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15 pages, 909 KB  
Review
A Critical Review on Misleading Evidence in Cardiac Arrest Trials—Why Less Complexity Does Not Result in Better Outcomes
by Andreas Schäfer, Tobias J. Pfeffer, Johann Bauersachs and Vera Garcheva
J. Clin. Med. 2026, 15(2), 821; https://doi.org/10.3390/jcm15020821 - 20 Jan 2026
Viewed by 331
Abstract
Over the past two decades, advanced airway management, early coronary angiography, and therapeutic hypothermia have shaped post-out-of-hospital cardiac arrest (OHCA) care. However, recent large randomized trials have challenged these strategies and created substantial uncertainty leading to relevant guideline changes. This review focuses on [...] Read more.
Over the past two decades, advanced airway management, early coronary angiography, and therapeutic hypothermia have shaped post-out-of-hospital cardiac arrest (OHCA) care. However, recent large randomized trials have challenged these strategies and created substantial uncertainty leading to relevant guideline changes. This review focuses on the trials that ultimately influenced current guideline recommendations by downgrading previous recommendations. We determine how structural limitations may have affected the validity and interpretation of their results. The review critically evaluates the methodological design and execution of those trials. Despite neutral findings from recent randomized trials, use of advanced airway management during resuscitation, coronary angiography in patients with a high likelihood of acute coronary occlusion, and therapeutic hypothermia for comatose OHCA survivors still play a relevant role in post-resuscitation management. Full article
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13 pages, 861 KB  
Article
Mid-Term Results of the Multicenter CAMPARI Registry Using the E-Liac Iliac Branch Device for Aorto-Iliac Aneurysms
by Francesca Noce, Giulio Accarino, Domenico Angiletta, Luca del Guercio, Sergio Zacà, Mafalda Massara, Pietro Volpe, Antonio Peluso, Loris Flora, Raffaele Serra and Umberto Marcello Bracale
J. Cardiovasc. Dev. Dis. 2026, 13(1), 48; https://doi.org/10.3390/jcdd13010048 - 15 Jan 2026
Viewed by 150
Abstract
Background: Intentional occlusion of the internal iliac artery (IIA) during endovascular repair of aorto-iliac aneurysms may predispose patients to pelvic ischemic complications such as gluteal claudication, erectile dysfunction, and bowel ischemia. Iliac branch devices (IBDs) have been developed to preserve hypogastric perfusion. [...] Read more.
Background: Intentional occlusion of the internal iliac artery (IIA) during endovascular repair of aorto-iliac aneurysms may predispose patients to pelvic ischemic complications such as gluteal claudication, erectile dysfunction, and bowel ischemia. Iliac branch devices (IBDs) have been developed to preserve hypogastric perfusion. E-Liac (Artivion/Jotec) is one of the latest modular IBDs yet reports on mid-term performance are limited to small single-center cohorts with short follow-up. The CAMpania PugliA bRanch IliaC (CAMPARI) study is a multicenter investigation of E-Liac outcomes. Methods: A retrospective observational cohort study was conducted across five Italian vascular centers. All consecutive patients undergoing E-Liac implantation for aorto-iliac or isolated iliac aneurysms between January 2015 and December 2024 were identified from prospectively maintained registries. Inclusion criteria comprised elective or urgent endovascular repair of aorto-iliac aneurysms in which an adequate distal sealing zone was not available without covering the IIA and suitability for the E-Liac device according to its instructions for use (IFU). Patients with a life expectancy < 1 year or hostile anatomy incompatible with the IFU were excluded. The primary end point was freedom from branch instability (occlusion/stenosis, kinking, or detachment of the bridging stent). Secondary end points included freedom from any endoleak, freedom from device-related reintervention, freedom from gluteal claudication, aneurysm-related and all-cause mortality, acute renal failure, and sac regression > 5 mm. Results: A total of 69 consecutive patients (68 male, 1 female, median age 72.0 years) received 74 E-Liac devices, including 5 bilateral implantations. The mean infrarenal aortic diameter was 45 mm and the mean CIA diameter 34 mm; 14 patients (20.0%) had a concomitant IIA aneurysm (>20 mm). Concomitant fenestrated or branched aortic repair was performed in 23% of procedures. Two patients received a standalone IBD without implantation of a proximal aortic endograft. Technical success was achieved in 71/74 cases (96.0%); three failures occurred due to inability to catheterize the IIA. Distal landing was in the main IIA trunk in 58 cases and in the posterior branch in 13 