Search Results (489)

Background: Low admission low-density lipoprotein cholesterol (LDL-C) is paradoxically associated with worse outcomes after acute coronary syndrome, but this may reflect confounding rather than causation. We examined the paradox in statin-naïve patients. Methods: We studied 388 statin-naïve patients with a first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and followed for up to five years. Admission LDL-C was analyzed continuously and as three categories (<100, 100–130, >130 mg/dL), with all-cause mortality assessed using Kaplan–Meier, Cox regression, restricted cubic splines, and landmark sensitivity analyses. Results: Crude mortality was highest in the lowest LDL-C group (20.0% vs. 8.3% vs. 10.7%; p = 0.014), and LDL-C < 100 mg/dL predicted higher mortality (hazard ratio 2.03, 95% CI 1.02–4.03). After adjustment, this remained non-significant across the parsimonious and fully adjusted models (adjusted HR 1.27–1.43, all 95% CIs including 1); older age, lower ejection fraction, and diabetes were independent predictors of death. The lowest stratum also had lower albumin and higher CONUT scores, consistent with a frailty phenotype. Conclusions: In statin-naïve STEMI patients undergoing primary PCI, the lipid paradox reflected age- and frailty-related confounding rather than protection; low admission LDL-C marks a higher-risk phenotype and should not discourage guideline-directed lipid-lowering therapy. Full article

Background: The ‘obesity paradox’, whereby obese patients demonstrate better clinical outcomes compared to normal-weight patients, has been reported in acute myocardial infarction, including ST-segment elevation myocardial infarction (STEMI). However, potential sex differences in this association remain largely unexplored. Methods: Using a prospective registry-based multicenter cohort of consecutive STEMI presentations, we evaluated the association between body mass index (BMI) and mortality in patients with STEMI. Patients were divided into three groups based on BMI: normal weight (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30.0 kg/m²). We studied the odds of in-hospital, hospital discharge-to-5-year, and presentation to 5-year all-cause mortality by BMI groups in the overall cohort and in sex-stratified analyses. Results: Among 4682 consecutive STEMI patients, 30.1% were female, and 22.2% were normal weight, 36.2% overweight, and 41.6% obese. In the overall cohort, compared to normal-weight patients, the odds of in-hospital mortality were higher in obese patients (aOR 1.73, 95% CI 1.08–2.8) and the risk of discharge-to-5-year mortality was lower in overweight (aHR 0.69, 95% CI 0.57–0.85) and obese (aHR 0.66, 95% CI 0.53–0.82) patients. In sex-stratified analysis, compared to normal-weight males, obese males had higher odds of in-hospital mortality (aOR 2.25, 95% CI 1.18–4.51). Overweight and obese males (aHR 0.63, 95% CI 0.49–0.82, aHR 0.64, 95% CI 0.48–0.85) and obese females (aHR 0.68, 95% CI 0.49–0.94) had a lower discharge-to-5-year mortality risk. Conclusions: In this large STEMI cohort, obesity was associated with higher odds of in-hospital mortality but lower risk of discharge-to-5-year mortality. Sex-stratified analyses demonstrated that obese males were at high odds of in-hospital mortality and both obese males and females were at lower risk of discharge-to-5-year mortality. Full article

Background/Objectives: Transradial access (TRA) is a standard approach in the management of ST-segment elevation myocardial infarction (STEMI); however, evidence on using a single catheter for both diagnostic angiography and percutaneous coronary intervention (PCI) is limited. This study evaluates the feasibility and clinical outcomes of using a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients. Methods: A total of 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were included. Procedural success was defined as completing both diagnostic coronary angiography and PCI without catheter exchange. Procedural characteristics and access-site complications were evaluated. Results: The success rate of completing diagnostic angiography and PCI using a single JL 3.5 guiding catheter without catheter exchange was 91.1%. Compared to procedures requiring multiple catheters, the single-catheter group had significantly lower total contrast volume (200 vs. 250 mL), procedure time (20 vs. 30 min), fluoroscopy time (10.3 vs. 17.6 min), radiation dose (358 vs. 545 mGy), and needle-to-balloon time (6 vs. 9 min), all with p < 0.001. Access-site complications were also lower (8.2% vs. 15.8%; p = 0.010), primarily due to reduced radial artery spasm (4.0% vs. 12.9%; p = 0.001). Conclusions: A single JL 3.5 catheter strategy via transradial access is a safe, efficient, and effective method for STEMI intervention, offering significant procedural and clinical advantages. Full article

