Search Results (262)

Background: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly in low- and middle-income countries. Although elevated cholesterol is a well-established modifiable risk factor for atherosclerotic CVD, the phenomenon known as the “cholesterol paradox” has raised uncertainty regarding the prognostic significance of admission cholesterol levels in patients with acute coronary syndrome (ACS). Therefore, this study aimed to evaluate the association between admission total cholesterol (TC) levels and in-hospital mortality among patients with first-episode ACS. Methods: Data were obtained from the National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry, where this cross-sectional study implemented a consecutive sampling of the nationwide ACS patient database for eligible records from January 2006 to December 2015. The patients were then classified into quartiles according to their TC levels, with the corresponding all-cause in-hospital mortality considered the outcome. Following adjustments for potential confounding factors, multilevel analysis ensued to determine the association between cholesterol groups and mortality. Results: The quartile two (Q2) group (4.50–5.36 mmol/L) was employed as the reference for this study. From the 16,860 ACS cases (mean age = 54.1 years; 83.9% male) analysed, which included 648 in-hospital fatalities, lower cholesterol levels were linked to higher mortality rates, except among patients with unstable angina. Interestingly, patients with non-ST-segment elevation myocardial infarction (NSTEMI) demonstrated a U-shaped trend. The results also revealed adjusted odds ratio (OR) for mortality (95% CI: 1.15–4.03) for Q1 at 2.15 (2.00–4.49 mmol/L), 2.01 (95% CI: 1.01–3.98) for Q3 (5.37–6.25 mmol/L), and 2.15 (95% CI: 1.08–4.26) for Q4 (>6.25 mmol/L), suggesting an increased mortality among patients with low and high cholesterol levels. Conclusions: Among first-episode ACS patients, both low and high cholesterol levels were associated with increased in-hospital mortality. A significant U-shaped relationship was observed among NSTEMI patients. Full article

Cardiovascular diseases remain the leading cause of mortality worldwide, and endoplasmic reticulum (ER) stress has emerged as an important molecular mechanism underlying myocardial injury and heart failure. This study investigated the expression of the ER stress-related genes GRP78, PERK, and CHOP in peripheral whole blood obtained from patients with acute cardiovascular diseases. A total of 300 participants were enrolled, including 200 patients with ST-segment elevation myocardial infarction (STEMI, n = 55), non-ST-segment elevation myocardial infarction (NSTEMI, n = 88), decompensated heart failure (DHF, n = 40), or unstable angina pectoris (USAP, n = 17), and 100 healthy controls. Relative mRNA expression levels were quantified using quantitative real-time PCR. Intergroup comparisons were performed using the Kruskal–Wallis test followed by Dunn’s post hoc test with Bonferroni adjustment. Significant differences in GRP78, PERK, and CHOP expression were observed among the study groups (all p < 0.001). GRP78 and PERK expression levels were highest in the STEMI and DHF groups, whereas CHOP expression was highest in the STEMI group. Significant positive correlations were identified between troponin and CHOP (r = 0.48), GRP78 (r = 0.42), and PERK (r = 0.39) (all p < 0.001), while weaker but significant associations were observed between inflammatory markers (CRP and NLR) and ER stress-related gene expression. Exploratory receiver operating characteristic (ROC) analysis showed that CHOP demonstrated the highest discriminatory performance for distinguishing patients with acute cardiovascular disease from healthy controls. These findings indicate that peripheral whole-blood ER stress-related gene expression is associated with acute cardiovascular disease and correlates with established biomarkers of myocardial injury and inflammation. Further prospective studies are required to determine the clinical significance of these findings. Full article

