http:www.cardiocirugia.sld.cu

Res Pract Thromb Haemost. 2025 May 21;9(4):102897. doi: 10.1016/j.rpth.2025.102897. eCollection 2025 May.

ABSTRACT

BACKGROUND: The incidence of left ventricular thrombus (LVT), a significant complication postacute myocardial infarction (AMI), has seen a decline in the percutaneous coronary intervention era. Patients may not undergo coronary revascularization due to medical contraindications or patient preference.

OBJECTIVES: This study compared post-AMI LVT patients treated with or without revascularization.

METHODS: This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from an echocardiography database. Patients were stratified by their revascularization status.

RESULTS: Mean (SD) follow-up duration was 2.1 ± 2.1 years. Most post-AMI LVT patients underwent revascularization via percutaneous coronary intervention (71.5%; n = 188). Unrevascularized patients (24.0%; n = 63) were older (P < .001), more often female (P < .001), more comorbid, less likely to have anterior AMI (P < .001), or treated with anticoagulation (P < .001). In multivariable analysis, at least anticoagulation + P2Y12 inhibitor (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.14-2.96; P = .01), but not revascularization (aHR, 1.25; 95% CI, 0.74-2.13; P = .40), was associated with LVT resolution. Both absence of revascularization (aHR, 2.30; 95% CI, 1.09-4.85; P = .03) and LVT resolution (aHR, 6.06; 95% CI, 2.99-12.3; P < .001) were associated with higher mortality after adjusting for age, sex, anemia, anterior AMI, and ejection fraction.

CONCLUSION: Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution. Optimizing medical therapy remains a key treatment goal.

PMID:40599364 | PMC:PMC12210294 | DOI:10.1016/j.rpth.2025.102897

Sci Rep. 2025 Jul 1;15(1):21479. doi: 10.1038/s41598-025-05578-w.

ABSTRACT

Drug-Coated Balloons (DCB) have been widely used in interventional treatment for coronary artery de novo lesions. However, DCB treatment still have a certain proportion of target vessel restenosis (TLR) and adverse follow-up events. Quantitative flow ratio (QFR) loss are important indicators for evaluating long-term vascular functional changes. However, in patients with de novo lesions treated by DCB, the potential risk and protective factors affecting QFR loss remain unclear. The aim of this study was to explore the factors affecting QFR loss in patients with de novo lesion after DCB-angioplasty. Patients who underwent DCB-only intervention de novo lesions and underwent coronary angiography within 12 ± 3 months were enrolled. The QFR loss was defined as difference between the immediate post-procedure QFR and follow-up QFR. The subjects were divided into high QFR loss and low QFR loss groups according to the binary method. The predictors of QFR loss were then analyzed. A total of 115 patients with 1-year follow-up were included in this study, and the median follow-up time was 357 days. Multivariate Logistic analysis showed that patients with diabetes mellitus (OR = 4.937, 95%CI 1.497-16.278, P = 0.009) and LDL-C > 1.8 mmol/L (OR = 2.575, 95%CI 1.021-6.493, P = 0.045) was significantly associated with higher QFR loss 1 year after surgery. In patients undergoing DCB treatment for coronary de novo lesions, diabetes is an independent risk factor for late QFR loss at 1 year. Conversely, achieving LDL-C targets during follow-up is an independent protective factor against late QFR loss at 1 year.

PMID:40594463 | PMC:PMC12216008 | DOI:10.1038/s41598-025-05578-w

Sci Rep. 2025 Jul 1;15(1):21890. doi: 10.1038/s41598-025-08181-1.

