Fourth Universal Definition of Myocardial Infarction (2018)

Predictive value of angiographic microvascular resistance for left ventricular thrombus in anterior ST-segment elevation myocardial infarction

Angiographic microvascular resistance (AMR) serves as an effective metric for assessing coronary microvascular status. The aim of this study was to investigate the predictive value of AMR for left ventricular thrombus (LVT) in ST-segment elevation myocardial infarction. This study enrolled 401 consecutive patients with anterior STEMI who underwent primary percutaneous coronary intervention (PPCI) between May 2019 and July 2023. AMR was measured immediately after PPCI via coronary angiography. LVT was identified during hospitalization through cardiac magnetic resonance imaging (CMR) or transthoracic echocardiography (TTE). Major adverse cardiac and cerebrovascular events (MACCEs) were recorded over 36 months follow-up. The predictive value of AMR was evaluated by logistic regression and receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was performed to estimate event-free rates for MACCEs. LVT was identified in 38 out of 401 anterior STEMI patients (9.5%). After adjusting for confounders through multivariable analysis, AMR was found to be an independent predictor of LVT (odds ratio [OR] 1.240 per 0.1 mmHg·s/cm, 95% confidence interval [CI]: 1.131-1.359, P < 0.001). ROC analysis demonstrated an area under the curve (AUC) of 0.742. For LVT, AMR provided modest incremental predictive value over established risk factors (continuous net reclassification improvement, 0.826 [95% CI: 0.523-1.129]; P < 0.001). Furthermore, Kaplan-Meier analysis revealed MACCEs for anterior STEMI patients with AMR ≥ 2.82 (log-rank P < 0.001). AMR is an independent predictor of LVT in anterior STEMI, providing incremental predictive value beyond traditional risk factors, and may be utilized to identify patients at risk for LVT.

Accuracy of the 0/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Atrial Fibrillation

BACKGROUND

Patients with atrial fibrillation (AF) often present with symptoms similar to acute coronary syndrome (ACS), including chest pain and elevated levels of high-sensitivity cardiac troponin (hs-cTn). The 0/1-hour algorithm using hs-cTn is a rapid diagnostic tool endorsed by the European Society of Cardiology to rule out myocardial infarction (MI). However, because its effectiveness in patients with AF remains unclear, in this study we assessed the diagnostic accuracy of the 0/1-hour algorithm in patients with and without AF presenting with chest pain in the emergency department.

METHODS AND RESULTS

We conducted a secondary analysis of the DROP-ACS cohort, including 1,333 patients from Japan and Taiwan, with AF in 10.3% of cases. We examined the algorithm's negative predictive value (NPV), sensitivity, positive predictive value (PPV), and specificity for ruling MI in or out. Patients with AF were more frequently placed in the observe group (54% vs. 34.9%, P<0.05) and less often in the rule-out group (24.1% vs. 44.6%, P<0.05). The NPV and sensitivity for ruling out MI were 100%, while the PPV and specificity were lower in patients with AF (60% and 89.7%, respectively).

CONCLUSIONS

The 0/1-hour algorithm effectively ruled out MI in patients with AF, with high safety and accuracy. However, patients with AF are more likely to be stratified into the observe group, requiring further examination for final diagnosis.

Real-world antithrombotic strategies in patients with atrial fibrillation and recently developed acute coronary syndrome

Background

The antithrombotic strategy for patients with atrial fibrillation (AF) and coronary artery disease following percutaneous coronary intervention is shifting towards less intensive. Nevertheless, for patients with AF and acute coronary syndrome (ACS), an optimal antithrombotic strategy is yet to be established.

Methods and results

We conducted a multi-center cohort study involving 146 Japanese centers that had prospectively registered 460 patients with AF and ACS followed for 2 years. Primary endpoint was the composite of thrombotic and bleeding events, and secondary endpoints included heart failure hospitalization. At the time of study registration, 86 % of participants had received direct oral anticoagulants (DOACs) and 75 % had received aspirin-based triple antithrombotic therapy (TAT) between March 2017 and August 2019. Apixaban was the most frequently used DOAC (29 %). While the proportion of anticoagulants did not change according to the time course, the intensity of antiplatelets significantly attenuated over time (dual antiplatelet at baseline: 75 %, and at 2-years: 7 %). The cumulative incidence of the primary outcome measure was similar in patients with warfarin and DOACs. However, the risk of heart failure hospitalization was significantly higher in those with warfarin compared to DOACs (Hazard ratio: 2.8, 95 % confidence interval: 1.1-5.8, p = 0.022).

Conclusions

The present findings suggest the appropriate optimization of antithrombotic medication balancing in patients with AF and ACS in Japan by reducing the intensity of antiplatelets during the study period.

IPNA consensus definitions for clinical trial outcomes in steroid-resistant nephrotic syndrome

Assessment of the true impact of therapeutic interventions is a challenge in the absence of universal, standardized definitions for clinical trial endpoints in children with kidney diseases. Steroid-resistant nephrotic syndrome (SRNS) is a difficult kidney disease to treat, with unremitting disease progressing to kidney failure. Currently, available therapies result in suboptimal cure rates. Clinical trials with innovative, targeted treatments will likely be conducted for this disease in the foreseeable future. An international consortium of the IPNA Best Practices and Standards Committee and the Pediatric Nephrology Expert Group of the conect4children (c4c) network developed through consensus, standardized, internationally acceptable definitions for trial outcomes for SRNS. The endpoint definitions were formulated for use with urine protein to creatinine ratios and estimated glomerular filtration rates. Definitions of complete remission, partial remission, non-remission of disease, reduction in proteinuria, kidney disease progression, kidney failure, and composite kidney outcome were refined using an iterative process until a consensus was achieved.

Aptasensor-based point-of-care detection of cardiac troponin biomarkers for diagnosis of acute myocardial infarction

Acute myocardial infarction (AMI) represents a critical health challenge characterized by a significant reduction in blood flow to the heart, leading to high rates of mortality and morbidity. Cardiac troponins, specifically cardiac troponin I and cardiac troponin T, are essential proteins involved in cardiac muscle contraction and serve as vital biomarkers for the diagnosis of AMI. Aptasensors utilize synthetic aptamers or peptides with high affinity for specific biomarkers and offer a promising approach for integration into portable, user-friendly point-of-care (POC) applications. This review explores recent advances in POC aptasensor-based platforms for the rapid detection of cardiac troponin biomarkers. Furthermore, this review addresses current challenges and potential future directions in the development of aptasensor. Also, it highlights their potential to improve timely and accurate diagnosis in clinical and emergency settings.

Clinical Utility of Immature Platelet Fraction (IPF) as a Biomarker in the Diagnosis of Acute Coronary Syndrome (ACS)

Introduction Acute coronary syndrome (ACS) is a critical medical emergency requiring prompt diagnosis and treatment to prevent severe complications, including death, and the underlying pathology of ACS involves the rupture or erosion of an atheromatous plaque within the coronary arteries. Platelets get consumed in an atherosclerotic blood vessel (artery) soon after the rupture of atherosclerotic plaque, which can result in the release of larger immature platelets from bone marrow. The primary objective of this study was to determine the clinical utility of immature platelet fraction (IPF) as a biomarker in the diagnosis of ACS. As secondary objectives, we tried to determine the association between mean platelet volume (MPV) and IPF in the diagnosis of ACS and to determine the role of IPF in differentiating single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Materials and methods A pilot study was conducted with 15 samples, and the sensitivity of IPF (90%) to diagnose ACS was obtained with a 95% confidence interval and 10% allowable error; the overall minimum sample size came to 53 (including a minimum 35 ACS). Fifty-four patients with chest pain, including patients who presented to the emergency room (ER) and who got admitted in the ward and critical care unit (CCU), satisfying the inclusion criteria, were included in the study. Statistical analysis was done using the IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, NY). The results are given in mean ± SD for all the continuous variables and in frequency (percentage) for categorical variables. The normality of the data was checked by the Kolmogorov-Smirnov Z test. The receiver operating characteristic (ROC) curve was applied to find an ideal cut-off of IPF for the diagnosis of ACS with respect to ECG and cardiac enzymes. Diagnostic measures such as sensitivity and specificity were applied. To test the statistical significance of the difference in the proportion of IPF and MPV with ACS, the Chi-square test was used, and the same test was used to differentiate SVD, DVD, and TVD using IPF with respect to coronary angiogram (CAG). Pearson's correlation coefficient was applied to find the correlation of IPF with MPV and platelet count, and its statistical significance was checked by linear reg t test. Results Among the 54 participants, 38 (70.4%) were diagnosed with ACS, while 16 (29.6%) were found to have non-cardiac chest pain. The ROC curve was plotted, and a cut-off value of 1.7250% was determined for IPF with a sensitivity of 94.7% and a specificity of 93.7%. The area under the ROC curve (AUC) was 0.984, with a standard error of 0.014 (p < 0.001). There was a strong positive correlation between IPF and MPV (r = 0.731, p < 0.001) in ACS patients. Conclusion Our study demonstrates that IPF and MPV are valuable biomarkers for the diagnosis of ACS.

Myocardial infarction with nonobstructive coronary arteries: A clinical review

ABSTRACT

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an important, often underrecognized working diagnosis. MINOCA is defined as an acute MI in a patient whose coronary angiography reveals no significant obstructive coronary artery disease. A comprehensive diagnostic approach beyond the initial coronary angiogram is essential for identifying this heterogeneous infarction pathophysiology. Distinguishing disease-specific causes affects patient management and prognosis, especially in female patients. This article provides an evidence-based overview of the tailored management strategies and ongoing clinical research likely to shape future guidelines.

Utilization of Cardiovascular Procedures, Consultation Services, and Cardioprotective Medications Among Type 2 Myocardial Infarction Patients

BACKGROUND

Coronary atherosclerosis and recurrent cardiovascular events are common among individuals with type 2 myocardial infarction (T2MI). However, cardiovascular resource utilization among T2MI patients is unclear.