Drug-coated balloon (DCB) PCI can avoid permanent metallic scaffolding in selected acute coronary syndrome (ACS) lesions, but interpretation depends on lesion preparation, procedural selection, and follow-up ascertainment. We analyzed a retrospective dual-center registry of 276 unique patients who underwent one index DCB-treated ACS procedure after operator-judged adequate lesion preparation. Presentations were NSTEMI in 174 patients (63.0%), STEMI in 90 (32.6%), and unstable angina in 12 (4.3%). Paclitaxel-coated DCBs were used in 262 patients (94.9%) and sirolimus/non-paclitaxel DCBs in 14 (5.1%). Thrombus aspiration and GP IIb/IIIa inhibitors were used selectively in 17 (6.2%) and 28 (10.1%) patients, respectively. Bail-out stenting was required in 13 patients (4.7%). Predominantly benign/non-flow-limiting angiographic dissection was recorded in 18 patients (6.5%). A follow-up of at least 365 days or death within 365 days was available for 274 patients (99.3%). Clinically driven TLR occurred in 18 patients (crude 18/274, 6.6%; Kaplan–Meier 365-day estimate, 6.8%; 95% CI, 4.3–10.5), all occurring between 3 and 9 months. All-cause death occurred in 12 patients (Kaplan–Meier estimate, 4.4%; 95% CI, 2.5–7.5). In selected ACS lesions that passed a preparation gate, DCB treatment was associated with feasible procedural results and acceptable 12-month clinically recorded outcomes. The findings do not estimate all-comer DCB eligibility and should not be interpreted in terms of the efficacy of DCBs compared with DESs. Full article

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up. Full article

Background: Although extreme heat is associated with adverse cardiovascular outcomes, the relationship between heat-alert-threshold days, acute myocardial infarction (AMI) admissions, and post-AMI mortality remains uncertain. We aimed to evaluate the association between temperature-defined heat-alert-threshold days and (i) daily AMI admissions and (ii) cumulative all-cause mortality after hospitalized AMI in Hungary. Methods: We conducted a nationwide registry-based study using data from the Hungarian Myocardial Infarction Registry (HMR). All AMI admissions between 1 January 2018 and 31 December 2019 were eligible, with mortality follow-up through 16 June 2021. Heat-alert-threshold days were defined using the temperature criterion applied in the Hungarian national heat-health action plan (daily mean temperature ≥25 °C). AMI admissions were analyzed using adjusted quasi-Poisson regression models and cumulative mortality using stratified Cox proportional hazards models. This operational temperature threshold was used as the exposure definition and does not represent linkage to administrative heat-alert declarations. Results: The cohort included 30,883 AMI events from 29,596 unique patients (mean age, 67.2 [SD 12.8] years; 60.3% male). Patients admitted on heat-alert-threshold days had baseline clinical characteristics similar to those admitted on non-alert days (all standardized mean differences <0.10). Heat-alert-threshold days were associated with fewer recorded AMI admissions during summer (adjusted incidence rate ratio [aIRR] 0.93, 95% CI 0.90–0.97). In contrast, no association was observed between heat-alert-threshold exposure and subsequent all-cause mortality after AMI hospitalization (adjusted hazard ratio [aHR] 0.96, 95% CI 0.87–1.05). These findings remained consistent across sensitivity analyses. Conclusions: In this nationwide Hungarian registry-based study, temperature-defined heat-alert-threshold days were associated with fewer recorded AMI admissions during summer but not with differences in post-AMI mortality among hospitalized patients. The observed inverse association should not be interpreted as evidence of a protective effect of heat exposure. Alternative explanations include behavioral adaptation, delayed care-seeking, exposure misclassification, residual confounding, and the possibility of unmeasured out-of-hospital cardiovascular events, which were not captured by the registry. Because administrative heat-alert declarations were not linked to the analytic dataset, the findings should be interpreted as associations with temperature-defined heat-alert-threshold days rather than evaluations of the effectiveness of the Hungarian heat-alert system. Full article

