http:www.cardiocirugia.sld.cu

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