OBJECTIVES

The aim of the study was to characterize cardiovascular resource utilization among T2MI patients across the United States.

METHODS

Using Optum's de-identified Clinformatics Data Mart Database, cardiovascular procedures, physician services, and prescriptions within 6 months postdischarge were compared among patients with T2MI vs type 1 myocardial infarction (T1MI) between October 1, 2017, and June 30, 2020. Multivariable logistic regression examined the odds of resource utilization in T2MI vs T1MI and identified predictors of utilization for T2MI.

RESULTS

We identified 140,344 patients with myocardial infarction; 121,738 patients (87%) had T1MI and 18,606 (13%) had T2MI. All participants had 183 days of postdischarge follow-up. Within 6 months postdischarge, patients with T2MI were significantly less likely to fill new prescriptions for P2Y12 inhibitors (4.8% [603/14,176] vs 52.8% [44,833/99,593], adjusted OR: 0.28; 95% CI: 0.25-0.31), beta blockers (27.1% [2,070/14,176] vs 62.8% [38,219/99,593], OR: 0.59; 95% CI: 0.55-0.63), statins (19.1% [1,439/14,176] vs 59.1% [32,434/99,593], OR: 0.51; 95% CI: 0.47-0.55), and SGLT2i or glucagon-like peptide-1 agonists (4.8% [595/14,176] vs 35.4% [30,202/99,593], OR: 0.30; 95% CI: 0.27-0.33) as compared to T1MI. Patients with T2MI were significantly less likely to undergo an echocardiogram (71.8% [10,179/14,176] vs 82.9% [82,551/99,593], OR: 0.61; 95% CI: 0.58-0.64) and coronary angiogram (11.7% [1,664/14,176] vs 76.6% [76,327/99,593], OR: 0.10; 95% CI: 0.09-0.11) compared to T1MI.

CONCLUSIONS

In the United States, T2MI patients received less cardiovascular testing and secondary preventative therapies than T1MI patients.

Triple Rule Out CT in the Emergency Department: Clinical Risk and Outcomes (Triple Rule Out in the Emergency Department)

RATIONALE AND OBJECTIVES

Triple rule out CT protocols (TRO-CT) have been advocated as a single test to simultaneously evaluate major causes of acute chest pain, in particular acute myocardial infarction (MI), acute pulmonary embolism (PE), and acute aortic syndrome. However, it is unclear what patient populations would benefit from a such comprehensive exam and current guidelines recommend tailoring CT protocols to the most likely diagnosis.

METHODS

We retrospectively reviewed TRO-CT scans performed from the Emergency Department (ED) at our institution from April 2021 to April 2022. Charts were reviewed to calculate clinical risk of MI, PE, and acute aortic syndrome using conventional clinical scoring systems (HEART score, PERC score, ADD-RS). TRO-CT findings and 30-day clinical outcomes were recorded from chart review.

RESULTS

1279 patients ED patients scanned with TRO-CT were included in the analysis. 831 patients (65.0%) were at-risk for two or more clinical risk scores. At TRO-CT, 381 (29.8%) patients had obstructive CAD. 91 (7.1%) had acute PE. 7 (0.5%) had acute aortic syndrome. At 30-day clinical follow up, 28 patients (2.2%) had the diagnosis of acute MI (95% CI: 1.5-3.2%). 90 patients (7.0%) had the diagnosis of acute PE (95% CI: 5.7-8.6%). 7 patients (0.5%) had the diagnosis acute aortic syndrome (95% CI: 0.2-1.2%). A low-risk HEART score was associated with a 0.3% 30-day clinical diagnosis of acute MI (95% CI: 0.0-1.6%). Low-risk-PERC was associated with a 2.9% 30-day clinical diagnosis of acute PE (95% CI: 0.7-8.7%). Low-risk ADD-RS was associated with a 0.3% 30-day clinical diagnosis of acute aortic syndrome (95% CI: 0.0-1.8%).

CONCLUSIONS

We found a high clinical overlap in the presentation of acute MI, acute PE, and acute aortic syndrome based on clinical risk scores. Further studies will be needed to compare a TRO-CT algorithm to a standard-of-care algorithm in patients presenting to the ED.

AlBarakat M, Elewidi M, Abuelazm M, Turkmani M, Abdelazeem B, Laeeq R. The effect of sodium-glucose co-transporter 2 inhibitors on clinical outcomes after acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular events, especially in diabetic patients. However, the cardioprotective effects of early SGLT2i administration following acute myocardial infarction (AMI) remain unclear.

OBJECTIVE

This study aims to investigate the impact of SGLT2is on clinical outcomes in patients post-AMI.

METHODS

A comprehensive search was conducted in PubMed, CENTRAL, WOS, Scopus, and EMBASE up to April 2024. Risk ratio (RR) was used for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI).

RESULTS

Seven studies with 11,407 patients were included. SGLT2is did not significantly reduce the incidence of major adverse cardiovascular events (MACE) (RR = 0.94, 95% CI [0.68, 1.29], p = 0.69), all-cause mortality (RR = 1.01, 95% CI [0.84, 1.21], p = 0.93), or stroke (RR = 0.61, 95% CI [0.29,1.28], p = 0.19). However, SGLT2is significantly reduced the risk of heart failure (RR = 0.76, 95% CI [0.63, 0.91], p < 0.01) and improved left ventricular ejection fraction (MD = 1.86, 95% CI [1.58, 2.14], p < 0.01).

CONCLUSION

In post-AMI patients, SGLT2is do not significantly affect MACE or mortality but are associated with reduced heart failure risk and improved ejection fraction.

PROTOCOL REGISTRATION

PROSPERO identifier number: CRD42024506806.

Accelerated diagnostic pathways for myocardial infarction using a Siemens High-Sensitivity cardiac troponin I assay

BACKGROUND

Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay.

METHODS

We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 h of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.

RESULTS

Median age was 72 years (interquartile range 58-82), and 30.4 % (126/414) of patients were over 80. Females comprised 44.2 % (183/414) of patients, 87.7 % (363/414) had chest pain, and the primary outcome occurred in 9.2 % (38/414). The High-STEACS pathway ruled out 62.0 % of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9 % and 45.2 %, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27 %). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was ≥ 3 ng/L in 99.1 % and ≥ 5 ng/L in 84.1 %.

CONCLUSIONS

The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters.

Recent advances in biomimetic nanodelivery systems for the treatment of myocardial ischemia reperfusion injury

Myocardial ischemia/reperfusion injury (MIRI) is a significant challenge in the treatment of myocardial infarction, a leading cause of global mortality due to irreversible cardiac damage. Biomimetic nanodelivery systems offer promising therapeutic strategies to address MIRI. In this review, we comprehensively investigate the underlying pathophysiological mechanisms of MIRI and discuss recent advances in biomimetic nanodelivery systems including cell membrane-coated nanoparticles, exosomes, and nanoenzymes as innovative approaches for MIRI treatment. We emphasize the advantages and potential of biomimetic strategies in enhancing therapeutic efficacy, assess the preclinical effectiveness of these nanodelivery systems, and discuss the challenges associated with translating these approaches into clinical practice. This paper aims to provide new perspectives on biomimetic strategies for MIRI treatment, contributing to the development of effective drug delivery systems.

Prognostic value of HALP score in predicting in-hospital mortality in patients with NSTEMI

AIMS

We aimed to investigate the association between the HALP score and in-hospital mortality in patients with non-ST segment myocardial infarction (NSTEMI).

MATERIALS AND METHODS

In this retrospective study participants were divided into two groups, based on the median HALP score. Findings were compared between the groups.

RESULTS

A total of 1648 patients included. The median HALP score cutoff value was 3.87. While the low HALP score group (<3.87) included 824 patients, the high HALP score group (>3.87) included 824 patients. Patients with the low HALP score were older and had a higher prevalence of comorbidities. A HALP score ≤ 2.62 predicted in-hospital mortality with sensitivity of 72.5% and a specificity of 77.3% (area under curve 0.809), according to ROC curve analysis. In multivariate analysis, age, diastolic blood pressure, Killip Class > 1 and Syntax Score, creatinine level, LVEF and HALP Score (OR: 0.504, 95% CI: 0.415-0.613; p < 0.001) were independently associated with in-hospital mortality.

CONCLUSIONS

According to the current study, the HALP score was independently associated with in-hospital mortality in patients with NSTEMI. Moreover, HALP score might be used as a predictor of in-hospital mortality in this population.

Derivation of an artificial intelligence-based electrocardiographic model for the detection of acute coronary occlusive myocardial infarction

Objectives

We aimed to assess the performance of an artificial intelligence-electrocardiogram (AI-ECG)-based model capable of detecting acute coronary occlusion myocardial infarction (ACOMI) in the setting of patients with acute coronary syndrome (ACS).

Methods

This was a prospective, observational, longitudinal, and single-center study including patients with the initial diagnosis of ACS (both ST-elevation acute myocardial infarction [STEMI] & non-ST-segment elevation myocardial infarction [NSTEMI]). To train the deep learning model in recognizing ACOMI, manual digitization of a patient's ECG was conducted using smartphone cameras of varying quality. We relied on the use of convolutional neural networks as the AI models for the classification of ECG examples. ECGs were also independently evaluated by two expert cardiologists blinded to clinical outcomes; each was asked to determine (a) whether the patient had a STEMI, based on universal criteria or (b) if STEMI criteria were not met, to identify any other ECG finding suggestive of ACOMI. ACOMI was defined by coronary angiography findings meeting any of the following three criteria: (a) total thrombotic occlusion, (b) TIMI thrombus grade 2 or higher + TIMI grade flow 1 or less, or (c) the presence of a subocclusive lesion (> 95% angiographic stenosis) with TIMI grade flow < 3. Patients were classified into four groups: STEMI + ACOMI, NSTEMI + ACOMI, STEMI + non-ACOMI, and NSTEMI + non-ACOMI.