Background and Objectives: Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous emergency condition in which early diagnostic assessment may be challenging. YKL-40 is associated with vascular inflammation and extracellular matrix remodeling, but its age-independent diagnostic relevance in NSTE-ACS remains uncertain. We evaluated the association and discriminatory performance of serum YKL-40 in patients with adjudicated NSTE-ACS versus non-ACS chest-pain controls; subtype discrimination, revascularization, and correlations with routinely measured inflammatory indices were explored as secondary outcomes. Materials and Methods: This prospective, single-center observational study included 88 adults presenting to the emergency department with chest pain between December 2024 and March 2025. Sixty had adjudicated NSTE-ACS, including 32 with non-ST-segment elevation myocardial infarction and 28 with unstable angina, while 28 constituted the non-ACS control group. Serum YKL-40 was measured at presentation using an enzyme-linked immunosorbent assay. Patient–control discrimination was assessed using receiver operating characteristic analysis, logistic regression, and bootstrap internal validation. Exploratory sensitivity analyses included Firth penalized regression and comparisons restricted to overlapping age ranges. Results: In the unadjusted analysis, serum YKL-40 concentrations were higher in the NSTE-ACS group than in non-ACS controls (median, 832.1 vs. 552.6 ng/L; p = 0.002). Log-transformed YKL-40 yielded an area under the curve of 0.709 (95% CI, 0.599–0.819; p < 0.001) and was associated with NSTE-ACS status (OR per 1-standard-deviation increase, 1.89; 95% CI, 1.15–3.12; p = 0.013). After adjustment for age, the association was attenuated and no longer statistically significant (OR, 1.58; 95% CI, 0.92–2.71; p = 0.100). Models additionally accounting for renal function and cardiovascular risk factors, together with analyses restricted to overlapping age ranges, yielded consistent findings. YKL-40 showed limited discrimination between NSTEMI and unstable angina (AUC, 0.527; 95% CI, 0.376–0.678), was not significantly associated with revascularization (OR, 1.76; 95% CI, 0.86–3.59; p = 0.120; AUC, 0.614), and was not significantly correlated with C-reactive protein, white blood cell count, or the neutrophil-to-lymphocyte ratio. Conclusions: The unadjusted association between YKL-40 and NSTE-ACS was attenuated after accounting for age and other baseline differences. These findings do not establish an age-independent diagnostic role or support the routine diagnostic use of YKL-40 in NSTE-ACS. Full article

Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide. Although traditional cardiovascular risk factors remain central to ACS development, recreational drug use is increasingly recognized as a clinically relevant trigger, particularly in younger patients with fewer conventional risk factors. This narrative review synthesized evidence identified through searches of PubMed/MEDLINE and Scopus up to June 2026, including clinical guidelines, systematic reviews, observational studies, mechanistic investigations, and clinically informative case-based evidence. Cannabis, cocaine, amphetamines, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), opioids, lysergic acid diethylamide (LSD), synthetic cannabinoids, and polysubstance use may promote myocardial ischemia and infarction through overlapping mechanisms, including sympathetic activation, coronary vasospasm, endothelial dysfunction, oxidative stress, inflammation, platelet activation, thrombosis, arrhythmogenesis, and myocardial oxygen supply–demand mismatch. Clinical presentation may be typical or atypical and may overlap with intoxication, withdrawal, anxiety, neurological symptoms, or non-cardiac chest pain, making diagnosis challenging. Underreporting of recreational drug use is common, and targeted toxicology screening may improve diagnostic accuracy and risk stratification, particularly in patients younger than 50 years, those with few traditional cardiovascular risk factors, or those presenting with otherwise unexplained ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), coronary vasospasm, arrhythmias, or cardiac arrest. Acute management should generally follow standard ACS guidelines, while considering drug-specific issues such as stimulant-induced vasospasm, sympathetic excess, cautious use of beta-blockers during acute intoxication, and preference for primary percutaneous coronary intervention when fibrinolysis carries increased risk. Long-term care should combine evidence-based secondary prevention with substance-use counseling, addiction medicine referral, cardiac rehabilitation, and behavioural interventions. This review summarizes the pathophysiology, clinical manifestations, epidemiology, treatment considerations, preventive strategies, and knowledge gaps related to recreational drug-associated ACS. Full article

