Meta-analysis comparing immediate versus staged complete revascularization for ST-elevation myocardial infarction with multivessel disease.

Patients with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI), and the optimal timing of complete revascularization (CR) in these cases remains uncertain. This study aims to assess major adverse cardiovascular events (MACE) and procedural complications in STEMI patients with multivessel CAD undergoing immediate (index procedure) versus staged CR. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged complete revascularization (CR) in STEMI and multivessel CAD.

Antithrombotic therapy in patients with chronic coronary syndrome: a focus on the 2024 European Society of Cardiology guidelines.

Antithrombotic therapy represents the mainstay of the pharmacological treatment in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). The optimal choice, combination, and duration of antithrombotic therapy represent still a clinical conundrum requiring a critical assessment of patient comorbidities, clinical presentation, and PCI features. The 2024 European Society of Cardiology (ESC) guidelines for the management of patients with CCS have been recently published encompassing new and revised recommendations on antithrombotic therapy.

Discordant Diagnosis of Coronary Microvascular Dysfunction by Microvascular Resistance Reserve: Transthoracic Doppler Echocardiography vs Bolus Thermodilution Method.

Background: Epicardial stenosis and coronary microvascular dysfunction (CMD) may coexist in patients with chronic coronary syndrome (CCS). Microvascular resistance reserve (MRR) has been demonstrated to be a valid cross-modality metric using continuous saline infusion thermodilution and intracoronary Doppler flow velocity methods. This study aimed to investigate the prevalence and diagnostic concordance of CMD defined by MRR using two methods-stress transthoracic Doppler echocardiography (S-TDE) and the invasive bolus thermodilution method (B-Thermo)-in patients with functionally significant epicardial stenosis.

DIFFERENCES ON IN-HOSPITAL OUTCOMES IN PATIENTS WITH CARDIOGENIC SHOCK DUE TO STEMI VERSUS NSTEMI USING A NATIONWIDE DATABASE.

Background: Our study aims to compare in-hospital management and outcomes in patients with cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI) versus non-ST-segment elevation myocardial infarction (NSTEMI). Methods: We conducted a retrospective cohort study using the National Inpatient Sample database between 2016-2019, including patients with STEMI/NSTEMI complicated by cardiogenic shock. An inverse probability treatment weighting analysis was performed to compare in-hospital management and outcomes between patients with STEMI and NSTEMI.

Clinical Outcomes Following Optical Coherence Tomographic Versus Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.

Background: Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are adjunctive intracoronary imaging modalities used to optimize coronary stent implantation. However, the impact of OCT versus IVUS on clinical outcomes and periprocedural complications is unclear.

Aims: To perform a meta-analysis of all vetted randomized controlled trials comparing OCT-guided versus IVUS-guided percutaneous coronary intervention.

Long-term efficacy of drug-coated balloon only angioplasty for IgG4-related coronary artery disease: a case report.

Background: Although coronary artery involvement in patients with IgG4-related disease (IgG4-RD) is rare, emergency revascularization is recommended for managing acute coronary syndrome. However, coronary aneurysm formation and stent migration after sirolimus-eluting stent implantation have been reported for this disease. Thus, new treatment modalities are warranted for the management of coronary artery disease in this vasculitis.

Late mitral leaflet tear after transcatheter edge-to-edge repair for acute ischaemic mitral regurgitation: a case report.

Background: Acute mitral regurgitation due to papillary muscle rupture is a severe complication of acute myocardial infarction. Transcatheter edge-to-edge repair is emerging as an effective alternative to surgical treatment, with encouraging outcomes. Leaflet adverse events are rare and are associated with relapse of significant mitral regurgitation.

Steroid-resistant immunoglobulin G4-related coronary arteritis: a case report.

Background: Immunoglobulin G4 (IgG4)-related diseases are systemic fibroinflammatory disease characterized by extensive infiltration of IgG4-positive plasma cells in the affected tissue(s), with high plasma levels of IgG4. However, coronary involvement is rare.

Case Summary: A 70-year-old man was diagnosed with IgG4-related coronary arteritis, pancreatitis, and cholangitis during full-body contrast computed tomography (CT) examination prior to surgery for an iliac artery aneurysm.

Impact of white blood cell count on the development of contrast-induced acute kidney injury in patients receiving percutaneous coronary intervention.

This study aimed to investigate the efficacy of a pre-procedural white blood cell (WBC) count in the prediction of contrast-induced acute kidney injury (CI-AKI) risk in coronary artery disease patients receiving a percutaneous coronary intervention (PCI). This observational study comprises a sample of 1,013 coronary artery disease patients (including ACS and stable angina) receiving PCI, gathered from September 2015 to July 2017. CI-AKI incidence in the study population was 4.

Percutaneous coil embolization of a post-traumatic left anterior descending coronary artery pseudoaneurysm: a case report.

Background: Coronary artery pseudoaneurysm (PSA) is a rare occurrence linked to percutaneous coronary interventions (PCIs), infection, or chest trauma, lacking established management guidelines due to its low incidence.

Case Summary: A 78-year-old male with a medical history of triple vessel disease, post coronary artery bypass grafting, heart failure, and chronic obstructive pulmonary disease, presented with intractable left-sided chest pain following a mechanical fall. The initial workup was positive for mildly elevated high-sensitivity troponin and brain natriuretic peptide raising suspicion for a pulmonary embolism; but chest computed tomography angiography revealed an enlarging pericardial haematoma.

Rotational atherectomy with cutting balloon before stenting in severely calcified coronary lesions: a meta-analysis.