Takotsubo syndrome (TTS) is an acute disorder characterized by transient left ventricular dysfunction with typical regional wall motion abnormalities, most commonly apical ballooning. It accounts for 1–3% of all suspected acute coronary syndromes and up to 5–6% in women presenting with ST-segment elevation myocardial infarction requiring coronary angiography to exclude obstructive coronary artery disease. The pathophysiology of TTS is complex and not fully elucidated, with sympathetic hyperactivation playing a central role through calcium dysregulation, oxidative stress, and metabolic alterations. Both clinical and experimental data demonstrate the importance of inflammation, with cell infiltration and persistent immune activation exceeding the acute phase. Increasing evidence highlights the impact of coronary microvascular disfunction (CMVD) as a secondary phenomenon, with some findings that support its role as a causative substrate. Beyond well-known predisposing conditions such as female sex, postmenopausal age, and neurological and psychiatric disorders with the trigger of a physical or psychological event, numerous case reports associate the syndrome with chronic autoimmune diseases, even if clear experimental evidence remains poor and worthy of further study. Echocardiography and advanced imaging techniques, including cardiac magnetic resonance and positron emission tomography, have provided insights into transient CMVD, reversible myocardial edema, and metabolic impairment, strengthening our knowledge of the syndrome as a dynamic process. It is also of growing interest to perform invasive hemodynamic assessment to explain the increase in microvascular resistance. This review offers a comprehensive and up-to-date overview of these techniques in the context of TTS. Since clinically, TTS may be associated with significant morbidity and mortality, with some unexplained cases of long-term myocardial disfunction or even recurrence, a deeper understanding of the interplay between catecholamines, inflammation, immune substrate, and CMVD may improve risk stratification and lead to the development of targeted therapeutic strategies. Full article

Background/Objectives: Cardiac magnetic resonance (CMR) imaging provides a comprehensive assessment of myocardial injury after ST-segment elevation myocardial infarction (STEMI), yet the relative prognostic value of segmental infarct zone parameters compared with global indices for predicting left ventricular (LV) functional recovery remains incompletely defined. This study aimed to determine whether segmental infarct zone functional and structural CMR parameters provide prognostic information for LV functional recovery after a first STEMI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center study, 93 patients with a first STEMI (median age 61 years; 77% male) underwent CMR at baseline (median 3 days post-PCI) and at a 6-month follow-up. The comprehensive CMR assessment included cine imaging for volumetric and feature-tracking strain analysis, T1 and T2 mapping, and late gadolinium enhancement (LGE) for infarct size (IS) and microvascular obstruction (MVO) quantification. The myocardial segments were classified as infarcted, adjacent, or remote based on the LGE distribution. The primary outcome was unfavorable LV functional recovery, defined as failure to achieve an absolute increase of >10 percentage points in the LV ejection fraction (LVEF) or a follow-up LVEF ≤ 50%. Results: At the 6-month follow-up, significant reverse remodeling was observed: the LVEF improved from 49.0% [40.7–52.4] to 55.8% [47.9–59.9] (p < 0.001), the LV end-systolic volume decreased from 91.8 mL [75.1–113.8] to 80.8 mL [61.9–108.3] (p = 0.005), and the relative IS decreased from 30.9% [18.9–45.5] to 19.0% [11.1–31.3] of LV mass (p < 0.001). At the follow-up, MVO was no longer detectable in any patient. Unfavorable functional recovery occurred in 17 patients (18.3%). In the multivariable analysis, the infarct zone circumferential strain (CS) was the strongest independent predictor of unfavorable recovery (OR 8.81; 95% CI 1.98–39.28; p = 0.004), followed by the relative IS (OR 4.02; 95% CI 1.03–15.73; p = 0.045) and a lower infarct zone post-contrast T1 (OR 4.40; 95% CI 1.12–17.36; p = 0.034). Conclusions: Segmental infarct zone characteristics—particularly circumferential strain, post-contrast T1, and infarct size—provide clinically relevant prognostic information for LV functional recovery after STEMI. The infarct zone CS offers incremental predictive value beyond its structural parameters, reflecting the residual contractile reserve and myocardial viability. Full article