ABSTRACT

In the patients receiving coronary artery bypass grafting (CABG), arterial stiffness is an independent predictor of disease-related mortality. Higher serum levels of big endothelin-1 (BigET-1) are associated with arterial stiffness. The present study aimed to determine the association between serum BigET-1 levels and arterial stiffness in patients undergoing CABG. A total of 90 patients undergoing CABG were enrolled in the study. Serum levels of BigET-1 are examined with a commercial sandwich enzyme immunoassay. If carotid-femoral pulse wave velocity (cfPWV) > 10 m/s, arterial stiffness is diagnosed. In the study cohort, 30 (33.3%) patients with arterial stiffness were older and had lower body mass index, higher rates of diabetes mellitus and hypertension, higher systolic and diastolic blood pressures, and higher serum BigET-1 levels compared to the controls. Multivariable logistic regression analysis revealed that serum BigET-1 > 1 pg/mL was an independent predictor of arterial stiffness (odds ratio 17.492, 95% confidence interval 2.728-112.147, p = 0.003). Multivariable linear regression analysis revealed that cfPWV significantly correlated with age (β = 0.238, adjusted R2 change = 0.043, p = 0.004), systolic blood pressure (β = 0.251, adjusted R2 change = 0.102, p = 0.002), and BigET-1 level (β = 0.533, adjusted R2 change = 0.387, p < 0.001). Increased serum BigET-1 levels were associated with arterial stiffness in patients undergoing CABG.

PMID:40593258 | PMC:PMC12219143 | DOI:10.1038/s41598-025-08181-1

Cardiovasc Revasc Med. 2025 Jun 20:S1553-8389(25)00305-7. doi: 10.1016/j.carrev.2025.06.019. Online ahead of print.

ABSTRACT

BACKGROUND: Left main coronary artery disease (LMCAD) complexity is assessed using the SYNTAX score. High scores may reflect complex LM lesions or multivessel disease. Evidence on the prognosis of these distinct populations is scarce.

METHODS: Patients undergoing percutaneous coronary intervention (PCI) for unprotected LMCAD were categorized into four groups based on LM lesion location (Body/Ostial vs. Bifurcation) and non-LM SYNTAX score (≤8 vs. >8). The reference group was Body/Ostial cases with low non-LM score. The primary endpoint was Major Adverse Cardiac Events (MACE), composite of death, myocardial infarction, or target vessel revascularization (TVR) at 1 year.

RESULTS: Out of 869 patients undergoing LM PCI, 69.2 % had a LM bifurcation lesion, and 44.8 % non-LM SYNTAX score >8. Patients with high non-LM score (>8) were older, had higher rates of chronic kidney disease, and were more likely to present with congestive heart failure or low ejection fraction. After adjustment, both groups with LM bifurcation disease had higher rates of 1-year MACE, driven by TVR. In contrast, there was no difference between the Body/Ostial lesion with high non-LM score group and the reference group.

CONCLUSION: Amongst patients undergoing LM PCI, those with LM bifurcation lesions are more likely to require repeat revascularization, regardless of non-LM SYNTAX score. Lesion complexity should be considered separately from the number of lesions.

PMID:40592694 | DOI:10.1016/j.carrev.2025.06.019

Clin Cardiol. 2025 Jul;48(7):e70170. doi: 10.1002/clc.70170.

ABSTRACT

BACKGROUND: High-intensity statins are recommended for patients with chronic coronary artery disease, with reports suggesting improved clinical outcomes. However, recent findings in coronary artery bypass graft (CABG) patients question whether a treat-to-target low density lipoprotein (LDL) approach is non-inferior to high-intensity statin therapy.

METHODS: This single-center observational study analyzed all CABG only (n = 1854) procedures performed between 2013 and 2015. Patients were divided into three groups based on statin prescription: high-intensity statin therapy (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg), low/moderate-intensity statin therapy, and a no-statin group. The primary outcome measured was major adverse cardiovascular events (MACE), a composite of post-CABG acute coronary syndrome, cerebrovascular accident and cardiovascular mortality.

RESULTS: No-Statin group had significantly higher incidence of MACE compared to statin group (14.2% vs 8.9%; odds ratio (OR) 1.60, 95% confidence interval (CI) 1.055-2.427, p = 0.029). Low/moderate-intensity therapy (n = 1301) was associated with a numerically higher overall rate of MACE compared to high-intensity therapy (n = 397) but was not statistically significant (9.6% vs 6.6%; OR 1.45, CI 0.961-2.172, p = 0.073). Beyond 2 years post-CABG, low/moderate intensity statin use was associated with a significant higher incidence of MACE (9.1% vs 5.3%; OR 1.72, 95% CI 0.993-2.978, p = 0.047) compared to high intensity statins. Patients who received high-intensity statin therapy had the lowest LDL levels (82.21 ± 41.85 mg/dL), compared to those on low/moderate-intensity statins (90.84 ± 45.89 mg/dL) and no-statin group (104.83 ± 38.93 mg/dL, p < 0.001).