Results

For the primary objective of the study, AI outperformed human experts in both NSTEMI and STEMI, with an area under the curve (AUC) of 0.86 (95% confidence interval [CI] 0.75-0.98) for identifying ACOMI, compared with ECG experts using their experience (AUC: 0.33, 95% CI 0.17-0.49) or under universal STEMI criteria (AUC: 0.50, 95% CI 0.35-0.54), (p value for AUC receiver operating characteristic comparison < 0.001). The AI model demonstrated a PPV of 0.84 and an NPV of 1.0.

Conclusion

Our AI-ECG model demonstrated a higher diagnostic precision for the detection of ACOMI compared with experts and the use of STEMI criteria. Further research and external validation are needed to understand the role of AI-based models in the setting of ACS.

Assessment of postoperative prognosis in patients with acute ST-segment elevation myocardial infarction after PCI using LRP1

Purpose

To evaluate the prognostic value of Low-density lipoprotein receptor-related protein 1 (LRP1) in patients with acute ST-segment elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI).

Method

This prospective study included 96 STEMI patients who underwent PCI and 19 control subjects with normal coronary arteries. Coronary blood was taken from both groups, and LRP1 expression levels were quantified using real-time quantitative PCR (qPCR). The STEMI patients were stratified into low, middle, and high LRP1 groups based on tertiles of LRP1 expression. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) during a six-month follow-up period post-PCI.

Results

LRP1 expression in arterial blood was significantly lower in the STEMI group [0.63(0.23,1.1)] compared to the control group [1.5(0.84,1.85)] (P < 0.05). The incidence of MACE showed an increasing trend across the LRP1 tertiles: 6.7% (95% CI: 1.9-21.3%) in the low LRP1 group, 22.6% (95% CI: 11.4-39.8%) in the middle LRP1 group, and 41.9% (95% CI: 26.4-59.2%) in the high LRP1 group. The high LRP1 group exhibited a significantly higher MACE rate compared to the low LRP1 group (P < 0.05). Spearman's rank correlation analysis revealed positive correlations between LRP1 and both NT-proBNP and cTnT (r = 0.349, 95% CI: 0.156-0.515, P < 0.001; r = 0.328, 95% CI: 0.133-0.497, P = 0.001, respectively), and a negative correlation with LVEF values (r = -0.285, 95% CI: -0.460 to -0.087, P = 0.006). Receiver operating characteristic (ROC) analysis identified an LRP1 expression threshold of 0.79 for predicting MACE within six months post-PCI, with a sensitivity of 81.8% (95% CI: 61.5-92.7%), a specificity of 70% (95% CI: 58.5-79.5%), and an area under the curve (AUC) of 0.789 (95% CI: 0.688-0.890, P < 0.001).

Conclusion

LRP1 expression appears to be an independent predictor of MACE in STEMI patients and may have prognostic value for short-term outcomes following PCI.

The Dual Role of Oxidative Stress in Atherosclerosis and Coronary Artery Disease: Pathological Mechanisms and Diagnostic Potential

Oxidative stress plays a pivotal role in the pathogenesis of atherosclerosis and coronary artery disease (CAD), with both beneficial and detrimental effects on cardiovascular health. On one hand, the excessive production of reactive oxygen species (ROS) contributes to endothelial dysfunction, inflammation, and vascular remodeling, which are central to the development and progression of CAD. These pathological effects drive key processes such as atherosclerosis, plaque formation, and thrombosis. On the other hand, moderate levels of oxidative stress can have beneficial effects on cardiovascular health. These include regulating vascular tone by promoting blood vessel dilation, supporting endothelial function through nitric oxide production, and enhancing the immune response to prevent infections. Additionally, oxidative stress can stimulate cellular adaptation to stress, promote cell survival, and encourage angiogenesis, which helps form new blood vessels to improve blood flow. Oxidative stress also holds promise as a source of biomarkers that could aid in the diagnosis, prognosis, and monitoring of CAD. Specific oxidative markers, such as malondialdehyde (MDA), isoprostanes (isoP), ischemia-modified albumin, and antioxidant enzyme activity, have been identified as potential indicators of disease severity and therapeutic response. This review explores the dual nature of oxidative stress in atherosclerosis and CAD, examining its mechanisms in disease pathogenesis as well as its emerging role in clinical diagnostics and targeted therapies. The future directions for research aimed at harnessing the diagnostic and therapeutic potential of oxidative stress biomarkers are also discussed. Understanding the balance between the detrimental and beneficial effects of oxidative stress could lead to innovative approaches in the prevention and management of CAD.

Prognostic Value of Endogenous-Type Coronary Microvascular Dysfunction After Elective Percutaneous Coronary Intervention

BACKGROUND

Global coronary flow reserve (G-CFR) impairment represents coronary microvascular dysfunction (CMD) and correlates with poor prognosis. Hyperemic coronary flow is reduced in conventional CMD, but normal or mildly reduced with elevated resting flow in endogenous-type CMD (E-CMD). This retrospective study assessed the prognostic value of post-percutaneous coronary intervention (PCI) CMD, focusing on E-CMD.

METHODS AND RESULTS

We included 320 chronic coronary syndrome (CCS) patients undergoing PCI and post-PCI phase contrast cine-cardiac magnetic resonance imaging (CMR). Major adverse cardiac and cerebrovascular events (MACCE) were evaluated, considering the presence of post-PCI CMD and E-CMD based on G-CFR and resting myocardial flow assessed by coronary sinus flow using CMR. CMD was defined as G-CFR <2.0 and classified as E-CMD or non-E-CMD. Post-PCI CMD was observed in 43.4% of patients, 63.3% exhibiting E-CMD. During a median 2.5-year follow-up, MACCE occurred in 26 (8.1%) patients, more often in those with CMD (11.5% vs. 5.5%; P=0.063). MACCE incidence was higher in E-CMD than non-E-CMD and non-CMD (14.8% vs. 5.9% and 5.5%, respectively; P=0.027). Kaplan-Meier analysis revealed worse prognosis in E-CMD (P=0.025). Cox proportional hazards modeling revealed that E-CMD independently predicted MACCE (hazard ratio 3.24; 95% confidence interval 1.47-7.14; P=0.004).

CONCLUSIONS

Post-PCI CMD, particularly E-CMD, was significantly associated with worse outcomes in CCS patients. Post-PCI CMD evaluation could guide therapeutic strategies for CCS patients.

Long-Term Outcomes in Patients With Chronic Total Occlusion and Left Ventricular Systolic Dysfunction - A Single-Center Inverse Probability of Treatment Weighting Analysis

BACKGROUND

The optimal treatment strategy for patients with coronary chronic total occlusion (CTO) and left ventricular systolic dysfunction (LVSD) remains unclear. This study investigated the long-term outcomes of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT) in this specific patient cohort.

METHODS AND RESULTS

This retrospective cohort study included 987 consecutive patients with CTO and LVSD who met the inclusion criteria and underwent either CTO-PCI (n=277), CTO-CABG (n=222), or CTO-MT (n=488) between 2014 and 2020. The primary outcome was all-cause mortality during follow-up. Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and their components, including cardiovascular mortality, myocardial infarction (MI), stroke, unplanned revascularization, and hospitalization for heart failure. During a median follow-up of 5.3 years, 232 (23.51%) patients died from any cause. In the unadjusted analysis, CTO-MT was associated with worse long-term survival prospects. After inverse probability of treatment weighting and variable adjustment, CTO-PCI and CTO-CABG demonstrated significant reductions in the long-term risks of all-cause and cardiovascular mortality. Notably, CTO-CABG was associated with the lowest long-term risks of MACCE, MI, unplanned revascularization, and hospitalization for heart failure.

CONCLUSIONS

For patients with CTO and LVSD, successful CTO revascularization significantly improved long-term survival compared with CTO-MT. CTO-CABG can be regarded as the optimal treatment modality for better long-term prognosis.

Discussion on the comparison of Raman spectroscopy and cardiovascular disease-related imaging techniques and the future applications of Raman technology: a systematic review

Cardiovascular disease (CVD) is a major cause of unnatural death worldwide, so timely diagnosis of CVD is crucial for improving patient outcomes. Although the traditional diagnostic tools can locate plaque and observe inner wall of blood vessel structure, they commonly have radioactivity and cannot detect the chemical composition of the plaque accurately. Recently emerging Raman techniques can detect the plaque composition precisely, and have the advantages of being fast, high-resolution and marker-free. This makes Raman have great potential for detecting blood samples, understanding disease conditions, and real-time monitoring. This review summarizes the origin and state-of-art of Raman techniques, including the following aspects: (a) the principle and technical classification of Raman techniques; (b) the applicability of Raman techniques and its comparison with traditional diagnostic tools at different diagnosis targets; (c) the applicability of Raman spectroscopy in advanced CVD. Lastly, we highlight the possible future applications of Raman techniques in CVD diagnosis.