Background: Patients with type 2 diabetes mellitus (T2DM) who present with ST-segment elevation myocardial infarction (STEMI) remain at high risk of adverse remodeling after reperfusion. This observational study examined whether pre-admission glucose-lowering therapy class was associated with six-month left ventricular (LV) reverse remodeling and myocardial work recovery. Methods: We analyzed 253 patients with STEMI, baseline LV ejection fraction ≤ 50%, successful primary PCI, and complete baseline and six-month echocardiography. The primary inferential analyses focused on 75 patients with T2DM, grouped according to pre-admission therapy with SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or conventional therapy; non-diabetic patients were retained as a descriptive reference group. Clinical outcome, propensity-score, subgroup, and mediation analyses were considered exploratory because of small subgroup and event counts. Results: SGLT-2 inhibitor and GLP-1 receptor agonist exposure was associated with larger improvements in LVEF, LV volumes, and global work efficiency than DPP-4 inhibitors or conventional therapy. Crude MACE rates were highest in the conventional-therapy group, but event estimates were imprecise and confounded by baseline risk, revascularization status, and discharge therapy. Conclusions: In patients with T2DM recovering from STEMI, pre-admission exposure to SGLT-2 inhibitors and, to a lesser extent, GLP-1 receptor agonists was associated with more favorable structural and myocardial work recovery. These hypothesis-generating findings should be interpreted as associations and require confirmation in adequately powered prospective studies. 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

Background and Objectives: Angiographic no-reflow (NRF) after percutaneous coronary intervention (PCI) reflects impaired microvascular reperfusion despite successful treatment of the epicardial culprit lesion. Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in endothelial signaling, platelet biology, inflammation, and angiogenesis. Its relationship with NRF in non-ST-segment elevation myocardial infarction (NSTEMI) remains insufficiently characterized. Materials and Methods: This single-center prospective observational cohort study included 700 consecutive NSTEMI patients undergoing culprit-lesion PCI. Admission serum total BDNF was measured before PCI using a standardized enzyme-linked immunosorbent assay protocol. Angiographic NRF was defined as final thrombolysis in myocardial infarction (TIMI) flow <3 and/or TIMI 3 flow with myocardial blush grade (MBG) 0–1 in the absence of residual stenosis, dissection, severe spasm, or other mechanical obstruction. Four sequential logistic regression models were used to evaluate the stability of the association between BDNF and NRF: Model 1 adjusted for clinical variables; Model 2 further adjusted for laboratory and inflammatory variables; Model 3 further adjusted for cardiac injury and functional variables; and Model 4 further adjusted for angiographic and procedural variables. Discrimination, calibration, reclassification, decision-curve analysis, and internal validation were assessed. Results: NRF occurred in 114 of 700 patients (16.3%). Serum total BDNF was higher in the NRF group than in the reflow group [555 (465–688) vs. 386 (292–496) pg/mL, p < 0.001]. BDNF remained independently associated with NRF across sequential models: Model 1 OR 1.67 per 100 pg/mL (95% CI 1.43–1.96), Model 2 OR 1.49 (95% CI 1.24–1.79), Model 3 OR 1.41 (95% CI 1.16–1.72), and Model 4 OR 1.31 (95% CI 1.07–1.60). The BDNF-only AUC was 0.787, while the final BDNF-enriched Model 4 reached an AUC of 0.866. The optimism-corrected bootstrap AUC was 0.852 and the 10-fold cross-validated AUC was 0.845. Conclusions: Higher admission serum total BDNF was independently associated with angiographic NRF in NSTEMI patients undergoing PCI and improved risk discrimination when added to clinical, biochemical, cardiac, and angiographic predictors. These findings suggest that serum total BDNF may reflect a context-dependent biomarker signal related to acute thrombo-inflammatory, platelet-associated, and microvascular injury pathways; however, the observed incremental value was modest and requires external validation. Full article

Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained “oozing” ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging—echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect—and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging—particularly cardiac CT—in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication. Full article

Non-ST-segment elevation myocardial infarction (NSTEMI) has become the predominant form of acute coronary syndrome (ACS) and is frequently associated with multivessel coronary artery disease (MVD). Patients presenting with NSTEMI and MVD represent a particularly high-risk population characterized by advanced age, comorbidities, and an increased atherosclerotic burden. Although advances in pharmacological therapy and early invasive management have improved prognosis, the optimal revascularization strategy in this setting remains uncertain. In contrast to ST-segment elevation myocardial infarction (STEMI), where randomized controlled trials consistently support complete revascularization, evidence in NSTEMI with MVD is limited and is largely derived from observational studies and registry data. This has generated ongoing debate regarding whether complete revascularization offers superior outcomes compared with culprit-only percutaneous coronary intervention (PCI), and whether non-culprit lesions should be treated during the index procedure (immediate strategy) or in a staged manner. Current data suggest that complete PCI is generally associated with reduced recurrent ischemia, reinfarction, and repeat revascularization, with potential long-term survival benefits. However, patient comorbidities, lesion complexity, and procedural risk continue to influence outcomes, highlighting the importance of individualized decision-making. This narrative review synthesizes contemporary evidence on PCI-based revascularization strategies in NSTEMI with MVD, focusing on two central aspects: the extent of revascularization (complete versus incomplete) and the timing of intervention (single-stage versus staged). By integrating findings from registries, randomized trials and guideline recommendations, the review identifies areas of consensus, persisting uncertainties, and key evidence gaps. Ultimately, it underscores the need for large, dedicated trials to guide practice and optimize outcomes for NSTEMI patients with multivessel coronary disease. Full article

Background/Objectives: Impaired kidney function is associated with persistently elevated cardiac troponin levels, complicating evaluation of suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The comparative performance of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) across sampling intervals in this population remains uncertain. We aimed to identify a kidney function-adapted assay-sampling protocol combination for suspected NSTE-ACS that may support collaborative pathways between nephrologists and acute care clinicians. We therefore assessed kidney function-specific diagnostic and prognostic performance using 0/1 h and 0/3 h protocols. Methods: We conducted a prospective observational cohort study of adults presenting with suspected NSTE-ACS at a tertiary emergency department between March 2019 and December 2020. Patients were stratified according to kidney function at presentation using estimated glomerular filtration rate (eGFR). Impaired kidney function was operationally defined as eGFR < 60 mL/min/1.73 m². Serial hs-cTnT and hs-cTnI concentrations were measured at 0, 1, and 3 h and interpreted using assay-specific thresholds and delta criteria. Diagnostic performance for NSTE-ACS and prognostic performance for 30-day major adverse cardiovascular events (MACEs) were evaluated. Results: Among 140 patients, 58 (41%) had impaired kidney function. Baseline hs-cTnT and hs-cTnI concentrations were significantly higher in patients with impaired kidney function across all sampling time points. In this group, the 0/3 h protocol demonstrated superior diagnostic performance compared with the 0/1 h protocol for both assays. Using 0/3 h testing, hs-cTnI achieved the highest sensitivity (88.6%; 95% CI, 49.2–95.3), whereas hs-cTnT showed the highest negative predictive value (92.2%; 95% CI, 76.2–94.6). In patients with preserved kidney function, both assays demonstrated high specificity and positive predictive value with the 0/3 h protocol. Prognostic discrimination for 30-day MACEs also improved with a 0/3 h strategy, particularly in patients with impaired kidney function. Conclusions: In patients with impaired kidney function and suspected NSTE-ACS, extending troponin testing to 3 h improves diagnostic accuracy and short-term prognostic performance, supporting kidney function-adapted troponin strategies in emergency and nephrology care. Full article