CONCLUSION: High-intensity statin therapy following CABG is associated with improved long-term clinical outcomes compared to low- or moderate-intensity statin regimens.

PMID:40590628 | PMC:PMC12210389 | DOI:10.1002/clc.70170

Eur Heart J. 2025 Jul 1:ehaf284. doi: 10.1093/eurheartj/ehaf284. Online ahead of print.

ABSTRACT

The diagnosis of refractory angina has conventionally been limited to patients with angina and ischaemia secondary to obstructive atherosclerotic epicardial coronary disease who experience persistent symptoms despite optimal pharmacological and revascularization therapies. It is now well-established that angina may also be caused by ischaemia resulting from coronary microcirculatory disorders, coronary vasospasm, and bridging in the absence of obstructive epicardial coronary disease or after "successful" revascularization. This increasingly prevalent and symptomatic group of patients, with both angina and demonstrable ischaemia, have been excluded from the conventional definition of refractory angina. In patients with obstructive epicardial coronary disease, disturbed microcirculatory and vasomotor function, amongst other ischaemic mechanisms, may account for continuing symptoms despite revascularization. Under-recognition of these mechanisms results in inadequate treatment and symptom persistence. In this review, a redefinition of refractory angina is proposed to include the full spectrum of patients experiencing persistent angina despite current maximal guideline-directed medical and revascularization therapies. Systematic approaches for comprehensive investigation are suggested to identify underlying mechanisms of ischaemia and stratify treatments accordingly. The complex needs of patients with refractory angina are likely best addressed by an inter-disciplinary Angina Heart Team with the aim of improving patient symptoms, quality of life, and clinical outcomes.

PMID:40590516 | DOI:10.1093/eurheartj/ehaf284

Int J Epidemiol. 2025 Jun 11;54(4):dyaf079. doi: 10.1093/ije/dyaf079.

ABSTRACT

BACKGROUND: Migraine aura without headache was previously described as a benign condition. We investigated an association between migraine aura without headache and risks of stroke, myocardial infarction (MI) or percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), atrial fibrillation or flutter, and composite outcome (MI, PCI, and CABG).

METHODS: We conducted a nationwide, registry-based cohort study in Denmark in 2003-18, which included 755 individuals with typical aura without headache, 11 420 individuals who experience migraine with aura, 13 415 individuals who experience migraine without aura, 12 000 individuals with unspecified migraine, and a comparison cohort of 702 755 individuals aged 15-80 years randomly sampled from the general population. We computed incidence rates (IRs) per 1000 person-years (PYs) of the outcomes and hazard ratios (aHRs) adjusted for age, sex, calendar year, and pre-existing chronic conditions in Cox proportional-hazards regression analyses.

RESULTS: The IR per 1000 PYs among individuals experiencing aura without headache were 4.58 (2.09-7.07) for stroke, 2.10 (0.42-3.79) for MI or PCI, 0.69 (0.00-1.66) for CABG, and 4.95 (2.35-7.54) for atrial fibrillation or flutter. Individuals who experience aura without headache versus the comparator had increased risks of stroke [aHR: 2.58, 95% confidence interval (CI): 1.49-4.44] and atrial fibrillation or flutter (aHR: 2.22, 1.31-3.75). Associations with MI or PCI (aHR: 1.56, 0.70-3.47), CABG (aHR: 2.66, 0.66-10.65), and composite outcome (aHR: 1.65, 95% CI: 0.79-3.46) were in the same direction, but lacked precision.

CONCLUSION: Aura without headache was associated with increased risks of stroke and atrial fibrillation or flutter; associations with remaining outcomes could not be ruled out.