Association Between Shift Work and Acute Coronary Syndrome According to Alcohol Intake and Smoking

Background and Objectives: Shift work is associated with an increased risk of acute coronary syndrome (ACS) and higher rates of smoking and alcohol consumption. This study examines how smoking and alcohol intake may influence the effect of shift work on ACS risk, indicating a complex interaction among these factors in individuals engaged in shift work. Materials and Methods: This investigation utilized data from the Korean Genome and Epidemiology Study (KoGES). Shift work was the primary exposure, and the main outcome was ACS, defined as either myocardial infarction or angina pectoris diagnosed from 2003 to 2020. Cox proportional regression analysis was employed to assess the impact of shift work, smoking, and alcohol intake on ACS incidence. Additionally, we performed an interaction analysis to examine the effects of shift work in conjunction with smoking and alcohol intake on ACS incidence. Results: Out of 10,038 participants enrolled during the study period, 3696 (36.8%) met the inclusion criteria. The incidence rate of ACS was 11.88 per 1000 person-years in the shift work group compared to 5.96 per 1000 person-years in the non-shift work group. Using Cox proportional logistic regression, shift work was found to be associated with a hazard ratio (HR) of 1.74 (95% CI, 1.20, 2.53) compared to the non-shift work group. Smoking and alcohol consumption did not exhibit a significant HR for ACS incidence, with HRs of 1.31 (95% CI, 0.98, 1.75) and 0.83 (95% CI, 0.65, 1.07), respectively. In the interaction model, after adjusting for other covariates, shift work was not significantly associated with ACS incidence in current smokers (HR 1.05, 95% CI 0.49, 2.23). However, among non-current smokers, shift work emerged as a significant risk factor for ACS incidence (HR 2.26, 95% CI 1.44, 3.55) (p for interaction < 0.01). No interaction was found between alcohol consumption and shift work in relation to ACS incidence. Conclusions: Shift work is an independent risk factor for acute coronary syndrome (ACS), particularly among non-current smokers. This finding highlights the need to address both lifestyle and occupational factors when developing strategies to mitigate ACS risk among shift workers. Employers and policymakers should consider implementing targeted workplace interventions to reduce this risk. These may include optimizing shift schedules to minimize circadian disruption, providing regular health screenings focused on cardiovascular health, and promoting healthy lifestyle habits such as balanced nutrition, regular physical activity, and stress management programs. Additionally, workplace wellness initiatives could focus on reducing other modifiable risk factors, such as providing resources for smoking cessation and limiting exposure to occupational stressors. Integrating these strategies into occupational health policies can contribute to the early detection and prevention of ACS, ultimately improving the cardiovascular health of shift workers.

Effect of perioperative remote ischemic conditioning on myocardial injury in patients with unstable angina undergoing percutaneous coronary intervention: protocol of a multicenter, randomized, double-blind clinical trial

BACKGROUND

Cardiovascular disease is a leading cause of death, with ischemic heart disease being a significant contributor. While percutaneous coronary intervention (PCI) effectively reduces mortality in myocardial infarction patients, its efficacy for unstable angina (UA) patients is controversial. Complications associated with PCI further limit application in UA. RIC is hypothesized to be an effective co-intervention that reduces PCI-related complications and may potentially enhance the efficacy of the PCI procedure itself.

METHODS

This is a pragmatic, prospective, dual-center, double-blind, randomized controlled clinical trial assessing the effect of remote ischemic conditioning (RIC) during percutaneous coronary intervention (PCI) on injury in unstable angina patients aged ≥ 18 years undergoing coronary angiography. Participants will be randomized to receive either RIC or Sham RIC, in addition to standard pharmacotherapy. Primary outcome includes periprocedural myocardial injury measured by hs-cTnT levels, while secondary outcomes encompass major adverse cardiovascular events, coronary artery lesions Gensini Score, arrhythmia, angina incidence, SAQ scores, ECG changes, and cardiac function assessed by two-dimensional echocardiography. The trial aims to recruit 574 participants and is scheduled to be initiated on 15 January 2024. We will conduct the primary statistical analysis using the intention-to-treat principle. Results from the trial will be presented as comparative summary statistics following the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

TRIAL REGISTRATION

ChiCTR2400079855, 15 January 2024.

Diastolic Versus Systolic or Mean Intraoperative Hypotension as Predictive of Perioperative Myocardial Injury in a White-Box Machine-Learning Model

BACKGROUND

Intraoperative hypotension (IOH) and tachycardia are associated with perioperative myocardial injury (PMI), and thereby increased postoperative mortality. Patients undergoing vascular surgery are specifically at risk of developing cardiac complications. This study aimed to explore the association between different thresholds for IOH and tachycardia, and PMI. It also aimed to explore which threshold for IOH and tachycardia best predicts PMI.

METHODS

In this single-center prospective observational study, high-sensitivity cardiac troponin T was measured preoperatively and at 4, 24, and 48 hours after vascular surgery. Absolute and relative thresholds were used to define intraoperative systolic, mean, and diastolic arterial hypotension, measured every 15 seconds by invasive arterial pressure monitoring and heart rate using the Philips IntelliVue X3 monitor. Decision tree machine-learning (ML) models were used to explore which thresholds for IOH and tachycardia best predict PMI. Clinical utility and transparency were prioritized over maximizing the performance of the ML model and therefore a white-box model was used.

RESULTS

In all, 498 patients were included in the study. Ninety-nine patients (20%) had PMI. Significant associations were found between IOH and PMI using both absolute and relative thresholds for systolic, mean, and diastolic arterial pressure. Absolute thresholds based on diastolic arterial pressure had the strongest correlation with PMI and yielded greater statistical significance. The threshold that was most predictive of PMI was an absolute diastolic arterial pressure <44 mm Hg. The prediction model with the absolute threshold of diastolic arterial pressure <44 mm Hg had a macro average F1 score of 0.67 and a weighted average F1 score of 0.76. No association was found between tachycardia and PMI.

CONCLUSIONS

We found that an absolute, not relative, IOH threshold based on diastolic arterial pressure, and not systolic or mean arterial pressure, or tachycardia, was most predictive of PMI.

Perioperative Myocardial Injury/Infarction in Patients with Stable or Unstable Angina Pectoris Undergoing Elective Percutaneous Coronary Intervention: The Effects of Preoperative Lipid Management

Background

Identifying the risk factors for perioperative myocardial injury/infarction (PMI) is critical to prevent postoperative adverse cardiovascular events. However, whether reducing the preoperative LDL-C can mitigate the risk of PMI remains unclear. We therefore investigated the effect of the preoperative LDL-C level in patients with stable angina pectoris (SAP) or unstable angina pectoris (UAP) on perioperative myocardial injury/infarction (PMI) after elective percutaneous coronary intervention (PCI).

Methods

Patients with SAP or UAP who received PCI from January 2021 to June 2023 at one of the two institutions (Hebei Provincial People's Hospital, Handan Central Hospital) were reviewed. The occurrence of PMI was determined based on the elevation of cardiac troponin I (cTnI) after the operation. The preoperative low density lipoprotein cholesterol (LDL-C) level was divided into three grades: low, <1.4 mmol/L; medium, 1.4-1.8 mmol/L; high, >1.8 mmol/L. The relationship between PMI and preoperative LDL-C was analyzed.

Results

Of all 308 included patients, 226 did not have PMI and 82 experienced PMI. Positive correlation was found both between PMI and preoperative LDL-C level (r = 0.322, P < 0.05) and between PMI and preoperative LDL-C grade (r = 0.189, P < 0.05). According to the multivariate logistic regression analysis, the preoperative LDL-C grade (Medium vs Low, OR=3.994, P < 0.05; High vs Medium, OR=6.140, P < 0.05) and the number of stents implanted during PCI were independent risk factors for PMI (OR=1.940; P < 0.05).

Conclusion

For SAP and UAP patients, decreasing LDL-C to <1.4 mmol/L before elective PCI can reduce the incidence of PMI after the operation. We strongly recommend the practice of sufficiently reducing LDL-C level below 1.4 for patients with SAP or UAP who receive elective PCI.

Inflammatory Cell-Targeted Delivery Systems for Myocardial Infarction Treatment

Myocardial infarction (MI) is a cardiovascular disease (CVD) with high morbidity and mortality worldwide, which is a serious threat to human life and health. Inflammatory and immune responses are initiated immediately after MI, and unbalanced inflammation post-MI can lead to cardiac dysfunction, scarring, and ventricular remodeling, emphasizing the critical need for an effective inflammation-regulating treatment. With the development of novel therapies, the drug delivery system specific to inflammatory cells offers significant potential. In this review, we introduce immune cells and fibroblasts involved in the development of MI and summarize the newly developed delivery systems related to the use of injectable hydrogels, cardiac patches, nanoparticles, and extracellular vesicles (EVs). Finally, we highlight the recent trends in the use of inflammatory cell-targeting drug delivery systems involving different strategies that facilitate the effective treatment of MI.

Independent Prognostic Significance of Myocardial Flow Reserve over Coronary Artery Calcium, Myocardial Perfusion, and Clinical Variables in Patients without Known CAD, according to Diabetes Status

OBJECTIVE

To explore differences in prevalence and prognosis associated with reduced myocardial flow reserve (MFR) in patients without known coronary artery disease (CAD) based on diabetes status.

METHODS

Of 2,639 patients without known CAD who underwent rubidium positron emission tomography myocardial perfusion imaging (MPI), 818 patients (31%) had diabetes. Reduced MFR was defined as MFR <2.0. Coronary artery calcification (CAC) score was categorized as 0, 1-99, 100-399, and ≥ 400. Ischemic total perfusion deficit (TPD) was categorized as <1%, 1-<5%, and ≥ 5%. Outcome variables were all-cause death (ACD) and non-fatal myocardial infarction (MI).

RESULTS

During median follow-up of 4.1 year, 574 (21.8%) ACD/MI occurred (204 [25.1%] diabetic patients, 370 [20.3%] non-diabetic patients). In multivariable Cox analysis, reduced MFR was associated with increased ACD/MI in patients with diabetes (per 0.1 decrease: HR: 1.04, 95% CI: 1.02-1.06, P < 0.001) and patients without diabetes (per 0.1 decrease: HR: 1.03, 95% CI: 1.02-1.04, P < 0.001). No interaction existed between diabetes and MFR for ACD/MI risk regardless of CAC or ischemic burden (all p > 0.05). Adding MFR to the risk prediction model of clinical, conventional MPI findings, and CAC improved the discrimination for clinical outcomes in both groups (DM: 0.003, non-DM: <0.001, respectively).

CONCLUSION

Reduced MFR was more common in patients with diabetes and an important independent prognostic marker over CAC and clinical variables. The association between MFR and ACD/MI risk did not differ between patients with and without diabetes who had no prior CAD, regardless of CAC and ischemic burden.