Multivessel coronary artery disease is observed in a substantial proportion of patients presenting with ST-segment elevation myocardial infarction (STEMI) and identifies a higher-risk phenotype characterized by larger atherosclerotic burden, recurrent ischemic events, and greater need for subsequent revascularization. Over the past decade, randomized evidence has progressively shifted the interventional paradigm from culprit-lesion-only primary percutaneous coronary intervention (PCI) toward complete revascularization in hemodynamically stable STEMI patients with suitable non-culprit lesions. Nevertheless, several clinically relevant questions remain unresolved, including the optimal criteria for selecting non-culprit lesions, the relative value of angiography, coronary physiology, and intracoronary imaging, the timing of complete revascularization, and the management of patients presenting with cardiogenic shock. Angiography-guided complete revascularization has the strongest evidence base, while physiology-guided approaches may reduce unnecessary PCI but have not demonstrated superiority over angiography-guided strategies in direct randomized comparisons. Intracoronary imaging offers unique information on plaque vulnerability and PCI optimization, although dedicated outcome trials in STEMI remain limited. The timing of complete revascularization has also evolved, with contemporary trials supporting early treatment in selected stable patients but not establishing a universal immediate strategy. This review summarizes current evidence, unresolved controversies, and emerging directions regarding strategies and timing of complete revascularization in STEMI patients with multivessel disease. Full article

Background/Objectives: The Osaka Prognostic Score (OPS) has demonstrated prognostic value in various cardiovascular settings. However, its role in predicting long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) remains insufficiently explored. This study aimed to investigate the association between baseline OPS and one-year all-cause mortality in patients presenting with STEMI. Methods: OPS was calculated in 463 consecutive patients with STEMI at hospital admission. The primary endpoint was one-year all-cause mortality. Clinical, laboratory, echocardiographic, and angiographic variables were analyzed for each patient. Results: During one-year follow-up, patients who died exhibited significantly higher OPS values compared with survivors (1.70 ± 0.89 vs. 0.38 ± 0.65; p < 0.001). In multivariable logistic regression analysis, lower hemoglobin levels (OR 0.780, 95% CI 0.630–0.967; p < 0.001) and left ventricular ejection fraction (OR 0.948, 95% CI 0.902–0.997; p = 0.037) were associated with an increased risk of mortality whereas both the GRACE risk score (OR 2.653, 95% CI 1.345–3.987; p < 0.001) and OPS (OR 1.536, 95% CI 1.102–2.234; p = 0.001) were positively associated with mortality. The combined GRACE + OPS logistic regression model demonstrated significantly better discriminative performance for predicting 1-year mortality compared with the GRACE-only model (AUC: 0.836 vs. 0.761). DeLong analysis confirmed that the addition of OPS significantly improved predictive accuracy (ΔAUC = 0.075, 95% CI: 0.015–0.136; p = 0.014). Conclusions: Baseline OPS is independently associated with one-year all-cause mortality in patients with STEMI and may have potential utility in this group of patients. Full article