PMID:40587417 | DOI:10.1093/ije/dyaf079

CJC Open. 2025 Mar 26;7(6):777-783. doi: 10.1016/j.cjco.2025.03.016. eCollection 2025 Jun.

ABSTRACT

Patients with chest pain and symptoms of acute coronary syndromes account for > 600,000 emergency department (ED) visits annually in Canada. Of these patients, 85% do not have acute coronary syndromes, and most are discharged from the ED after a thorough evaluation. However, a large proportion of these patients are referred for outpatient cardiac testing after ED discharge, even though their short-term risk of major adverse cardiac events (MACE), including death, new myocardial infarction, and need for revascularization, is very small. These referrals contribute to substantial low-value healthcare utilization, and limit access for those patients who are more likely to benefit from objective testing.Existing risk-prediction tools-developed prior to the advent of new high-sensitivity cardiac troponin assays-were derived in nonrepresentative populations, and when applied to ED patients with low cardiac troponin concentrations, systematically overestimate the short-term risk of MACE.This multicentre prospective cohort study will enroll ED patients with chest pain to derive and validate a novel risk prediction tool that distinguishes patients at low risk of MACE who do not require further cardiac testing from those who may benefit from additional cardiac testing. We will enroll 6500 patients in 13 Canadian EDs and prospectively follow them to ascertain a primary outcome of MACE within 30 days after their index ED encounter. The risk-prediction tool developed in this project will guide the safe, efficient, and appropriate referral of ED patients with chest pain.

CLINICAL TRIAL REGISTRATION: NCT06743672.

PMID:40586028 | PMC:PMC12198596 | DOI:10.1016/j.cjco.2025.03.016

CJC Open. 2025 Mar 22;7(6):719-724. doi: 10.1016/j.cjco.2025.03.012. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Our institution implemented a clinical pathway to facilitate early hospital discharge (EHD) in < 48 hours post-primary percutaneous coronary intervention for low-risk ST elevation myocardial infarction. This study characterizes the exclusion criteria, barriers, safety profile, and patient satisfaction for EHD.

METHODS: We prospectively identified all patients with ST-elevation myocardial infarction between January 2023 and March 2024. Patient characteristics, potential EHD barriers and 30-day readmission rates were recorded. A postdischarge telephone survey assessed patient satisfaction. Patients discharged at ≤ 48 hours formed the EHD cohort; those discharged later comprised the non-EHD cohort. Statistical comparisons were performed using the chi-squared and Mann-Whitney U tests, with logistic regression assessing EHD barriers.

RESULTS: Among 433 STEMI patients, 65% (n = 282) were ineligible for EHD, primarily due to revascularization needs (29%) or infarct-related complications (47%). Of 151 eligible patients, 72% (n = 109) achieved EHD. Afternoon presentations were associated with higher EHD rates (82% vs 61%, odds ratio = 3.5, 95% confidence interval 1.57-7.83, P = 0.002). Rates of 30--day readmission were lower in the EHD cohort (0% vs 7%, P = 0.007). Patient satisfaction (96% vs 95%, P = 0.841), perceived appropriate length of stay (91% vs 82%, P = 0.15), and intention to attend cardiac rehabilitation (63% vs 67%, P = 0.73) were comparable between cohorts.

CONCLUSIONS: Revascularization considerations and infarct-related complications were the most common reason for exclusion. Morning or overnight admissions were potential barriers to EHD, suggesting a role for optimized discharge planning. No adverse impacts on safety or patient satisfaction occurred.

PMID:40586018 | PMC:PMC12198500 | DOI:10.1016/j.cjco.2025.03.012

Theranostics. 2025 Jun 9;15(14):6737-6752. doi: 10.7150/thno.110162. eCollection 2025.