Silent Myocardial Infarction and Risk of Stroke Recurrence: A Post Hoc Analysis of the IRIS Trial

BACKGROUND

Unrecognized or silent myocardial infarction (MI) detected on an ECG is associated with first-ever stroke, but the impact on stroke recurrence is unknown. We aimed to determine the association of silent MI with stroke recurrence in patients with a recent ischemic stroke.

METHODS AND RESULTS

Subjects from the IRIS (Insulin Resistance Intervention After Stroke) trial with an available ECG were included. Clinical MI was defined as a history of hospitalization for MI. Silent MI was defined as ECG evidence of MI in the absence of clinical MI. The primary outcome was recurrent stroke. Ischemic stroke and subtype were assessed as secondary outcomes. Multivariable Cox regression analysis adjusted for demographics, pioglitazone, and vascular risk factors was used to examine the association between MI and stroke recurrence. A total of 2282 participants met the inclusion criteria. Clinical and silent MI were identified in 161 (7.1%) and 94 (4.1%) subjects, respectively. Over the study period, 209 recurrent strokes occurred, with 191 classified as ischemic. In the fully adjusted model, silent MI was significantly associated with any stroke (hazard ratio [HR], 2.29 [95% CI, 1.34-3.90]) and ischemic stroke (HR, 2.09 [95% CI, 1.18-3.70]) recurrence. Clinical MI was associated with stroke recurrence in the unadjusted analysis but not in the fully adjusted model (HR, 1.31 [95% CI, 0.81-2.11]). Silent MI was not associated with potential cardioembolic subtypes (HR, 1.50 [95% CI, 0.70-3.22]).

CONCLUSIONS

Among patients with a recent ischemic stroke, silent MI was associated with stroke recurrence. Tailored prevention strategies in this population warrant future investigation.

REGISTRATION

URL: https://clinicaltrials.gov. Unique Identifier: NCT00091949.

Zero Background Visualizing Phosphorescence Lateral Flow Immunoassay of Cardiac Troponin I for Rapid and Accurate Diagnosis of Myocardial Infarction

Fluorescence lateral flow immunoassays (FL-LFIA) have attracted considerable attention in clinical diagnosis due to their outstanding merits of affordable, sensitive, on-site, and quick detection. However, they are still plagued by significant signal interference, such as autofluorescence and scattered light. The development of high-performance and robust phosphors, i.e., label probes featuring with the character of low/no optical background, remains a great challenge. Herein, we report a novel visualized phosphorescence LFIA (Phos-LFIA), where the composite microspheres, i.e., carbon dots (CDs) covalently embedded in dendritic mesoporous silicon nanoparticles (DMSNs), were designed and selected as the report probes. The obtained CDs@DMSNs revealed uniform morphologies and particle sizes, as well as ultralong (lifetime: 1.14 s, visible for over 8 s to naked eyes) room temperature phosphorescence (RTP) in aqueous solution. As competitive nanotags, CDs@DMSNs were designed for an ultralong phosphorescence-based time-gated LFIA for cardiac troponin I (cTnI) without optical interference. The fabricated Phos-LFIA test strips demonstrated zero-background signal and were applied for highly sensitive cTnI detection in both buffer and a complex serum matrix, with corresponding limits of detection (LODs) of 0.19 and 0.21 ng/mL, respectively. For a clinical validation, the proposed Phos-LFIA revealed an excellent clinical analytical performance (sensitivity: 95.45%, specificity: 88.9%, κ value: 0.85), demonstrating its potential for rapid and accurate diagnosis of myocardial infarction. This work provided a promising background-free probe for FL-LFIA, and it would also open an opportunity for developing highly sensitive screening platforms for other targets through modifying different recognition ligands onto CDs@DMSNs.

Hybrid coronary revascularization versus traditional coronary artery bypass grafting for left main coronary artery disease

BACKGROUND

The current recommended intervention for significant left main (LM) stenosis, especially in patients with complex and high SYNTAX score disease, is coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) combines robotic coronary artery bypass and percutaneous coronary intervention, offering a less invasive approach for patients with LM disease.

OBJECTIVES

We compare clinical outcomes between HCR and CABG in patients with LM disease.

METHODS

We retrospectively screened all patients treated for LM disease between 2019 and 2023 at a single institution. Propensity matching was used for baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) at 30 days, 6 months and 1 year. Secondary outcomes included death, myocardial infarction, repeat revascularization and stroke.

RESULTS

Out of a total of 761 patients treated for LM disease, 59 HCR patients were propensity matched to 59 CABG patients and were included in the final analysis. SYNTAX score was >33 for 49.1 % of HCR patients and 67.3 % of CABG patients (p = 0.15). Hospital length of stay was significantly shorter for HCR patients compared to CABG (4.07 days vs. 7.58 days, p < 0.001). MACE were significantly lower in the HCR group at 30 days (0 % vs 10.2 %; p = 0.01), 6 months (0 % vs 17 %; p = 0.002) and 1 year (2.4 % vs 20.5 %; p = 0.01) compared to CABG group. Additionally, there was a lower rate of repeat revascularization at 6 months in the HCR group (0 % vs 10.9 %; p = 0.02).

CONCLUSIONS

This retrospective study demonstrates that HCR is a safe and viable alternative to CABG in patients with LM disease. Randomized clinical trials comparing the two treatment modalities are needed to confirm these findings.

Detection of late gadolinium enhancement in patients with hypertrophic cardiomyopathy using machine learning

BACKGROUND

Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in hypertrophic cardiomyopathy (HCM) typically represents myocardial fibrosis and may lead to fatal ventricular arrhythmias. However, CMR is resource-intensive and sometimes contraindicated. Thus, in patients with HCM, we aimed to detect LGE on CMR by applying machine learning (ML) algorithm to clinical parameters.

METHODS AND RESULTS

In this trans-Pacific multicenter study of HCM, a ML model was developed to distinguish the presence or absence of LGE on CMR by ridge classification method using 22 clinical parameters including 9 echocardiographic data. Among 742 patients in this cohort, the ML model was constructed in 2 institutions in the United States (training set, n = 554) and tested using data from an institution in Japan (test set, n = 188). LGE was detected in 299 patients (54%) in the training set and 76 patients (40%) in the test set. In the test set, the area under the receiver-operating-characteristic curve (AUC) of the ML model derived from the training set was 0.77 (95% confidence interval [CI] 0.70-0.84). When compared with a reference model constructed with 3 conventional risk factors for LGE on CMR (AUC 0.69 [95% CI 0.61-0.77]), the ML model outperformed the reference model (DeLong's test P = 0.01).

CONCLUSIONS

This trans-Pacific study demonstrates that ML analysis of clinical parameters can distinguish the presence of LGE on CMR in patients with HCM. Our ML model would help physicians identify patients with HCM in whom the pre-test probability of LGE is high, and therefore CMR will have higher utility.

Exploring the Cardiovascular Benefits of Extra Virgin Olive Oil: Insights into Mechanisms and Therapeutic Potential

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, driven by complex interactions among genetic, environmental, and lifestyle factors, with diet playing a pivotal role. Extra Virgin Olive Oil (EVOO), a cornerstone of the Mediterranean diet (MedDiet), is a plant-based fat that has garnered attention for its robust cardiovascular benefits, which are attributed to its unique composition of monounsaturated fatty acids (MUFAs), particularly oleic acid (OA); and bioactive polyphenols, such as Hydroxytyrosol (HT) and oleocanthal. These compounds collectively exert antioxidant, anti-inflammatory, vasodilatory, and lipid-modulating effects. Numerous clinical and preclinical studies have demonstrated that EVOO's properties reduce major modifiable cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and type 2 diabetes. EVOO also promotes endothelial function by increasing nitric oxide (NO) bioavailability, thus favoring vasodilation, lowering blood pressure (BP), and supporting vascular integrity. Furthermore, it modulates biomarkers of cardiovascular health, such as C-reactive protein, low-density lipoprotein (LDL) cholesterol, and NT-proBNP, aligning with improved hemostatic balance and reduced arterial vulnerability. Emerging evidence highlights its interaction with gut microbiota, further augmenting its cardioprotective effects. This review synthesizes current evidence, elucidating EVOO's multifaceted mechanisms of action and therapeutic potential. Future directions emphasize the need for advanced extraction techniques, nutraceutical formulations, and personalized dietary recommendations to maximize its health benefits. EVOO represents a valuable addition to dietary strategies aimed at reducing the global burden of cardiovascular diseases.

Mapping the knowledge of omics in myocardial infarction: A scientometric analysis in R Studio, VOSviewer, Citespace, and SciMAT

Many researchers nowadays choose multi-omics techniques for myocardial infarction studies. However, there's yet to be a review article integrating myocardial infarction multi-omics. Hence, this study adopts the popular bibliometrics. Based on its principles, we use software like R Studio, Vosviewer, Citespace, and SciMAT to analyze literature data of myocardial infarction omics research (1991-2022) from Web of Science. By extracting key information and calculating weights, we conduct analyses from 4 aspects: Collaboration Network Analysis, Co-word Analysis, Citing and Cited Journal Analysis, and Co-citation and Clustering Analysis, aiming to understand the field's cooperation, research topic evolution, and knowledge flow. The results show that myocardial infarction omics research is still in its early stage with limited international cooperation. In terms of knowledge flow, there's no significant difference within the discipline, but non-biomedical disciplines have joined, indicating an interdisciplinary integration trend. In the overall research field, genomics remains the main topic with many breakthroughs identifying susceptibility sites. Meanwhile, other omics fields like lipidomics and proteomics are also progressing, clarifying the pathogenesis. The cooperation details in this article enable researchers to connect with others, facilitating their research. The evolution trend of subject terms helps them set goals and directions, quickly grasp the development context, and read relevant literature. Journal analysis offers submission suggestions, and the analysis of research base and frontier provides references for the research's future development.

Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis

BACKGROUND

Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition needs to be settled.

RESEARCH QUESTION

What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients?

STUDY DESIGN AND METHODS

We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 definition. For the synthesis of the effect of hs-cTn on mortality, we applied random effect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean difference (SMD) of hs-cTn between survivors and non-survivors.

RESULTS

In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41-1.33). Elevated hs-cTn was associated with increased mortality (OR = 1.78, 95% CI: 1.41-2.25). However, this prognostic effect was absent in studies that adjusted for different confounders (aOR = 1.06, 95% CI: 0.99-1.14).

DISCUSSION AND CONCLUSIONS

Non-survivors of sepsis exhibited significantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis.

Invasive versus conservative strategies for non-ST-elevation acute coronary syndrome in the elderly: an updated systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Advances in managing non-ST-elevation acute coronary syndrome (NSTE-ACS) have yet to clarify the optimal treatment for elderly patients, whose complex health profiles and underrepresentation in trials add challenges to decision-making.

METHODS

We systematically searched PubMed, Embase, Web of Science, and Scopus for randomized controlled trials comparing invasive versus conservative strategies in elderly patients (≥ 70 years) with NSTE-ACS through October 2024. Co-primary outcomes were all-cause and cardiovascular mortalities, with secondary outcomes including myocardial infarction (MI), revascularization, stroke, decompensated heart failure, and bleeding events. Outcomes were analyzed using both risk ratios (RR) and hazard ratios (HR).

RESULTS

Analysis of 11 trials (4,114 patients) showed no significant differences in all-cause mortality (RR: 1.04, 95% CI: 0.98-1.11; HR: 1.10, 95% CI: 0.94-1.29) or cardiovascular mortality (RR: 0.98, 95% CI: 0.85-1.12; HR: 0.94, 95% CI: 0.73-1.20) between strategies. The invasive approach significantly reduced subsequent revascularization (RR: 0.41, 95% CI: 0.27-0.62; HR: 0.30, 95% CI: 0.19- 0.47; p < 0.01 in both analyses) and MI risk (RR: 0.75, 95% CI: 0.57-0.99, p = 0.04; HR: 0.64, 95% CI: 0.49-0.83, p < 0.01), though with some levels of heterogeneity in sensitivity analyses for MI. Stroke and heart failure outcomes were comparable between strategies. However, it significantly increased the risk of both composite major and minor bleeding risk (RR: 1.50, 95% CI: 1.02-2.20, p = 0.04) and major bleeding alone (RR: 1.92, 95% CI: 1.04-3.56, p = 0.04).

CONCLUSION

In elderly patients with NSTE-ACS, an invasive strategy reduces revascularization needs and, potentially, MI risk without impacting survival, but at the cost of increased bleeding risk. This supports individualized treatment decisions based on patient-specific characteristics, particularly bleeding risk and geriatric factors.

Efficacy and prognosis of dapagliflozin in the treatment of patients with acute myocardial infarction complicated with type 2 diabetes in Xining area

Background

The acute myocardial infarction (AMI) is a prevalent and severe cardiovascular disease, characterized by its sudden onset, high mortality rate, and unfavorable prognosis. The presence of type 2 diabetes not only signifies a chronic metabolic disorder, but also serves as a catalyst for various cardiovascular and cerebrovascular ailments such as coronary heart disease and stroke. Xining is situated in a region of middle to high altitude and due to its unique geographical environment, coupled with the population's limited health awareness, unequal medical standards and other factors, there remain some AMI patients who are difficult to diagnose early on. The objective of this study is to investigate the efficacy and prognosis of dapagliflozin in patients with acute myocardial infarction complicated by type 2 diabetes in the Xining region.

Method

analysis on January 1, 2018 to January 1, 2020, in Qinghai province people's hospital of cardiovascular internal medicine hospital treatment of 245 cases of acute myocardial infarction combined the clinical data of patients with type 2 diabetes. The patients were divided into dapagliflozin group and control group according to whether they took dapagliflozin during hospitalization. The basic data, laboratory examination indicators and long-term prognosis of the two groups were observed. Follow-up deadline is December 31, 2023, at the end of follow-up, including the primary endpoint and the secondary endpoint.

Results

245 patients were included in this study, age 34-94, the average age (61-11), 200 cases (81.63%) of men, women, 45 cases (18.37%), dapagliflozin group of men 92 cases (77.97%) and control group, 108 cases (85.04%). Two groups of patients' age, gender, diabetes duration, merge disease, echocardiogram and blood biochemical indexes, had no statistical difference (P > 0.05). There were no significant differences in the number of coronary artery lesions, treatment regimens, cardiovascular and hypoglycemic drugs between the two groups (P > 0.05). However, up to dapagliflozin group of patients after discharge significantly lower than the control group, the incidence of cardiovascular adverse events at dapagliflozin group of 4 cases of heart failure and cardiovascular death in 1 case and control group in heart failure 13 cases, 10 cases of cardiovascular death, cerebral hemorrhage 2 cases died. KaplanMeier survival analysis showed that the primary endpoint of survival was significantly higher in the dapagliflozin group than in the control group (P < 0.05). In addition, the overall survival rate of the dapagliflozin group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05).

Conclusions

Dapagliflozin is safe and reliable in the treatment of patients with acute myocardial infarction and type 2 diabetes, and can effectively reduce the incidence of cardiovascular events and improve the overall survival rate of patients.

The Association Between Mitral Regurgitation and Long-Term Outcomes in Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Retrospective Large Sample Cohort Study

Background

The relationship between mitral regurgitation (MR) and long-term outcomes in Chinese patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) remains scarce. This study aimed to elucidate the connection between MR and long-term clinical outcomes following AMI treated with PCI.

Methods

In this retrospective study 6940 patients who were diagnosed with AMI were consecutively enrolled from General Hospital of Ningxia Medical University (2014-2019). The included AMI patients were divided into no MR, mild MR and moderate/serve MR according to MR occurred. All patients were clinically followed for 3-year to collect major adverse cardiac and cerebrovascular events (MACCEs), comprising all-cause death, nonfatal myocardial infarction (MI), rehospitalization for angina, rehospitalization for heart failure (RHF), and stroke. Cox regression models were employed to analyze the association between MR and 3-year clinical outcomes after adjusting for various confounding factors.

Results

Among the 6940 patients, 2871 (41.35%) exhibited no MR, 3681 (53.04%) had mild MR, and 388 (5.59%) had moderate/severe MR. The cumulative 3-year incidence of MACCEs was 19.21% overall, with rates of 15.26%, 20.37%, and 37.37% in the no MR, mild MR, and moderate/severe MR groups, respectively (log-rank p < 0.001). Kaplan-Meier survival curves of MR with all-cause death and RHF were also plotted (log-rank p < 0.001). After controlling confounding variables completely, we found that moderate/severe MR compared to none MR was found to be significantly associated with 3-year MACCEs [hazard ratio (HR) = 1.83; 95% confidence interval (CI) = 1.21-2.77; p = 0.0042], all-cause mortality (HR = 3.11; 95% CI = 1.75-5.50; p=0.001) and RHF (HR = 1.69; 95% CI = 1.09-2.62; p=0.019) through Cox proportional hazards regression models.

Conclusion

MR significantly predicted 3-year clinical outcomes in AMI patients undergoing PCI, highlighting the need for physicians to prioritize MR assessment in clinical practice.

From Mechanisms to Management: Tackling In-Stent Restenosis in the Drug-Eluting Stent Era

PURPOSE OF REVIEW

Drug-eluting stent (DES) technology has greatly enhanced the safety and effectiveness of percutaneous coronary interventions (PCI). The aim of the present paper is to provide a comprehensive review of in-stent restenosis (ISR), focusing on the contemporary DES era, including its incidence, mechanisms, and imaging characterization.

RECENT FINDINGS

Despite the widespread use of DES and numerous improvements, recent clinical data indicate that ISR still occurs in 5-10% of PCI procedures, posing a considerable public health issue. The incidence, morphology, and clinical implications of ISR are determined by a complex interplay of several factors: the patient, stent, procedure, and vessel and lesion-related factors. Advancements in intracoronary imaging have provided greater insight into its patterns and underlying causes. Over time, treatment strategies have evolved, and current guidelines recommend an individualized approach using intracoronary imaging to characterize ISR's underlying substrate.

ANOCA, INOCA, MINOCA: The New Frontier of Coronary Syndromes

The growing prevalence in the diagnosis of INOCA (Ischemia with Non-Obstructive Coronary Arteries), ANOCA (Angina with Non-Obstructive Coronary Arteries), and MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) highlights the need to reassess their clinical relevance. Historically regarded as benign syndromes, emerging evidence suggests that these conditions may cause serious cardiovascular events and considerable long-term disability. Additionally, emerging studies suggest that non-obstructive coronary artery disease (CAD) may have a higher prevalence compared to traditional obstructive forms of CAD. This leads to the need to better clarify the underlying pathogenic mechanisms as well as the risk factors associated with these syndromes. This is precisely the aim of this review, which focuses on the complex and heterogeneous mechanisms underlying these syndromes as well as the associated risk factors. This review also sums up the diagnostic steps necessary to achieve an accurate diagnosis, along with the interventional and pharmacological approaches to be implemented in light of the latest evidence.