Background: High-intensity interval training (HIIT) is increasingly used in exercise-based cardiac rehabilitation (ebCR) after myocardial infarction (MI), yet the temporal sequence of physiological, cardiac, biochemical, and functional adaptations remains incompletely characterized. Methods: Stable post-STEMI (ST-segment elevation myocardial infarction, MI-group) and previously inactive participants without known cardiovascular, metabolic or systemic disease (CTRL group) completed 12-week supervised outpatient HIIT (4 × 4 min intervals at 85–90% HRpeak (peak heart rate), ~80–90% of VO₂peak, 3 sessions/week). Assessments were performed at baseline (T1), 4 (T2), 8 (T3), and 12 weeks (T4), including cardiopulmonary exercise testing (CPET), echocardiography, blood biomarkers, body composition, six-minute walk test (6MWT), and RAND-36. Longitudinal changes were analyzed using Friedman tests with Dunn post hoc comparisons; between-group differences used Mann–Whitney U tests with Holm correction. Results: VO₂peak increased significantly in both groups (p < 0.001), increasing by ~22% from T1 to T4 in MI (median 20.1 to 24.5 mL·kg⁻¹·min⁻¹) and ~23% from T1 to T4 in CTRL (median 22.3 to 27.6 mL·kg⁻¹·min⁻¹). LVEF (left ventricular ejection fraction) improved early in MI, increasing from 52.5% (50.0–55.0) at T1 to 57.5% (55.2–58.7) at T2 and up to 60% (55.8–60.0) at T4 (all p < 0.001), while LV dimensions remained stable. NT-proBNP (N-terminal pro-B-type natriuretic peptide) showed no significant longitudinal change (p = 0.510), and CRP (C-reactive protein) decreased from 2.1 to 0.7 mg·L⁻¹ (p = 0.008) in MI. Both groups improved body fat % and 6MWT distance (p < 0.001). Conclusions: In low-risk stable post-STEMI patients, longitudinal changes during supervised HIIT-based ebCR were consistent with improved VO₂peak and LVEF, without clinically relevant increases in cardiac stress biomarkers. However, due to the observational design and absence of clinical comparator groups, these findings should be interpreted as descriptive and support further evaluation in larger randomized studies. Full article

Background/Objectives: People with non-ST-segment elevation myocardial infarction (NSTEMI) with an occluded culprit vessel represent a unique subset of patients; however, their long-term outcomes remain unclear. This study aimed to compare 5-year mortality between NSTEMI patients treated with percutaneous coronary intervention (PCI) based on TIMI flow states in the culprit vessel on presentation (TIMI 0-1 compared to TIMI 2-3). Methods: A retrospective analysis of prospectively collected data of all NSTEMI patients who underwent PCI from 2012 to 2019 at a tertiary cardiac center (The Freeman Hospital, Newcastle-Upon-Tyne, UK) with follow up for 5 years until January 2024. Patients were identified from the database and categorized based on pre-procedural TIMI flow in the culprit vessel. A propensity score was used to pair TIMI 0-1 patients with a matched cohort of TIMI 2-3 patients. The primary outcome was 5-year all-cause mortality. Results: A total of 775 patients with TIMI 0-1 flow were matched with 750 patients who had TIMI 2-3 flow. Patients with TIMI 0-1 flow were more likely to have transient ST elevation (24% vs. 18%, p < 0.001) or Q waves (4% vs. 1%, p < 0.001) compared with patients who had TIMI 2-3 flow. They were also more likely to have moderately to severely impaired left ventricular systolic function compared with patients with TIMI 2-3 flow (21% vs. 16%, p = 0.01). In-hospital mortality (1.2% vs. 1.2%, p = NS), 1-year mortality (5% vs. 6.9%, p = NS), and 5-year mortality (16% vs. 18%, p = 0.34) were not significantly different between the two groups. The use of glycoprotein IIb/IIIa antagonists was associated with lower mortality, HR 0.64 (0.46 to 0.87). Conclusions: NSTEMI patients with occluded culprit vessels who underwent PCI had similar in-hospital and long-term outcomes to patients with patent culprit vessels. The use of glycoprotein IIb/IIIa inhibitors appears to be associated with lower mortality. Full article