Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

Validation and the psychometric properties of the Persian version of the sleep quality scale for coronary care patients: a methodological survey

Sleep quality is crucial for recovery in coronary care patients, yet sleep disturbances are prevalent in intensive care settings. This study aimed to validate the Persian version of the Sleep Quality Scale for Coronary Care Patients (SQ-CC-P) in the Iranian population and ensure its psychometric robustness for clinical and research applications. A methodological study was conducted in the Coronary Care Unit (CCU) and heart unit of Imam Khomeini Hospital in Ardabil Province, Iran, from May to September 2024, involving 220 participants diagnosed with acute coronary conditions. The SQ-CC-P, which includes self-assessment and environmental factors, was assessed for content validity, construct validity, and reliability in accordance with COSMIN guidelines. The SQ-CC-P demonstrated strong content validity, with CVI (0.80-0.92), CVR (0.70-1.00), S-CVI/UA (0.85), S-CVI/Ave (0.91), and Adjusted Kappa (0.697) confirming item relevance and necessity. Construct validity was supported by exploratory factor analysis (EFA), which revealed a two-factor structure explaining 62.4% of the variance, and confirmatory factor analysis (CFA), which showed strong factor loadings (0.72-0.82) and excellent model fit. The scale exhibited high internal consistency (Cronbach's alpha = 0.862, McDonald's omega = 0.864) and test-retest reliability (ICC = 0.785, 95% CI [0.718, 0.841]). The SQ-CC-P is a valid and reliable tool for assessing sleep quality among coronary care patients, addressing a critical gap in sleep assessment in intensive care settings.

Complex versus non-complex percutaneous coronary intervention in patients with atrial fibrillation: a real-world study

BACKGROUND

Patients with atrial fibrillation (AF) often underwent percutaneous coronary intervention (PCI), and the complexity of PCI has risen in recent years. However, there is limited data available on clinical outcomes in patients with AF who underwent complex PCI.

METHODS

This was a prospective, observational study. Complex PCI was defined as PCI performed to ≥ 3 separate major coronary vessels; ≥3 stents implanted; ≥3 lesions treated; or total stented length > 60 mm. The primary outcome was defined as major adverse cardiovascular event (MACE) including all-cause death, spontaneous myocardial infarction (MI), stroke/ transient ischemic attack (TIA), systemic embolism or ischemia-driven revascularization. The secondary outcome was defined as net adverse clinical events (NACE), which included major adverse cardiovascular events (MACE) and major bleeding.

RESULTS

A total of 1132 patients who underwent PCI with AF were enrolled consecutively. The mean age was 67 ± 9, and 75.1% were male. 320 participants (28.2%) underwent complex PCI. During a median follow-up of 1045 days (interquartile range: 666-1327), the primary outcome occurred in 52 out of 320 patients (16.2%), while the secondary outcome was observed in 55 out of 320 patients (17.2%) in the complex PCI group. MACE showed no differences between groups (hazard ratio [HR], 1.30; 95% confidence interval [CI], 0.93-1.82), nor did NACE (HR:1.34, 95%CI: 0.97-1.85). Patients with complex PCI still had a higher likelihood of experiencing spontaneous MI (HR, 2.17, 95%CI, 1.00-4.70) and ischemic driven revascularization (HR, 1.86, 95%CI, 1.01-3.45) after adjusted for confounders.

CONCLUSION

The complexity of PCI was an independent risk factor for adverse clinical outcomes, particularly for myocardial infarction and revascularization events in patients with atrial fibrillation. However, it was not associated with major bleeding, all-cause mortality, or stroke/TIA.

CLINICAL TRIAL NUMBER

Not applicable.

Evaluation of Structure Prediction and Molecular Docking Tools for Therapeutic Peptides in Clinical Use and Trials Targeting Coronary Artery Disease

This study evaluates the performance of various structure prediction tools and molecular docking platforms for therapeutic peptides targeting coronary artery disease (CAD). Structure prediction tools, including AlphaFold 3, I-TASSER 5.1, and PEP-FOLD 4, were employed to generate accurate peptide conformations. These methods, ranging from deep-learning-based (AlphaFold) to template-based (I-TASSER 5.1) and fragment-based (PEP-FOLD), were selected for their proven capabilities in predicting reliable structures. Molecular docking was conducted using four platforms (HADDOCK 2.4, HPEPDOCK 2.0, ClusPro 2.0, and HawDock 2.0) to assess binding affinities and interactions. A 100 ns molecular dynamics (MD) simulation was performed to evaluate the stability of the peptide-receptor complexes, along with Molecular Mechanics/Poisson-Boltzmann Surface Area (MM/PBSA) calculations to determine binding free energies. The results demonstrated that Apelin, a therapeutic peptide, exhibited superior binding affinities and stability across all platforms, making it a promising candidate for CAD therapy. Apelin's interactions with key receptors involved in cardiovascular health were notably stronger and more stable compared to the other peptides tested. These findings underscore the importance of integrating advanced computational tools for peptide design and evaluation, offering valuable insights for future therapeutic applications in CAD. Future work should focus on in vivo validation and combination therapies to fully explore the clinical potential of these therapeutic peptides.