cases. Over a median follow-up of 18 (6; 36) months, there were four branch instability events (5.4%): three occlusions and one bridging stent detachment. Seven patients (9.5%) developed endoleaks (one type Ib, two type II, two type IIIa, and two type IIIc). Five patients (6.8%) required reintervention, and five (6.8%) reported gluteal claudication. There were seven all-cause deaths (10%), none within 30 days or related to aneurysm rupture; causes included COVID-19 pneumonia, acute coronary syndrome, melanoma, gastric cancer, and stroke. No acute renal or respiratory failure occurred. Kaplan–Meier analysis showed 92% (95% CI 77–100) freedom from branch instability in the main-trunk group and 89% (60–100) in the posterior-branch group (log-rank p = 0.69). Freedom from any endoleak at 48 months was 87% (95% CI 75–95), and freedom from reintervention was 93% (95% CI 83–98). Conclusions: In this multicenter cohort, the E-Liac branched endograft demonstrated high technical success and favorable early–mid-term outcomes. Preservation of hypogastric perfusion using E-Liac was associated with low rates of branch instability, endoleak, and reintervention, with no 30-day mortality or aneurysm-related deaths. These findings support the safety and efficacy of E-Liac for aorto-iliac aneurysm management, although larger prospective studies with longer follow-up are needed. Full article
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20 pages, 16316 KB  
Article
Percutaneous Coronary Intervention for Chronic Total Occlusions Modulates Cardiac Hypoxic and Inflammatory Stress
by Luis Carlos Maestre-Luque, Rafael Gonzalez-Manzanares, Ignacio Gallo, Francisco Hidalgo, Javier Suárez de Lezo, Miguel Romero, Simona Espejo-Perez, Carlos Perez-Sanchez, Julio Manuel Martínez-Moreno, Rafael González-Fernandez, Manuel Pan and Soledad Ojeda
J. Clin. Med. 2026, 15(2), 517; https://doi.org/10.3390/jcm15020517 - 8 Jan 2026
Viewed by 228
Abstract
Background/Objectives: The cardiac hypoxia- and inflammation-associated processes in patients with chronic coronary artery disease remain unknown. The coronary sinus (CS) can be used to explore changes in cardiac microenvironment. This study sought to evaluate acute changes in the CS concentration of hypoxia [...] Read more.
Background/Objectives: The cardiac hypoxia- and inflammation-associated processes in patients with chronic coronary artery disease remain unknown. The coronary sinus (CS) can be used to explore changes in cardiac microenvironment. This study sought to evaluate acute changes in the CS concentration of hypoxia and inflammation-associated biomarkers after the percutaneous revascularization of chronic total occlusions (CTO-PCI). Additionally, we explored changes in systemic inflammation and the potential of CS biomarkers to predict left ventricular ejection fraction (LVEF) improvement on follow-up. Methods: Thirty-three patients undergoing CTO-PCI were included. Samples from CS were collected before and after the revascularization. Twenty-six protein biomarkers associated with hypoxia and inflammation were measured using proximity extension assay technology. Systemic inflammation markers and LVEF on cardiac magnetic resonance imaging were assessed at baseline and 6-month follow-up. Results: CTO-PCI yielded a significant decrease in the concentration of CS pro-angiogenic biomarkers (angiopoietin-1, vascular endothelial growth factors). In addition, there was a significant increase in the anti-inflammatory biomarker interleukin-10 and a decrease in several pro-inflammatory biomarkers like interleukin-1β. The acute response in cardiac microenvironment was followed by a mid-term reduction in systemic inflammatory markers, particularly high-sensitivity C-reactive protein. Notably, interleukin-10 showed good performance to identify patients achieving LVEF improvement on follow-up in our cohort. Conclusions: Our results suggest that CTO-PCI might attenuate cardiac hypoxic and inflammatory stress. These exploratory findings warrant confirmation in larger, controlled studies. Full article
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9 pages, 5076 KB  
Case Report
The Heart Under Pressure: Transient ST-Segment Elevation Due to Severe Intestinal Distension
by Fulvio Cacciapuoti, Angela Iannuzzi, Ferdinando Fusco, Alessandro De Masi, Flavia Casolaro and Angelo Sasso
Cardiovasc. Med. 2026, 29(1), 1; https://doi.org/10.3390/cardiovascmed29010001 - 24 Dec 2025
Viewed by 391
Abstract
Acute extracardiac conditions can occasionally produce electrocardiographic abnormalities that closely mimic acute coronary occlusion, posing a diagnostic challenge and increasing the risk of unnecessary activation of invasive cardiac pathways. Severe gastrointestinal distension, although uncommon, is a recognized cause of transient ST-segment elevation due [...] Read more.