ABSTRACT

Rationale: Myocardial ischemia reperfusion (I/R) injury is a major cause of adverse outcomes following revascularization therapy. Although alterations in metabolic activities during reperfusion have been implicated, the molecular mechanisms underlying the pathogenesis of I/R injury remain elusive. Metaxin 2 (MTX2), initially identified as a core component of protein import complexes, has recently been characterized in diverse cellular functions. Nevertheless, its involvement in myocardial I/R injury has yet to be fully elucidated. In this study, we aim to evaluate the role and the underlying mechanism of MTX2 in I/R injury. Methods: The myocardial I/R model was established, and the protein levels of MTX2 were determined at different time points following coronary occlusion. Loss-of-function and gain-of-function strategies were applied via genetic ablation or intra-myocardial adenovirus injection to ascertain the role of MTX2 in myocardial I/R injury. RNA sequencing, seahorse metabolic analysis, and mass spectrometry were conducted to uncover the underlying molecular mechanisms. Results: We observed that the expression of MTX2 was significantly decreased in I/R hearts. Tamoxifen-induced cardiomyocyte-specific deletion of Mtx2 led to aggravated myocardial I/R injury, resulting in impaired cardiac oxidative phosphorylation and glycolysis. Mechanistically, dimeric PKM2, a less active pyruvate kinase form compared with tetrameric PKM2, was found to be dramatically accumulated in Mtx2 deficiency mice after myocardial I/R surgery. The TOM37 domain of MTX2 interacted directly with PKM2 to promote PKM2 tetramerization, thereby modulating glucose metabolic flux. Pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, rescued the metabolic and functional outcomes of I/R in Mtx2 deficiency mice. Conclusions: Our results identified, for the first time, a cardioprotective role of MTX2 in modulating cardiac glucose metabolism by facilitating PKM2 tetramerization. Targeting metabolic homeostasis by restoring MTX2 might be a promising therapeutic strategy to mitigate myocardial I/R injury.

PMID:40585998 | PMC:PMC12203670 | DOI:10.7150/thno.110162

Multimed Man Cardiothorac Surg. 2025 Jun 30;2025. doi: 10.1510/mmcts.2025.048.

ABSTRACT

Total arterial, anaortic, off-pump coronary artery bypass grafting is seen by many as a complex, specialized operation; however, when broken down into its component parts, it can be approached as multiple reproducible techniques that all trainees should master. These components include skeletonized mammary harvest, construction of composite arterial grafts and off-pump cardiac surgery. In this video tutorial, we describe step-by-step approaches to each of these elements and demonstrate how these principles come together to facilitate an excellent surgical outcome for the patient: revascularization of all diseased coronary arteries with arterial grafts while avoiding arresting the heart or aortic manipulation.

PMID:40583699 | DOI:10.1510/mmcts.2025.048

Inflamm Res. 2025 Jun 30;74(1):99. doi: 10.1007/s00011-025-02058-9.

ABSTRACT

BACKGROUND: Treatment effects of anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in coronary artery disease (CAD) had conflicting results. The study aims to evaluate efficacy and safety outcomes of treatments inhibiting this pathway.

METHODS: Cochrane Library, Embase, Pubmed, and ClinicalTrials.gov were searched for randomized controlled trials evaluating therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in CAD patients. Relative risks (RR) with 95% confidence intervals (CI) were calculated.

RESULTS: 32 studies and 37,056 individuals were included. Anti-inflammatory therapies inhibiting the pathway reduced the risks of myocardial infarction (MI) (RR 0.85, 95% CI 0.78-0.93) and coronary revascularization (RR 0.80, 95% CI 0.74-0.86), with no benefits in major adverse cardiovascular events (MACE), heart failure (HF), stroke, cardiovascular or all-cause mortality. Colchicine reduced the risks of MACE, MI, and coronary revascularization. IL-1 inhibitors reduced the risks of coronary revascularization, with potential benefits in MI and HF. Increased risks of infections, gastrointestinal adverse effects, and injection site reactions were found. Meta-regression analysis demonstrated that post-treatment hsCRP/CRP was correlated with MACE (p < 0.001) and MI (p = 0.048) and post-treatment IL-6 was associated with MI (p = 0.033).

CONCLUSION: Anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway had satisfying safety profiles and were beneficial in preventing MI and coronary revascularization in CAD patients despite no benefits in stroke, cardiovascular, or all-cause mortality.