Evaluation of Thrombomodulin, Heart-Type Fatty-Acid-Binding Protein, Pentraxin-3 and Galectin-3 Levels in Patients with Myocardial Infarction, with and Without ST Segment Elevation

Background: Medical history, ECG findings and cardiac markers are used in the diagnosis of myocardial infarction (MI). Biomarkers used especially for the diagnosis of MI include high-sensitivity troponins (hsTns), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), myoglobin, cardiac myosin-binding protein C and new cardiac biomarkers. This study evaluated the levels of serum thrombomodulin (TM), heart-type fatty-acid-binding protein (H-FABP), pentraxin-3 (PTX-3) and galectin-3 (Gal-3) to determine their utility in distinguishing between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Methods: This study included a total of 180 patients (90 patients with acute STEMI and 90 patients with NSTEMI) who presented to the Gaziosmanpaşa Training and Research Hospital, Cardiovascular Surgery and Emergency Department, with ischemic chest pain lasting longer than 30 min. Ninety healthy volunteers were included as the control group. Results: Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), TM, H-FABP, PTX-3 and Gal-3 were significantly different across the STEMI, NSTEMI and control groups (p < 0.001). Strong positive correlations were observed between NT-proBNP and TM, H-FABP, PTX-3 and Gal-3 in the STEMI group. ROC analysis demonstrated excellent diagnostic accuracy for these biomarkers in distinguishing STEMI from NSTEMI and control groups. Conclusions: Vascular inflammation plays an important role in the pathophysiology of STEMI and NSTEMI. A comprehensive cardiac biomarker panel enhances diagnostic accuracy and risk stratification, particularly when distinguishing between STEMI and NSTEMI. The biomarkers hs-TnI, CK-MB, NT-proBNP, TM, H-FABP, PTX-3 and Gal-3 offer complementary information when used together as a panel. Further research and validation are essential to establish standardized protocols for their widespread use.

Impact of Acute Myocardial Injury on Short- and Long-Term Outcomes in Patients With Primary Intracerebral Hemorrhage

BACKGROUND

Myocardial injury is common after brain injury; however, few studies have reported serial cardiac troponin (cTn) measurements to distinguish whether the myocardial injury is acute or chronic. The fourth Universal Definition of Myocardial Infarction introduced for the first time the criteria for acute myocardial injury (AMI). We aimed to investigate the prevalence and prognostic implications of AMI in primary intracerebral hemorrhage.

METHODS AND RESULTS

We retrospectively analyzed patients with primary intracerebral hemorrhage within 48 hours after symptom onset. All patients included had at least 2 cTn measurements: 1 obtained at the time of emergency admission and at least 1 more within the first 2 days of hospitalization. AMI was defined as an elevated cTn above the upper-reference limit (14 ng/L) along with a rise/fall >20%. Patients were followed for up to 5 years. Outcomes included major adverse cardiac events (MACEs; a composite of vascular death, nonfatal coronary events, and nonfatal stroke) and 90-day unfavorable outcomes (modified Rankin scale score ≥4). Cox proportional hazards models, multivariable logistic regression models, and Kaplan-Meier analyses were used to evaluate the association between AMI and outcomes. Of 600 patients included, 115 had AMI (19.2%). AMI independently conferred an increased risk for major adverse cardiac events (adjusted hazard ratio, 1.69 [95% CI, 1.12-2.53]) and 90-day unfavorable outcomes (adjusted odds ratio, 2.15 [95% CI, 1.26-3.67]) compared with patients without AMI.

CONCLUSIONS

AMI is relatively common in patients with intracerebral hemorrhage and is associated with both long-term major adverse cardiac events and 90-day unfavorable outcomes.

Development and Validation of Risk Stratification for Heart Failure After Acute Coronary Syndrome Based on Dynamic S100A8/A9 Levels

BACKGROUND

The early assessment of heart failure (HF) risk in patients with acute coronary syndrome (ACS) can help reduce mortality. S100A8/A9 is not only rapidly released after myocardial ischemia, but is also involved in reperfusion injury, which is an important predictor of HF after ACS. We attempted to construct a reliable HF risk stratification tool for evaluating patients with ACS after reperfusion therapy based on S100A8/A9 dynamic changes.

METHODS AND RESULTS

This prospective study included 3 independent cohorts of patients with ACS who received reperfusion therapy. The discovery cohort was divided into 2 subgroups: the longitudinal subgroup (n=264) with serum S100A8/A9 levels measured at admission and on days 1, 2, 3, and 4 postadmission, respectively, and the 2-point subgroup (n=798) with S100A8/A9 levels measured at admission and on day 1 postadmission, respectively. Validation cohorts 1 (n=1399) and 2 (n=1183) both had S100A8/A9 levels measured on day 1 postadmission. HF events included in-hospital HF events after the initial presentation and long-term HF events after discharge. The median follow-up for the discovery cohort, validation cohort 1, and validation cohort 2 was 4.2, 2.6, and 1.8 years, respectively. In the discovery cohort, S100A8/A9's predictive ability at day 1 surpassed other time points. Through the S100A8/A9-guided risk stratification, patients deemed high risk (>7900 ng/mL) exhibited a higher 1-year HF event rate (46% versus 2%, 38% versus 5%) than patients at low risk (<2100 ng/mL) in both validation cohorts. Among patients without left ventricular dysfunction after ACS, β-blocker therapy correlated with reduced 1-year HF events in intermediate-to- high-risk patients but not in low-risk patients.

CONCLUSIONS

S100A8/A9 levels on day 1 accurately classified patients at varying risks of HF, serving as a robust tool for HF risk prediction and treatment guidance.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03752515.

Low ambient temperature and incident myocardial infarction with or without obstructive coronary arteries: a Chinese nationwide study

BACKGROUND AND AIMS

Although non-optimum ambient temperature is a major non-traditional risk factor for acute myocardial infarction, there is no prior knowledge on whether non-optimum ambient temperature could differentially affect myocardial infarction with obstructive coronary artery disease (MI-CAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA).

METHODS

Using the Chinese Cardiovascular Association database-Chest Pain Center Registry, a nationwide, time-stratified, case-crossover investigation was conducted from 2015 to 2021. Meteorological data were obtained from an established satellite-based model, and daily exposures were assigned according to the onset of myocardial infarction in each patient. A conditional logistic regression model combined with distributed lag non-linear models (10 days) was used to estimate the exposure-response relationships.

RESULTS

A total of 83 784 MINOCA patients and 918 730 MI-CAD patients were included. The risk of MINOCA and MI-CAD associated with low temperature occurred at lag 2 day and lasted to 1 week. Extremely low temperature was associated with a substantially greater odds ratio (OR) of MINOCA [OR 1.58, 95% confidence interval (CI) 1.31-1.90] than MI-CAD (unmatched: OR 1.32, 95% CI 1.23-1.43; equally matched by age and sex: OR 1.25, 95% CI 1.04-1.50), compared with the corresponding reference temperatures (30°C, 35°C, and 30°C). Stronger associations were observed for patients who were aged ≥65 years, female, or resided in the south. There was no significant difference for the impacts of high temperature on MINOCA and MI-CAD.

CONCLUSIONS

This nationwide study highlights the particular susceptibility of MINOCA patients to ambient low temperature compared with that of MI-CAD patients.

Prognostic Significance of Homocysteine Levels in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Propensity Score Matching and Weighting Analysis

Background

Elevated homocysteine (Hcy) levels have been linked to poorer outcomes in acute coronary syndrome. This study aimed to assess the predictive value of elevated Hcy levels for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods

This retrospective cohort study included 183 STEMI patients who underwent primary PCI at a tertiary university hospital in southern China from January 2020 to December 2021. Laboratory values, including Hcy levels, were obtained within 24 hours of admission. Patients were categorized into elevated and normal Hcy groups using a threshold of 12 μmol/L. The study outcome was the occurrence of 6-point MACE, defined as cardiac death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization (PCI or coronary artery bypass grafting), heart failure and all-cause death. Survival analyses were conducted using Kaplan-Meier and Cox proportional hazard methods. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) approaches were employed to minimize bias.

Results

The mean age of the patients was 64.8 years, with 76.0% being male. After adjusting with PSM or IPTW, covariate imbalances between the two groups were corrected. Over a median follow-up period of 25.8 months, 55 MACE events occurred, resulting in an event rate of 30.1%. Patients with elevated Hcy levels had a higher incidence of MACE in both unadjusted (hazard ratio [HR] = 2.778; 95% confidence interval [CI]: 1.591-4.850; p < 0.001) and adjusted analyses (PSM: HR = 2.995; 95% CI: 1.397-6.423, p = 0.005; IPTW: HR = 3.2; 95% CI: 1.631-6.280, p < 0.001). Multivariate Cox regression further confirmed that elevated Hcy levels were associated with a worse prognosis across the entire cohort (HR = 1.062, 95% CI: 1.029-1.097, p < 0.001), PSM cohort (HR = 1.089, 95% CI: 1.036-1.145, p < 0.001), and IPTW cohort (HR = 1.052, 95% CI: 1.020-1.086, p = 0.001).

Conclusions

Elevated plasma levels of Hcy (≥12 μmol/L) are associated with worse outcomes in STEMI patients undergoing primary PCI, highlighting the potential role of Hcy as a prognostic marker in this population.

Cardiac adverse events associated with statins in myocardial infarction patients: a pharmacovigilance analysis of the FDA Adverse Event Reporting System

BACKGROUND

Despite the advent of new pharmacotherapies, statins remain a cornerstone in the secondary prevention of myocardial infarction (MI). However, the cardiac adverse events (AEs) linked to statins are not well-documented.

AIM

This pharmacovigilance study used data from the FDA Adverse Event Reporting System (FAERS) to investigate the association between statin use and cardiac AEs in MI patients.

METHOD

Reports from the FAERS database (2004-2023) identifying statins as the primary suspect in MI patients were analyzed. The study evaluated seven types of statins: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Disproportionality analysis using four major indices, Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-Item Gamma-Poisson Shrinker (MGPS), was conducted to detect signals of statin-related cardiac AEs.

RESULTS

Of the 20,346,289 reports reviewed, 150 identified statins as the primary suspect drug in MI patients. The most common cardiac AEs were recurrent MI (50 reports), acute MI (14 reports), followed by tachycardia (10), angina pectoris (8), coronary artery occlusion (6), cardiac failure (6), and arrhythmia (6). The analysis revealed no significant signals of statin-induced cardiac AEs.

