:jnumed.125.269457. doi: 10.2967/jnumed.125.269457. Online ahead of print.

ABSTRACT

Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest (MBFrest) and stress (MBFstress). Methods: Consecutive patients undergoing 82Rb PET imaging with regadenoson stress testing at a tertiary care center between August 2019 and August 2024 were included in this study. The 2 coprimary outcomes were a composite of death or heart failure (HF) hospitalization and a composite of myocardial infarction (MI) or late revascularization. Multivariable Andersen-Gill Cox models with robust variance estimators were used to incorporate recurrent events. Outcomes were modeled as a smooth function of MBFstress and MBFrest, with restricted cubic splines to allow nonlinearity. Results: The analysis included 8,131 consecutive patients (median age of 68 y; 46.1% were women; median follow-up of 520 d (interquartile range, 186-921 d), among whom 471 deaths, 828 HF hospitalizations, 164 MIs, and 429 late revascularizations occurred. After adjusting for the relevant covariates, an MFR of 2 achieved through a lower MBFrest was associated with a significantly lower incidence of death and HF hospitalization, whereas an MFR of 2 achieved through a greater MBFstress was associated with a significantly lower incidence of MI and late revascularization. Assessments of the partial χ2 statistic, which measures the importance of predictors, similarly confirmed that MBFrest was more important for predicting death or HF hospitalization whereas MBFstress was more important for predicting MI or late revascularization. Conclusion: Measurements of absolute myocardial blood flow offer complementary prognostic value to MFR. A diminished MBFstress may signal a greater risk of future ischemic outcomes, whereas an elevated MBFrest may signal a greater risk of future death or HF hospitalization.

PMID:40533355 | DOI:10.2967/jnumed.125.269457

Harefuah. 2025 Jun;164(6):388-389.

ABSTRACT

A 61-year-old man with a complex cardiovascular history and chronic kidney disease was hospitalized with an anterior STEMI and found on catheterization to have severe occlusions in multiple coronary arteries. He underwent PCI followed by urgent coronary artery bypass surgery. On the day after the surgery, he developed acute abdominal pain, and a CTA revealed thrombosis of the superior mesenteric artery (SMA) with ischemia of the small intestine - a condition that was treated surgically with bowel resection and thrombectomy.

PMID:40530637

J Cardiovasc Med (Hagerstown). 2025 Jun 6. doi: 10.2459/JCM.0000000000001744. Online ahead of print.

ABSTRACT

AIMS: Inflammation is a main pathophysiological driver in atherosclerotic cardiovascular diseases (ASCVD). Low-dose long-term colchicine for secondary prevention in patients with established ASCVD has been studied in multiple randomized trials in the last decade.This meta-analysis aimed to evaluate the efficacy and safety of long-term low-dose colchicine for secondary prevention in patients with established ASCVD.

METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate studies reporting long-term outcomes in patients with ASCVD. We systematically searched PubMed, EMBASE and Scopus databases for relevant studies up to 1 December 2024. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), a composite of cardiovascular death (CVD), myocardial infarction (MI) and stroke. Random-effects models were used to calculate pooled risk ratios (RRs).

RESULTS: Ten randomized clinical trials enrolling 22 532 patients were identified. Addition of colchicine to standard medical treatment in patients with established ASCVD reduced the risk for MACE by 27% [RR 0.73, 95% confidence interval (CI) 0.57-0.95], with a number needed to treat of 52. Colchicine was found to significantly reduce the risk of MI (RR 0.83, 95% CI 0.72-0.96) and coronary revascularization (RR 0.79, 95% CI 0.65-0.94). There were no significant differences between the two groups concerning cardiovascular and noncardiovascular mortality, risk of serious gastrointestinal events, infections requiring hospitalization and cancer.

CONCLUSIONS: These findings support the use of long-term low-dose colchicine for secondary prevention of MACE in clinical practice.