PMID:40583093 | PMC:PMC12206679 | DOI:10.1007/s00011-025-02058-9

Med Princ Pract. 2025 Jun 27:1-16. doi: 10.1159/000547099. Online ahead of print.

ABSTRACT

OBJECTIVES: This meta-analysis compared the efficacy and safety of drug coated balloon (DCB) angioplasty with drug eluting stent (DES) for the treatment of de novo coronary artery disease.

METHODS: Following PRISMA guidelines, we conducted a systematic search of major databases, including Cochrane, MEDLINE, Embase and clinicaltrials.gov, to identify eligible randomized controlled trials (RCTs) comparing DCB and DES. Mantel-Haenszel model was used for dichotomous outcomes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model using RevMan software.

RESULTS: Thirteen RCTs with a total of 4,686 patients were included. The analysis found no significant differences between DCB and DES for all-cause mortality (RR: 1.11, 95% CI: 0.81-1.53, p = 0.51) or myocardial infarction (RR: 0.80, 95% CI: 0.56-1.15, p = 0.23). Similarly, no significant differences were observed for cardiac death (RR: 1.33, 95% CI: 0.86-2.05, p = 0.19), target lesion revascularization (RR: 1.19, 95% CI: 0.64-2.21, p = 0.59), or target vessel revascularization (RR: 1.34, 95% CI: 0.79-2.28, p = 0.28).

CONCLUSION: This meta-analysis demonstrates comparable efficacy and safety outcomes for DCBs and DES in the treatment of de novo coronary artery disease. While DCBs offer a viable alternative, particularly for high-risk patients or those unsuitable for prolonged dual antiplatelet therapy, further large-scale studies are warranted to strengthen these findings and refine clinical recommendations.

PMID:40582348 | DOI:10.1159/000547099

Eur Heart J. 2025 Jun 23:ehaf446. doi: 10.1093/eurheartj/ehaf446. Online ahead of print.

NO ABSTRACT

PMID:40581490 | DOI:10.1093/eurheartj/ehaf446

Microvasc Res. 2025 Jun 26:104838. doi: 10.1016/j.mvr.2025.104838. Online ahead of print.

ABSTRACT

OBJECTIVES: We investigated the predictive value of the average microvascular resistance of the three main vessels (3VA-AMR) for the prognosis of patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI).

METHODS: This study was conducted on patients with NSTEMI who underwent PCI between March 1, 2021, and February 28, 2022, at Fujian Medical University Union Hospital. Quantitative flow ratio (QFR) analysis was conducted on all patients' PCI angiography images to assess postoperative QFR and angio-based microvascular resistance (AMR) for three main vessels. All enrolled patients were devided into two groups based on the criteria for coronary microvascular dysfunction (CMD): high 3VA-AMR group and low 3VA-AMR group. The primary outcome was 2-year major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and ischemia-driven revascularization.

RESULTS: A total of 290 patients were included in the final analysis. Compared with the low 3VA-AMR group, the three vessels of high 3VA-AMR group showed lower area stenosis (49.46 ± 13.70 % vs. 52.93 ± 15.43 %，P = 0.001), higher QFR value (0.92 ± 0.05 vs. 0.88 ± 0.09, P < 0.001), and higher AMR value (274.50 [257.33-301.42] mmHg*s/m vs. 208.00 [182.00-231.83] mmHg*s/m, P < 0.001). The incidence of 2-year MACEs was significantly higher in the high 3VA-AMR group than in the low 3VA-AMR group (21.90 % vs. 10.27 %, P = 0.007). Univariate and multivariate Cox regression analyses confirmed that 3VA-AMR was independently associated with 2-year MACEs (HR:1.007, 95 % CI:1.004-1.010, P < 0.001). The Kaplan-Meier method further confirmed the difference in 2-year MACE risk between two groups. Receiver operating characteristic curve analysis showed a significant correlation between 3VA-AMR and MACE (area under the curve: 0.701, P < 0.001).

CONCLUSIONS: 3VA-AMR was an independent risk factor for 2-year MACEs in NSTEMI patients. Compared with target-vessel AMR, 3VA-AMR demonstrated superior predictive value for 2-year MACEs following PCI.