Platelet-derived sTLT-1 is associated with platelet-mediated inflammation in coronary artery disease patients

The development of coronary artery disease (CAD) depends heavily on platelet activation, and inflammation plays a major role in all stages of atherosclerosis. Platelet-specific soluble triggering receptor expressed on myeloid cells like transcript 1 (sTLT-1) facilitate clot formation and have been linked to chronic inflammation. In this study, we explored the role of platelet-derived sTLT-1 in platelet-mediated inflammation in CAD patients. Plasma levels of sTLT-1 were measured using enzyme-linked immunosorbent assay in CAD patients (n = 163) and healthy controls (n = 99). Correlation analysis was performed to determine the circulatory sTLT-1 levels with platelet activation markers, immune cells, and inflammatory cytokines/chemokines. Increased plasma sTLT-1 levels were observed in CAD patients compared with those in healthy controls (p < 0.0001). A positive correlation was observed between sTLT-1 and platelet activation markers (P-selectin, PAC-1), CD14++ CD16- cells (classical monocytes), Natural killer T (NKT) cells, and platelet-immune cell aggregates with monocytes, neutrophils, dendritic cells, CD11c+ cells, and NKT cells. In contrast, a significant negative correlation was observed with CD8 cells. Furthermore, a significant positive correlation was observed between sTLT-1 and inflammatory markers (TNF-α, IL-1β, IL-2, IL-6, IL-12p70, IL-18, CXCL-12, and CCL-11). Logistic regression analysis identified sTLT-1 and triglycerides as predictors of CAD. Receiver operating characteristic curve (ROC) analysis showed that sTLT-1 had a higher sensitivity and specificity for predicting CAD. Our findings suggest that platelet activation induces the release of sTLT-1 into the circulation in CAD patients, which aggregates with immune cells and enhances inflammatory responses.

The Impact of Age, Comorbidities, and Discharge Timing on Clinical Outcomes Following Elective Percutaneous Coronary Intervention

Background The adoption of same-day discharge (SDD) in elective percutaneous coronary intervention (PCI) procedures offers potential benefits in terms of patient satisfaction and reduced healthcare costs. Despite these advantages, the safety and efficacy of SDD, especially among patients with diverse health profiles, are not fully understood. This study investigates the effects of patient-specific factors, including age, comorbidities, and discharge timing, on the clinical outcomes of elective PCI, focusing on the viability of SDD. Methods A prospective study was carried out at Lady Reading Hospital, Peshawar, Pakistan, involving 220 patients undergoing elective PCI from January to June 2023. This research compared the clinical outcomes of patients discharged on the same day with those who had extended hospital stays, examining the impact of age, comorbidities, and PCI success. Main outcome measures included post-procedure complications and hospital readmissions within 30 days. Results The study enrolled participants with an average age of 62 years, the majority (88%, n=194/220) of whom had comorbidities. Interestingly, 16% (n=35/220) of the participants were discharged on the same day, while the rest stayed longer in the hospital. Notably, those in the SDD group experienced significantly more complications and readmissions, with 95.14% (n=33/36) compared to only 16.22% (n=30/184) in their counterparts. Factors such as age, comorbidities, success of PCI, timing of discharge, and patient satisfaction emerged as significant predictors of the observed outcomes. Conclusion This study highlights the essential role of personalized care in discharge planning following elective PCI, advocating for a cautious approach towards SDD, especially for older patients and those with multiple health issues.

Special Issue "Coronary Artery Disease Interventions"

The treatment and burden of patients with severe ischemic heart disease, whether acute or chronic, remain some of the greatest challenges in cardiology [...].

Multi-proteomic Biomarker Risk Scores for Predicting Risk and Guiding Therapy in Patients with Coronary Artery Disease

PURPOSE OF REVIEW

Patients with established coronary artery disease (CAD) are at high residual risk for adverse events, despite guideline-based treatments. Herein, we aimed to determine whether risk scores based on multiple circulating biomarkers that represent activation of various pathophysiologically important pathways involved in atherosclerosis and myocardial dysfunction help identify those at greatest residual risk.

RECENT FINDINGS

Numerous circulating proteins, representing dysregulation of the pathways involved in the development and stability of coronary and myocardial diseases, have been identified. When aggregated together, biomarker risk scores (BRS) more accurately stratify patients with established CAD that may help target interventions in those individuals who are at elevated risk. Moreover, intensification of guideline-based therapies has been associated with parallel improvements in both BRS and outcomes, indicating that these risk scores may be employed clinically to target therapy. Multi-protein BRS are predictive of risk, independent of, and in addition to traditional risk factor assessments in patients with CAD. Those with elevated risk may benefit from optimization of therapies, and improvements in the BRS will identify those with improved outcomes.