Acute extracardiac conditions can occasionally produce electrocardiographic abnormalities that closely mimic acute coronary occlusion, posing a diagnostic challenge and increasing the risk of unnecessary activation of invasive cardiac pathways. Severe gastrointestinal distension, although uncommon, is a recognized cause of transient ST-segment elevation due to mechanical displacement of the heart, autonomic imbalance, and abrupt changes in ventricular loading conditions. These alterations may be particularly misleading in patients with chronic regional wall motion abnormalities, in whom new ECG changes risk being misinterpreted as recurrent ischemia. We report the case of a 68-year-old man with a history of inferior myocardial infarction who presented with marked abdominal distension secondary to a closed-loop small bowel obstruction. Despite the absence of chest pain, his ECG showed significant anterolateral ST-segment elevation. High-sensitivity troponin I remained negative, and transthoracic echocardiography demonstrated preserved anterior and apical motion, chronic inferior akinesia, and unchanged global longitudinal strain. Following nasogastric decompression, the ST-segment normalized completely within fifteen minutes. Subsequent imaging confirmed a closed-loop volvulus requiring urgent surgical intervention, with full bowel viability preserved. This case underscores the importance of integrating clinical context, biomarkers, and rapid echocardiographic assessment when evaluating ST-segment elevation, helping avoid unnecessary coronary angiography in the presence of extracardiac causes. Full article
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14 pages, 423 KB  
Review
Unraveling Spontaneous Coronary Artery Dissection in Sudden Cardiac Death: Integrating Pathology, Genetics, and Molecular Autopsy
by Cecilia Salzillo, Andrea Quaranta, Gerardo Cazzato and Andrea Marzullo
Int. J. Mol. Sci. 2025, 26(22), 11072; https://doi.org/10.3390/ijms262211072 - 16 Nov 2025
Cited by 1 | Viewed by 687
Abstract
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndrome, characterized by the development of a false lumen within the coronary arterial wall, leading to narrowing or complete occlusion of the true lumen. This underrecognized condition accounts for a substantial [...] Read more.
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndrome, characterized by the development of a false lumen within the coronary arterial wall, leading to narrowing or complete occlusion of the true lumen. This underrecognized condition accounts for a substantial proportion of sudden cardiac death (SCD), particularly among young, otherwise healthy women. Macroscopically, SCAD is defined by intramural hematoma and focal thickening of the arterial wall, while histological examination demonstrates separation of the tunica media, elastic fiber degeneration, and variable inflammatory infiltrates. Proposed pathogenic mechanisms include primary intimal tear and primary intramural hematoma, frequently associated with predisposing conditions such as fibromuscular dysplasia, connective tissue disorders, and specific hormonal states. In cases of myocardial infarction, the myocardium exhibits acute ischemic necrosis and early hypoperfusion injury. Postmortem diagnosis requires meticulous coronary dissection, adjunctive histochemical and immunohistochemical staining, and, when indicated, molecular autopsy (MA). The purpose of this review is to provide an updated synthesis of current knowledge on SCAD as a cause of SCD, integrating pathogenetic, morphological, and genetic perspectives, and to emphasize the role of MA as both a diagnostic and preventive tool. Full article
(This article belongs to the Special Issue Molecular Mechanism in Cardiovascular Pathology)
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14 pages, 1032 KB  
Review
Thyrotoxicosis and the Heart: An Underrecognized Trigger of Acute Coronary Syndromes
by Larisa Anghel, Anca Diaconu, Laura-Cătălina Benchea, Cristina Prisacariu, Dragoș Viorel Scripcariu, Răzvan-Liviu Zanfirescu, Gavril-Silviu Bîrgoan, Radu Andy Sascău and Cristian Stătescu
Biomedicines 2025, 13(11), 2591; https://doi.org/10.3390/biomedicines13112591 - 23 Oct 2025
Viewed by 1018
Abstract
Background: Thyrotoxicosis is a systemic condition with well-documented cardiovascular effects, but its role as a precipitant of acute coronary syndromes (ACS) is often overlooked. This review summarizes clinical cases and original studies from the last 20 years, describing ACS triggered by thyrotoxicosis. Methods: [...] Read more.