PMID:40581281 | DOI:10.1016/j.mvr.2025.104838

Rev Port Cardiol. 2025 Jun 26:S0870-2551(25)00188-X. doi: 10.1016/j.repc.2025.01.009. Online ahead of print.

ABSTRACT

AIM: We performed a systematic review to compare revascularization to optimal medical therapy (OMT) alone in reducing mortality and improving cardiovascular outcomes, in women with chronic coronary syndrome, due to obstructive coronary artery disease.

METHODS: PUBMED/EMBASE and CINAHL were searched for randomized trials comparing routine revascularization versus OMT alone in patients with chronic coronary syndrome. We extracted data regarding cardiovascular death, myocardial infarction, heart failure and relief of angina in women. Published data from sub-group analysis in women were the primary sources.

RESULTS: Four randomized clinical trials that enrolled 10 722 patients followed for a mean 4.5 years of follow-up fulfilled our inclusion criteria. 2401 women were included in these trials. Male patients with preserved left ventricular systolic function and without left main disease, formed the majority of trial participants. Compared with medical therapy alone, revascularization was not associated with a reduced risk of death or myocardial infarction, among women. Greater relief from angina and reduction in heart failure hospitalization was observed with revascularization in women in some studies.

CONCLUSIONS: Routine revascularization was not associated with improved survival or decreased rates of myocardial infarction in women when compared to OMT as an initial approach. Better relief from angina, and decreased hospitalizations due to heart failure were noted. Women continue to be underrepresented in clinical trials which limits our ability to draw robust conclusions.

PMID:40581179 | DOI:10.1016/j.repc.2025.01.009

Expert Rev Cardiovasc Ther. 2025 Jun 28. doi: 10.1080/14779072.2025.2527707. Online ahead of print.

ABSTRACT

BACKGROUND: Acute limb ischemia (ALI) is a critical vascular emergency marked by a sudden reduction in blood flow to the limb, significantly increasing amputation risk. Revascularization outcomes in urban versus rural areas have not been examined.

RESEARCH DESIGN AND METHODS: The National Inpatient Sample from 2016 to 2021 identified patients with ALI who underwent revascularization. Propensity score matching compared outcomes, analyzed using STATA version 18.

RESULTS: Of 85,760 hospitalizations for ALI receiving percutaneous revascularization 81,880 (95.5%) were in urban centers and 3,880 (4.5%) in rural facilities. Patients in urban hospitals showed higher mortality (4% vs. 2.7%), myocardial infarction (MI) (3.4% vs. 2.7%), cardiogenic shock (1.6% vs. 0.6%), cardiac arrest (6.5% vs. 5.9%), major adverse cardiovascular and cerebrovascular events (MACCE) (7.5% vs. 5.3%), mechanical circulatory support (1.1% vs. 0.5%), and acute kidney injury (18.5% vs. 15.4%). However, urban patients had lower intravascular ultrasound (IVUS) (3.4% vs. 6.5%), major amputation (6.3% vs. 7.8%), fasciotomy (1.8% vs. 2.2%), and major adverse limb events (MALE) (46.4% vs. 49.1%), with a significant difference of p < 0.01 compared to rural hospitals.

CONCLUSIONS: Urban hospitals in the United States report elevated mortality rates and significant cardiovascular events in comparison to their rural counterparts.

PMID:40580162 | DOI:10.1080/14779072.2025.2527707

J Int Med Res. 2025 Jun;53(6):3000605251342671. doi: 10.1177/03000605251342671. Epub 2025 Jun 28.