CONCLUSION

The findings confirm that statin use in MI patients does not significantly increase the risk of cardiac adverse effects, supporting their safety profile in this context.

The role of SELE gene polymorphism in ST-elevation myocardial infarction

Ischemic heart disease (IHD) is an important medical and social problem. ST-elevation myocardial infarction (STEMI) is the most severe form of IHD, affecting all layers of the heart muscle. One of the diagnostic criteria for endothelial dysfunction in myocardial infarction is the level of sE-selectin, a cell adhesion molecule that recruits neutrophils and induces neutrophil inflammation. The aim of this study is to investigate intronic polymorphisms rs5353, rs3917412 and rs1534904 of the E-selectin coding gene SELE in patients with STEMI. We have analyzed a group of patients with STEMI (n = 74) and a population sample of Tomsk (n = 136) as the control group. The frequencies of the rs5353 genotypes in the SELE gene have shown statistically significant differences between patients and the control sample (p = 0.004). The CC genotype is a predisposing factor to STEMI (OR = 6.93, CI:95 % (1.84-26.04), χ2 = 8.69, p = 0.002). The analyzed markers were not studied previously in cardiovascular diseases (CVDs) and were rarely involved in association studies at all; there is no information on these SNPs in the leading databases. At the same time, all three variants, according to the RegulomeDB classification, belong to the functional class 1f, and are highly likely to have regulatory potential relative not only to the SELE gene, but also to other genes in the nearby region. The analysis of the functional significance of the studied markers has shown the presence of a region more extensive than one gene, which is co-regulated by the studied nucleotide substitutions. The association of rs5353 with STEMI identified in this study once again confirms the involvement of the SELE gene in the pathogenesis of CVDs. It is possible that this entire region of the genome may be involved indirectly in the pathogenesis of CVD through the systems of inflammation, immune response and DNA repair.

Impact of Robotic Percutaneous Coronary Intervention (R-PCI) With and Without CCTA-Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry

BACKGROUND

Several studies have confirmed the safety and efficacy of robotic assisted coronary interventions for simple and complex coronary lesions. However, in the real-world clinical setting the currently available evidence is still inconclusive with regard to clinical outcomes. In terms of financial sustainability, the emerging use of pre-PCI Coronary Computed Tomography Angiography (CCTA) may potentially impact the overall patient journey and related costs. However, the role of CCTA guidance in elective robotic-assisted revascularizations and its potential impact on hospital economics has never been investigated. Therefore, we aimed to assess the clinical impact of R-PCI according to procedural complexity and its potential financial sustainability when integrated with CCTA guidance.

METHODS

Major adverse cardiovascular events (MACE) at the latest clinical follow-up available have been prospectively evaluated in a single center cohort of 111 patients undergoing elective R-PCI (CorPath, Corindus GRX Robotic Drive, Boston, MA). The study population was subsequently divided into two groups according to either the median Syntax Score (SS = 14) as a surrogate of procedural complexity or the adoption of CCTA-guidance. Additionally, both periprocedural and in-hospital outcomes have been investigated in the overall cohort and in the subgroups.

RESULTS

Overall, MACE occurred in 5.4% of the patients at a median follow-up of 309 days. Procedural complexity was associated with significantly longer procedural time and radiation exposure (SS ≥ 14: 94.5 ± 32.1 vs. 78.7 ± 25.5 min, p = 0.011, and 32.7 ± 30.9 vs. 22.5 ± 19.8 mSv, p = 0.010, respectively), but not with increased in-hospital and long-term clinical outcomes. Additionally, patients undergoing CCTA-guided R-PCI had a significantly higher rate of same-day-discharge (SDD-64.6% vs. 44.2% respectively, p = 0.034) than those without CCTA support.

CONCLUSION

R-PCI appears safe and effective regardless the procedural complexity. Moreover, the integration of robotics and CCTA-guidance appears to have beneficial impact on hospital economics by optimizing resource utilization and improving patient selection for percutaneous revascularization.

Characteristics and outcomes of myocardial infarction among burn patients: A nationwide analysis

PURPOSE

To examine the characteristics and outcomes of myocardial infarction (MI) among burn patients.

MATERIALS AND METHODS

The Nationwide Readmissions Database was utilized to identify hospitalizations of patients with burns from 2016 to 2020. The main outcome was the difference in all-cause in-hospital mortality between burn patients with and without MI.

RESULTS

Of 200,130 hospitalizations with burns, 1997 (1 %) developed acute MI. Burn patients with MI were older, more likely to be men, and had a higher prevalence of cardiovascular risk factors. Only burns affecting the trunk and respiratory tract, and those affecting > 20 % of body surface area (BSA), were associated with an increased risk of MI. All-cause in-hospital mortality was higher among patients with MI (18.7 % vs. 3 %, adjusted odds ratio (aOR) 4.59, 95 % confidence interval (CI) 3.66, 5.76). Cardiogenic shock, ventricular tachycardia, and stroke rates were higher among patients with MI. Revascularization was associated with lower in-hospital mortality (aOR 0.33, 95 % CI 0.17, 0.64) CONCLUSIONS: The incidence of MI in burn patients is low but is associated with high mortality and morbidity. Burns involving the trunk and respiratory tract, and those affecting > 20 % BSA, were associated with an increased risk of MI. Revascularization was associated with lower in-hospital mortality.

The Clinical Significance of PCI-Related Myocardial Infarction in Stable Ischaemic Heart Disease Patients in the Era of hs-Troponin

BACKGROUND & AIM

The definition and clinical relevance of percutaneous coronary intervention (PCI)-related myocardial infarction (MI) has been a topic of significant debate and controversy. It has particularly garnered widespread attention recently due to a contemporary trend of including it as a component of primary end points in major trials. The study aimed to assess the clinical relevance of PCI-related MI (PMI) according to the Fourth Universal Definition of MI using a high-sensitivity troponin (hs-Tn) assay in a real-world setting.

METHODS

This was a single centre, retrospective registry analysis of consecutive patients who underwent elective PCI for stable ischaemic heart disease between January 2014 to December 2018. The primary end point was major adverse cardiovascular events (MACEs)-the composite of death, spontaneous MI, stent thrombosis and the need for repeat revascularisation within 12 months from the index procedure.

RESULTS

We treated 858 patients with a mean age of 67.6 years and 78.3% were men. The incidence of PMI in our cohort was 12.8%. On univariable analysis, contrast volume >150 mL, prior coronary artery bypass graft, final thrombolysis in MI flow 0-2, total stent length and stent length >20 mm were significantly associated with increased risk of PMI. There were 46 (5.4%) MACE in total with seven (6.4%) in the PMI group and 39 (5.2%) in the non-PMI group (p=0.6). Kaplan-Meier survival curves were used to estimate 1-year MACE-free survival for the patients with PMI versus non-PMI and there was no significant difference. On multivariable Cox proportional hazards analysis, contrast volume >150 mL, prior coronary artery bypass graft and estimated glomerular filtration rate <60 (mL/min/1.73 m2) were independent predictors of MACE during 1-year follow-up, whereas PMI was not an independent predictor.

CONCLUSIONS

PMI defined according to the Fourth Universal Definition of MI and using hs-Tn was common, occurring in 12.8% of patients, but not independently predictive of MACE in 1 year. As PMIs are increasingly used as a component of composite primary end points in major, practice-changing trials, establishing a clinically relevant definition of PMI is of utmost importance.

Editor's Choice - Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair

OBJECTIVE

Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes.

METHODS

A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up.

RESULTS

A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality rate was similar (SAPT 2.1% vs. DAPT 1.5%; p = .42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p = .040), with DAPT being an independent protector for acute mesenteric (p = .009) and lower limb ischaemia (p = .020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p = .40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no survival confounders, with similar rates between groups (log rank p = .71). DAPT patients enjoyed higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 97.0%, SE 0.6%; log rank p = .007) at thirty six months. Cox regression revealed B-EVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 - 3.03; p < .001). DAPT was related to higher patency within B-EVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001).

CONCLUSION

DAPT after F/B-EVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in B-EVAR cases. No difference in major haemorrhagic events was observed at 30 days.

Differences between MINOCA and type 2 myocardial infarction: An ITALIAN observational study

BACKGROUND

Myocardial infarction with non-obstructive coronary arteries (MINOCA) and type 2 myocardial infarction (MI), both presenting as non-ST-elevation MI (NSTEMI), are often grouped together due to overlapping symptoms. The aim of our study is to compare their characteristics and prognosis to distinguish between them.

METHODS

Among 7815 patients with NSTEMI who underwent coronary angiography between 2005 and 2022 we identified 538 patients with diagnosis of MINOCA (n = 301; 3,9 %) and type 2 MI (n = 237; 3 %). The outcome was a composite of all-cause mortality, non-fatal MI, hospitalisation for heart failure (HF) and transitory ischemic attack or non-fatal stroke.

RESULTS

The mean age of the entire cohort was 68 (11.5) years, with women being the most frequently represented group (65 %). Comparing the sub-cohorts, MINOCA patients were younger (66.3 (11.7) Vs. 70.6 (11) years, p < 0.01), and less likely to have typical cardiovascular risk than type 2 MI patients. At multivariable analysis different clinical (age, heart rate, typical chest pain, palpitations, postmenopausal status), and instrumental (cardiac rhythm, ST-segment changes, diastolic dysfunction, hypo/akinesia with non-coronary distribution) variables were independent predictors of MINOCA with AUC of 0.83 [95 % CI, 0.78-0.88], p < 0.01 at ROC analysis. At a median follow-up of 61 (IQR 34-100) months, MINOCA patients had significantly lower rate of the composite endpoint compared to type 2 MI (20 % Vs. 32 %, p < 0.01).

CONCLUSIONS

MINOCA cohort was associated with different characteristics compared to type 2 MI and had a better prognosis despite the number of events was not negligible.