Background: Thyrotoxicosis is a systemic condition with well-documented cardiovascular effects, but its role as a precipitant of acute coronary syndromes (ACS) is often overlooked. This review summarizes clinical cases and original studies from the last 20 years, describing ACS triggered by thyrotoxicosis. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, and Embase for reports published between 2004–2025. Only case reports and original articles were included. Data extracted included demographics, ECG findings, angiography results, thyroid function, etiology of hyperthyroidism, and outcomes. Results: A total of 35 cases were identified. The mean age was in the fourth decade of life, with a female predominance (57%, 20 out of 35). More than half of the patients presented with ST-segment elevation myocardial infarction (STEMI) or STEMI equivalents (21 out of 35; 60%). Electrocardiographic abnormalities most often involved anterior or inferior leads. Coronary angiography revealed normal vessels or diffuse vasospasm in 18 cases (51%), while thrombotic occlusion was observed in 4 cases (11%), spontaneous dissection in 2 cases (6%), and myocardial bridging in 3 cases (9%). The leading cause of thyrotoxicosis was Graves’ disease (≈65%), followed by painless thyroiditis, iatrogenic causes, and gestational hyperthyroidism. Thyroid storm was reported in approximately 20% of cases and was associated with malignant ventricular arrhythmias or sudden cardiac death. Conclusions: Thyrotoxicosis should be recognized as a rare but important trigger of ACS, especially in young patients without traditional risk factors. Pathophysiological mechanisms include coronary vasospasm, increased myocardial oxygen demand, and hypercoagulability. Early recognition may prevent unnecessary revascularization and optimize outcomes through integrated endocrine and cardiac management. Full article
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11 pages, 384 KB  
Article
Percutaneous Coronary Interventions in Nonagenarians: Single-Centre Insights
by Gwidon Polak
J. Clin. Med. 2025, 14(20), 7371; https://doi.org/10.3390/jcm14207371 - 18 Oct 2025
Viewed by 500
Abstract
Background/Objectives: Despite the common use of invasive diagnostics and treatment of coronary artery disease (CAD), there are still doubts concerning the disease management method of choice in the population of very old patients. Our goal was to assess the patient profile, feasibility [...] Read more.
Background/Objectives: Despite the common use of invasive diagnostics and treatment of coronary artery disease (CAD), there are still doubts concerning the disease management method of choice in the population of very old patients. Our goal was to assess the patient profile, feasibility of coronary angiography (CAG), effectiveness (successful relieving of the coronary artery’s narrowing or occlusion) of percutaneous coronary intervention (PCI) and safety (mortality and other complications) of both procedures in nonagenarians. Methods: The database of the Dr. E. Warmiński Clinical Hospital of the Bydgoszcz University of Technology was searched for patients aged 90 years and older who underwent CAG and PCI between 2013 and 2023. We retrospectively analysed the case reports of these patients, including reason for hospital admission, course of hospitalisation, procedure data, and complications. Results: A total of 150 nonagenarians meeting the criteria were found, with a mean age of 92 years and 63% being female. A total of 110 patients (73%) were admitted on the basis of acute coronary syndrome (ACS). Upon CAG, 108 patients had obstructive coronary artery disease confirmed, 90% of whom had multivessel disease. In 96 out of 108 of these patients (that is, 89%), PCI was performed successfully in 89 (93%) procedures. Transradial access was used in 112 patients (75%). According to the diagnosis, PCI was performed in all cases (100%) of STEMI patients, in 80% cases of non-ST elevation acute coronary syndrome (NSTE-ACS) patients, and in 27% cases of stable CAD patients. Median time of hospitalisation was 6.5 days (IQR 4–10). In the course of hospitalisation, mortality was 8.7% (13 out of 150), although two cases were non-cardiological in nature. In the PCI group, mortality was 11.5% (11 out of 96); all 11 were treated due to ACS (no deaths in patients with stable ACS). In the STEMI subgroup, mortality was much higher at 33% (4 out of 12, with all 4 admitted with cardiogenic shock). Accordingly, in the NSTEMI group, mortality was 8.97%. Other complications in the PCI group were perforation of coronary artery in 1 case, access site complications in the case of transfemoral access in 10 patients, bleeding requiring transfusion in 2 patients, and contrast-induced nephropathy (CIN) in 4 patients. Conclusions: This analysis demonstrates that the CAG and PCI procedures are feasible and effective in nonagenarians, and the risk of complications is not as great as it was heretofore believed. Full article
(This article belongs to the Section Cardiovascular Medicine)
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11 pages, 3684 KB  
Case Report
Diagnostic Pitfalls of Prosthetic Valve Endocarditis: From Sacroiliitis to Coronary Septic Embolization
by Camelia Bianca Rus and Corina Cinezan
Diagnostics 2025, 15(20), 2620; https://doi.org/10.3390/diagnostics15202620 - 17 Oct 2025
Viewed by 560
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in elderly and high-risk patients. However, prosthetic valve endocarditis (PVE) remains a rare but devastating complication. Its diagnosis is often delayed due to atypical clinical manifestations and the frequent [...] Read more.
Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in elderly and high-risk patients. However, prosthetic valve endocarditis (PVE) remains a rare but devastating complication. Its diagnosis is often delayed due to atypical clinical manifestations and the frequent occurrence of culture-negative endocarditis. Case Presentation: We report the case of a 68-year-old woman with a prior TAVI who presented with sacroiliitis, initially interpreted as a localized musculoskeletal infection. Subsequent evaluation revealed infective endocarditis involving the prosthetic aortic valve and the native mitral valve. Blood cultures remained negative, most likely due to prior antibiotic therapy, which complicated timely diagnosis. During hospitalization, the patient developed acute ST-segment elevation myocardial infarction (STEMI), caused by coronary septic embolization. Discussion: Distinguishing septic emboli from thrombotic occlusion in the setting of STEMI complicating endocarditis is extremely challenging but essential, as therapeutic approaches diverge. While percutaneous coronary intervention is the standard treatment for thrombotic occlusion, it carries major risks of septic embolization, including stent infection, mycotic aneurysm, and uncontrolled sepsis. Conclusions: This case highlights the need for high clinical suspicion of PVE in atypical presentations, the diagnostic challenges of culture-negative endocarditis, and the therapeutic dilemmas posed by acute coronary complications without clear guideline-based solutions. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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11 pages, 1505 KB  
Article
Door-to-Balloon Time Outperforms ST-Segment Elevation in Predicting the STEMI vs. NSTEMI Final Diagnosis
by José Nunes de Alencar, Harvey Pendell Meyers, William Frick, Jesse T. T. McLaren and Stephen W. Smith
J. Clin. Med. 2025, 14(18), 6588; https://doi.org/10.3390/jcm14186588 - 18 Sep 2025
Cited by 1 | Viewed by 7746
Abstract
Background: The STEMI/NSTEMI classification guides management and quality metrics for acute myocardial infarction (AMI). We examined whether the final cath-lab diagnosis of STEMI versus NSTEMI correlates more closely with door-to-balloon (D2B) time than with either ST-segment elevation (STE) on pre-angiogram ECG or a [...] Read more.
Background: The STEMI/NSTEMI classification guides management and quality metrics for acute myocardial infarction (AMI). We examined whether the final cath-lab diagnosis of STEMI versus NSTEMI correlates more closely with door-to-balloon (D2B) time than with either ST-segment elevation (STE) on pre-angiogram ECG or a culprit lesion with TIMI 0-1 flow. Methods: This retrospective study analyzed 410 patients with AMI from the DOMI-ARIGATO database who underwent coronary angiography. For each patient, we recorded FDx coded by the interventional cardiologist, D2B < 120 min versus > 120 min, STE criteria (Fourth Universal Definition), and angiographic TIMI 0-1 culprit. Predictors of FDx-STE discordance were evaluated with multivariable logistic regression. Results: Among 410 angiographed AMI patients (mean age 63 ± 13; 71% male), 165 (40.2%) received an FDx-STEMI and 245 (59.8%) an FDx-NSTEMI. D2B time showed 94% agreement with FDx (160/165 FDx-STEMI treated < 120 min; 225/245 FDx-NSTEMI treated > 120 min), exceeding concordance for STE (82%; p < 0.001) and TIMI 0-1 flow (75%; p < 0.001). FDx and STE diverged in 75 patients (18%): 60 rapidly treated STE-negative cases were labelled STEMI, whereas 15 delayed STE-positive cases were labelled NSTEMI. In regression analysis, D2B < 120 min remained the sole independent predictor of discordance (adjusted OR 6.7, 95% CI 3.5–13.8). Conclusions: In this registry, the cath-lab label “STEMI” showed the strongest correlation with meeting a 120 min benchmark, exceeding correlations for STE or angiographic occlusion. These findings suggest that quality-metric compliance, rather than electrocardiographic or anatomic criteria, predominantly drives final diagnosis. Full article
(This article belongs to the Section Cardiology)
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14 pages, 2827 KB  
Article
Bayesian Diagnosis of Occlusion Myocardial Infarction: A Case-Based Clinical Analysis
by José Nunes de Alencar, Hans Helseth, Henrique Melo de Assis and Stephen W. Smith
Diagnostics 2025, 15(17), 2148; https://doi.org/10.3390/diagnostics15172148 - 25 Aug 2025
Cited by 3 | Viewed by 2603
Abstract
Background: Millimetric ST-segment elevation (STEMI) rules miss more than half of angiographic coronary occlusions. Re-casting acute infarction as Occlusion MI (OMI) versus Non-Occlusion MI (NOMI) and embedding that paradigm in Bayesian reasoning could shorten time to reperfusion while limiting unnecessary activations. Methods [...] Read more.