PMID:40530569 | DOI:10.2459/JCM.0000000000001744

Zhonghua Xin Xue Guan Bing Za Zhi. 2025 Jun 24;53(6):679-682. doi: 10.3760/cma.j.cn112148-20240605-00312.

ABSTRACT

冠状动脉旁路移植术（CABG）是冠状动脉多支病变患者的主要治疗手段之一，乳内动脉桥血管对于CABG术后患者的远期生存率至关重要。该文报道1例CABG术后罹患主动脉弓部动脉瘤患者，且主动脉瘤开口位于左锁骨下动脉开口处，造成的血肿亦累及左锁骨下动脉，应用一体式分支型支架联合体外开窗及内分支技术，在处理主动脉弓部动脉瘤的同时保证了颈动脉及乳内动脉的供血。术后患者恢复良好，未见明显并发症。.

PMID:40528607 | DOI:10.3760/cma.j.cn112148-20240605-00312

A A Pract. 2025 Jun 17;19(6):e02000. doi: 10.1213/XAA.0000000000002000. eCollection 2025 Jun 1.

ABSTRACT

The serratus posterior superior intercostal plane block (SPSIPB) is a novel regional anesthesia technique providing broad dermatomal coverage. We present 2 patients who underwent coronary artery bypass grafting via median sternotomy and received bilateral SPSIPB for postoperative analgesia. Both patients exhibited effective pain control with low numeric rating scale scores and minimal morphine consumption (8 mg and 10 mg, respectively) within the first 24 postoperative hours, without any complications. These findings support the potential role of SPSIPB as a safe and effective component of multimodal analgesia in cardiac surgery, particularly in patients at increased risk for neuraxial techniques. .

PMID:40525732 | DOI:10.1213/XAA.0000000000002000

Ann Thorac Surg Short Rep. 2024 Nov 14;3(2):402-407. doi: 10.1016/j.atssr.2024.10.024. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Despite sternum sparing and without cardiopulmonary bypass, the actual value of minimally invasive coronary surgery (MICS) is still debatable. This study aimed to compare the completeness of revascularization and intermediate-term outcomes of MICS with conventional sternotomy coronary artery bypass grafting (CABG).

METHODS: Two groups of 244 patients each receiving MICS-CABG and sternotomy-CABG between November 2015 and March 2019 were matched by propensity score matching. The completeness of revascularization and major adverse cardiovascular and cerebrovascular events (MACCE; a composite of death, myocardial infarction, stroke, or repeated target vessel revascularization) were compared between the groups.

RESULTS: In the MICS-CABG group, the percentages of bypassed vessels 2, 3, and ≥4 were 53.7%, 36.1%, and 10.2%, respectively. Completeness of revascularization (95.5% vs 96.3%; P = .65) was comparable between MICS-CABG and sternotomy-CABG groups. Postprocedural angiography revealed an overall patency of 96.2% (578/601) for the MICS-CABG group. At 5 years, rates of MACCE (19.9% vs 22.1%; hazard ratio [HR], 0.80; 95% CI, 0.49-1.32; P = .39), death (10.6% vs 12.9%; HR, 0.87; 95% CI, 0.46-1.65; P = .67), myocardial infarction (5.6% vs 4.2%; HR, 0.82; 95% CI, 0.27-2.52; P = .73), stroke (6.7% vs 6.6%; HR, 1.11; 95% CI, 0.43-2.86; P = .83), and repeated target vessel revascularization (1.9% vs 1.8%; HR, 0.85; 95% CI, 0.17-3.15; P = .84) were similar between MICS-CABG and sternotomy-CABG.

CONCLUSIONS: MICS-CABG, which appeared to yield noninferior completeness of revascularization and intermediate-term MACCE compared with sternotomy-CABG, could be an alternative for patients with multivessel coronary diseases.

PMID:40525194 | PMC:PMC12167539 | DOI:10.1016/j.atssr.2024.10.024