Background and Objectives: Psychological distress is common in acute coronary syndrome (ACS), yet its relationship with objective coronary anatomical complexity is incompletely understood. The Kessler Psychological Distress Scale-10 (K10) is a brief self-report instrument that measures non-specific psychological distress over the preceding four weeks. We investigated whether the K10 score is associated with the anatomical SYNTAX I score and the clinical–anatomical SYNTAX II PCI score in patients hospitalized with ACS. Materials and Methods: This prospective, single tertiary-center observational study assessed 865 adult patients with suspected or confirmed ACS between 6 January 2026 and 5 June 2026. After applying predefined inclusion and exclusion criteria, 750 consecutive eligible patients with complete K10, SYNTAX I, and SYNTAX II PCI data were included in the final analytic cohort. The cohort consisted of STEMI in 337 patients (44.9%), NSTEMI in 310 (41.3%), and unstable angina pectoris in 103 (13.7%). The validated Turkish version of the K10 scale was administered after pain control and hemodynamic stabilization, within 24–48 h of admission, by trained study personnel blinded to the final SYNTAX analysis. SYNTAX I and SYNTAX II PCI scores were calculated by two blinded interventional cardiologists. The primary endpoint was SYNTAX I score ≥ 23; the key secondary endpoint was SYNTAX II PCI score ≥ 36, interpreted as a cohort-based high clinical–anatomical risk threshold. Results: Mean age was 61.3 ± 11.6 years, and 543 patients (72.4%) were men. Mean K10, SYNTAX I, and SYNTAX II PCI scores were 23.7 ± 6.7, 22.4 ± 9.5, and 31.2 ± 9.6, respectively. K10 score correlated with SYNTAX I (Spearman rho = 0.417, p < 0.001) and SYNTAX II PCI (rho = 0.348, p < 0.001). Each 5-point increase in K10 was independently associated with SYNTAX I ≥ 23 (extended model-adjusted odds ratio [OR] 1.84, 95% confidence interval [CI] 1.59–2.12; p < 0.001) and SYNTAX II PCI ≥ 36 (extended model-adjusted OR 2.26, 95% CI 1.85–2.75; p < 0.001). K10 predicted SYNTAX I ≥ 23 with an area under the curve (AUC) of 0.706 (95% CI 0.674–0.744; cutoff ≥ 24) and SYNTAX II PCI ≥ 36 with an AUC of 0.693 (95% CI 0.654–0.736; cutoff ≥ 26). Adding K10 to the extended clinical model improved cross-validated AUC for SYNTAX I ≥ 23 from 0.708 to 0.774 and for SYNTAX II PCI ≥ 36 from 0.871 to 0.905; bootstrap optimism-corrected AUCs were 0.754 and 0.899, respectively. The findings remained consistent in sensitivity analyses excluding prior CABG patients, adjusting for psychiatric history/medication use, and evaluating patients whose K10 was completed before angiography. Conclusions: In this prospective ACS cohort, early in-hospital assessment of K10-defined recent psychological distress was independently associated with both anatomical and clinical–anatomical coronary complexity. K10 should not replace angiographic risk scoring, but it may help identify a psychocardiological phenotype characterized by higher coronary disease burden and greater clinical vulnerability. Full article

Background/Objectives: High-sensitivity cardiac troponin (hs-cTn) assays are used in routine diagnostics to detect myocardial injury. However, a fraction of circulating cardiac troponin T (cTnT) enclosed within extracellular vesicles (EVs) goes widely undetected. This study introduces a combined lysis- and sonication-based protocol to release and quantify EV-bound cTnT in a time-efficient manner using a state-of-the-art hs-cTnT immunoassay. Methods: Plasma samples from patients with non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina, pulmonary embolism, decompensated aortic stenosis, atrial fibrillation, myocarditis, and healthy controls were treated with a lysis buffer and subsequently sonicated. Treated and untreated samples were assessed and compared to a conventional EV isolation method. Results: Following combined lysis and sonication, cTnT levels were significantly higher compared to native, unprocessed samples across all cohorts. The median increase post-processing ranged from ~10% in decompensated aortic stenosis to ~34% in young healthy controls. In NSTEMI, the EV-bound cTnT accounted for ~15% of plasma cTnT and remained stable over 72 h. The EV cTnT/plasma cTnT ratios were comparable between the combined lysis and sonication approach and the EV isolation method. Processing time prior to cTnT measurement was reduced from ~2.5 h to ~10 min using the lysis and sonication protocol. Conclusions: Our method allows for the rapid liberation of a previously inaccessible EV-bound fraction of cTnT without the need for time-consuming and resource-intensive EV isolation workflows and is therefore readily implementable alongside standard hs-cTnT testing. The observed EV-cTnT patterns suggest differential compartmentation of cTnT, potentially reflecting the myocardial pathophysiology underlying troponin elevation. Full article