Background: Millimetric ST-segment elevation (STEMI) rules miss more than half of angiographic coronary occlusions. Re-casting acute infarction as Occlusion MI (OMI) versus Non-Occlusion MI (NOMI) and embedding that paradigm in Bayesian reasoning could shorten time to reperfusion while limiting unnecessary activations. Methods: We derived age- and sex-specific baseline prevalences of OMI from national emergency-department surveillance data and contemporary angiographic series. Pre-test probabilities were adjusted with published likelihood ratios (LRs) for chest-pain descriptors and clinical risk factors, then updated again with either (1) the stand-alone accuracy of ST-elevation or (2) the pooled accuracy of a broader OMI ECG spectrum. Two decision thresholds were prespecified: post-test probability >10% to trigger catheterization and >75% to justify fibrinolysis when angiography was unavailable. The framework was applied to five consecutive real-world cases that had elicited diagnostic disagreement in clinical practice. Results: The Bayesian scaffold re-classified three “NSTEMI” tracings as intermediate or high-probability OMI (post-test 27–65%) and prompted immediate reperfusion; each was confirmed as a totally occluded artery. A fourth patient with crushing pain and a normal ECG retained a 17% post-ECG probability and was later found to have an occluded circumflex. The fifth case, an apparent South-African-Flag pattern, initially rose to 75% but fell after a normal bedside echo and normal troponins. Conclusions: Layering pre-test context with sign-specific LRs transforms ECG interpretation from a binary rule into a transparent probability calculation. The OMI/NOMI Bayesian framework detected occult occlusions that classic STEMI criteria missed. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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12 pages, 1439 KB  
Article
Humanized Monoclonal Antibody Against Citrullinated Histone H3 Attenuates Myocardial Injury and Prevents Heart Failure in Rodent Models
by Matthew Weber, Yuchen Chen, Xinyu Zhou, Heejae Chun, Di Wu, Ki Ho Park, Chuanxi Cai, Yongqing Li, Jianjie Ma and Zequan Yang
Biomolecules 2025, 15(8), 1196; https://doi.org/10.3390/biom15081196 - 20 Aug 2025
Viewed by 1749
Abstract
Background: Excessive formation of neutrophil extracellular traps (NETs) leads to NETosis, accompanied by the release of citrullinated histone H3 (CitH3), a key mediator of septic inflammation. However, the role of CitH3 in sterile inflammation, such as acute myocardial infarction (MI) and post-MI heart [...] Read more.
Background: Excessive formation of neutrophil extracellular traps (NETs) leads to NETosis, accompanied by the release of citrullinated histone H3 (CitH3), a key mediator of septic inflammation. However, the role of CitH3 in sterile inflammation, such as acute myocardial infarction (MI) and post-MI heart failure, remains incompletely understood. Methods and Results: We investigated the role of CitH3, a byproduct of NETosis, in myocardial ischemia/reperfusion (I/R) injury using a murine MI model. C57BL/6J mice were subjected to left coronary artery (LCA) occlusion followed by reperfusion and treated with either a humanized anti-CitH3 monoclonal antibody (hCitH3-mAb) or control human IgG. In mice undergoing 40 min of LCA occlusion and 24 h of reperfusion, hCitH3-mAb administered 10 min before reperfusion significantly reduced infarct size by 36% compared to control (p < 0.05). Plasma levels of CitH3, IL-1β, and interferon-β were significantly elevated following MI but were attenuated by hCitH3-mAb. In addition, plasma and cardiac tissue from treated mice showed significantly lower levels of citrate synthase, a marker of mitochondrial injury, suggesting that hCitH3-mAb preserved mitochondrial integrity after MI. In mice undergoing 50 min of LCA occlusion and 21 days of reperfusion, longitudinal echocardiography revealed preservation of left ventricular ejection fraction (LVEF) in hCitH3-mAb-treated mice, with significant improvement observed on days 7, 14, and 21 post-MI (p < 0.05 vs. control). hCitH3-mAb also mitigated myocardial fibrosis and preserved tissue architecture. Conclusions: These findings demonstrated CitH3 as a critical mediator of myocardial injury and adverse remodeling following acute MI. Neutralization of CitH3 via hCitH3-mAb attenuates I/R injury and preserves cardiac function by mitigating inflammation and protecting mitochondrial integrity. Targeting CitH3 represents a promising therapeutic strategy to prevent heart failure following MI. Full article
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13 pages, 3885 KB  
Article
Clinical Effectiveness and Safety of Reduced-Dose Prasugrel in Asian Patients: The PROMISE-TW Registry
by Yu-Chen Wang, Chiung-Ray Lu, Yi-Tzone Shiao, Kuan-Cheng Chang, Chun-Hung Su, Yu-Wei Chiu, Chien-Lung Huang, Wei-Shin Liu, Ching-Lung Yu, Ming-Jer Hsieh, Ye-Hsu Lu, Ho-Ming Su, Po-Chih Lin, Hsin-Bang Leu and Wen-Lieng Lee
J. Clin. Med. 2025, 14(16), 5791; https://doi.org/10.3390/jcm14165791 - 15 Aug 2025
Viewed by 998
Abstract
Background: Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. Methods: The PROMISE-TW Registry was a multicenter, retrospective study including [...] Read more.