ABSTRACT

The incidence and mortality of coronary heart disease are increasing annually, and the disease is now one of the leading causes of death in China. Percutaneous coronary intervention has become the preferred approach for treating coronary artery disease. The use of a drug-coated balloon is a new treatment strategy for coronary artery disease that has been shown to be safe and effective in intravascular restenosis, bifurcation disease, and small-vessel disease, and this approach has been extended to other indications, such as large-vessel coronary artery disease. However, some experts believe that the intima muscularis fibrosa of large vessels is thick. After dilation of large vessels with drug-coated balloons, elastic contraction may occur. Additionally, the use of drug-coated balloons cannot prevent the occurrence of vessel dissection; therefore, their use for treating large-vessel coronary disease remains controversial. This review has aimed to discuss the findings of clinical trials demonstrating the efficacy and safety of drug-coated balloons for the treatment of coronary artery de novo large-vessel lesions.

PMID:40579943 | PMC:PMC12206261 | DOI:10.1177/03000605251342671

J Am Heart Assoc. 2025 Jul;14(13):e040848. doi: 10.1161/JAHA.124.040848. Epub 2025 Jun 27.

ABSTRACT

BACKGROUND: The fibrosis-4 index (FIB-4) score, a noninvasive marker of subclinical liver fibrosis, has shown prognostic utility in general surgical populations. Current risk assessment models for patients with coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting do not account for liver dysfunction apart from overt liver cirrhosis. We analyzed the distribution of the baseline FIB-4 score and its association with all-cause death in patients with coronary artery disease using data from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial.

METHODS: The baseline FIB-4 score was calculated for all ISCHEMIA randomized participants with laboratory data (platelet count, aspartate aminotransferase, and alanine aminotransferase). The primary outcome was the association between baseline FIB-4 and all-cause death. Secondary outcomes were cardiovascular death, heart failure, myocardial infarction, and stroke. Multivariable Cox regression was performed adjusting for key risk factors.

RESULTS: The FIB-4 score was calculated for 3735 participants. Baseline FIB-4 score was significantly associated with an increased risk of all-cause (hazard ratio [HR], 1.19 [95% CI, 1.07-1.32]; P=0.001) and cardiovascular death (HR, 1.19 [95% CI, 1.04-1.36]; P=0.011). This association was consistent across the overall population and within subgroups of patients treated with percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy. There was no significant association regarding heart failure, myocardial infarction, and stroke.

CONCLUSIONS: The FIB-4 score may be a significant predictor of death in patients with coronary artery disease. Preprocedural hepatic assessment should be considered to stratify risk in patients undergoing invasive cardiac procedures.

PMID:40576034 | DOI:10.1161/JAHA.124.040848

Ann Nucl Med. 2025 Jun 27. doi: 10.1007/s12149-025-02077-w. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to assess the prognostic value of non-perfusion parameters for gated myocardial perfusion imaging (MPI) performed using Cadmium-Zinc-Telluride (CZT) single-photon emission computed tomography (SPECT) for individuals with normal myocardial perfusion.

METHODS: We analyzed data from consecutive patients who underwent thallium-201 MPI SPECT with normal perfusion. Major adverse cardiovascular events (MACEs) were recorded during a 2-year follow-up. Non-perfusion parameters were evaluated as predictors of MACEs.

RESULTS: Among 1570 patients with normal SPECT perfusion, 80 (5.1%) experienced MACEs over a mean follow-up of 22.5 ± 10.8 months: 12 (0.8%) had cardiac death, and 68 (4.3%) underwent coronary revascularization due to significant coronary artery disease. Independent predictors of MACEs included worsening post-stress ejection fraction (HR: 1.971; p = 0.008), and increased lung-to-heart ratio (HR: 2.207; p = 0.001). Kaplan-Meier analysis showed the highest MACEs' incidence in patients with two of these factors (p < 0.001). Among patients with normal resting ejection fraction, EF worsening (OR: 2.16; p = 0.004) and increased lung-to-heart ratio (OR: 1.91; p = 0.0013) both remained strong predictors.

CONCLUSIONS: Although normal myocardial perfusion typically indicates low risk for obstructive coronary artery disease, worsening post-stress ejection fraction and increased lung-to-heart ratio are crucial prognostic indicators. Importantly, these non-perfusion parameters retain their prognostic value even in patients without clinical heart failure, highlighting their relevance in comprehensive risk stratification beyond perfusion assessment alone.

PMID:40576735 | DOI:10.1007/s12149-025-02077-w