Background and Objectives: Risk stratification is an important tool for guiding clinical decision-making in patients with non-ST-segment elevation myocardial infarction (NSTEMI), yet mortality remains considerable despite contemporary therapeutic advances. Endothelial Activation and Stress Index (EASIX), calculated using lactate dehydrogenase, serum creatinine, and platelet count, is a readily available composite prognostic index that has demonstrated prognostic value across various cardiovascular settings. However, its role in NSTEMI has not been fully established. We therefore evaluated the association between EASIX and 1-year mortality and examined whether it provides incremental prognostic information beyond the GRACE risk score. Materials and Methods: We retrospectively evaluated 624 consecutive patients with NSTEMI who underwent invasive coronary angiography. EASIX was calculated from laboratory parameters obtained at admission. The prognostic significance of EASIX was evaluated using Cox proportional hazards models, Kaplan–Meier survival analysis, restricted cubic spline modelling, and incremental performance metrics. Results: During 1-year follow-up, 75 patients (12.0%) died. Admission EASIX values were higher among non-survivors than survivors (p < 0.001). Mortality increased progressively across EASIX tertiles (p < 0.001). In multivariable analyses, log₂(EASIX) remained independently associated with mortality both in the clinical model (HR 1.381, p = 0.002) and after adjustment for the GRACE score (HR 1.315, p = 0.005). Restricted cubic spline analyses supported a graded relationship between EASIX and mortality risk. Addition of EASIX to the GRACE score improved discrimination (ΔAUC = 0.015, p = 0.032) and risk reclassification (continuous NRI = 0.385, p = 0.020). Conclusions: Admission EASIX emerged as an independent predictor of 1-year mortality among patients with NSTEMI. Furthermore, it provides incremental prognostic information beyond the GRACE risk score and may represent a simple, inexpensive, and readily available tool for risk stratification in contemporary NSTEMI practice. Full article

Background and Objectives: Early diagnosis of acute myocardial infarction (AMI) remains challenging due to the “diagnostic blind window” of conventional protein biomarkers and the limited sensitivity of electrocardiograms in non ST-segment elevation myocardial infarction (NSTEMI). Cardiospecific circulating microRNAs, specifically the microRNA-208 (miR-208) family, have emerged as promising candidates to bridge this gap. This systematic review and meta-analysis evaluated the diagnostic accuracy of circulating miR-208 and outlines a proposed conceptual framework to guide its clinical translation. Materials and Methods: PubMed and Embase were systematically searched up to June 24th, 2026, for clinical studies evaluating the diagnostic performance of circulating miR-208a and/or miR-208b against standard reference definitions for AMI. Risk-of-bias assessment using the QUADAS-2 tool was performed independently by two reviewers. Pooled sensitivity and specificity were estimated using bivariate random effects modeling, and sources of heterogeneity were explored via subgroup analyses. Results: Forty-one studies enrolling 6306 participants were included in the qualitative synthesis, of which 14 were eligible for meta-analysis. The pooled sensitivity and specificity of circulating miR-208 for AMI detection were 0.89 (95% CI: 0.81–0.94) and 0.90 (95% CI: 0.83–0.94), respectively. Marked between-study heterogeneity was observed. Subgroup analyses revealed significantly higher diagnostic accuracy in isolated STEMI (sensitivity: 0.95) or NSTEMI (sensitivity: 0.93) cohorts compared to mixed chest pain populations (sensitivity: 0.65; p < 0.0001). Specificity dropped from 0.90 with healthy controls to 0.80 when using non-AMI controls (p = 0.002), indicating spectrum bias. Funnel plots suggested prominent small-study effects. Conclusions: Circulating miR-208 exhibits a powerful biological signal for the early detection of cardiomyocyte injury, but its standalone clinical utility is constrained by methodological heterogeneity and publication bias. Rather than an immediate clinical tool, future prospective translation requires evaluating this biomarker within the standardized miAMI framework—conceptually prioritizing future investigation of the hyper-acute (<2 h) window, absolute quantification to resolve normalization variability, and integration into multi-marker point-of-care panels. Full article