Background: Reduced-dose prasugrel is widely used in East Asia for acute coronary syndrome (ACS), but real-world data in diverse Asian populations are limited. This study evaluated its effectiveness and safety in Taiwanese patients. Methods: The PROMISE-TW Registry was a multicenter, retrospective study including 1167 patients with ACS or chronic coronary syndrome (CCS) treated with reduced-dose prasugrel (20 mg loading, 3.75 mg maintenance) across 13 hospitals in Taiwan from 2018 to 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACEs: cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke). Secondary outcomes included composite ischemic events and major bleeding (BARC 3–5). Results: Among enrolled patients (mean age 63.9 years; 81.2% male; 83% ACS), percutaneous coronary intervention was performed in 90.8%. At one year, MACEs occurred in 1.9%, composite ischemic events in 8.2%, and major bleeding in 0.8%. Subgroup analysis identified prior stroke, diabetes, and chronic total occlusion intervention as predictors of bleeding. Male sex, chronic kidney disease, and left circumflex artery intervention predicted higher ischemic risk. Conclusions:Reduced-dose prasugrel provided effective ischemic protection and low bleeding rates in Taiwanese patients, especially those with ACS. These findings support the clinical utility of dose-adjusted prasugrel in East Asian populations and highlight the importance of individualized risk assessment. Full article
(This article belongs to the Section Cardiovascular Medicine)
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19 pages, 3597 KB  
Article
Proximal vs. Distal LAD Lesions in ST-Elevation Myocardial Infarction: Insights from ECG and Coronary Angiography
by Marius Rus, Bianca Maria Negruțiu, Felicia Liana Andronie-Cioara, Georgeta Pasca, Claudia Teodora Judea Pusta, Cristian Sava, Adriana Ioana Ardelean, Mihaela-Simona Popoviciu and Claudia Elena Staniș
J. Clin. Med. 2025, 14(16), 5637; https://doi.org/10.3390/jcm14165637 - 9 Aug 2025
Viewed by 2253
Abstract
Background: The identification of the left anterior descending (LAD) artery as the culprit vessel in ST-segment elevation myocardial infarction (STEMI) is critical for rapid decision-making and targeted reperfusion. Electrocardiography (ECG) remains a vital diagnostic tool, especially in cases of no prior clinical or [...] Read more.
Background: The identification of the left anterior descending (LAD) artery as the culprit vessel in ST-segment elevation myocardial infarction (STEMI) is critical for rapid decision-making and targeted reperfusion. Electrocardiography (ECG) remains a vital diagnostic tool, especially in cases of no prior clinical or imaging data. This study evaluates the accuracy of 12-lead ECG in identifying LAD involvement and occlusion level, while examining the prognostic significance of proximal versus distal LAD lesions in the era of modern reperfusion techniques. Methods: Data from 382 patients with STEMI were analyzed, focusing on the correlation between specific ECG patterns, particularly ST-segment elevation in aVL and aVR, and coronary angiographic findings. The predictive performance of ECG in localizing proximal LAD lesions was assessed through sensitivity, specificity, and predictive values. Clinical outcomes at 30 days and 2.5 years were compared between patients with proximal and distal LAD occlusions. Results: ST-segment elevation ≥ 0.5 mm in aVL or elevation in aVR, when associated with elevation in at least two contiguous precordial leads (V2–V4), demonstrated good sensitivity and predictive value for proximal LAD occlusion. Contrary to earlier studies, no significant difference in short- or long-term clinical outcomes was observed between proximal and distal LAD occlusion groups, possibly reflecting improvements in percutaneous coronary intervention (PCI) techniques and modern pharmacotherapy. Conclusions: The 12-lead ECG remains a valuable tool for identifying LAD as the culprit artery and approximating lesion location. However, in the era of advanced reperfusion therapy, the prognostic value of proximal LAD occlusion may be less pronounced than previously thought. These findings support a nuanced interpretation of ECG in guiding acute management without overestimating the long-term prognostic weight of lesion location alone. Full article
(This article belongs to the Section Cardiovascular Medicine)
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13 pages, 879 KB  
Article
Three-Dimensional Speckle Tracking Echocardiography for Detection of Acute Coronary Occlusions in Non-ST-Elevation Acute Coronary Syndrome Patients
by Thomas M. Stokke, Kristina H. Haugaa, Kristoffer Russell, Thor Edvardsen and Sebastian I. Sarvari
Diagnostics 2025, 15(15), 1864; https://doi.org/10.3390/diagnostics15151864 - 25 Jul 2025
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Abstract
Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE. Methods: Fifty-six patients [...] Read more.
Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE. Methods: Fifty-six patients with NSTE-ACS (mean age 64 ± 11 years; 80% male) underwent 2D and 3D transthoracic echocardiography prior to coronary angiography. Global longitudinal strain (GLS), global circumferential strain (GCS), and 3D ejection fraction (EF) were analyzed. Acute coronary occlusion was defined as TIMI flow 0–1 in the presumed culprit artery. Results: Acute coronary occlusion was present in 16 patients (29%). Patients with occlusion had significantly more impaired strain compared to those without: 3D GLS (−12.5 ± 2.7% vs. −15.5 ± 2.1%, p < 0.001), 2D GLS (−12.6 ± 2.8% vs. −15.6 ± 2.0%, p < 0.001), 3D GCS (−24.8 ± 4.4% vs. −27.8 ± 4.3%, p = 0.02), and 2D GCS (−18.1 ± 5.5% vs. −22.9 ± 4.7%, p = 0.002). In contrast, 3D EF did not differ significantly between groups (52.5 ± 4.7% vs. 54.7 ± 5.7%, p = 0.16). Receiver operating characteristic analysis showed that 3D and 2D GLS had the highest diagnostic performance (AUCs 0.81 and 0.78), while 3D EF had the lowest (AUC 0.61). Feasibility was lower for 3D STE (86%) than for 2D longitudinal strain (95%, p = 0.03). Conclusions: Both 3D and 2D GLS showed higher diagnostic accuracy than 3D EF in identifying acute coronary occlusion in NSTE-ACS patients. While 3D STE enables simultaneous assessment of multiple parameters, it did not offer incremental diagnostic value over 2D STE and had lower feasibility. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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Article
Sudden Cardiac Death Due to Ventricular Arrhythmia in Acute Coronary Occlusion: Potential Roles of the Sinoatrial Nodal Artery and Conus Artery
by Justine Bhar-Amato, Aurojit Roy, Benjamin Lambert, Sofia Kassou, Stephen P. Hoole and Sharad Agarwal
J. Cardiovasc. Dev. Dis. 2025, 12(6), 210; https://doi.org/10.3390/jcdd12060210 - 31 May 2025
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Abstract
Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting [...] Read more.
Background: Despite advances in the management of coronary disease, the incidence of sudden cardiac death (SCD) in the context of coronary artery disease (CAD) remains significant and unpredictable. We investigated the patient and angiographic characteristics, and predictors of long-term outcomes, of patients presenting with cardiac arrest in the context of acute coronary occlusion, to elucidate possible mechanisms of ventricular arrhythmia. Methods: A total of 127 consecutive patients presenting to a tertiary cardiac centre with pulseless ventricular tachycardia or ventricular fibrillation during acute myocardial infarction (AMI) were compared to 100 patients with uncomplicated AMI (Cohort A). We also compared a separate group comprising 20 patients with acute RCA occlusion complicated by cardiac arrest and 24 patients with uncomplicated inferior STEMI (Cohort B). Results: In Cohort A, there was a higher incidence of proximal lesions in the arrest group (55% vs. 41%, p < 0.05). There was an almost equivalent incidence of both LAD and non-LAD (RCA/Cx) infarcts presenting with cardiac arrest. In the non-LAD arrest patients, sinoatrial nodal artery (SANa) involvement was seen in 77%, compared with 33% in non-arrest patients (p < 0.005). In Cohort B, involvement of the SANa or conus artery (CA) was found in 74% of arrest versus 21% of non-arrest patients (p < 0.005). Cohort A patients were followed up for 3.8 to 8.7 years, and at the end of this period, 22% of arrest patients and 16% of non-arrest patients were deceased. Mortality <30 days was highest in the arrest group (43% vs. 7%, p < 0.05). Beyond 30 days, there were no differences in all-cause mortality between arrest and non-arrest patients. There were more cardiac causes of death in the arrest group (54% vs. 20%, p < 0.05). Conclusions: VT/VF arrest due to acute coronary occlusion was more common in those with proximal disease and there was an increased incidence of SANa and/or CA involvement in non-LAD infarcts. Short-term mortality was higher in patients with cardiac arrest post-AMI, but beyond 30 days there was no significant difference. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
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