Background: Rotational atherectomy (RA) has been proven to treat coronary artery calcification (CAC) during percutaneous coronary intervention (PCI).

Purpose: This study evaluates the safety and efficacy of RA followed by cutting balloon angioplasty (ROTACUT) before stent placement in CAC.

Methods: A systematic review and meta-analysis of randomized controlled trials and observational studies was conducted.

Post-PCI coronary physiology: clinical outcomes and can we optimize?

Invasive coronary physiology is well-established for identifying stable lesions appropriate for revascularization with percutaneous coronary intervention (PCI). Furthermore, fractional flow reserve (FFR)-guided PCI is associated with better clinical outcomes compared with routine angiography-guided PCI. The rise of intravascular imaging-guided PCI has generated great interest in optimizing the technical results of a PCI procedure, and this has now extended to an interest in optimizing coronary physiology following PCI.

Functional assessment of coronary artery disease in patients with severe aortic stenosis: a review.

A significant proportion of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) have concomitant coronary artery disease (CAD). The best way to treat these patients is contentious. Conventional assessments of ischaemia such as fractional flow reserve (FFR) and instantaneous wave-free ratio are not validated in the context of severe AS despite having a Class I European Society of Cardiology indication in patients with isolated coronary disease.

Coronary Artery Dissection in Drug-Coated Balloon Angioplasty: Incidence, Predictors, and Clinical Outcomes.

Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCB) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. The aim of this study was to evaluate incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease (CAD).

The State of STEMI Care Across NSW: A Comparison of Rural, Regional, and Metropolitan Centres.

Background: At a global level, regional variation in the management of ST-elevation myocardial infarction (STEMI) is influenced by patient demographics and geography. Rural patients with STEMI are disadvantaged in reaching timely care owing to distance and limited ambulance and healthcare resources. Optimising models of STEMI care is key to overcoming the excess rural vs metropolitan cardiovascular morbidity and mortality.

Comprehensive Overview of Retrograde-Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques.

Background: Advancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization.

Objectives: To detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios.

Methods: We describe the two main techniques, tip-in and rendezvous, and their derivatives such a facilitated tip-in, manual MC-tip modification, tip-in the balloon, tip-in the stent, deep dive rendezvous, catch-it and antegrade microcatheter probing.

The Impact of Age in Patients Undergoing Impella-Assisted Percutaneous Coronary Interventions.

Background: Short-term percutaneous mechanical circulatory support (MCS) devices provide hemodynamic support in cardiogenic shock or during high-risk percutaneous coronary intervention (PCI).

Aims: To assess the impact of age on the clinical and angiographic characteristics and in-hospital outcomes of all patients undergoing PCI with the Impella MCS.

Methods: Data on all patients that underwent PCI with an Impella was divided into three groups according to age: < 65, 65 to < 75 years, and ≥ 75 years.

Urgent Coronary Angiography Following Cardiac Surgery: Insights from a High-Volume Cardiac Surgery Center.

Background: Post-operative myocardial infarction is a possible complication following cardiac surgery. Data on the incidence, predictors and prognosis of urgent coronary angiography (UCA) after cardiac surgery are scarce.

Aims (objectives): This study aims to report in hospital and 1-year follow-up outcomes of a recent large cohort of patients undergoing UCA after cardiac surgery.

Qingre Huoxue decoction attenuates myocardial ischemia‒reperfusion injury by regulating the autophagy‒endoplasmic reticulum stress axis via FAM134B-mediated ER-phagy.

Background: Autophagy‒endoplasmic reticulum (ER) stress axis dysregulation is linked to myocardial ischemia‒reperfusion injury (MIRI), which counteracts the benefits of acute myocardial infarction (AMI) reperfusion therapy. Qingre Huoxue decoction (QRHX) improves the short- and long-term prognosis of AMI after percutaneous coronary intervention and alleviates myocardial injury in AMI rats by stimulating autophagy via the PI3K/Akt pathway. We aimed to further explore the efficacy of QRHX in treating MIRI and its regulatory relationship with FAM134B-mediated ER-phagy.

Calcified plaque modification during percutaneous coronary revascularization.

The presence and severity of calcified coronary plaque negatively impacts angiographic and clinical outcomes following percutaneous coronary intervention (PCI). Severe coronary calcification is associated with suboptimal stent delivery, deployment, apposition and expansion which can lead to in-stent restenosis and/or thrombosis. Severe coronary calcification is associated with incremental hazard for adverse clinical events, including death, during 5-10 years following PCI despite the use of new generation drug- eluting stents.

Comparison of clinical outcomes between direct and indirect transfer in patients with ST-segment elevation myocardial infarction.

Primary percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-segment elevation myocardial infarction (STEMI). Previous studies suggest that direct transport by ambulance to a primary PCI facility is associated with better clinical outcomes in patients with STEMI. However, those studies included seriously ill patients for whom direct transport is the only option.

Perspectives on why DanGer Shock is the first positive trial on mechanical circulatory support in cardiogenic shock.

Cardiogenic shock related to acute myocardial infarction (AMI-CS) remains a severe condition associated with a high risk of mortality despite increased availability of primary percutaneous coronary intervention and improvements in pharmacologic and device-based therapy. The results of the DanGer Shock trial stand out compared with the outcomes of the previous trials and mark the first mechanical circulatory support (MCS) strategy to show a benefit in patients with AMI-CS, a population that has always been challenging to study. Notably, negative findings from previous trials may mask positive treatment effects in specific subgroups and patient category.