Background and Objectives: Secondary prevention after acute myocardial infarction (AMI) is often assessed by discharge prescribing, yet first-year prognosis depends on whether pharmacological, rehabilitation and lifestyle measures are completed after discharge. We evaluated one-year secondary prevention pathway completion after AMI and its relationship with LDL-C target achievement and exploratory outcomes. Materials and Methods: Consecutive STEMI/NSTEMI patients with documented follow-up were identified from the Cardiology Research Dubrava registry. We assessed discharge lipid-lowering therapy, statin persistence, LDL-C <1.4 mmol/L at 12 months, cardiac rehabilitation, exercise, dietary pattern, smoking status, left ventricular ejection fraction, angiographic complexity, biomarkers and one-year outcomes. Results: Among 2976 patients, statins were prescribed at discharge in 2782/2838 (98.0%), but LDL-C <1.4 mmol/L was achieved in 749/2566 (29.2%). Statin discontinuation or irregular use occurred in 915/2619 (34.9%) and was strongly associated with failure to reach target. Rehabilitation, exercise, favorable dietary pattern and smoke-free status were incompletely achieved and clustered with better LDL-C target attainment. One-year all-cause mortality was 288/2942 (9.8%), and ischemic MACE occurred in 395/2902 (13.6%). Events were associated with older age, reduced LVEF, greater angiographic complexity and higher inflammatory/neurohormonal burden. Conclusions: After AMI, the main first-year prevention gap was not discharge statin prescribing but post-discharge pathway completion. These findings support structured follow-up focused on statin persistence, LDL-C monitoring, treatment intensification, rehabilitation and lifestyle domains. Full article

Background: This study evaluated the potential effects of different COVID-19 vaccine platforms (mRNA and inactivated) on acute coronary syndrome (ACS) through Galectin-3, a biomarker of chronic inflammation and fibrosis. It aimed to compare serum Galectin-3 levels among NSTEMI patients according to COVID-19 vaccination status and vaccine type. Methods: A total of 75 patients with NSTEMI were prospectively enrolled and categorized into three groups: inactivated vaccine recipients (n = 25), mRNA vaccine recipients (n = 25), and unvaccinated controls (n = 25). Serum Galectin-3 levels were measured to assess chronic inflammatory status. Additionally, markers of acute myocardial injury and inflammatory response were analyzed. Results: Galectin-3 levels were similar across the inactivated vaccine, mRNA vaccine, and unvaccinated NSTEMI group, with no statistically significant difference observed (p = 0.481). Although troponin I levels and acute inflammatory cell burden were higher in vaccinated patients compared with the unvaccinated NSTEMI group, Galectin-3 levels remained comparable among all groups. No significant differences in Galectin-3 levels were observed according to vaccination status or vaccine type. Conclusions: In this exploratory cohort of NSTEMI patients, serum Galectin-3 levels did not differ significantly according to COVID-19 vaccination status or vaccine type. These findings suggest no detectable association between vaccination history and Galectin-3 levels in the study population. Larger prospective studies with longitudinal follow-up are needed to confirm these observations. Full article

Introduction: Coronary artery bypass grafting (CABG) in patients with chronic kidney disease/chronic renal failure (CKD/CRF) poses additional surgical risk, both perioperatively and beyond, compared to their non-renal failure counterparts. Patients with end-stage renal disease (ESRD) are at particularly high risk for complications with prognoses limited by cardiovascular (e.g., myocardial infarction, heart failure, stroke) and non-cardiovascular (e.g., infection) conditions associated with the disease itself and the treatment of it (i.e., dialysis). For decades, cardiac surgeons have continued to offer CABG to patients with ESRD on dialysis with variable success. The purpose of this report is to describe a relatively contemporary analysis of CABG surgery in ESRD patients utilizing a pump-assisted beating-heart technique with the analysis of and comparison to outcomes reported by other investigators as well as predictions generated by the Society of Thoracic Surgery outcome tool. We report both short- and intermediate-term outcomes. Methods: From 1 January 2019 through 31 May 2025, the data from all consecutive patients undergoing BH-CABG at a single institution by a single surgeon were collected. Demographic information as well as a preoperative risk assessment was performed using the Society of Thoracic Surgeon (STS) Risk Assessment tool. The BH-CABG was performed via median sternotomy with maintenance of normothermia and ventilation throughout the case. Postoperative outcomes were recorded including mortality, major morbidity, and length of stay (LOS). Hospital/operative results were compared to the STS risk calculations. On-going intermediate-term follow-up beyond the index hospitalization was completed using direct or indirect methods (i.e., clinic, telephone, email). Results: There were 439 BH-CABG patients during the study period. Fifty-nine patients (13.4%) had ESRD on HD. There were 39 men and 20 women with a mean age of 61 years (41–76 years). Fifty-one (86%) underwent pump-assisted BH-CABG (PADCAB) and eight patients underwent complete off-pump BH-CABG (OPCAB). The mean ejection fraction (EF) was 48% (15–70%). The mean number of grafts was 2.3 (1 to 4) and the mean cardiopulmonary bypass (CPB) time for the PADCAB cases was 80 min (34 to 118 min). Patient presentation consisted of the following: one with cardiogenic shock, one with cardiac arrest, two with STEMI, 18 with NSTEMIs, 10 with CHF, five with NSTEMI/CHF, six with unstable angina (USA), and 16 with a positive stress test in preparation for renal transplant consideration. There was one operative mortality (1.7%), one stroke (1.7%), no reoperation for bleeding, no deep sternal wound infection, one prolonged ventilation (1.7%), and one prolonged length of stay (1.7%); overall mortality/morbidity was 5.1%. Comparatively, the STS-predicted mortality was 5.7%, stroke 2.2%, reoperation for bleeding 3.5%, deep sternal wound infection 0.6%, prolonged ventilation 17.8%, prolonged LOS 14.8%, and combined mortality/morbidity 26.8%. Thirty-six of the 59 patients remained alive (61%) in the follow-up period. Twenty-three patients expired (39%) in the follow-up: 11 of cardiac issues, eight of sepsis, two of stroke, one of gastrointestinal issues, and one of cancer. The average duration of survival for expired patients was 2.28 years (13 days to 5 years and 4 months). Nine patients (15%) underwent renal transplantation and six of them remained alive (67%). Conclusions: CABG surgery in patients with ESRD is complicated with historically high mortality and morbidity. The results of this study demonstrate significant improvement in the reduction in hospital mortality and morbidity. However, intermediate-term outcomes remain poor with a preponderance of cardiovascular and infectious deaths. A trend toward improved intermediate-term outcomes appears in patients in whom CABG surgery was performed for purposes of renal transplantation. Full article

Background/Objectives: Inflammation plays a central role in the pathophysiology and prognosis of non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to investigate the clinical and prognostic significance of the Cumulative Inflammatory Index (IIC) in patients with NSTEMI. Methods: This single-center, retrospective study included 2274 individuals, comprising 1172 patients with NSTEMI and 1102 angiographic controls without acute coronary syndrome or obstructive coronary artery disease. IIC was calculated using mean corpuscular volume, red cell distribution width, neutrophil count, and lymphocyte count. The primary outcome was 360-day all-cause mortality in the NSTEMI cohort. Logistic regression, receiver operating characteristic curve analysis, and DeLong testing were performed. Results: Patients with NSTEMI had significantly higher IIC values than controls [9.08 (4.05–15.03) vs. 1.90 (1.45–2.89), p < 0.001]. Among NSTEMI patients, non-survivors had significantly higher IIC levels than survivors [14.25 (8.56–26.59) vs. 8.57 (3.73–14.06), p < 0.001]. In multivariable logistic regression analysis, IIC remained independently associated with 360-day all-cause mortality after adjustment for age, diabetes mellitus, estimated glomerular filtration rate, hemoglobin, albumin, and C-reactive protein (OR: 1.045, 95% CI: 1.029–1.060; p < 0.001). IIC showed a modestly higher area under the curve among the evaluated indices (AUC: 0.704). Conclusions: IIC was significantly elevated in patients with NSTEMI and was independently associated with 360-day all-cause mortality. IIC may serve as a simple adjunctive marker for risk stratification in patients with NSTEMI. Full article